Tag Archives: Poor Technique

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Why We Can Be Our Own Worst Enemy

I must warn you that this is not the typical post from me. All of the information is true and sadly, not exaggerated in any way. My hope in documenting this true account of events is that it will help others know how to better avoid injury. If you do develop an injury, then maybe some of my self-treatment strategies could be helpful.

What most people don’t know about me is that I have struggled with low back pain (LBP) for over 20 years. Early on, I had years of constant and chronic LBP. This pain helped drive me to seek out different self-treatment methods. I began to understand LBP along with the best practices on how to self-manage and most importantly, avoid future flare-ups. This has personally helped me manage my own pain while helping thousands of others either directly with physical therapy or by sharing my book, Treating Low Back Pain during Exercise and Athletics.

Even with all my diligent efforts (most of the time), the occasional LBP flare-up occurs. Unfortunately, the last incident was due to poor judgement on my part. In early November of last year, I had been sitting a lot while working on a few projects, and my back started to ache. It was mild at first. However, by mid-month, I could hardly get out of a chair and walk.

As a physical therapist (PT) that specializes in treating LBP, I should have known better, but I chose to do what most people do. I ignored it, and pressed on. I reminded myself that I’ve had this pain before, and it typically goes away. Right then, I didn’t have time to address it.

Monday morning rolled around, and I was scheduled for my 5 mile tempo run. As any runner or exercise enthusiast knows, if it’s scheduled, then it must be done (no matter what, right?). I was sure my back would loosen up as I ran. Often times, a warm up prior to running makes it feel better. (If I was being honest, the pain was pretty bad that particular morning. It was preventing me from sitting, getting out of my car, and even walking straight. Was that a good enough reason to cancel a run?)

I managed a short walking warm up since that was all I could muster and proceeded into a slow jog. About 2 miles into my jog, my right calf started to hurt. Why stop? I was sure it would all shake loose soon…

As mile 3 approached, I was falling apart. My back hurt to the point I couldn’t stand up straight. My right calf was completely locked up. It was giving me a sharp pain with every step. The bottom of my left foot started aching. I finally shut it down and limped home.

Later that day, my calf wasn’t any better (neither was my back), and now I had full on plantar fasciitis. Pretty good start to the week, but I got that run in. By the end of the day Monday (post run), I was miserable, but I didn’t dare tell anyone.

As a PT, I should have known better. I started to analyze exactly what was going on. For some reason, my disc bulges (a pre-existing problem at L4/L5 and L5/S1) had flared up for no apparent reason and were hurting terribly. My back pain had caused a left lateral shift in my spine, which meant I couldn’t stand normally. The nerve tightness down my left leg affected my walk, so I could not fully stride out.

In hindsight, my sad attempt at a run early that morning was actually a terrible idea! I had obviously been running with a poor gait pattern. This altered gait pattern with poor running mechanics resulted in a right calf strain and the development of plantar fasciitis in my left foot. (And this all started in 3 miles!)

My initial treatment was to determine my directional preference for my lumbar spine pain:  

A directional preference is a way to identify a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement? Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try moving in the opposite direction. If you were moving into flexion, try extension. If you had trialed extension biased movements, try flexion. Find the movement pattern that helps the pain improve and that has a positive effect on any other symptoms you may be having.

I determined my directional preference. As I performed my series of movements, my symptoms were peripheralizing (returning back to the middle of my back to the point I could stand straight and walk normal).

After a series of 10 side glides followed by 10 press-ups (as demonstrated below), I could eliminate 75% of my LBP and symptoms as long as I didn’t sit. Sitting would immediately bring the pain back on. For the next several weeks, I avoided sitting at all costs including during dinner.

I also started back extensions over an exercise ball (3 sets of 15 repetitions as demonstrated below) every morning as part of a lumbar strengthening program. I chose back extensions to insure that I was working my lumbar extensor muscles. I kept my movement patterns within my directional preference. This was preceded by and followed by side glides and press-ups as well as continuing to avoiding sitting. I stopped running since I couldn’t fully walk or jog without an altered gait pattern.

For my calf, I started foam rolling and stretching regularly. I used a mobility band (as demonstrated below) as a way to provide compression while I performed heel raises (typically a set of 20-30 repetitions). Thankfully, I had the opportunity to trial a product that not only utilized the compression from the mobility band, but added a way to self-mobilize the calf. The CTM Band worked exceedingly well for this. (“CTM” stands for compression, tension, and movement.) Use code MTA15 for a 15% discount. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)

For my plantar fasciitis, I also performed calf stretches as well as used a small ball (as demonstrated below on the left) to mobilize the bottom of my foot. Pain in the morning seemed to be the biggest issue, so I would sit up and stretch before getting out of bed (as demonstrated below on the right). By the end of the day, my foot would really start to hurt. Since I was unable to sit due to my back, I used a padded stool to kneel on whenever possible.

I continued this treatment plan for over 3 weeks. For the first 2 weeks, I was unable to run, so I concentrated on rehabilitation exercises only. During this time, I utilized a self-prescribed course of over-the-counter Ibuprofen (anti-inflammatory). I didn’t have any medical issues with taking this medication. Please consult your physician before taking any medications or supplements.

I also initiated a supplementation protocol consisting of adding collagen hydrolysate to my daily smoothie as well as taking CapraFlex by Mt. Capra. (It combines an organic glucosamine and chondroitin supplement with other natural herbs and enzymes which are designed to reduce inflammation, promote bone and joint healing, and wellness.)

This continued for approximately 4 weeks. The rationale behind the supplementation was to insure that my body had the necessary building blocks to heal and to provide additional anti-inflammatory support to my body during my recovery.

After 3 weeks, I returned to running for only shorter distances (under 5 miles). I was tapering back into other exercise routines with appropriate modifications which included increasing my warm up and cool down times and avoiding bending forward since I wasn’t 100% better.

The reason I chose to share my most recent LBP episode with you is because I have heard versions of this story over and over again from other runners, weekend warriors, and patients.  We really can be our own worst enemy!

As a PT, I should have known better than to run that day. As a runner and weekend warrior, the feeling that it may be a “mortal” sin to miss a scheduled run or work out can be a powerful temptation to do it even though your body may be telling you to reconsider.

As any frequent exerciser knows, a few aches and pains is par for the course. In fact, it’s pretty normal! Oddly, I will have just as many if not more, aches and pains when I stop running and exercising as when I’m regularly training.

The moral of my story is a reminder to be very self-discerning and self-aware to understand what is a typical ache and pain versus something more serious. In my case, not being able to walk normally due to pain should have been a clue not to run abnormally either. My abnormal running pattern that day is what led to the overuse injuries in both my calf and foot. What was surprising even to me was how fast the pain developed and turned into a true overuse injury in only the course of 3 miles!

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

Treating low back pain does not need to be difficult or expensive. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

SAVE 15% NOW!

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 liking The Physical Therapy Advisor!

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Why Does My Lower Back Hurt?

Have you ever wondered what exactly makes your back pain worse? Why does your back continue to hurt on and off again? Why does it seem to “act up” right at the wrong time? Is it something you are doing? Is there something seriously wrong? Is it just bad luck?

These are all fantastic questions. It’s time to answer the age old question as to why your back keeps hurting. Here are the top reasons why your back may be hurting and what to do about it.

The Top Reasons Why Your Back may be Hurting:

You smoke or vape.

Smoking is a major risk factor for low back pain (LBP). The chemicals in cigarette smoke affect both the lunges’ ability to exchange oxygen and the body’s normal healing response. These chemicals alter the blood supply to the discs and other spinal structures which affects nutrient exchange and increases the risk of pain. Healing time for all medical conditions worsen with smoking.

You’re biologically male.

Males have a higher risk of LBP. Females tend to experience more cervical or neck pain. (Obviously, you have very little control over this factor other than the knowledge that you’re at an increased risk if you are a male.)

It may be your parents’ fault.

A family history of low back pain increases your risk. In some cases, this may be due to actual structural deformities which may be genetically linked. More commonly, it’s a learned behavior, such as chronic sitting and slouching (poor posture), that can lead to a higher risk of LBP.

You’re pregnant.

Pregnancy increases your risk for LBP due to structural changes as the baby develops and hormones change. The expectant mother releases relaxin, a hormone which loosens the whole body, to prepare for the baby’s delivery. Again, a risk worth taking! Most women can manage the pain by modifying posture and movements while learning techniques for self-management.

You don’t exercise.

A sedentary lifestyle will increase your risk for LBP. The spine is designed to work and move. In order for the spine to remain healthy, it requires exercise and movement.

I WANT TO GET RID OF MY BACK PAIN NOW!

You sit for more than 2 hours a day.

Sitting for a long period of time not only affects your general health status in a negative way, but it also increases your risk for LBP. It’s even worse if you’re a heavy equipment operator who sits on a vibrating surface.

You have poor posture.

In western culture, we spend most of our day sitting slouched or standing hunched over. This is an excellent way to increase your risk for LBP. It’s one of the major risk factors for disc herniation and development of spinal stenosis.

You don’t warm up before exercise.

This is a common mistake which can lead to injury. Jump out of your bed in the morning without warming up, and then start your exercise routine. (Please don’t!) Instead, prepare your body for challenging activities in order to avoid injury. A warm up should consist of a cardiovascular component and a dynamic stretching routine of the actual exercises you will be performing to insure you’re ready for the movement. This is also pertinent for weightlifting and running.

You keep moving even when you’re exhausted.

This is a common problem among CrossFitters (including myself). Just keep pushing yourself even when you can’t see straight. Typically, this results in poor technique which further increases your risk. Combine poor technique with muscles which can no longer perform the proper movement pattern, and you’re likely to become injured. High Intensity Training (HIT) is a wonderful form of exercise and has many health benefits as long as you’re able to properly perform the exercise.

You’re using poor technique.

Poor technique, along with feeling exhausted, often occurs when performing exercises that are too advanced. Performing unfamiliar lifting techniques or lifting too much weight will likely result in poor technique. Please see your coach, athletic trainer or physical therapist for the proper technique for your activity of choice.

Your training volume is too high.

Who needs a rest day? ALL of us can benefit from taking a break. Training every day without regard to rest is an excellent way to cause over training syndrome and injury to your back.

You’ve experienced prior episodes of LBP.

Once you have experienced LBP, you are more likely to have re-current episodes. This may be the major reason why your low back pain re-occurs. This is partially due to weakness in the deep multifidus muscles that help support the spine and prevent shearing forces. This weakness can be addressed with proper physical therapy intervention. The loss of structural strength is the primary reason why your back pain continues to re-occur, and this can be changed.

Core strength does matter, but it is likely not what you think. Most people don’t quite understand the relationship between the “core” and lumbar stabilization. It’s way more than just doing sit-ups. In fact, sit-ups may actually make your back pain worse.

Low back pain is a serious and debilitating condition. It will either most certainly affect you or someone close to you. Be mindful of your risk factors and be pro-active in maintaining a healthy back! The good news is that nearly all low back pain is mechanical (meaning there is a physical reason for the pain). There are physical treatment options that not only can help you recover from the pain, but also to avoid re-occurring back pain!

If you’re not sure how to effectively and safely exercise your back or if you’re already experiencing low back pain, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package.

Treating low back pain does not need to be difficult or expensive. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

SAVE 15% NOW!

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 liking The Physical Therapy Advisor!

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Why Your Upper Back Hurts When You Run

WhyYourUpperBackHurtsWhenYouRun

http://running.competitor.com/2016/06/injury-prevention/upper-back-hurts-run_151708

Competitor

June 13, 2016

As featured in this post for Competitor, I explain how poor technique or weak back muscles can contribute to upper back pain while running.  You’ll learn why it’s important to get your body to do the opposite of hunching forward and to stretch out the neck and upper back muscles in order to eliminate pain when running.  I also recommend a series of exercises to strengthen the lower and mid trapezius muscles, and the rhomboid muscles, along the spine at the base of the neck.

At the end of a long hard run, you expect your legs and lungs to be burning, but your upper back? No way.

Unfortunately, “it’s a very common thing,” said Nick Studholme, a sports chiropractor in Colorado.  As the intensity and length of a run increases, many runners will often experience a worsening sharp pain in their upper back, in between or under the shoulder blades.  It’s not quite debilitating, but it sure is painful and annoying.

It’s particularly common in novice runners, said physical therapist Ben Shatto, but it can happen to anyone with poor technique or weak back muscles.  And that’s most of us.  Continue Reading

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12 Risk Factors for Low Back Pain

We all work hard exercising and training for the next race, game, and/or competition.  We invest hundreds and thousands of dollars and hours upon hours training for our sport or activity.  We learn everything we can about our sport.  We buy the newest gear and fitness apps.  We invest in the newest and greatest training plans and programs.  Yet, we often fail to address the obvious. The best training plan in the world won’t do us much good if we’re unable to implement that plan due to pain and/or injury.  Many of us just accept occasional episodes of low back pain (LBP) as a normal part of life, but these episodes of LBP can have both devastating monetary and training consequences.

Young woman out jogging suffers a muscle injury

What if you could prevent injury and the loss of training days?  What if you could prevent costly physician visits?  What if you could spend your money on the best fitness and training programs and gear instead of on pain relief gels, oils, and scams?

The following list of potential risk factors for LBP addresses how you can be proactive in maintaining a healthy back.  How many of the following 12 risk factors can you relate to?

12 Risk Factors for Low Back Pain:

  1. Smoking – Smoking is a major risk factor for low back pain (LBP).  The chemicals in cigarette smoke affect both the lung’s ability to exchange oxygen and the body’s normal healing response.  These chemicals alter the blood supply to the discs and other spinal structures which affects nutrient exchange and increases the risk of pain.  Healing time for all medical conditions worsen with smoking.  Although research is forthcoming, it’s likely that vaping also has a negative impact on healing and LBP.  Anything that negatively affects optimal health will increase your risk of LBP and recovery from injury.
  2. Gender – This is an interesting one.  It may relate to certain behaviors more than anatomical differences, but males have a higher risk of LBP.  Females tend to experience more cervical or neck pain.
  3. Pregnancy – Pregnancy increases your risk for LBP due to structural changes as the baby develops and hormones change.  The expectant mother releases relaxin, a hormone which loosens the whole body, to prepare for the baby’s delivery.  Again, a risk worth taking!  Most women can manage the pain by modifying posture and movements while learning techniques for self-management.
  4. Heredity – A family history of low back pain increases your risk.  In some cases, this may be due to actual structural deformities which may be genetically linked.  More commonly, it’s a learned behavior, such as chronic sitting and slouching (poor posture), that can lead to a higher risk of LBP.
  5. Prior Episodes of LBP – Once you have experienced LBP, you are more likely to have re-current episodes.  This is typically due to not addressing the precipitating factors that led to the first episode of LBP.  It’s also likely due to weakness in the deep multifidus muscles that help to support the spine and prevent shearing forces.  This weakness can be addressed with proper physical therapy intervention.  (Please refer to Why You Keep Hurting Your Back.)
  6. Lack of Exercise/Activity – A sedentary lifestyle will increase your risk for LBP.  The spine is designed to work and move.  In order for the spine to remain healthy, it requires exercise and movement.
  7. Too Much Sitting – Sitting for even a moderate amount of time not only affects your general health status in a negative way, but it also increases your risk for LBP.  Sitting for more than 30 minutes at a time can increase your risk.  Worse yet is sitting with poor posture or unsupported.  Sitting on vibrating surfaces such as a heavy equipment operator will increase your risk further.  Please refer to The #1 Way to Extend Your Life Span for the reasons why sitting has such a negative effect on your body.
  8. Poor Posture – In western culture, we spend most of our day sitting slouched or standing hunched over.  This is an excellent way to increase your risk for LBP.  It’s one of the major risk factors for disc herniation and development of spinal stenosis.  Please refer to How to Improve Posture & Eliminate Pain for exercises that can help you to develop better posture and strength to eliminate back pain.
  9. Lack of Warm Up Before Exercise – This is a common mistake which can lead to injury.  A proper warm up prior to an event or exercise session is critical for injury prevention and in order to achieve peak performance.  A poor warm up affects your ability to get the most out of each training session.  A warm up should consist of a cardiovascular component, a spine specific component, and a dynamic stretching routine of the actual exercises you will be performing to insure you’re ready for the movement.  This is pertinent for any training session regardless of sport including weightlifting and running.
  10. Training when Exhausted – Allowing yourself to become over fatigued will increase your risk of all types of injury including LBP.  This is a common problem among CrossFitters and anyone who trains at a very high intense level.  Typically, this results in poor technique which further increases your risk.  Combine poor technique with muscles which can no longer perform the proper movement pattern, and you’re likely to become injured.
  11. Poor Technique – Poor technique often occurs when performing exercises that are too advanced, with too much resistance, and/or when feeling exhausted.  Performing unfamiliar lifting techniques or lifting too much weight will likely result in poor technique.
  12. Training Volume – Overtraining syndrome (OTS) can occur when you train too hard for too long.  Your training plan should include scheduled rest and recovery cycles to allow your body the time to recover between competitions and high volume or intense training cycles. OTS definitely increases your risk of injury.

The key component to preventing reoccurring episodes of LBP is to address your risk factors.  Determine what initially caused your LBP.  If you are looking to finally prevent those reoccurring episodes of LBP that derail your training and/or are currently suffering from LBP, then Treating Low Back Pain (LBP) during Exercise and Athletics is the solution.  This complete guide and system will help you to prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.

Treating Low Back Pain during Exercise and Athletics

product-cover-lbp

In this complete self-treatment package, Treating Low Back Pain (LBP) during Exercise and Athletics, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

BUY NOW

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Why Low Back Pain almost always Reoccurs

I had waited all year for the City of Trees half marathon.  My goal (as always) was to post a PR (personal record) for the event.  Since it was a fairly flat course, I figured it would be a good opportunity to run fast (at least, fast for me).  As part of my training protocol, I was squatting two days per week and working on general leg strength and cross training (practicing yoga) one day per week.

Group of people running.

My back had been sore off and on for almost five years.  Medical professionals didn’t offer me any specific reasons as to why.  Neither chiropractic nor physical therapy seemed to help much, so I just ignored it.  But not this day!

I had just completed my second work set of squatting at the gym.  At the time, I wasn’t experiencing any notable back pain.  I was on my second repetition and on my third set when my low back gave way.  The weight came down and hit the rack safety rails!  My back hurt, but worse, it felt unstable.  I decided to leave the gym in shame.  I picked up the weights I was using, but the pain began to worsen.

By the time I drove home, I could barely get out of my truck.  I decided I was tough, so I took some ibuprofen and still went to work.  By the time I made it to the office (about 10 minutes), I was in real trouble.  I walked around for a while, and I took some Tylenol before I decided to go home.  I got in my truck, but by then the pain was so bad that I couldn’t push in the clutch or hardly use the brakes.  I really don’t know how I make it home that morning, but I needed help from my wife to get out of my truck.

LowBackPainIt only got worse from there.  I went to lie on my bed.  Again, another bad plan!  An hour later when I needed to urinate, I realized I couldn’t even get out of bed!  The pain was worse than anything I had ever experienced.  After much struggle and help from my dad (who was called in to help), I was able to get upright, only to break out in a cold sweat, start shaking, and nearly pass out from the pain.  Still having to urinate, I experienced one of the more humbling things I have ever done.  I had to ask for help from my wife to urinate into a plastic bottle because I couldn’t get out of bed.

Long story short, I went to a doctor who diagnosed me with low back pain (LBP) from a lumbar strain and prescribed pain medication and a steroid pack.  After many more days of pain, I was finally upright again.

A month later, I was ready to start back into my training, but frankly, I was nervous!  My back felt weak, and I had no idea how much was too much.  The worst part of it all:  I’m a physical therapist!  Shouldn’t I known what to do?  It sure didn’t feel like it at the time.

The medication did mostly relieve the pain, but I had a chronically sore back that felt weak and unstable.  I was performing physical therapy exercises and stretches.  I was even using heat and electrical muscle stimulation (EMS).

My treatment wasn’t helping me that much.  At least, not to the point that I felt I could get resume my training for my upcoming half marathon.  All I wanted to do was to get back to training, but I was too scared to!

This experience started me down a path of study that changed my life.  I realized how incompetent I had been as a physical therapist who treated others experiencing severe low back pain.  I had new appreciation for those patients who wanted to get back to their sport and activity.  I also realized that my prior physical therapy interventions were not preparing people to get back to sport nor most high level activities.

What do you do when you’re past the worst of the pain and want to resume training, but you don’t feel physically, mentally or emotionally ready?  Your insurance money may be used up.  The pain may have dissipated, but you’re still not sure how to progress through the next steps.  What if it happens again?  Can I train as hard as before?  Am I really better?  I have lost so many days of training, should I even compete in my event?

Often after a severe case of low back pain, you may be too scared to train like you did prior to the injury, and it turns out you should be!  At least until you understand why low back pain almost always reoccurs and what you can do to prevent it. 

The most common treatment strategies for low back pain are too general for most active individuals, weekend warriors, sport enthusiasts, CrossFitters, weightlifters, and runners.  I have spent the past 11 years researching, studying, and refining best practices for treating LBP.  I have combined research with known anatomical and physiological principles in order to develop very specific strategies for LBP prevention among active individuals.  I have designed a complete guide and system to help you to prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.

Treating Low Back Pain during Exercise and Athletics

product-cover-lbp

In this complete self-treatment package, Treating Low Back Pain (LBP) during Exercise and Athletics, I share very specific strategies for LBP prevention among athletes such as sport enthusiasts, CrossFitters, weightlifters, and runners.  These principles are helpful for anyone participating in athletics as well as those implementing a healthy lifestyle.  You’ll learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies.

LBP_Video

In this package, you get an in-depth look at treating LBP with a 7-part series of instructional videos in which I address low back pain prevention during exercise; specific warm ups for exercise and activities; what really is the “core” and why it matters; treatment techniques (including how to apply Kinesiological tape); and long term management strategies.  This includes nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports (such as running), and athletics.

product-cover-ot

In this BONUS eBook, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

BUY NOW

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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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Q & A: Is Weight Training Safe for Children?

Q.  My son is 11 years old and wants to start lifting weights with me. Is it safe for him to do this at such a young age?  -Matt

A.  Great question, Matt! I believe weight training and activity in general should be encouraged in whatever form the child prefers.  Research regarding the effects of heavy weight training or high intensity training in younger children continues to evolve.  The long standing belief that weight lifting will stunt a child’s growth has never been proven.  In fact, current research indicates that weight lifting may actual help to increase a child’s growth rate.  This may be due to hormonal improvements or actual physical stress (in response to the training) on the child’s body.  Most likely, the positive effect on growth rate is due to a combination of both factors.

When addressing weight training, keep in mind that children’s physical, mental, and emotional development will vary widely and is not necessarily correlated to their chronological age.  Most children will have varying degrees of muscle strength and asymmetry in that strength as they grow and develop.  Encouraging activity and exercise is a critical component to how the child will ultimately develop.  When choosing which type of activity and exercise is appropriate for a child, his/her physical, mental, and emotional development need to be considered.

Physiological considerations include:

  • Growth Plates. The epiphyseal plate (growth plate), which is a cartilaginous plate at each end of a long bone, in children typically closes between 18-25 years old. It is most active when the child is younger. There is no evidence that weight lifting will negatively affect the growth plates. The question that research has failed to answer is: How much stress and strain is too much? A child’s boney structure is not the same as that of an adult. Lifting excessively heavy loads with poor technique could cause damage to these growth plates. In order to insure your child’s safety and limit the risk of injury, his/her weight lifting schedule or program should not be the same as that of an adult.
  • Muscle Strength. Adolescent muscle development will vary widely. It’s highly dependent on proper hormonal balance. Most children don’t have the proper hormonal balance to develop muscle like an adult. Therefore, a child should not be trained as an adult.

Weight training can be appropriate at a young age.  Focus on learning the techniques while developing proper motor patterns and motor control (particularly, if he/she is performing advanced activities such as Olympic weight lifting).  Children’s growth and development tends to occur in spurts.  They often have evolving issues with muscle tightness and asymmetric muscle development.  A weight lifting program that stresses proper movement patterns and full range of motion (ROM) is an excellent method to help insure proper muscle development.  Weight lifting is just one of many training activities for a child.  I highly encourage children to participate in many different activities in order to develop a wide physiological and neurological baseline.

Alexis_Squat

Consider the following when designing a training program for your child:

  • Keep it fun! This is your child’s time to learn and have fun. There is no need to push heavy weights on his/her young body. However, it’s perfectly acceptable to progress strength gains when he/she is able.
  • Develop proper motor programs. Focus on optimizing patterns and mobility. A weight lifting program that stresses proper movement patterns and full range of motion (ROM) is an excellent method to help insure proper muscle development.
  • Encourage variety. For other strength development and motor program development options, encourage body weight exercises such as the TRX system. A CrossFit class, designed specifically for kids, may also be fun option.
  • Proper programming. A child should not be trained as an adult. The exercise programming should be tailored to your child. I recommend an emphasis on technique and a slower progression of resistance and load compared to that of an adult. For young children, double the time it takes for an adult to progress the load. Physical ability will widely vary in the teenage years. Focus on form and technique while developing proper movement patterns. Encourage participation in many different activities in order to develop a wide physiological and neurological baseline. Training volume should be less than an adult.

If your child is experiencing pain or you suspect a developing problem, consult your pediatric physician or a qualified physical therapist about your concerns.  I would also caution you that many pediatric physicians may not be too keen on the idea of weight training in pre-teen children.  Seek a physician who is open to the idea and can work with you and your child to insure optimal health.

As parents, we want to encourage activity and exercise while instilling a life time love of exercise in all of its many forms.  When weight training at a young age, focus on proper ROM and symmetrical strength development.  Thanks, Matt, for the question!

Does your child lift weights and/or participate in sports such as CrossFit?  Why or why not?  Please share your thoughts 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!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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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.

Don’t forget to subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step by step exercise instructions and photos!

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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Top 10 Strategies to Avoid Injury

An ounce of prevention is worth a pound of cure.  –Benjamin Franklin

As a physical therapist, I help people who have suffered from an injury through the process of rehabilitation.  Accidents will happen, but certain activities can help you to avoid and limit the chance of an injury.  Nothing will derail a perfectly designed training program like an injury.  Optimize your health and lessen your risk of injury by being proactive upfront.

Top 10 Strategies to Avoid Injury:

1.  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 and remove any cellular waste products.  I like to use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated.

2.  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 provide range of motion (ROM).  The perfect time to perform static stretching is after exercising.  Work on those tight and restricted areas.  Keep moving throughout the day and avoid sitting for extended periods of time.

CoolDownStretch

3.  Eat healthy. A healthy diet is critical to avoid injury.  Your body tissue needs nutrients to be able to perform at a high level.  Avoid processed food as much as possible.  Limit sugary food and add more protein and healthy fat in your diet.  Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system.  Adequate protein intake is necessary to support muscle health and development.

4.  Stay hydrated. The human body is primarily made of water, which is critical for all body functions.  Adequate water intake is critical to avoid dehydration which can negatively affect your training.  Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair.  Dehydrated tissues are less flexible and tend to accumulate waste products.  Stay hydrated by drinking water.  Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce.

5.  Supplement. I take certain supplements during times of heavy training volume or when I am in a phase of overreaching.  I also take them intermittently to help prevent injury or heal from one.

My most recommended supplement is CapraFlex by Mt. Capra.  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 also recommend a colostrum supplement called CapraColostrum by Mt. Capra.  Colostrum is the first milk produced by female mammals after giving birth.  It contains a host of immunoglobulins, anti-microbial peptides, and other growth factors.  It is especially good at strengthening the intestinal lining which prevents and heals conditions associated with a leaky gut.  Colostrum can also help a person more effectively exercise in hotter conditions.  Over all, it can boost the immune system, assist with intestinal issues, and help the body to recover faster.

Like CapraFlex, Tissue Rejuvenator by Hammer Nutrition contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation.  I recommend taking either CapraFlex OR Tissue Rejuvenator.  You can take CapraColostrum independently or in conjunction with either CapraFlex or Tissue Rejuvenator.

I recommend taking these supplements for injury prevention or as a recovery strategy.  I recommend trying a 14-30 day protocol.  (Please consult with your pharmacist and/or physician prior to starting any new supplementation protocol.)

6.  Take cross training seriously. Performing the same activity day after day without variation can lead to overuse injuries or muscle imbalances.  You may spend a majority of your time specifically training for a particular sport or activity, but it is important to vary the training load and/or stimulus.  Not only can cross training limit your risk of injury, it makes training fun by keeping the body stimulated and ready to improve.

7.  Actively manage your aches and pains. Spot train your weak areas and work on whole body mobility and fitness.  Don’t neglect the small stuff as it will catch up with you sooner or later.  Consider seeing a masseuse for regular body work.  To learn how to use a foam roller for self-treatment, please refer to Foam Rolling for Rehabilitation.

8.  If it hurts, don’t do it! Modify the activity or discontinue it completely. 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.  Work with your coach or athletic trainer to determine if poor form and technique is causing the pain.  With instruction, you may avoid pain and injury while taking your training to the next level.

9.  Adequate rest is important. Your body must rest in order to grow and develop.  Training every day is not the best way to improve.  It can lead to injury and burn out.  Take a rest day and have fun.  Participate in a yoga class, take a leisurely bike ride, or take a walk in the park.   If you are participating in a yearly training cycle, be sure to incorporate an off season which involves a change of pace from your regular training and some active rest.  Proper programming includes mini cycles with an off season as well as active rest cycles in between heavy load and heavy volume training cycles.

10.  Seek help early. If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately.  A healthy lifestyle is a lifelong pursuit.  If you are injured or not enjoying an activity, you will not stay engaged or motivated in the long term.  Seeking advice specifically from a running coach, physical therapist, or physician can be beneficial.

Unfortunately, injuries will occur.  However, incorporating these strategies will reduce your risk of injury while likely taking your training and exercise program to the next level.  If and when an injury occurs, take it seriously and manage it quickly.

How do you avoid injury?  Which particular strategy has aided in your recovery?  Please leave your comments 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!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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12 Sure Fire Ways to Injure Your Back

You caught me red-handed! A physical therapist with a lapse in judgment which lead to an injury that I could have avoided had I followed my own advice.  During an early morning workout, I recently tweaked my low back.  I’m guilty of being exhausted, using poor technique, and not taking a rest day.  Sound familiar?

LowBackPain

In the following days (as I was forced to rest although I would rather have been at the gym), I drafted a rather cheeky list of risk factors and how to maintain a healthy back.

12 Sure Fire Ways to Injure Your Back:

  1. Start Smoking – Smoking is a major risk factor for low back pain (LBP). The chemicals in cigarette smoke affect both the lunges’ ability to exchange oxygen and the body’s normal healing response. These chemicals alter the blood supply to the discs and other spinal structures which affects nutrient exchange and increases the risk of pain. Healing time for all medical conditions worsen with smoking.
  2. Be Male – Males have a higher risk of LBP. Females tend to experience more cervical or neck pain. (Obviously, you have very little control over this factor other than the knowledge that you’re at an increased risk if you are a male.)
  3. Choose Parents Who have Experienced LBP – A family history of low back pain increases your risk. In some cases, this may be due to actual structural deformities which may be genetically linked. More commonly, it’s a learned behavior, such as chronic sitting and slouching (poor posture), that can lead to a higher risk of LBP.
  4. Prior Episodes of LBP – Once you have experienced LBP, you are more likely to have re-current episodes. This is partially due to weakness in the deep multifidus muscles that help support the spine and prevent shearing forces. This weakness can be addressed with proper physical therapy intervention.
  5. Have a Baby – Pregnancy increases your risk for LBP due to structural changes as the baby develops and hormones change. The expectant mother releases relaxin, a hormone which loosens the whole body, to prepare for the baby’s delivery. Again, a risk worth taking! Most women can manage the pain by modifying posture and movements while learning techniques for self-management.
  6. Don’t Exercise – A sedentary lifestyle will increase your risk for LBP. The spine is designed to work and move. In order for the spine to remain healthy, it requires exercise and movement.
  7. Sit for more than 2 Hours a Day – Sitting for a long period of time not only affects your general health status in a negative way, but it also increases your risk for LBP. To increase your risk further, be a heavy equipment operator who sits on a vibrating surface! Please refer to The #1 Way to Extend Your Life Span for the reasons why sitting has such a negative effect on your body.
  8. Practice Poor Posture – In western culture, we spend most of our day sitting slouched or standing hunched over. This is an excellent way to increase your risk for LBP. It’s one of the major risk factors for disc herniation and development of spinal stenosis. Please refer to How to Improve Posture & Eliminate Pain for exercises that can help you to develop better posture and strength to eliminate back pain.
  9. Don’t Warm Up Before Exercise – This is a common mistake which can lead to injury. Jump out of your bed in the morning without warming up, and then start your exercise routine. (Please don’t!) Instead, prepare your body for challenging activities in order to avoid injury. A warm up should consist of a cardiovascular component and a dynamic stretching routine of the actual exercises you will be performing to insure you’re ready for the movement. This is also pertinent for weightlifting and running.
  10. Keep Moving even when Exhausted – This is a common problem among CrossFitters (including myself). Just keep pushing yourself even when you can’t see straight. Typically, this results in poor technique which further increases your risk. Combine poor technique with muscles which can no longer perform the proper movement pattern, and you are likely to become injured. High Intensity Training (HIT) is a wonderful form of exercise and has many health benefits as long as you’re able to properly perform the exercise.
  11. Use Poor Technique – Poor technique, along with feeling exhausted, often occurs when performing exercises that are too advanced. Performing unfamiliar lifting techniques or lifting too much weight will likely result in poor technique. Please see your coach, athletic trainer, or physical therapist for the proper technique for your activity of choice.
  12. Keep the Training Volume High – Who needs a rest day? All of us can benefit from taking a break. Training every day without regard to rest is an excellent way to cause over training syndrome and injury.

Low back pain is a serious and debilitating condition. It will either most certainly affect you or someone close to you. Be mindful of your risk factors and be pro-active in maintaining a healthy back!  Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

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