It’s that time of year again where we start looking at the calendar and deciding on our next running race.

The wintertime in Arizona is when a lot of those happen. Some people don’t use a training schedule although there are some good ones out there. However, sometimes not following one creates for too much too soon. The body isn’t ready for it. One of the most common injuries is shin splints a.k.a. Medial Tibial Stress Syndrome (MTSS). MTSS is from increasing training too quickly and the muscles not being able to keep up.

The complaint is usually pain on the inside of the tibia or shin pain.

It can be seen in high impact sports such as running or dancing. There are some factors to consider such as flat feet, shoe wear and poor warm-ups or cooldowns. Shin splints can be devastating to an athlete and take time to resolve. Resting from the activity is a must. Try non-impact activities such as biking and swimming to keep the cardiovascular benefit while not doing these activities. Ice the area. Look into getting fitted for shoes or inserts. I’ve found that kinesio taping can be beneficial for decreasing pain and inflammation to the area and giving a feeling of support. Also, finding the right exercises to do are important.

A few exercises you can try on your own would aim to increase strength and stability to the foot and ankle, knee, hip, and core.

In regard to the foot, try towel scrunches. Sit on a chair with your foot on the floor. Then put a towel on the floor – preferably on tile or a sliding surface – and scrunch the towel up with your toes. Another exercise is a side-lying clamshell. This is where you lay on your side with your knees bent. Keep your feet together and lift your knee up. Don’t lift your knee up so high that you are rocking backwards. Another exercise is a single leg stance. Stand on one leg and balance for 30 seconds on the floor. If this is easy, then put a pillow underneath your foot. One more exercise you can do is a sidestep with a resistance band. Pick a space where you can step sideways at least 10-15 steps, put a band around your ankles, keep your feet straight and sidestep back and forth.

If you’re doing all of this and finding the pain is still there, then I would follow up with the doctor at this time.

Looking at coming in for physical therapy may also be beneficial. We would do manual techniques with you and create a program for you to do. We can also try modalities at this time. In regard to running, finding the right training program is important because it tells you what days to do what. However, the downfall of some of them is they don’t tell you what exercises to do. One of the programs I’ve used in the past is from Hal Higdon. He has a lot of different ones on his site and I usually refer to that. I believe he even has some exercises that are beneficial to do while you’re training.

Shin splints can be a persistent pain for athletes doing high impact sports due to the repetitiveness of it. There are ways to possibly prevent it by using the right training programs. Also, getting fitted for shoes or just changing shoes more often can be beneficial. Trying exercises to help with strength and stability or trying modalities such as ice or kinesio taping can make a big difference. It’s best not to push through it.

If pain persists, come into a Foothills Sports Medicine Physical Therapy near you to get you back to where you want to be.

 

Upper back pain, also known as thoracic pain, is a problem many people experience. Individuals work at their computers for hours and don’t realize their posture is getting progressively worse. Eventually, this leads to poor posture characterized by rounded shoulders and a forward head. They may start to experience upper back strain, neck pain, lower back pain, and even headaches associated with muscle tightness and weakness.

An important factor to consider is the workplace. In my experience, a large portion of people who come to me for upper back pain therapy sit at a desk or on a plane traveling for long periods of time. One piece of advice I usually give to a patient is to look at their workspace and habits. Check and see if your work has someone who can come out and make ergonomic adjustments for you. If not, I usually instruct them to take a photo of your workspace and I give them pointers. A standing desk is becoming more popular and people have had good results from using it. If your workplace doesn’t offer a standing desk, try limiting your time at the computer. If you lose track of time, set a timer for 15 minutes. Get up, stretch, and walk around each time the timer goes off.

If you decide to try to alleviate your pains without therapy, here are some exercises that I’ve used and had good results from. They include self-joint mobilization, stretches, and strengthening exercises. When you sit for long periods of time, the thoracic spine is flexed and you start losing spinal mobility moving into extension — these exercises work to combat that.

Stretching Your Upper Back
Different exercises that stretch your upper back include physioball mobilizations (PB mobs), doorway stretch, and an upper stretch.

Physioball Mobilizations (PB Mobs)
One exercise I like to do for spinal mobility is called physioball mobilizations or PB mobs. You do this by sitting against a physioball — an exercise ball — with your knees bent and your hands cradling your head for support. Next, you extend your back over the ball until you feel a stretch in your upper back. There shouldn’t be any neck motion on this exercise. Complete two sets of five repetitions.

How to Prevent or Stop Upper Back Pain

 

Doorway Pectoral Stretch
A doorway stretch (pectoral stretch) begins with you facing forward and placing your arms against the doorframe in a 90-degree position. Next, you slowly lean forward until you feel a slight stretch.

Upper Trap Stretch
An upper trap can be done seated at your desk. Sit up tall and look forward. Next, slowly try to bring your ear to your shoulder. Be careful that your shoulder doesn’t lift up and your head isn’t rotating. To get more stretch you can use your hand to give slight overpressure. Do this two times and hold for 20–30 seconds at a time.

Strengthening Your Upper Back
Some strengthening exercises to start with are scapular squeezes, prone I, and prone T’s.

Scapular Squeeze
A scapular squeeze is performed sitting with your hands relaxed on your thighs. You then think about bringing your shoulders down and back. Do this with a five-second squeeze and try to complete 10.

Prone I and T’s
Prone I and T’s are performed face down on a table (bed, floor, or physioball can also be used). Roll up a towel and put it under your forehead, arms down at your side with palms facing the ceiling, and start to squeeze your shoulder blades together and lift your arms off the table. Do a five-second hold and then lower them back down 10 times. Prone T’s are performed in the same position but arms are now moved out to the side with the palms facing the floor. Now squeeze your shoulder blades together and lift your arms up. Do this with a five-second hold 10 times.

Prone I
Back pain therapy exercises can be used to strengthen and stretch your back.

Prone T
Back pain therapy exercises can be used to strengthen and stretch your back.

A program like this should be done consistently and should be progressed as it gets easier. Physical therapy can be helpful in determining when to start progressing if you’re unsure. I would do a program with these exercises daily. The strengthening portion can be done every other day and you can start to incorporate other exercises, like rows, over time. You can also add weight to exercises that are fairly easy as long as you can maintain proper form. The stretches can be done multiple times during the day.

If you decide to go the physical therapy route, a typical visit includes a manual therapy component. This involves manually stretching, soft tissue massage, and joint mobilizations. We can also add in Kinesio taping to help decrease pain and increase awareness of the muscles involved.  I’ve used this on upper traps to get them to relax due to compensation because of pain or limitation contributing to poor posture. We also utilize modalities such as moist hot packs to get muscles to relax, and ultrasound, ice packs, and electrical stimulation to decrease pain.

Upper back pain is a common complaint by those working at a desk, traveling, or performing tasks that require you to sit for long periods. Strengthening weak muscles and stretching out tight muscles can help increase your body’s tolerance for those types of jobs. Other ways to deal with upper back pain is looking at ergonomic options or possibly a standing desk. This will allow you control of how much you want to sit and stand during the day. If trying these back pain therapy exercises alone for a period of time doesn’t decrease your pain, then I would look into getting a physical therapy consultation to make sure you can get back to being pain-free and back to what you want to do.

You just competed in a long-distance run and pushed your body harder than ever. One thing to be aware of is DOMS, otherwise known as delayed onset muscle soreness, which tends to set in after a day or two.

Upon onset, muscle soreness will be very severe and leg motion can be restricted. Training for a 5K, 10K, 15K, half-marathon, or full marathon takes great discipline and preparation. The team at Foothills Sports Medicine is always happy to help with physical therapy for pain in your legs post-race. Here are some of my favorite options to decrease the effects of DOMS and speed up recovery.

So much of what goes into a marathon is preparation pre-race, without much thought into what comes post-race. Immediately after running my first half marathon I was extremely sore, but I didn’t know how tough the next few days would be to get through. I went back to work the next day extremely sore and with a black toenail! To get some relief, I decided to cool off in a pool.

I did a little test next time I went out and used my compression socks, and to my delight I felt better, which left me wondering if they helped speed up recovery. I also decided to take a closer look at traditional methods of recovery such as icing, foam rolling, stretching, nutrition, NSAIDS, and the newest craze—compression socks.

It feels like icing has been around since the dawn of time. The benefits of icing are that it decreases metabolic rate, spasms, and blood flow; it won’t prevent swelling, but it will stop new swelling from forming. The traditional way is to use an ice pack during an immersion; I did this after my half marathon.

Tips for using an ice pack: always elevate the area in question, and don’t use ice packs longer than 20 minutes. Personally, I like the 20 minutes on and 40 minutes off rule. Don’t sleep with your ice pack either because you run the risk of getting frostbite.

Foam rolls, tennis balls, lacrosse balls, and Thera Canes, which are frequently used in physical therapy for pain, are all highly effective methods of self-myofascial release (SMR). I always say it depends on the area and how mean you want to be to yourself.

A Thera Cane can work well for necks and low back areas. If all of these are too painful, then using a roller can help control how much force you want to use. The benefits to SMR are that it can increase your motion, extensibility of the tissue involved, and increase neuromuscular efficiency (Clark 219).

Gentle stretching is a great follow up to using a foam roll. Guidelines for SMR and stretching are foam-rolling 10 times on the muscle or holding it for 30 seconds on the tender spot. Stretching should be held for 30 seconds in a few sets.

I see a lot of people running in compression socks so I decided to do a little research to see how effective they are for recovery. An article out of North Carolina studied compression socks versus regular socks worn by women running a 5K to see their responses. What they found was there was no difference in their performance times. They also went on to suggest that the compression socks might contribute to lowering blood lactate levels during recovery.

Another article studied recovery following a marathon and whether compression socks had an impact. They ended up finding that wearing below-the-knee compression socks for up to two days post-marathon did aid in functional recovery (Armstrong 528). Compression socks continue to be an interesting topic that still needs further research, but it seems there are some benefits to compression socks during the recovery period.

How do nutrition and the use of NSAIDS aka non-steroidal anti-inflammatory drugs, affect recovery? Having some inflammation after a race is important to healing, and by taking an anti-inflammatory to reduce inflammation, you are actually impeding the healing process.

As for nutrition, I found an article discussing the top foods you should try after a race to maximize recovery. They were chocolate milk, pretzel, fruit, bagel, and a pint of beer—my favorite.

A lot of time is spent in preparation and training, but thinking ahead to the recovery part is also important. Good recovery options are icing, SMR, gentle stretching, nutrition, hydration, and fitted compression socks. Hopefully, I helped the runners out there so that they can get through the recovery phase quickly and on to the next one!

Training for long-distance runs can be taxing to the body. Schedule an appointment at one of our Foothills Sports Medicine locations for great training leading up to the race, and the option of physical therapy for pain after the race.

 

References:

Armstrong, Stuart A, Till, Eloise S, Maloney, Stephen R, Harris, Gregory A. Compression Socks and Functional Recovery Following Marathon Running: A Randomized Controlled Trial. Journal of Strength and Conditioning Research 29(2): 528-533, 2015.

Clark, Michael A, Lucett, Scott C, Sutton, Brian G. NASM Essentials of Corrective Exercise Training.  Burlington, MA. Jones and Bartlett Learning.  2014.

Treseler, Christine, Bixby, Walter R, Nepocatych, Svetlana. The Effect of Compressions Stockings on Physiological and Psychological Responses After 5-KM Performance In recreationally Active Females. Journal of Strength and Conditioning Research 30(7): 1985-1991, 2015.

Working at a physical therapy clinic provides a lot of opportunities to see different diagnoses. One that I’ve been coming across as of late is low back pain. The main complaint from patients is that they spend most of their day seated at their desk, in meetings or even frequently flying for their jobs. These patients will vary in the times they spend seated, from an hour to 16 hours at their desk because they can’t get away or they get on a roll. They come into therapy and want to know how to decrease their pain and prevent it from happening again.

One of the suggestions I always make for these patients is to look at their workstation. Is their station ergonomically correct? If not, many companies will provide a service for their workers to have someone come in, take a look at their station and change it according to the demands of their jobs. Ergonomic optimization includes changing and adjusting chairs, adding a foot support, adjusting computers and keyboards. Some jobs are even offering the sitting standing desks so employees can easily adjust to either when they get tired. Another option for patients is lumbar support. There are stores that sell these supports to encourage better posture and decrease pain. In the clinic, I usually use a large bath towel; I roll it up and put it behind their low back to see if they get some relief while sitting. I even suggest this when my patients are flying for long periods, as it’s easy to carry a towel with them through the airport.

I get asked about Swiss Balls regularly. Patients ask, “should I get rid of my chair and get a ball to sit on?” I always answer no. The truth is, in theory, a Swiss Ball sounds great for core stability but once you’ve been sitting all day, you can easily fall back into bad postural habits and it has done nothing for you. Instead, I encourage them to start working on core stability and postural exercises to prevent muscle fatigue and increase their endurance for sitting at their desk all day. These exercises in the clinic include rows, abdominal bracing, bird dogs and bridges as well as walking and stretching. Examples of muscles to stretch would be the hamstrings, calves as well as upper traps, to name a few. I’ve also been asked about lumbar brace supports, to which I also say no. In this case, you rely on the brace instead of using your muscles.

Another option for decreasing low back pain after long durations of sitting is simply to get up. If you cannot leave your station, or feel you are too engrossed with your work, then set a timer to remind you to get up. I usually say every 15 minutes is a good time to stand up and get out of the sitting position. Do a few general stretches to reset. Answer your phone while standing for a few minutes. Walk to the water station or the bathroom. But definitely, make it a priority to get up. Other patients tell me they work from home and I ask about their workstations too. You’d be surprised at the positions patients get themselves into with their laptops. Some say they have a desk with a good chair. Others work at their kitchen table. Some even work on the floor. However, they have one thing in common—they are all there for long periods of time. I can’t stress enough the importance of getting up. The body doesn’t want to stay in that position for hours at a time.

Getting back to my frequent flier patients, they need to get up from their seats as well. Some of these patients are international fliers. On long flights, I tell them to get up from their seats and stand up front, or walk up and down the aisles whenever possible. I’ve done a few international trips and it always astounds me how few people get up and move around. Overall it’s just a good idea.

Low back pain complaints from patients who sit or fly for long periods seems to be on the rise. Encouraging them to look into ergonomic solutions and lumbar supports, or having them periodically get up and walk around can help decrease their pain as well as prevent it. Other options include beginning a workout program that incorporates walking outside or on a treadmill, stretching and strengthening to counteract the fatigue they feel while sitting at their desk for long periods.

Contact your local Foothills Sports Medicine Physical Therapy location today to schedule an appointment to treat your low back pain.

Lauren Keel, a Chandler physical therapy assistant, is here to give her expertise on corrective exercise and how it can help you:

As a physical therapist assistant, I work in conjunction with a physical therapist. We watch the way our patients move, assess them, and try to correct abnormalities to decrease pain and increase function. I had the opportunity to take the National Academy of Sports Medicine’s Corrective Exercise Specialist (CES) course, which is geared towards preventative exercise.

Our patients vary from children to geriatrics and they all have one common goal— to get back to doing what they love. Sometimes that is in the form of a sport such as soccer or golf, but often, it’s as simple as being able pick up their grandchildren once again.

As Corrective Exercise Specialist, we first conduct an assessment, which screens out more serious conditions. The CES looks at the way you move during exercises, such as a squat with your arms overhead, single leg squats, pushup form, rowing form, etc.

Once that is complete, the CES begins a thorough history review. We look at patient’s past injuries, medications, job, lifestyle, etc. From there, a CES will look at their posture. This alone can reveal a lot about an individual and their habits. To examine dynamic posture, we may opt to have the patient walk in the room or on a treadmill. When we test the response to exercises, we focus on the lower extremity exercises and upper extremity exercises, which reveal how well one moves and whether they’re compensating to complete the movement. Afterward, a CES may further examine one’s motion and test their strength.

Once a thorough evaluation is completed, a CES assesses the abnormalities they see and puts together exercises to correct them. After patients follow a comprehensive 4-6 week exercise routine, we re-assess them to see if the exercises have helped correct the movement issue.

A Corrective Exercise Specialist is vital to the healing process. If we can prevent injuries from occurring, then patients won’t be away from their favorite sport or activity as long. Athletes can spend less time away from games due to an injury, and it may even give them an edge when competing.

Preventative exercises are important to prevent injuries and make athletes more efficient. Assessing the underlying issue and implementing the right corrective exercises will help to alleviate pain and improve function. Moreover, these exercises can save a lot of time and money wasted on an injury that may have been prevented all together.

The main focus for me is keeping patients healthy, efficient and active without time spent away from sports or activities.

If you are interested in a CES evaluation or want to learn more about our Chandler physical therapy experts, request an appointment today! To learn more about AZ physical therapy at Foothills Sports Medicine Physical Therapy, check out the Foothills blog.