Tag Archives: Overpronation

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Plantar Fasciitis? Do this First Thing in the Morning

Plantar fasciitis is a very painful and potentially very debilitating condition. It’s one of the most common causes for heel and/or bottom of the foot pain. In the case of plantar fasciitis, the fascia on the bottom of the foot becomes swollen and irritated and may cause pain when you stand and/or walk. It’s typically at its worst in the morning with your first several steps after sleeping.

In this video, I demonstrate a simple, yet effective warm up to perform whenever you get up from sitting or lying down to prevent foot pain from plantar fasciitis.

Since the tissue on the bottom of the foot tightens as you sit or lay down for any length of time, be very intentional about preparing this area BEFORE you walk. This will lessen the pain and speed recovery. This is why I recommend doing this warm up throughout the day and especially, first thing in the morning.

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Be sure to check out my post, How to Self-Treat Plantar Fasciitis, for more tips! If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional. I recommend a physical therapist who specializes in feet or who works with athletes for the treatment of plantar fasciitis. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by following The Physical Therapy Advisor!

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Preventing Knee Pain

There isn’t a shortage of promising lotions, braces, taping techniques, exercises, and electric modalities when treating knee pain.  Many of these fancy options may or may not work to prevent and/or reduce pain.  There are many potential reasons for experiencing knee pain.  However, an often overlooked cause is the lack of a normal range of motion and tightness in the quadriceps and/or hamstrings.  Getting back to the basics can be an integral component to successfully treating knee pain or preventing further injury.

Potential Risk Factors for Knee Pain:

  • Poor quadriceps strength (particularly, the inner/medial quadriceps).
  • Poor hip abductor and/or hip external rotator strength.
  • Prior knee injury.
  • Over use.
  • Obesity.
  • Poor foot biomechanics including overpronation (when the feet excessively roll inward, which causes the knee to roll inward during each step).
  • A larger “Q-angle” which is the associated angle between the hip and knee.
  • Even anomalies in the shape of one of the bones that make up the knee joint could predispose you to knee pain.

The most obvious (yet rarely talked about) reason for experiencing knee pain directly relates to your range of motion (ROM).  In its simplest form, the knee is a hinge joint.  It bends and straightens (flexes and extends).  If your knee isn’t able to fully bend or straighten because of either excessive quadriceps tightness and/or hamstring tightness, then you’re at an elevated risk for many common knee pain diagnoses including Patellar Femoral Pain Syndrome (PFPS) and Patellar Tendinitis.

Quadriceps Tightness

Poor range of motion in the quadriceps can be associated with a higher risk for developing knee pain.  One potential reason for this is that the quadriceps muscle blends into the quadriceps tendon.  Eventually it attaches to the patella (kneecap) before becoming the patellar tendon where it attaches to the tibial tubercle on the tibial bone (the main lower leg bone).

Excessive tightness will cause alterations in force and tracking of the patella.  This can lead to inflammation and ultimately, pain in or around the structures of the knee (including the patella, quadriceps tendon, patellar tendon, the patellar femoral joint or the infrapatellar fat pad).  The following four muscles make up the quadriceps:  vastus lateralis; vastus medialis; rectus femoris; and the vastus medialis.  The rectus femoris is most likely to be tight as it crosses two joints–both the hip joint and the knee joint.  The other muscles only cross one joint–the knee joint.

Normal range of motion in the quadriceps will vary from person to person (especially, the older you get or if you have a history of injury).  For most healthy and younger to middle aged people, normal range of motion could be defined as the ability to touch your heel to your buttocks with your hip and low back in a neutral (not flexed or extended) position (as demonstrated below).

Regular static stretching and mobilization will help you to improve your range of motion in the quadriceps and ultimately, avoid knee pain. 

Static Stretch

Static stretching is best performed post workouts.  (Static stretching prior to a work out or activity has been shown to decrease performance.)  Hold the following stretch for at least 60 seconds, and perform two to three repetitions.

Quadriceps “Tack and Floss” Mobilization

You can use a foam roller to help mobilize the quadriceps while working on your range of motion.  Position your upper thigh onto the foam roller.  Roll around until you locate a particularly tight and/or restricted area, and then very slowly bend your knee back and forth.  If this is painful, do not exceed more than a mild to moderate amount of pain.  Perform 1-2 minutes on each leg once per day.

Hamstring Tightness

Hamstring tightness can often restrict full knee extension (particularly, during functional activities).  The most common reason for poor hamstring mobility is chronic poor posture while sitting and standing.  Most of us sit for a good portion of the day.  This results in tight hamstrings and increases your risk for experiencing knee pain as well as low back pain.

Poor range of motion can also be a contributing factor to muscle imbalances.  A hamstring that is either too long (over stretched) or a hamstring that is too short and contracted will not generate as much force and strength as a hamstring within its optimal length.  The ability for a muscle to contract optimally is dependent on it being at an optimal length.  This is known as the length tension relationship.

Many people (women in particular) struggle with adequate hamstring strength in relationship to quadriceps strength.  This muscle imbalance can lead to pain and is a major risk factor in suffering an ACL tear.  Therefore, one way to insure proper hamstring strength is to insure proper hamstring length. 

Hamstring Stretch in Doorway 

Static stretching is best performed post workouts.  (Static stretching prior to a work out or activity has been shown to decrease performance.)  Find a doorway and place one leg on the frame and stretch the opposite leg through the doorway.  Try to keep your back with a neutral arch.  As your hamstring relaxes, slowly move closer to the wall or doorframe.  Hold for at least 1 minute per side, and preferably two repetitions per side. 

Hamstring Mobilization Using the Foam Roller 

Place your leg on the foam roller.  Roll your hamstring back and forth on the foam roll.  Move slowly and spend extra time on the more painful areas.  Be sure to mobilize the entire hamstring and feel free to work on other areas of the leg that feel tight or restricted.  If this is painful, do not exceed more than a mild to moderate amount of pain.  Perform for 1-2 minutes per leg.

Don’t forget the basics when it comes to self-treating knee pain.  Lack of range of motion could be the most simple and obvious reason for why you’re experiencing knee pain.  Implement my recommended exercises in order to address any tightness in the quadriceps and/or hamstrings.  Getting back to the basics can be an integral component to successfully treating your knee pain and preventing further injury.

If you’re experiencing knee pain, do you think either poor range of motion and/or tightness in your quadriceps and/or hamstrings are causing it?  Which strategy can you implement to alleviate your pain and prevent injury?  Please share below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Prevent and Self-Treat Shin Splints

MTA_ShinSplints

http://marathontrainingacademy.com/self-treat-shin-splints

Marathon Training Academy

September 12, 2015

In this guest post for Marathon Training Academy, you will discover the common causes for shin splints and learn simple prevention strategies and treatment options to quickly help aid in your recovery.

ShinSplints_Arrows_LandscapeThe term shin splints, also known as an anterior compartment syndrome, refers to pain along the shinbone (tibia), the large bone in the front of your lower leg. Shin splints can be excruciatingly painful to the point that you may struggle to walk or run. They are typically caused by inflammation in the anterior muscle of the lower leg known as the anterior tibialis muscle. This is the primary muscle needed to lift your foot. Shin splints are often considered an over use injury and unfortunately, are relatively common in runners. Discover the common causes for shin splints and implement these strategies to prevent and self-treat shin splints. Continue Reading

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How to Self-Treat Runner’s Knee

MTA_RunnersKnee

http://marathontrainingacademy.com/how-to-self-treat-runners-knee

Marathon Training Academy

August 16, 2015

In this guest post for Marathon Training Academy, you will discover the common symptoms and causes for Patellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, and learn how to effectively self-treat and manage this condition.

LacrosseBallForQuadPatellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, is a common running related issue. The sooner you can manage this condition, the easier it will be to recover and eliminate future problems. As part of a quick and thorough method of treatment, first address the biomechanical causes for the pain. Then utilize the following strategies to quickly recover from the pain in order to keep training and running at a high level.  Continue Reading

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How to Self-Treat Shin Splints

If you have ever experienced shin splints (anterior compartment syndrome), you know how excruciatingly painful it can be.  You may struggle to run or walk.  The pain can linger for weeks and months–taking the fun out of running and exercise.  In the previous post, I discussed How to Prevent Shin Splints.  Now I will provide simple treatment options to quickly help aid in your recovery.  Shin splints can typically be easily self-treated if you don’t have a more serious medical condition, such as a stress fracture, causing the pain.

ShinSplints_Treatment_Landscape

How to Self-Treat Shin Splints: 

  • Ice. Although shin splints can occur insidiously, they are often associated with a specific event. An active inflammatory process typically occurs. Apply the ice to the anterior tibialis muscle (the muscle right next to the shinbone). The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a cold pack. A bag of frozen peas can be a cheap alternative. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Rest. If you are experiencing an episode of shin splints, then you will need to rest. Avoid running (particularly downhill). At the very least, taper your training intensity and avoid exercises that place undue stress on the shins, particularly the anterior tibialis muscle. Utilize this time to incorporate cross training activities, such as yoga, to improve flexibility as shin splints can be linked to poor mobility.
  • Consider changing your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. This can lead to shin splints as well as IT band syndrome or other hip, knee, or ankle related issues. Shoes only last 350-500 miles. If you are nearing those miles, then it may be time to change.
  • Add an orthotic. Additional foot control is often needed to normalize gait mechanics. Many running stores sell an over-the-counter orthotic such as Superfeet Blue Premium Insoles. The blue tends to fit most feet, but a variety of options are available for customization. In my experience, these insoles can last 1,000 to 1,500 miles easily. If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics. Seek assistance from a professional who is a runner and has experience with treating other runners.
  • Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise. Consider using a self-massage tool to roll up and down the anterior tibialis as part of your warm up. My favorite self-massage tools for this area include the Thera-Band Standard Roller Massager and The Stick Self Roller Massager. I also recommend using the massager on your calf muscles. Perform calf stretches, but be mindful that prolonged static stretching before exercise may worsen performance.
  • Cool down. After performing your exercises, take extra time to cool down and stretch. Focus on calf stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up. If you are prone to developing shin splints, I highly recommend regular massage and mobilization of the anterior tibialis muscle, as well as the calves. Tightness in the calves and Achilles tendon are a risk factor for developing shin splints. Be sure to emphasize stretching your calves. Hold each of the following stretches for at least 30 seconds, 3 times on each leg, 2-3 times a day. (These stretches shouldn’t cause more than a mild increase in pain or discomfort.)

Calves

  • Self-mobilize the tissue. Be sure to mobilize the tissue of the anterior tibialis. For this particular area, you may want to use one of the self-massage tools referenced above. You could also use a tennis or lacrosse ball to aggressively work out the tissue along the shin. Remember that mobility issues and myofascial restrictions in the lower legs are highly correlated with the development of shin splints. Use the foam roller to address any lower leg tightness or restrictions. I tend to use the foam roller for the larger parts of the leg including the thigh, back of the leg, calves, and buttock muscles. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
  • Work on the stabilizing muscles of your hips and ankles. As part of a comprehensive rehabilitation protocol, I almost always have clients work on keeping the muscles of the pelvis, hips, and ankles strong. This will help to maintain normal gait mechanics during exercise and running. Not only will this help to prevent shin splints, it will likely help to prevent developing other orthopaedic issues such as plantar fasciitis and hip or knee pain. Please refer to Ankle Resistance Exercises and How to Safely Self-Treat Low Back Pain for my recommended hip and lumbar stabilization strengthening exercises.
  • Work on your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain. I always include balance work as part of my recommended rehabilitation protocol. Please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II).
  • Kinesiological taping. The purpose of the tape is to assist the anterior tibialis muscle with its contraction and to possibly help with swelling and nutrient exchange by assisting the lymphatic system. I have had luck using the KT TAPE and Mummy Tape brands. When treating shin splints, I recommend following these step by step instructions for Kinesiological Taping for Shin Splints. For application and removal tips, please refer to Skin Care with Taping.
  • Use a compression sleeve or stocking. This condition is often associated with swelling and inflammation in the anterior compartment of the lower leg near the shinbone (tibia). The compression sleeve/socking can help to limit the amount of swelling and promote blood flow back out of the lower leg. This insures better nutrient exchange, waste removal, and can limit the swelling. I particularly recommend wearing a pair while you are in the rehabilitation phase or tapering back into full activity. There are many different styles of compression socks and sleeves, but I prefer Vitalsox Graduated Compression Socks. If you prefer a sock style, then I recommend choosing a pair that is at least knee high.
  • Start a supplement. Many herbs help to reduce inflammation and pain. One of my favorites is called Phenocane Natural Pain Management.  It combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)
  • Ask for help. If you’re still experiencing pain after implementing these self-treatment strategies, then it may be time to seek additional help. Your medical physician can help to determine if your pain is associated with a stress fracture. He/she could also prescribe stronger anti-inflammatory medication if necessary. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to seek your physician’s opinion as well).

Have you ever experienced shin splints?  If so, which treatment techniques have you found to be the most effective? Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the new Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Prevent Shin Splints

The term shin splints, also known as an anterior compartment syndrome, refers to pain along the shinbone (tibia), the large bone in the front of your lower leg.  Shin splints can be excruciatingly painful to the point that you may struggle to walk or run.  Worse yet, the pain can linger for weeks to months, but it may not be severe enough to prevent you from exercising.  However, it will take the fun out of exercising and running.  I will address the common causes for shin splints and share my top tips to prevent shin splints.  I provide treatment options in How to Self-Treat Shin Splints.

ShinSplints_Arrows_Landscape

Shin splints are typically caused by inflammation in the lower leg anterior muscles known as the anterior tibialis muscle.  This is the primary muscle needed to lift your foot.  Shin splints are often considered an over use injury.  Unfortunately, shin splints are relatively common in runners and dancers.

As a physical therapist, I commonly treat acute cases of shin splints that occur when an individual suddenly increases his/her training volume by largely increasing the distance he/she is running.  This condition may also occur when an individual isn’t appropriately trained for downhill running.  Running downhill causes the anterior tibialis muscle to work very hard in an eccentric manner (meaning that the muscle is lengthening).  This can very easily overwork a poorly trained muscle and may cause pain and inflammation.

Common Causes of Shin Splints include:

  • Flat feet, which cause overpronation while running.
  • Poorly fitting or worn out shoes.
  • Tightness in the calf muscle or Achilles tendon.
  • Weak ankle muscles (particularly the anterior tibialis).  Shin splints are also associated with weakness in the other muscles of the ankle and foot.
  • Weakness in the hip, pelvic, and/or core muscles can lead to faulty gait mechanics, which causes shin splints or possibly other knee and lower extremity injuries.
  • A change in running surfaces.  This is most evident when transitioning from a softer running surface, such as dirt, to a concrete running track.
  • Stress fractures in the shin (tibial bone).  Also, stress fractures in the foot can cause alterations in running form which may lead to shin splints.
  • Training overload.  The muscles of the anterior shin (the anterior tibialis) are performing training intensities and volumes that they are incapable of doing.  This causes inflammation, swelling, and pain.

How to Prevent Shin Splints:

  • Check your shoes.  Your shoes may be worn out and may be the cause of the pain.  If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance.  If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation.  Shoes typically only last 350-500 miles.  If you are nearing those miles, then it may be time to change.  If you’re unsure if your shoes are performing correctly, visit your local running shoe store.  The trained staff can inspect your shoes for wear and tear.  They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe.  Another option to help control overpronation is an over-the-counter orthotic such as Superfeet Blue Premium Insoles.  The blue tends to fit most feet, but a variety of options are available for customization.  In my experience, these insoles can last 1,000 to 1,500 miles easily.  If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.
  • Progress slowly into a minimalistic shoe.  If you are used to a standard built up shoe, progressing into a minimalistic shoe may be more difficult and take more time.  Unless you are a child or teenager, expect a safe transition to take at least three months.  Don’t transition during a period of intense sports.  I highly recommend waiting until the off season as progressing slowly is always a better choice.
  • If you change running surfaces, progress slowly.  If you are used to running on softer surfaces, such as dirt or a running track, progress carefully and slowly when you run on a harder surface like concrete.  Over all, softer running surfaces are better for your body.
  • Have your gait analyzed while running.  Gait or running abnormalities can increase your risk of developing shin splints.  Over striding tends to occur while running downhill.  Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic.  If you’re unable to obtain a gait analysis, ask your spouse or a friend to video record you (from behind) while you’re running.  Then watch the recording to see if you notice over striding or any abnormalities.
  • Warm up prior to exercise.  I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area.  This allows for better mobility and also prepares the tissues for exercise.  Consider using a self-massage tool to roll up and down the anterior tibialis as part of your warm up.  My favorite self-massage tools for this area include the Thera-Band Standard Roller Massager and The Stick Self Roller Massager.
  • Cool down.  After performing your exercises, take extra time to cool down and stretch.  Focus on calf stretching as well as general lower extremity mobility stretches.  Use the same self-massage tools as you did during your warm up.  If you are prone to developing shin splints, I highly recommend regular massage and mobilization of the anterior tibialis muscle.
  • Improve your mobility.  Mobility issues and myofascial restrictions in the lower legs are highly correlated with the development of shin splints.  Use the foam roller to address any lower leg tightness or restrictions.  To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
  • Strengthen the stabilizing muscles of your hips and ankles.  Strengthening the muscles of your hips and ankles will help to maintain normal gait mechanics during exercise and running.  Not only will this help to prevent shin splints, it will likely help to prevent developing other orthopaedic issues such as plantar fasciitis and hip or knee pain.  Please refer to Ankle Resistance Exercises and How to Safely Self-Treat Low Back Pain for my recommended hip and lumbar stabilization strengthening exercises.
  • Improve your balance.  Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature.  Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia.  Improving your balance can help to reduce the risk of shin splints and is an important part of the rehabilitation.  Please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II).
  • Train for running downhill.  Running downhill forces the anterior tibialis muscle to work much harder than it would otherwise.  Running downhill causes the anterior tibialis to perform more eccentric (when the muscle gets longer) loading and repetition.  This can overload the muscle, particularly when running downhill very fast.  Although running downhill may not be as aerobically taxing as running uphill, it’s actually physically much harder on your body.
  • If you experience pain, seek help early.  Don’t ignore those little aches and pains that can develop as you exercise and train.  They may be early warning signs of a developing problem.  If you experience pain in your shins, start implementing my recommended treatment protocol.  If the pain persists or continues to progress, please seek assistance from your medical physician or a physical therapist.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Have you ever experienced shin splints?  If so, how do you prevent them from re-occurring?  Please share the treatments that have been the most effective for you by leaving your comment below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the new Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Self-Treat Patellar Femoral Pain Syndrome (Runner’s Knee)

Patellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, is a common running related issue.  The sooner you can manage this condition, the easier it will be to recover and eliminate future problems.  Many of my recommended exercises can be adopted as part of a cross training program to prevent PFPS.  I will address the many potential causative factors for PFPS and offer advice on how to self-treat this condition.

PFPS can be quite painful and significantly affect a person’s ability to run or move properly.  The cause of the pain is often associated with a patellar or knee cap that is tracking in the femoral groove improperly.  This can occur for many reasons, but the most common causes are:

  1. Poor quadriceps strength (particularly the inner or medial quadriceps).
  2. Poor hip abductor and/or hip external rotator strength.
  3. Improper foot biomechanics during the single leg stance phase of the gait cycle or the mid foot strike during running. The most common issue within the foot is usually overpronation (when the feet excessively roll inward and cause the knee to roll inward as well during each step). Overpronation is more common among females although males experience it as well. Women may experience overpronation due to the angle of their hips in relation to the knee. A woman’s pelvis is typically a different shape to allow for child bearing. The larger “Q-angle” associated with the hip and knee can cause increased strain on the knee.

PFPS symptoms include:

  • The pain will typically increase when going downstairs. In more severe cases, going upstairs is also very painful.
  • Pain with squats, lunges, knee extensions, or other plyometric activity.
  • Pain typically worsens with prolonged sitting. The longer you sit in one position, the worse the pain becomes.
  • Grinding, popping, and cracking are often associated symptoms.
  • Pain can be anywhere along the patella (knee cap), but it’s typically associated with anterior knee pain or medial patellar pain.

In many cases, a very thorough warm up may allow you to participate in activity.  However, the pain may worsen again later that day or the next day.  Seek help or guidance quickly when your pain worsens with activity.  For the best result, the treatment plan should be multifactorial.

How to Self-Treat PFPS:

  • Improve your quad and your hip strength. Please refer to Patellar Femoral Pain Syndrome Rehabilitation Exercises for my recommended exercise program which is designed to improve quad and hip strength. To improve your quad strength, the emphasis should be on the inner quad known as the vastus medialis oblique (VMO). Weak hip abduction and hip external (lateral) rotation muscles significantly contribute to PFPS. The purpose of the lateral and external rotators of the hip is to prevent internal rotation (rolling inward) of the hip and knee. My recommended exercise program will help to improve your strength.
  • Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated. Then work on moving into a deep squat position multiple times as part of the warm up. You may need to hang onto a beam or a pole to take some pressure off of your knee as you move in and out of the squat.
  • Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing range of motion (ROM).
  • Self-Mobilize the Tissue. Myofascial release of the quadriceps muscle is an important component in order to relieve the pain and reduce the pressure and tension through the patellar femoral tendon and joint. I tend to use the foam roller for the larger part of the quadriceps. I also use a tennis or lacrosse ball to aggressively work the tissue above the patella. You can use your hand to press the ball in and work it around the tissue. To use the weight of your leg for a more aggressive mobilization, place the ball on the ground and mobilize the tissue with your leg on top of the ball.

LacrosseBallForQuad

  • Kinesiological Taping. The purpose of the tape is to assist the patella in its tracking. I have had luck using Kinesio Tape and Mummy Tape brands. There are many other useful taping techniques which utilize different forms of tape. When treating PFPS, I recommend that you apply the tape in a medial direction across the patella approximately 30 minutes prior to exercise or activity. To utilize Mummy Tape, first measure how much of the tape you intend to use. Start from the outside of the knee cap to half way around the leg minus about an inch. Cut the strip, then round the corners on the edge of the tape. This helps the tape to not catch onto clothing. Apply the tape without extra stretch to the first half of the knee cap, then apply between a 50-75% stretch for half of the tape medially toward the inside of the leg. With the last of the tape, apply without a stretch to the inner side of the leg. (You could also utilize Spider tape or KT TAPE.) To visually learn how to apply the tape, please refer to Kinesiological Taping for Patellar Femoral Pain Syndrome. For application and removal tips, please refer to Skin Care with Taping.
  • If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise. This would also be true for a lunge position or step up. Modify any exercise as you need to, and don’t compromise technique to complete an exercise. Poor technique will only increase your risk of injury elsewhere.
  • Have your gait analyzed while running. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re not a runner, but you’re experiencing pain during other forms of exercise (group aerobics or CrossFit), ask your teacher or coach to analyze your movements during an exercise session. How is your foot striking the ground? Is it rolling in (landing flat footed)? Does your knee rotate inward or stay tracking in line with the foot? Ideally, the knee tracks in line with your second toe. This is important for running as well as squats, step ups, and lunges. If your foot isn’t maintaining a good position during its mid foot strike, a new pair of shoes may be indicated specifically to control pronation. Over-the-counter orthotics can help as well. Superfeet Blue Premium Insoles are available in varying models to help support the arch and heel. They are color coded by model. I wear the blue insoles which are for moderately flat feet. These insoles are very durable. In the past, these insoles have lasted for 1,000 miles through the life cycles of two different pairs of shoes.
  • Start a supplement. Many herbs help to reduce inflammation and pain. CapraFlex is one of my favorite supplements. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I recommend that you try it for 30 days to see if it improves your pain. Another option is Phenocane Natural Pain Management. It combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

Patellar Femoral Pain Syndrome can be very painful, but it can be easily self-treated if you handle your pain and symptoms quickly.  If you’re not experiencing relief after aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing PFPS.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for PFPS helped you? Which treatments haven’t worked for you? Additional discussion can help others to manage this condition more effectively.  Please leave your comments below.

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How to Self-Treat Plantar Fasciitis

Plantar fasciitis is a very painful and potentially very debilitating condition.  It’s one of the most common causes for heel and bottom of the foot pain.  The plantar fascia is essentially a band of connective tissue (a ligament) which runs the length of your foot from your heel to your toes.  It helps to support the arch of your foot by using “windlass mechanism” to make the foot more rigid and aid in the foot’s ability to transfer force and push off when walking or running.   In the case of plantar fasciitis, the fascia on the bottom of the foot becomes swollen and irritated and may cause pain when you stand and/or walk.  It’s typically at its worst in the morning with your first several steps after sleeping.  Plantar fasciitis is also more common the older a person becomes.

Image courtesy of www.runnersgoal.com

Risk factors for developing plantar fasciitis include:

  • Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
  • Either excessively high arches or overly flat feet.
  • Spending long periods of time standing or walking.
  • Spending long periods of time on hard surfaces, such as concrete.
  • Obesity
  • Your shoes don’t fit well or the shoe is worn out.
  • You have transitioned too quickly from a more built up running shoe into a minimalistic style.
  • Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
  • Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.

Plantar fasciitis typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run.  Plantar fasciitis may occur after a specific event.  The plantar fascia could be over stretched due to a slip.  It could occur after an overzealous training day in unfamiliar circumstances, such as running barefoot in the sand.

Fortunately, plantar fasciitis doesn’t always require formal medical treatment.  The key is to intervene quickly to identify the actual cause or causes that led to the inflammation and irritation.  The recommended treatment is the same whether or not the plantar fasciitis developed over time or due to a specific event.

How to Self-Treat Plantar Fasciitis:

  • Begin your rehabilitation. Start with these Plantar Fasciitis Rehabilitation Exercises. Complete with instructions and photos, this guide outlines how to safely self-treat your plantar fasciitis. Stretch your calves as tight Achilles tendons and calf muscles can cause excessive strain on the plantar fascia, which increases your risk of pain. Stretch your plantar fascia by performing stretches prior to standing or walking upon morning waking and after any prolonged sitting.
  • Mobilize the tissue. Depending on how aggressive you want to be, a tennis ball, lacrosse ball, or golf ball can be used to mobilize the tissue. I recommend mobilizing once or twice per day for 2-3 minutes. Then perform additional stretching of the plantar fascia and calves.
  • Use ice. My favorite technique for icing this area is to use a frozen water bottle. Roll your foot over the bottle for 3-4 minutes until your foot starts to feel numb and the pain subsides. It’s possible to frost bite your foot, so be mindful of the length of time you’re icing.
  • Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the plantar fasciitis. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.
  • Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia. Improving your balance can help reduce the risk of plantar fasciitis and is an important part of the rehabilitation. Please refer to Improving Balance by Using a Water Noodle.
  • Start a supplement. I am a supporter of natural supplements and remedies. Many supplements include herbs which are designed to help reduce inflammation. Phenocane Natural Pain Management combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. If you are taking blood thinner medication, please consult with your physician prior to taking Phenocane Natural Pain Management.
  • Use a plantar fasciitis night splint. Although a little cumbersome and annoying, night splints can be helpful. While lying, the natural tendency is to flex the foot to point your toes (plantarflex). This position causes the plantar fascia to shorten and tighten, which explains the pain you might experience during the first few steps after sleeping or resting. The night splint helps you to heal by maintaining a neutral position which doesn’t allow the fibers to shorten.

While you’re self-treating your plantar fasciitis, you’ll likely need to modify your exercise or running program.  It’s an excellent time to focus on cross training activities.  I recommend following this protocol for two to three weeks.

If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional.  I recommend a physical therapist who specializes in feet or who works with athletes for the treatment of plantar fasciitis.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for plantar fasciitis helped you? Which treatments haven’t worked for you?   Additional discussion can help others to manage this condition more effectively.  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the new Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!