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Rehabilitation Articles

Anterior Knee Pain

What Muscles Should I Strengthen?

 Pain in the front of your knee or under your kneecap is often called patellofemoral pain. You may feel this pain after exercising or when you sit too long. The pain may be a nagging ache or an occasional sharp twinge. Because the pain is around the front of your knee, treatment has traditionally focused on the knee itself and may include taping or bracing the kneecap, or patella, and/or strengthening the thigh muscle the quadriceps that helps control your kneecap to improve the contact area between the kneecap and the thigh bone, or femur, beneath it.

However, recent evidence suggests that strengthening your hip muscles can also help. The theory is that strong hip muscles can decrease the stress in your knee. A study published in the January 2018 provides new insights and evidence-based suggestions on how to strengthen your entire leg to decrease your knee pain and help you return to full activity.

KNEE AND HIP MUSCLES. Knee pain that is in the front of your knee or under your kneecap is often called patellofemoral pain (A). Strengthening exercises for patellofemoral pain have historically focused on the muscles in the front of your thigh, the quadriceps muscles, because they help track the movement of the kneecap (B). There is now evidence that stronger hip muscles can help lessen the stress under the kneecap, indicating that it is best to strengthen both the knee and hip muscles to avoid the movement shown here, which can cause knee pain (C).

Plantar Fasciitis: Will Physical Therapy Help My Foot Pain?

One out of 10 people in the United States experience persistent pain along the bottom of the foot, a condition known as plantar fasciitis. In this country alone, outpatient clinics receive more than 1 million visits a year from people seeking help for this type of foot pain. In 2014, the Orthopaedic Section of the American Physical Therapy Association published updated clinical practice guidelines on the best treatments for patients with plantar fasciitis. The guidelines present evidence that strongly suggests a combination of manual therapy and rehabilitative exercises to help patients with this foot condition. In a more recent study published in the February 2017 issue of JOSPT, researchers reviewed the records of people with plantar fasciitis who were sent to physical therapy to determine whether this treatment lessened their pain.

Pelvic Floor Dysfunction

What is pelvic floor dysfunction? When you are unable to control the muscles in your pelvic floor to have a bowel movement, it is called pelvic floor dysfunction. People with pelvic floor dysfunction contract these muscles rather than relax them. Because of this, they cannot have a bowel movement, or they have an incomplete one.

The pelvic floor is a group of muscles in your pelvic area. These muscles support the organs in your pelvis like a sling. The organs in this area include the bladder, uterus (women), prostate (men), and rectum (the area at the end of the large intestine where your body stores solid waste). By contracting and relaxing these muscles, you control your bowel and bladder movements.

What causes pelvic floor dysfunction? Most of the causes of pelvic floor dysfunction are unknown. Traumatic injuries to the pelvic area, such as in an accident, and complications from vaginal childbirth can contribute to this condition.

What are the symptoms of pelvic floor dysfunction? Several symptoms may suggest pelvic floor dysfunction. If you have any of these, you should discuss them with your physician. Some symptoms may also indicate other conditions, but a complete physical exam should be able to determine what is causing your symptoms.

Tendonitis or Tendinosis?

Distinguishing the signs and symptoms of joint pain – and why it’s a critical difference.

Sports Medicine Focus
Tendinosis, the degenerative condition in a tendon, is far more severe and much less diagnosed than its cousin tendinitis, an inflammatory condition. Although tendinosis diagnoses are less common, the condition is actually more prevalent, especially among athletes. The more alarming fact is that popular treatments for tendonitis can actually have little-to-no success when treating tendinosis, which could delay or even terminate an athlete’s career.

Patellar tendinosis is often referred to as “jumper’s knee” or “runner’s knee.” It occurs mostly with athletes whose knees, specifically the tendon, are making rapid movements in multiple directions and being overused, like those in sports such as volleyball and basketball, or with strenuous activities like running and hiking.

Tackling Tough Football Injuries

Injuries to the face, rib cage and neck aren't common, but can bring severe and devastating consequences.

By Tricia J. Hubbard, MS, ATC

Collisions and football go hand-in-hand. It's an unfortunate combination that creates injuries on high school, collegiate and professional football fields across the country.
Football players sustain approximately 1.2 million injuries per year, estimates show.  Injury risks rise with the level of play and age, as athletes get bigger, faster, and stronger and more aggressive.

The likelihood of sustaining a specific injury in football ranges from 11 percent to 81 percent. The knees, ankles and shoulders are especially vulnerable, and these areas account for almost half of all injuries.

Face, Rib Cage and Neck
While bone-rattling hits create plenty of knee, ankle and shoulder injuries, other less prominent parts of the body can be affected as well, such as the face, rib cage and neck. The consequences can be just as severe and damaging.

The foot, face and chest are on the opposite end of the spectrum, and constitute between 1 percent and 4 percent of injuries. Although the percentage of injury is low, the implications can be serious.  As sports medicine clinicians, you might not see these traumas every day, but you should be prepared to manage them.

•Facial injuries. Most facial injuries are minor. However, players occasionally sustain facial fractures from blunt trauma during play.

Fractures can include more serious injuries to the zygoma, or orbit, which can cause greater disability. The most common mechanism of injury is a digital poke to the eye. Linemen are more likely to sustain these injuries because offensive and defensive players engage in contact on every play; using the hands allows players to be more effective.

Cold-Weather Injuries

Exercising in wet or reduced-temperature environments can pose serious risks.

Exposure to cold environments -- and thus increased risk for cold injury -- is a common occurrence for many athletes and workers, including winter sport athletes, outdoor enthusiasts, endurance athletes, water-based athletes, military personnel and those in the building and maintenance trades.No matter the reason for time spent outside in the cold, evidence-based risk assessment and swift intervention can help keep these athletes and workers safe.

Frostbite and Hypothermia
The most common injuries associated with cold exposure during physical activity are hypothermia and frostbite. Hypothermia is traditionally defined as exhibiting a core temperature of less than 95 degrees Fahrenheit, and is classified as mild, moderate, or severe.1,2

Preventing Baseball Injuries


Injuries in young athletes are on the rise, but elbow and shoulder injuries in children are on the verge of becoming an epidemic. Thousands of children are seen each year complaining of elbow or shoulder pain.

Preventing Softball Injuries


Softball injuries in young athletes are on the rise and nearly as frequent as baseball injuries, but they generally result in less time lost to competition. These injuries most commonly involve the back, shoulder, forearm, wrist, and hand. Pitchers are not more prone to injury than position players; catchers and infielders have similar injury rates. however, pitcher injuries differ from position player injuries because pitchers use a windmill motion that places unique demands on the back, neck, shoulder, forearm, and wrist.


For pitchers, the most common overuse injuries are shoulder tendinitis (inflammation of the tendon), back or neck pain, and elbow, forearm, and wrist tendinitis. For catchers, back and knee problems in addition to overhead throwing shoulder problems are the most common. For other position players, overhead shoulder and sometimes elbow problems predominate.


Overuse injuries are preventable. Some tips to keep young athletes in the game for life include:

• Warm up properly by stretching, running, and easy, gradual throwing.
• Rotate playing other positions besides pitcher.
• Concentrate on age-appropriate pitching.
• Adhere to pitch count guidelines (see tables).
• Avoid pitching on multiple teams with overlapping seasons.
• Flexibility of pitchers needs to be the focus during the season rather than strengthening.
• Don’t pitch with pain, and see a doctor if the pain persists for a week.
• Don’t pitch more than two consecutive days until age 13, and then no more than three days in a row.
• Don’t play year-round.
• Radar Guns should only be used during competition for best pitch of speed vs. change up (ages 15+).
• Communicate regularly about how your arm is feeling and if there is pain or fatigue.
• Develop skills that are age appropriate.
• Emphasize control, accuracy, and good mechanics.
• Speak with a sports medicine professional or athletic trainer if there are any concerns about injuries or prevention strategies.
• Return to play only when clearance is granted by a health care professional.

Lacrosse Injuries


Overall, lacrosse is a moderate risk sport in which the vast majority of injuries are minor strains, sprains, and bruises. However, more significant injuries can occur.

• Non-contact, ankle and knee ligament sprains, sustained while cutting and dodging are common in both girls and boys lacrosse. At the scholastic level, ankle sprains represent 21% of all reported injuries for girls and 16% for boys.

• Knee injuries, including anterior cruciate ligament (ACL) tears, are the leading cause of lost game and practice time for both girls and boys.

• Muscle strains of the hamstrings, quadriceps, and groin are common and related to similar, non-contact mechanisms.

• Head and face injury, including concussion, are less frequent but still an important issue for the game. Most commonly related to body to body or body to ground contact in the boys game and inadvertent stick or ball contact in the girls games, these injuries are more frequent in game than practice situations.

• Shin splints and foot blisters are common and related to continuous running and changing field surfaces.

• Abrasions about the uncovered lower extremities are common and required appropriate cleaning and protection.

• Seen more commonly in baseball and hockey, commotio cordis is very rare cardiac arrhythmia related to ball to chest contact. The few cases in lacrosse have involved adolescent boys. The condition is best treated by early activation of the EMS system and utilization of onfield AEDs.

Preventing Basketball Injuries



Ankle Sprains
Treatment for an ankle sprain involves rest, ice, compression, and elevation (RICE). The need for X-rays and evaluation by a physician is determined on a case- by-case basis and depends on the severity and location of pain. Pain and swelling over the bone itself may need further evaluation. An injury to the ankle in a child who is still growing could represent a simple sprain or could be the result of an injury to the growth plates located around the ankle and should be evaluated by a physician.

Jammed Fingers
Jammed fingers occur when the ball contacts the end of the finger and causes significant swelling of a single joint. Application of ice and buddy taping the finger to the adjacent finger may provide some relief and allow the athlete to return to play. If pain and swelling persist, evaluation by a physician or athletic trainer is recommended and an x-ray of the finger may be needed.

Knee Injuries
Basketball requires extensive stop and go and cutting maneuvers which can put the ligaments and menisci of the knee at risk. Injury to the medial collateral ligament is most common following a blow to the outside of the knee and can be often be treated with ice, bracing and a gradual return to activity. An injury to the anterior cruciate ligament is a more serious injury and can occur with an abrupt change in direction and landing for the jump. Although this ligament tear is most commonly a season ending injury that requires corrective surgery, current techniques used to repair the ACL ligament generally allow the player to return to play the following season.


Must Be the Shoes

What clinicians should understand about the minimalist shoe movement

Sports Focus
One thing you might notice at your local 10K race this summer is the variety of running shoe styles in use. No longer is the average runner sporting just the traditional chunky-heeled running shoe. Instead, many are venturing into the relatively new "minimalist" shoe market. Some runners might even be in the ultimate minimalist shoe: bare feet.

The minimalist movement in running shoes coincides with renewed focus on running form within the industry, and how shoes influence form. The bestselling book Born to Run facilitated this when it promoted barefoot running, profiling tribal Mexican runners who sported little more than handmade rubber sandals on their way to winning ultramarathons.

Knee Pain? First, Discover the Cause

It’s a common misconception that we humans have only one joint at the knee. A joint is the place at which two bones are joined to allow for movement. Technically, we have two joints at each knee. The three bones that make up the two joints are the femur (thighbone), the tibia (shinbone) and the patella (knee cap). The first joint—the patellofemoral, or PFJ—joins the kneecap and thighbone. The second joint—the tibiofemoral, or TFJ—joins the thigh and shinbone.

Every year, millions of Americans replace the TFJ knee joint, though it’s not always the joint causing the pain. In my experience, the PFJ is usually the main culprit behind knee pain, although total knee replacement surgery involves replacing the surfaces of the TFJ.

Pain from PFJ irritation can be severe, even crippling. It starts on the underside of the knee cap, grinding in the hollowed groove of the femur during weightbearing activities, such as walking up and down steps, standing for any length of time, walking, running and participating in sports.

Our physical therapists have had great success eliminating this irritation with simple exercises, stretching and deep-tissue massage. In my experience, the PFJ joint—not the TFJ joint—is the primary source of pain and physical limitation. I’ve helped many patients who had already scheduled a knee replacement to cancel surgery by working on the “correct” knee joint.

Tips from the Experts

Tips from the Experts

Tennis and Golfers Elbow II

If you are experiencing dull achiness or sharp pain on either side of your elbow which limits your ability to use your arm you may have tendonitis or bursitis. Tennis Elbow and Golfer’s Elbow, or lateral epicondylitis and medial epicondylitis, are two extremely common overuse injuries of the elbow.

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