With Winter soon coming to a close and with Spring upon us, many things come to mind…baseball, the return of flowers and foliage, warmer temperatures, and for a good number of us, golf. The sport generally consists of three different types of players, recreational, amateur, and professional. Although much attention goes to the pros such as Tiger Woods and Phil Mickelson, the vast majority of players are recreational.
I had been training for a mid-March half marathon when my left leg began hurting before, during and after all of my training runs. Last year I suffered from Achilles tendonitis in my right leg, so when this pain started flaring up, much to my disappointment I stopped running and consulted the experts. It turns out that I have a soleus strain on my left leg this time around.
I reached out to John Wilbert, MSPT, Director of our Flatiron District facility to get a better understanding of this new setback.
So John, what causes a soleus strain?
JW: A soleus strain is caused by overloading your calf by landing on your pointed foot with the knee bent, such as when descending stairs or running downhill. It’s not as common an injury as a gastro or Achilles injury/tendonitis.
How should I treat this injury, aside from picking up the phone and calling my colleague?
JW: As with a gastro/Achilles injury, you should avoid stretching and overloading that leg in the acute stage, about 48-72hrs after the pain begins. Icing and using a foam roller will help, but do not use NSAIDS in the initial stage.
After 72hrs, if still limping and painful, or any bruising present, a MD or PT should do a proper evaluation. The injury may be a tear and need bracing or more aggressive treatment and a layman may just do more damage than good.
Can I continue to run? I have a race in a few weeks.
JW: Absolutely no running or jumping until walking and stairs are pain free. You may do exercises involving muscles higher than the knee, if when you’re painless on a flat foot.
So the race is out?
JW: Yes, if the pain sticks around. You risk further injury.
What are exercises I should do to relieve my pain and prevent this from happening in the future?
JW: Once you are out of the acute stage, calf raises with knee straight and bent (seated calf raise machine is the easiest) with a focus on the eccentric, or lowering, phase should be performed 2-3x/wk. A PT should also evaluate your running form since that may have been the primary cause. Also a proper stretching routine for the calf and hamstring should be initiated only after the initial 72hrs of injury, not sooner for fear of aggravating a possible tear.
Do you have any other clinical advice?
JW: Listen to your body: if an injury worsens after running, don’t keep pushing. You risk making the injury much worse which will sideline you far longer than just skipping that day and seeking professional advice.
1. Adjust your program daily based on your perceived exertion.
Some days you have it and some you just don’t. Even if you are working at the same speed or resistance you’ve done with ease, variables such as the time of day, your level of fatigue, what you’ve had to eat, when you last ate, whether you are adequately hydrated and your general health can impact your ability to exercise. Fine-tune exercise accordingly so that while your program remains challenging, you avoid overdoing it. Set yourself up for success by establishing a routine that works for you and that includes proper nutrition, adequate rest and sufficient water intake.
2. Quality over quantity: When lifting weights or doing other forms of strength training, execute each exercise with precise form.
This ensures that the targeted muscles actually benefit. Though core muscles and others may assist with balance, providing a stable base from which to work, pristine form helps avoid substituting or compensating with additional muscles. This not only enables safer postures and stresses, it helps you achieve the desired results.
Gains aren’t only about upping the ante, but about how you isolate. For instance, if you must arch your back to do bicep curls or hike your shoulders to do various forms of arm lifts, then you are probably lifting too much weight. If your knees go beyond your toes when doing a squat, scale back to an easier exercise. Repetitive stresses when overdoing it will likely cause your fitness program to veer off into injury and keep you out of action.
3. Establish a foundation before advancing your program.
For instance, muscles that stabilize your scapulae (shoulder blades) must exhibit a baseline level of strength before you include lifting above the horizontal (the level of your shoulders). These muscles include the middle and lower trapezius, the rhomboids, and the serratus.
Likewise, another example would be having sufficient quadriceps strength to perform wall squats (with a ball) before attempting standard squats and then step-downs or lunges. Skipping steps in a progression may have unintended consequences.
4. Shoot for slower, safer exercise progressions.
When accelerating your program, increase the difficulty of one variable at a time. Measure your response and then continue to adjust and advance in subsequent workouts. For instance, with cardio, avoid drastically increasing variables such as pace, distance, incline and resistance in combination. Likewise with weight lifting — avoid increases to your resistance, reps and sets simultaneously. If you take on too much change at once, you may not realize you’ve done so until it is too late and an overuse injury results.
5. Explore reputable resources to guide you as to how to execute exercises properly.
Keep in mind that the guy working out next to you, or even a trainer in your gym, may not be the ideal advisor. Talking a good game and looking the part are no substitute for knowing (and effectively implementing) the science that sets the foundation. Publications and online resources written or compiled by recognized sports and orthopedic physical therapists might be a great place to start.
6. Avoid using momentum when strength training.
Working quickly through an arc of motion when lifting and lowering weights lessens the challenge to your muscles. This diminishes the benefit of the exercises. Though you’ll get through your program faster, it isn’t worth the diluted return on your investment of time.
Particular attention to the slow release or lowering of weights has an added benefit. These are eccentric contractions, when a muscle exerts a force as it lengthens. Muscles have an increased capacity to sustain tension when working eccentrically and this type of strength training has a significant benefit to function and injury prevention. Faster speeds factor in primarily if training with specificity for a high-speed activity (e.g., using resistive bands to replicate the pitching motion, or a weighted or resisted tethered club or racquet for golf or tennis strokes). Otherwise, keep it slow and steady.
7. Steer clear of high-risk, low-reward exercises that live on and deserve to die.
8. Mix it up!
There’s more than one way to get it done. In fact, surprising your body with different approaches to strengthening will jump start your improvement and prevent plateaus if you are trying to make steady gains. Likewise, cross-training when doing cardio will lessen the likelihood of overuse injury. The caveat? Point number nine.
9. Listen to your body!
The menu of exercises is vast, and even all the healthy options aren’t universally appropriate. Your particular structure, injury history, age, current level of muscle strength and flexibility and your joint ranges of motion all are factors that determine the ideal exercises for you. If you have musculoskeletal complaints, avoid any exercises that trigger pain, whether it occurs while exercising or in the hours/days following. See an orthopedist to assess any complaints of pain you may have. Avoid working through your symptoms to prevent conditions from worsening or becoming chronic.
10. Take a break!
Muscles need a day off from strength training to recover from the assault. It is this recovery that allows the healing of the muscle fibers to occur, leading to the benefits and minimizing risk of injury. For cardio training, at least consider one day of rest each week to allow your body to recoup. If you are shooting for exercise nearly every day, cross-training will enable you to utilize muscles in different ways and minimize impact to your joints, both of which will lessen the likelihood of overuse issues.
Lower back strains and muscle spasms are a common injury that dancers experience. Dancers require such enormous amounts of flexibility in their lumbar spine that over time it may get over stretched and thus become victim to micro-trauma or small tears. These tears can result from practicing the same move over and over again or rehearing a difficult lift repetitively. Once the muscles are injured, they will tighten up and go into a protective muscle spasm, which is the bodies’ natural response to injury.
A thorough evaluation by a physical therapist is essential to determine the cause of lower back pain. The musculature and fascia will tighten and become stiff in an effort to protect the area, so regaining the flexibility of the soft tissue is essential to complete recovery. In addition, joint mobility, general flexibility, core strength and training technique, such as an increased lordosis (aka sway back), will be addressed to flesh out any other contributing factors. A physical therapist will determine individual needs and treat accordingly. Treating the low back is a multi-factorial process, but if done properly, the dancer will be bounding across the floor in no time.
Robert Kotraba, PT, DPT, OCS
Lateral ankle sprains are a very common injury for dancers. They will frequently state, “I rolled over my ankle in class.” They may also report hearing or feeling a pop at the time of injury. This usually occurs when landing improperly from a jump which often causes swelling and pain on the outside of the ankle.
The most frequently injured ligament is the anterior talo-fibular ligament or the ATFL. Ankle sprains have different degrees of severity from a grade 1 to grade 3, depending on the amount of tearing of the lateral ligaments. A grade 1 injury may just need an ace wrap, where as a more severe sprain may require someone to use crutches.
An ankle injury should be evaluated by a physician to rule out fractures, but follow-up with a physical therapist is imperative. Physical therapy will first focus on reducing pain and inflammation using gentle stretching, joint mobilization, soft tissue mobilization and cryotherapy. Strengthening exercises will be started once the patient can tolerate them without pain.
As pain reduces and strength improves, the patient can begin balance exercises to address the lack of proprioception, or your body’s awareness of its position in space. Balance will progress to higher level activities, using foam squares and bosu balls, since a dancer requires a high level of stability. Upon returning to dance, the patient should wear an ankle brace and continue to follow a home exercise program to prevent the chance of injury recurrence. Being treated properly should keep a dancer on their toes for years to come.
Robert Kotraba, PT, DPT, OCS
Patient compliance is an on-going challenge for physical therapists. Patients need to attend their physical therapy appointments as prescribed and follow their home exercise programs in order to have optimal outcomes. A 2010 study in the Journal of Manual Therapy looked at twenty studies to figure out why patients are non-compliant, even though it is in their best interest to attend physical therapy.
Several factors contribute to this issue: low levels of physical activity prior to the start of PT, low in-treatment adherence with exercise, low self-efficacy, depression, anxiety, helplessness, poor social support, greater perceived number of barriers to exercise and increased pain levels during exercise.
Physical therapists can address many of the factors while their patients are in treatment. Patients complaining of discomfort while exercising often believe that injury is worsening, when in fact; it could be a normal expectation as part of the recovery process. It is critical that the PT asks the patient about their pain levels during treatment, as well as residual discomfort following treating; maintaining open lines of communication so any issues can be addressed immediately.
While physical therapists can’t control the level of activity prior to PT, they can influence their patients while in treatment and encourage them to start a physical activity program slowly and safely as they heal. Those who exercise are less likely to experience progressive problems, so it is important for patients to become active.
Setting goals and creating an action plan with the physical therapist can help a patient comply with their treatment plan. Within that action plan, the PT and patient should discuss any possible barriers; such as childcare, or lack of equipment, and plan accordingly. It is important that physical therapists review the exercises and make sure that the patient understands and is able to do the exercises as prescribed.
Communication with the patient is key. Understanding patients’ level of pain, challenges and activity levels and then creating plans to address potential issues can help to improve patient compliance
The benefits of walking are widely known and continually proven. Adding to the vast body of literature touting the benefits of walking, a recent study found that walking 6,000 steps a day—the equivalent of 1 hour— may help improve knee arthritis and prevent disability.
In the study, published in Arthritis & Care Research (“Daily Walking and the Risk of Incident Functional Limitation in Knee OA: an Observational Study” – June 12, 2014), nearly 1,800 adults who had or were at risk for knee arthritis had their steps counted over a week using a pedometer. Two years later, the researchers reassessed participants and discovered that for each additional 1,000 steps taken, functional limitations were reduced 16%-18%.
Physical Therapist’s Guide to Osteoarthritis of the Knee
James S Cardone
‘Tis the Season for Running: Here is a list of the Top Four Running Injuries and What a Physical Therapist Can Do For You
Now that fall is around the corner, runners tend to experience not only changes in training volume but also intensity and form of exercise (running outdoors vs. running indoors). Cold, rainy weather tends to push runners indoors onto treadmills. Whether you are a seasoned runner or just beginning, it is not uncommon for injuries to occur. The yearly occurrence of running injuries ranges between 37-56%. A majority of the injuries that we see are caused by overuse. These type of injures are more subtle and usually occur over a period of time because of repetitive trauma to joints, bones, or tendons. As physical therapists we can address not only the cause, but help you heal.
Here is a list of the top 4 running injuries and how to prevent them.
This is also commonly known as “patellofemoral syndrome.” Runner’s knee is due to the irritation of the cartilage that lies underneath the kneecap. Almost 50% of all running injuries involve the knee.
Risk Factors: Overpronation (inward movement of arch/ankle), Weak quadriceps, hips, and glutes.
Change in Running Form: By shortening your stride length and landing on a slightly bent knee, you can decrease the load on the knee by about 30%
The Achilles tendon is the connection between the calf and heel. Tendonitis occurs when the tendon tightens and becomes too sensitive. About 11% of running injuries involve this particular tendon. Pain is typically felt in the calf and/or behind the heel bone that is experiences as a dull ache.
Risk Factors: Excess increase in training intensity, Weak/Tight calves, improper running shoes.
This is one of the most common injuries we see with treadmill training as many people do not use an incline. The achy pain in the front of the lower leg is due to small tears in the muscles that surround the shin bone.
Risk Factors: Excess increase in training, Improper running shoes, Flat feet or high arches.
Every time the foot strikes the ground, force is absorbed through the leg that is several times our body weight. This is one of the top foot complaints among runners. Pain is typically a dull ache in the arch or bottom of the foot that is usually worse first thing in the morning.
Risk Factors: Tight hip flexors, Weak abdominals, History of low back pain, Very high or very low arches, Excess pronation or supination
Not only can we address these risk factors, but we can also assist in helping you perfect your running form, help you determine appropriate footwear, and teach you how to become a more efficient runner.
“If you want to become the best runner you can be, start now. Don’t spend the rest of your life wondering if you can do it.” ~ Priscilla Welch
Joann Nunez, PT, DPT practices at our Rockefeller Center and Fashion District locations.
Perfect Stretch For The Golfer With A Desk-Job! Sitting for hours on end can cause tightness in the hip flexors, which prevents good posture in your golf game…Check out today’s stretch to help you improve your swing, courtesy of our friends at the Titleist Performance Institute.
Do you have any of these swing faults? Come find out with a TPI Golf Fitness test and Swing Analysis at RPT’s Golf Improvement Program on the Upper West Side. For more information, contact Brett Weiss, PT, DPT, TPI at or 212-874-1550.