Tag Archives: running physical therapy

Elite PT Newsletter April 2018 – Running Injuries Part I – Foot/Ankle

Running Injuries – a Spring time tradition

Like the rest of you I’m done with the cold and snow and ready for some nicer weather. It’s that time of year to start thinking about summer which usually means being more active.

For you runners out there it will mean getting outside more and probably increasing your mileage.

For you athletes, it’s time to start thinking about what you’re going to do this summer to make you a better athlete for next year.

Luckily, we’ve got something this month for both of you!

Common Running Injuries
1. Patello-Femoral Pain Syndrome (anterior knee pain)
2. Achilles Tendinitis
3. Plantar Fascitis
4. Hamstring Tendinitis
5. Shin Splints
6. IT Band Syndrome (pain at the hip or lateral knee)
7. Stress Fractures
8. Patellar Tendinitis
9. Lower Back Pain

These are the most common running injuries I found searching running sites and this order is fairly consistent from site to site. We see our fair share of each of them here at Elite PT.

These are also known generically as ‘over use injuries’ – meaning that they are caused over time by repetitive stresses that gradually break down the various tissues involved (tendon, muscle, fascia, bone, etc).

These are also the most common injuries we see in high school sports that involves a lot of running, i.e football, soccer, basketball, track and cross country. So if you’re an athlete of any kind, at some point you are either going to be dealing with one or more of the above OR you should be working to prevent them.

Prevention starts from the ground up

How your foot and ankle function are huge for preventing the obvious conditions in that area but also those further up the chain in the knee, hip, and lower back.

The joints of your foot and ankle must move appropriately and the muscles must do their job to stabilize those joints as your foot hits the ground and then progresses to push off. This is a two pronged approach since the joints require adequate mobility and the muscles must stabilize at just the right times.

This month we’ll cover a few ankle/foot exercises you can use to prevent injury or to rehab from it. Sorry if I get a little deep in the ‘why’ sometimes but I do think its important to know ‘why’ you should perform these exercises.

Ankle Mobility

Here’s a great example of what good ankle mobility looks like. The knee should be able to travel 4″ past the big toe without the heel coming up or the arch collapsing.

Athletes need this much ankle mobility to squat deep, sprint, jump, cut, and so on. If you don’t then your body is going to find a way to compensate around that so you can still squat, sprint, jump, etc. Our compensations are usually what get us into trouble. In this case the common compensations are:

  •  arch of the foot collapses (excessive pronation)
  • foot turns out
  • heel comes up too soon
  • knee collapses inward

There are others but these are the easiest to see. Watch anyone with stiff ankles try to squat deep – its not uncommon to see all of the above.

These compensations put the tissues of our foot, knee and even higher up the chain into more stressful positions. With repetition, i.e. lots of mileage, this will eventually catch up with most athletes causing pain.

What to do about it?

There are two main reasons why your ankle joint may not move enough:

tightness through the muscles of the calf (will feel like stretching in the back of the lower leg)
limitations involving the ankle joint (will feel a pinching sensation in the front of side of the ankle when bending it all the way)

Tight muscles are something you can deal with fairly effectively yourself. Using foam rollers or massage sticks to loosen up the calf muscles followed by stretching are the easiest things to do. Working on ankle mobility in a kneeling posture as in the picture below is one of my favorites.

Kneeling Ankle Mobility

The goal is to get your knee as far past your big toe as possible without your heel coming up. Placing the stick at your 5th toe and taking your knee around the outside of the stick forces you to work the muscles of the foot and keep the arch high. I prefer shoes off so you can actually see what your foot is doing. It could also be done standing if kneeling causes knee pain.

If you experience that pinching sensation in the front or side of your ankle – that is going to be a tougher fix. That’s usually not something you can stretch out on your own. It’s actually a good reason to give us a call because you will need some manual therapy to deal with that stuck joint.

In conclusion

What is happening at your foot and ankle affects every other joint in your body so this is a great place to start. See how far your knee can go past your big toe – if it’s not 4″ (heel down and good arch) then it’s time to get to work.

If you want some other ideas, catch the video below featuring our former student Scott McKeel (who just ran the Boston Marathon this week) demonstrating some great ankle mobility drills.

And even if you don’t consider yourself a runner or an athlete, you still need a mobile ankle and stable foot to walk normal, go up and down stairs, and balance. These are for you too!

If you’re struggling to make gains or you do have that ankle pain I mentioned earlier, feel free to give us a call (231 421-5805). We can set up a free 30 minute assessment to determine if you just need more advanced exercises or you may need physical therapy to break through and get moving again.

I’ll leave this offer open through the end of April so get cracking!.

Have a great rest of April and be sure to look for the next article in our series on running injuries.

Joe Heiler PT

Elite PT January Newsletter – Therapist Spotlight: Kristy Ockert

Hi everyone

Hope you had a great Christmas and New Years.

2017 was a great year for us at Elite Physical Therapy and hopefully 2018 will be more of the same.  It’s a blessing for us to be able to work closely with clients like yourself.  We really love getting to know our clients and helping them to achieve their rehabilitation and training goals.  It’s awesome to be able to do something you love for a living, and hopefully it shows!

Free Screening Day

We’ll be hosting another free screening day coming up in February (date to be announced soon).  This is an annual service we’ve started providing to the following:

  • All past physical therapy clients
  • All present clients who have another problem currently not being treated
  • All loved ones, family, friends, neighbors and co-workers of our past and present patients

If you are having pain or problems with day to day activities such as walking, standing, sitting for long periods, going up or down steps, getting in and out of the car, sleeping or driving, then this is an excellent opportunity to see one of our world-class therapists, find out the cause of your problem, and get some treatment ideas.

I’ll be sending out an email soon with more information on how you can take advantage of this free offer.

Therapist Spotlight – Kristy Ockert MSPT

Kristy Ockert began working at Elite Physical Therapy 2 years ago and overall has been practicing since 2002 in the outpatient setting. She earned her Bachelor’s degree in Kinesiology with a specialization in Health Promotion from Michigan State University and her Master of Science in Physical Therapy degree from the University of Colorado Health Sciences Center. Kristy is a Certified Kinesio Taping Practioner (CKTP) and enjoys treating a wide variety of patient populations including post-operative, athletes, and patients with spinal dysfunctions.

She has enjoyed furthering her education with a Pilates specialization and various manual techniques including Graston Technique, Functional Dry Needling, Muscle Energy Technique (MET), Muscle Release Technique (MRT) and Myofascial Release (MFR). Kristy is passionate about providing one on one care to her patients and taking into account all pieces of their individual health puzzle for restoring optimal wellness and return to function.

Q & A:

What got you interested in physical therapy as a career?

It’s a long story!  When I was younger, I wanted to become a teacher, like my mom.  As I got into high school, I knew I wanted to be a doctor – either a pediatrician or sports medicine physician so I could focus on optimizing health for kids and athletes.

My first glimpse of PT was as a patient when I was injured during my high school senior year softball season.  I had a great PT and PTA work with me, but I didn’t think much of it until my senior year of college at MSU.  I decided that I did not want to go to medical school any longer and was looking for a new career path.

After some research and lots of deliberation, I changed my major from Human Biology to Kinesiology, which is the study of human movement.  I finally loved my classes – movement throughout the lifespan, biomechanics, adaptive movement, etc.  It all seemed to fall into place after that.  I got in touch with my former PTA and asked if I could interview her for a class assignment.  It turned into shadowing and weekly volunteering in a small outpatient clinic.  I was hooked!  If I were to become a physical therapist, I could work in the health care field with people of all ages and teach them about how to optimize their movement for improved quality of life.

Over the past couple years you’ve become certified in Graston Technique and dry needling.  Any other techniques you really like to use?

I also enjoy being a Certified Kinesiotaping Practitioner.  Whether it is to help with swelling, bruising, or scar tissue, working on retraining a muscle with proper activation or even unloading an injured area, Kinesiotape has so many uses.

What are your favorite things about being a PT?

I enjoy working with closely with people whether it’s younger athletes, weekend warriors, middle aged or even geriatric patients interested in remaining active.  If there are a few exercises, hands on techniques, and instruction in daily modifications that can make someone’s life more functional and optimize their movement, I’m happy!  I love seeing the changes that people go through from the start to finish of therapy.

Outside of working at Elite, what kinds of things do you and family enjoy?

I enjoy spending time with my husband of 16 years, Ken, and our three kids Carter (14), Peyton (11), and Emma (8).  We love watching movies, going to the beach, bowling and skiing as a family.  I also have a love-hate relationship with winter running, so I’m going to try snowshoeing with my running buddies this year for our longer distances to gear up for the 2018 racing season!

Kristy Ockert
 

 

 

 

 

 

Testimonial

Thank you, thank you, thank you!! After 5 years of physical therapy at numerous other locations, false diagnosis and lack of improvement, MRI’s that showed nothing, Kristy and Lydia correctly diagnosed the problem with my daughters knee and have fixed the problem! You have got her active again with little to no pain. You have brought a smile to her face and to her parents face as well! Thank you for getting her back to healthy! 5 stars isn’t enough! – M.R. Ludington

Sore Knees???
Pain site does not always equal pain source!

Just because your knee hurts doesn’t necessarily mean that the problem lies only with that knee.  You’ve got numerous joints above and below that must move correctly to take the pressure off the knees.

One of the prime examples (or prime offenders) is the ankle joint.  A stiff ankle will negatively affect your walking and running stride, ability to squat down, walk up/down stairs, balance, and more.

The client from the testimonial above was a great example of this.  Resolving her ankle mobility limitations went a long way toward making her knees feel better.

Check our the link below for a short article/video on how we assess and solve the problem of ankle mobility:  http://www.elitepttc.com/ankle-mobility-update/

This is exactly the kind of thing our free screening day is for!

Til next month

Joe Heiler PT

Dynamic Warm-Up for Runners Part II

Part II of Scott McKeel’s series on dynamic warm-up drills for runners.  In this episode Scott takes you through some of our favorite lower body warm up and run technique drills here at Elite Physical Therapy and Sports Performance. These drills are great for those who have been battling common running injuries like plantarfascitis, hip bursitis, IT band syndrome or low back pain.

 

We do small group, and even individual, training sessions for runners which includes the Functional Movement Screen plus other critical tests to find the weak links in mobility and flexibility, strength, and running technique.  If you’re interested contact us:  joe@elitepttc.com

The Bird Dog – A Core Stability Classic

The ‘bird dog‘ exercise is a core stability classic in the physical therapy world, and is certainly a favorite of ours here at Elite Physical Therapy.

That being said I see this exercise done incorrectly more often than not.

The whole idea behind core stability is to resist unwanted movement through the pelvis and spine when moving through the hips and shoulders.  Watching most therapists, and even yoga and pilates instructors, teach this exercise you would think just the opposite.  Check out the video below to see the exercise performed incorrectly (first 3 reps) and then done correctly (next 3 reps).

When performed incorrectly you can see how much movement is occurring through the lumbar spine.  Many folks are stuck in excessive lumbar lordosis (too much inward curvature) which can become painful especially with prolonged standing and walking.  A majority of the athletes I work with, including the dancers and gymnasts, would fall in this category as well.  Going into even more lordosis is only going exacerbate the issue.

As you can see when performed correctly, nothing moves through the pelvis and spine.  It’s only my shoulders and hips.  Performing a bit of a posterior pelvic tilt (think tucking the tailbone) will bring the person out of the excessive lordosis and help to stabilize the trunk.  Also notice there is much less excursion with the upper and lower extremities.  There is no way you can lift the arms and legs as high as in the first example and maintain any type of stability.

There are times however that a bit of lumbar lordosis (arch) may be necessary to maintain throughout the exercise.  Sometimes this is just the more comfortable position to be in.  If that’s the case then that is going to be the appropriate position for your body.

To learn to stabilize in this position, using a water bottle either across or along the spine is a nice trick (the latter being the more challenging).  Focusing on keeping the water bottle from rolling off your back will reflexively fire more muscles and with the correct timing to keep your spine and pelvis stable.

Adding a resistance band would be a higher level challenge. Do not attempt to add resistance until you are able to control your body weight.

Give the bird dog a try yourself and see how much more challenging it can be when you actually stabilize the core!

If you have any questions, contact me at joe@elitepttc.com or at 231 421-5805.

 

Competing at a High Level after an ACL Injury

Big thanks to Dave Chalmers who wrote this guest blog post.  Dave is an athletic trainer who currently writes on behalf of DME Direct

 

It’s every athlete’s worst nightmare. Tearing your anterior cruciate ligament and sustaining a devastating ACL injury. The reason these injuries are so terrifying to athletes is that the road to recovery is long and arduous, and even then there is no guarantee you will ever be the same player and you always run the risk of re-injury. However, over the years there have been major advancements in ACL rehabilitation and it is now much more plausible to return to competition after an ACL injury and compete at a high level.

Prehab

One aspect of ACL rehabilitation that often gets overlooked is the important time following the injury prior to surgery. As more people are realizing the significance of getting a recovery program off to a good start, the practice of prehabilitation is being implemented more frequently.

Typically the aim of prehab is to reduce swelling and stabilize the knee prior to surgery. This can be achieved through cold therapy and wearing a knee support to compress and stabilize the knee. Some mobility exercises can be performed at this stage if you experience no pain while doing them.

Post-Surgery

After successful reconstructive surgery, the rehabilitation process begins. This process can be broken down into a timeline with various phases. It is important that you stick to this timeline and do not rush things and risk re-injury.

The first two weeks immediately following surgery should be spent focusing on reducing swelling and controlling swelling. Similar to the processes of prehab, icing and compression should be applied here and the use of crutches combined with rest is commonly advised. At this time you can begin with static strengthening exercises such as lying down quadriceps and hamstring contractions.

After these two weeks, you should being a second phase of recovery. Mobility and strengthening exercises should continue and you can start to introduce exercises like shallow lunges and half squats. You can also start implementing adduction and abduction exercises for hip flexor strengthening as well as begin proprioception and balancing exercises.

At about the six week mark you can begin another phase of the rehabilitation. At this stage you can advance to full lunges and squats. You can now start to add weight for increased resistance and begin straight line jogging exercises.

Approximately twelve weeks after surgery you can begin to mix in training activities specific to your sport. The key here is to gradually increase speed and intensity of drills. Along with sport-specific drills, you should also focus on exercises that strengthen hip abductors and external rotators such as monster walks and single leg glute bridges.

Return to Competition

When and only when, your surgeon gives you permission to return to competition will you be able to start competing again. If you follow the processes outlined here you will give yourself the best chance to return to competition physically capable of competing at a high level. However, there is also a mental aspect that many athletes overlook.

Even if your body is ready physically, you may not be mentally prepared to trust your knee in live competition. Again, it is important to be patient and avoid returning until you are fully ready. Use the exercises mentioned above at the end of your recovery program to test yourself a bit and build confidence in your repaired knee. Once you return to competition, wearing a trusted ACL knee brace can give you extra support both physically and mentally.

The long road to recovery after an ACL injury can seem overwhelming at times. Dedication and discipline are required to rehabilitate yourself successfully. However, if you put in the work to reach a level where you are properly prepared physically and mentally to return, you can begin competing at a high level again.

Dave Chalmers is an athletic trainer who currently writes on behalf of DME Direct on topics related to sports medicine and physical therapy. When he’s not writing, you will most likely find Dave at the Staples Center cheering on his beloved Lakers.

 

Low Back Pain and Asymmetries

I was just looking back through the last two years of blog posts and realized I really hadn’t written anything specifically discussing low back pain.  Low back pain ranks second only to the common cold when it comes to work days missed every year, and is also the second most costly ailment to treat.  Low back pain is also the most common complaint that I treat here at Elite Physical Therapy and Sports Performance.

I will admit there was a time when I dreaded seeing that diagnosis on the physician’s order, and I guarantee you most other PT’s would agree with me.  The spine is so intricate, there are so many muscles that attach throughout that area, and so much freedom of movement through the spine, pelvis, and hips that it used to be hard to know where to start.

Over the past five years I’ve learned a few more things and have really come to enjoy treating low back pain.  When you really study human movement and learn to detect common asymmetries in how we are aligned and move, it really isn’t that hard anymore to know where to start and make quicker changes in how someone feels and moves.

There are a number of great examples but today I want to look at one of the most prevalent:

Asymmetry #1 – Inability to Internally Rotate over the Left Hip

Check out the pictures below – seeing it will probably make more sense than me trying to describe it although I’m going to try anyway.

This guy is standing with more weight on his Right leg and pelvis rotated to the right. Check out how his trunk rotates back to the Left to compensate. You can even see how the rotation torques his abdominals and chest!

Almost all of us tend to stand more on our Right leg, and when we do our pelvis shifts and rotates over that hip just fine (this is relative internal rotation of the hip).  The pelvis in this instance is rotated to the Right just like in the  picture above and below.

Here is another great example from my friend Michael Mullin with some arrows drawn in to help you get the idea of the torque it can create in the body:

When we do stand on our Left leg, our pelvis tends to stay rotated to the right (this is relative external rotation of the hip).  This tendency results in a loss of internal rotation ability of the Left hip and a pelvis that does not rotate correctly when we walk or run.  Lots of other bad things happen right up the spine and down the lower extremities because of this.

Check out what happens with this runner who is stuck in this pattern.

No problem rotating into his Right hip during stance. No such luck on the Left.

Notice how when he is on his right leg, his right foot is directly under his body (in the mid-line) and his foot lands in a fairly neutral position.  Now check out his positioning on the left leg.  His left foot is more under his left hip than directly under him causing his knee and foot to roll inward to support him.  He cannot get over his left hip and rotate his pelvis as efficiently on the left as he can on the right.

This picture shows the proper positioning over the Left leg with the pelvis facing Left.

Michael is looking pretty content on his Left leg now

An inability to move out of this pattern will change the way we stand, walk, and run, and can potentially lead to a host of injuries even beyond the lower back.  Fortunately this asymmetry is manageable with some simple exercises that can be worked into warm-ups or between sets when at the gym.

If you’ve been suffering from chronic back, SI joint, or hip problems that have failed traditional treatment, then it may be because the underlying asymmetry has not been addressed.  I’ve had some great success treating these areas by identifying and correcting these asymmetries so definitely something to think about.

Stay tuned and next time I’ll talk about why your ribs flare more on the left than on the right (I’m such a geek!).  If you have any questions feel free to email me:  joe@elitepttc.com

 

Ankle Rehab Update

So last week I posted this message on Facebook:  “Limited ankle mobility is a very common reason for nagging foot, knee, hip, and back pain in runners. Unfortunately not too many PTs or doctors are looking there. Maybe it’s time to call us and rid yourself of that pain for good!”

In the past week I have been asked 3 separate times about what is the best way to check your own ankle mobility and then how to improve it.  So to bring you up to speed on why it is so important to have great ankle mobility I refer you to a previous blog post title “Movement Proficiency and the Ankle” which you can find here:  http://www.elitepttc.com/blog/?p=20

Now for the measuring and correcting!

The first video below shows how I measure ankle mobility in the clinic with the foot on the floor and controlling the ankle to prevent pronation (arch flattening out):

To measure your own ankle mobility, simply assume the kneeling position shown in the video.  Rock your knee over the foot to touch the wall measuring how far your big toe is from the wall with a simple tape measure.  The heel must stay down and arch not allowed to collapse.  The goal is 4 inches!

The next video demonstrates how you can quickly address the soft tissue component of the limitation.  Be sure to measure again as we did in the video as this is the only way you are going to know if it is effective or not.  Always follow the rolling with stretching.

If this does not result in an immediate improvement in ankle mobility, you may have a joint restriction that will not be resolved with rolling or stretching.  Another sure sign of joint restriction is pain or pinching in the front or side of the ankle during the testing.  This can often be resolved quickly with ankle joint manipulation and/or mobilization and certain taping techniques that I employ here at Elite Physical Therapy (in other words it’s time to call the professional).

If you have any further questions feel free to contact me:  joe@elitepttc.com