Kinney Physical Therapy
Helping people in Denver stay active and mobile for years to come
Why Things Hurt
When individuals live in a state of chronic pain, it impacts many, if not all, aspects of their life. However, research continues to show that a chronic state of pain is reversible without the need for surgery, injections, or even drugs. Here is an entertaining talk by one of the leading clinical researchers in the world on chronic pain. For those in a chronic state of pain, learning about the role of pain can provide significant pain relief which can ultimately change someone’s outlook on life.
Rest & Ice: I tried that
For some aches and pains, rest and ice may be all you need. This method may help some forms of overtraining where your body just needs a break. With rest, your muscles actually get stronger after training which causes microtrauma and subsequent pain. However, with some forms of overuse, you may develop what is called a tendinopathy. This just means your muscle group is not able to keep up with the stress demands. Many times, this is happening secondary to weakened surrounding structures. Too much of your workload is being picked up by one muscle group instead of an ideal situation where there are many muscle groups involved. This is a general pattern that leads to a tendinopathy.
With tendinopathies, fibrosis (very small areas of scar tissue) can develop within the tendon and the muscle belly from overuse. Tendinopathies are associated with fibrosis development, which is not a swelling condition. This is different from tendonitis where there is inflammation and swelling. Hence, rest and ice may help a tendinitis but after time, it will not help a more progressive tendinopathy.
The video below demonstrates an old Eastern Medicine technique known as Gua Sha. In the physical therapy world, it is commonly referred to as “instrument-assisted massage.” Recent research has shown that this can help break up some of the fibrosis and decrease pain with a few physical therapy treatments. Following treatment, exercises to correct your movement pattern to decrease the stress on the area and make the area stronger will prevent future injuries.
This demonstration shows treatment to the back side of the forearm where a tendinopathy, commonly known as tennis elbow can develop. Additionally, this treatment can be very effective for many types of injuries not limited to plantar fascitis (fasciosis), heel pain, shin splints, ITband syndrome, and runner’s knee (patella-femoral pain syndrome).
Low Back Pain: The Good News
Other than the common cold, low back pain is the most frequent reason for trips to the doctor in the United States. What leads to back pain? Stress from work and traveling, sore muscles from working out, general weakness from not staying active, and stiffness in the joints can all play a part. Although low back pain can come on suddenly and be very painful, more often than not, it is what is referred to as “mechanical low back pain.” This term just means that there is no tissue damage and that the pain is likely from stiff joints and tight muscles. With careful guidance, people can obtain 100% relief.
Here is a short article summarizing low back pain with treatment options to relieve your pain.
After a thorough examination, a physical therapist can develop a successful plan to relieve your low back pain. Research is very clear that treatments provided by a physical therapist including manipulations/mobilizations (hands-on manual therapy to decrease pain and stiffness), guided exercise, and sound advice will lead to significant relief. Furthermore, studies are clear that early intervention is the key to success. If your symptoms are lasting longer than a week or two, it is a good idea to see your physical therapist so you can return to all of your normal activities without any pain or restriction. Many times, there will be significant pain relief in just 2-4 visits, particularly if symptoms originated < 2 weeks.
“Should I convert to barefoot running??”
This is a common question from patients. And the answer is, it depends. It depends on many factors all of which are unique to each and every runner.
Here is what I will generally tell patients…
I love the concept of barefoot (aka minimalist) running, but it is not for everyone. There are great aspects to barefoot/minimalist running. Some of these features may include:
- reduced joint stress particularly at the knees, as well as ankles, hips
- using muscles designed for endurance running versus compensating musculature that can lead to injury
- possible reduction in stress fractures
- inner-foot muscle/arch strengthening (this helps with your balance, may prevent conditions like plantar fasciitis/heel pain)
- stronger hip muscles which can reduce low back and knee pain
Given current research, all of these claims can be justified. However, most of these claims are under the assumption that minimalist runners adopt a midfoot/forefoot striking pattern versus a heel strike. Research has shown that the midfoot strike pattern has a reduction in ground reaction forces. This leads to less stress on the joints. Yet, there is no conclusive evidence at this time to suggest either strike pattern can prevent a running injury. Experts at this time state there can still be injuries from both shoes and strike patterns – types of injury will just be different.
Given the possible advantages of minimalist running, just remember most of the claims are based on the assumption that barefoot runners adopt the midfoot pattern. Here is recent evidence that when runners convert to a minimalist shoe, runners may not adopt a midfoot striking pattern. So then the question becomes, if I am still striking with my heel in the minimalist shoe, should I just stay in my conventional running shoe? Possibly.
All of these concepts are up for debate and there are individual factors for each runner. If you do not have a history of running injuries and you are running in a conventional shoe, you may just stick with the old phrase, “If it’s not broke, don’t fix it!” On the other hand, if you are looking to switch, it may be more beneficial to develop a midfoot strike pattern prior to converting over to a minimalist shoe.
Ultimately, running in a minimalist shoe can have many great benefits. If you decide to convert, it should be a very gradual process to see if it is right for you. Still have questions? Ask your physical therapist which method may be best for you and your unique running style!
Following A Concussion: Return To School
Concussion awareness is finally in the forefront. Research has come a long way over the last decade to develop protocols for returning athletes to participation following a concussion, also known as a mild traumatic brain injury (MTBI). Current events continue to drive public awareness especially with professional sports. As of this week, doctors diagnosed NFL Hall of Famer, Tony Dorsett, with chronic traumatic encephalopathy (CTE), an unfortunate condition resulting from the cummalative effects of head trauma.
Although research is still in its infancy for head trauma, return-to-play guidelines are becoming established which requries a team of sports medicine specialists for effective deicison making. Until recently, guidelines were only focused on athletes returning to sport. Physicians were previously suggesting that student-athletes may want to stay home from school; however, guidelines were never established. Current guidelines were recently established by Dr. Karen McAvoy, Psy.D. and colleagues suggesting that concussed athletes should not return to school until they can tolerate more than 30 minutes of light mental activity.
With advancing research focused on conservative treatment including holding student-athletes from returning to school, hopefully CTE will reduce in prevalance for future generations.
Why do I have knee pain when I run?!
Knee pain on the front of your knee is very common for people of all ages, especially runners. More often than not, your knee is picking up the slack for weakness and/or stiffness in surrounding structures. The origin of symptoms can be stemming from common areas like your back, hips, or ankles.
Here is a short article looking at several factors which may be leading to your knee pain. After careful evaluation to identify the source, your physical therapist can relieve your symptoms quickly and get you back to pain-free running within a few visits!