Tag Archives: shin splints

Why do I get shin splints?

Shin splints is a common term used to describe lower leg pain that occurs below the knee either on the front of the shin or along the inside of the shin. The technical term for this pain is medial tibial stress syndrome (MTSS), which is an overuse or repetitive stress injury of the shin.

The current thinking is that MTSS is a result of overloading the main bone in the shin, called the tibia. With weight-bearing activities the tibial bone bends slightly, straining the bone and causing micro-damage to it. This results in increased activity of bone cells to keep the bone strong and resist bending. At a certain point, the bone cells can no longer keep up with the damage being done and you start to see a decrease in bone density.

The muscles commonly involved in shin splints.

The muscles commonly involved in shin splints.

In addition to bone changes, evidence suggests that dysfunction of the muscles surrounding the tibia due to the repetitive stress also contributes to the shin pain. Weak and fatigued muscles are not able to absorb the shock from running as well as strong rested muscles, and therefore added stress is then placed on the bone. The stress on the tibia and its surrounding muscles occurs when the body is no longer able to heal properly in response to repetitive muscle contractions and tibial strain.

Improper walking and running patterns can also contribute to MTSS by increasing the stress applied to the muscles and bone of the shin. One major error in running mechanics commonly seen in people with MTSS is called overpronation. When we walk and run, pronation happens naturally as we shift our weight over the inside arch of our foot. This helps the foot absorb the shock of hitting the ground. However, without proper support to that arch, it is possible to overpronate which places excessive pressure over that arch causing it to flatten. This added pressure then pulls on the muscles that attach on the foot and travel up the shin. This puts extra strain on the bone because, as stated above, overworked muscles cannot absorb the shock from running as well as strong, rested muscles.

Who is at risk?

This pain is commonly seen in both runners and military personnel. In runners specifically, training errors tend to be a major factor in developing MTSS. Beginners often do not build their running mileage gradually enough and get pain as a result of doing too much too fast. The same pain can result in more experienced runners who abruptly change their workout regime, suddenly increasing their mileage, intensity, pace, or terrain. Individuals with previous injuries or those that run greater than 20 miles a week are even more at risk of developing an overuse injury, which is most often seen in runners but also in other ballistic sports such as football, basketball, soccer, and dancing.

There also appears to be a gender bias, as females are 1.5-3.5 times more likely to develop a stress fracture from MTSS. This higher risk is due to the higher incidence of diminished bone density and osteoporosis in women. This is often described by the “female athlete triad” which states that female athletes are more likely to experience osteoporosis, amenorrhea, which is the absence of a female’s menstrual cycle, and an eating disorder. These three conditions all affect and contribute to each other. These athletes are commonly energy deficient due to an imbalance between the amount of calories consumed and the amount of calories burned during exercise. This is the primary cause of the female athlete triad, as low calcium levels contribute to decreased bone density and make these athletes more vulnerable to stress fractures.

Signs and Symptoms

Early on, pain is worse at the beginning of exercise, gradually subsides throughout the training session and is relieved by rest. However, as the injury progresses, pain is present with less intense activity and may even occur at rest. There may also be some mild swelling and tenderness along the inner part of the lower leg.

How to Treat MTSS

Rest is a major factor in treating MTSS. The bone and muscles need a chance to heal themselves without the repetitive stress that running places on them. Avoiding activities that cause shin pain, swelling, or discomfort is important. However, you don’t need to stop exercising altogether. Low-impact exercise, like swimming or biking, is a great way to get a cardiovascular workout without placing too much stress on the shins. Ice can also be used to ease the shin pain, as ice helps to fight the inflammation that can form with tissue damage. Ice should be applied 15-20 minutes at a time, multiple times throughout the day.

If rest and ice do not help reduce the symptoms of MTSS, physical therapy is a good next step in treating the pain.  Proper running mechanics may be a factor in the shin pain and a physical therapist can help correct the abnormalities in your running pattern. As previously discussed, overpronation can contribute to symptoms of MTSS. This occurs once your foot has already contacted the ground and as you move your body weight over your foot. However, there is also discussion that the way in which your foot initially strikes the ground may affect shin pain. The ideal foot strike is landing on the middle of your foot, referred to as the midfoot. However, individuals that experience pain with running often land on their toes, or forefoot, or back on their heels, the rearfoot. Midfoot striking is the best way to ensure that shock absorption is equally distributed throughout the foot without causing increased symptoms of MTSS.

Proper footwear is another important aspect of preventing and treating MTSS.  A firmer shoe made to control pronation of the foot is ideal. Your shoes should allow your feet to absorb the shock of running without sending the stress elsewhere creating more problems in your body. Insoles could also be placed inside your shoes to help absorb some of the shock that running can place on your legs. Also, for runners sneakers should be replaced every 350-500 miles to ensure that the soles are still providing adequate support for the foot.

For any additional information on shin pain, please contact Total Performance Physical Therapy to schedule an appointment.

The importance of core training in runners

More and more people are becoming aware of the positive benefits from running.  Whether it’s to strengthen their heart, reduce stress, lose weight or just to get in shape for the upcoming summer running is becoming a popular activity.  Unfortunately, both novice and expert runners often experience preventable running related injuries.  The truth is the majority of running related injuries can be prevented by strengthening the core musculature. No matter if a person is a beginner who aspires to run a 5k or an avid runner who’s planning on running a full marathon core conditioning is essential in preventing injury and maximizing a runner’s overall performance.  Although strengthening one’s core is extremely beneficial most runners only focus on planning out and grading their running programs and as a result they completely neglect core conditioning.

Before a runner can begin to strengthen their core a basic knowledge of what muscles make up the core and how they function to protect the runner from injury is required. When a person thinks of a strong core a well defined six-pack is usually visualized.  However, this muscle is one of the least important muscles of the core. The muscle responsible for the six-pack is the rectus abdominis and it’s a very superficial muscle that allows the trunk to bend and is activated during crunches or sit ups. The muscles that truly strengthen the core are very deep muscles that are located near the spine and pelvis.

The five most significant core muscles are the transverse abdominis, multifidus, erector spinalis, quadratus lumborum and the hip abductors. The transverse abdominis is your deep abdominal muscles which aid in stabilizing the spine and keeping it in a neutral position. The multifidus is located deep in the lower back and its main function is also to stabilize the spine and prevent any excess motion.  The erector spinalis aids in extending the trunk. The quadratus lumborum aids in bending the trunk to the side and helps stabilize the hip.  The hip abductors aid in controlling the hip and control the knee while the foot strikes the ground.  All of these muscles must be properly conditioned in order to reduce the likelihood of developing a running related injury.

High Intensity Interval Training

To better understand this we can think of the core muscles as the foundation for the entire body.  If the foundation is unstable and prone to fatiguing then everything that attaches onto the core (i.e. the hips and legs) will be unstable.  As a runner strikes their foot on the ground energy is transferred from their foot up through their calf to their thigh and finally to their core.  This causes the spine and hips to rotate which helps drive the other leg forward to take the next step. If a runner has a weak core then their “foundation” will be unstable and the runner will waste unnecessary energy during a run.  Because running requires such a great deal of stamina the core must be conditioned in order to have a high level of endurance to prevent the core from fatiguing during a lengthy run. A conditioned core will also help maximize the efficiency of each stride which will reduce the overall amount of energy needed during a run.

In addition to improving performance, a well conditioned core will allow a runner to maintain proper posture and running mechanics during a long run.  As a result the runner will place minimal stress on the spine, joints and muscles.  If a runner has inadequate core strength they will demonstrate improper posture (i.e. forward slouch) during long runs which will place the runner at risk of developing trigger points, damaging their joints and muscle strains.  Furthermore, as the runner fatigues other muscles will begin to work harder in order to attempt to compensate for their insufficient core strength which will result in poor running mechanics.  Compensation strategies include excessive hip drop and trunk sway, inward bowing of the knee and uneven stride length.  If left untreated these compensation strategies can lead to Iliotibial band syndrome, shin splints, herniated discs, osteoarthritis and degenerative disc disease.

If you are experiencing difficulty or pain while running a physical therapist will identify any muscle imbalances, trigger points and strength deficits.  The therapist will also analyze the runner’s running mechanics to identify any compensation patterns.  With this information the physical therapist will develop an exercise program that will gradually strengthen the core.  Typically, the physical therapist will select exercises that utilize the runner’s own body weight as resistance and that force the runner to stabilize the spine by activating these deep core muscles.  A classic example of this is a plank.  The therapist will also focus on balance exercises.  Balance exercises force the patient to utilize their core muscles in order to stabilize their body from external forces.  This is especially important for outdoor runners.  People who enjoy running outdoors often will not be running on even track.  This will prepare the runner to maintain proper running mechanics and posture while avoiding obstacles while running and when running on uneven terrain.  As the runner progresses, plyometrics will then be incorporated.  This will help strengthen the core and adjust the body to excessive forces.  An example of this is when a runner is running up and down hill which requires more energy and requires much more control of the core musculature especially when running down hill. For all of these exercises proper form is crucial and the physical therapist will assess and correct any compensation strategies observed.

It’s important to note after a run our muscles become tense and more often than not trigger points will develop which usually lead to pain. To help prevent this, a great post run protocol is to use a foam roller to release any trigger points.  In addition to instructing the patient on foam rolling the therapist will also help develop a running program that will properly grade the runner’s mileage in order to reach their goal.

No matter if you’re a veteran runner or if you’re just starting out, preventive care is paramount in reducing running related injuries. If a person is a fairly sedentary then they may be able to get by with having a weak core, but if a person wants to maintain an active lifestyle without developing an injury core conditioning is a must. If you are experiencing pain, instability or fatigue while running contact Total Performance Physical Therapy for an examination today.

Ankle Sprains and Chronic Ankle Instability

By far ankle sprains are the common sports related injury.  In fact, there are over 28,000 ankle sprains per day in the United States.  Furthermore, approximately 30% of people who experience an ankle sprain will go on to develop chronic ankle instability. The most common way a person sprains their ankle is by “rolling” the ankle which quickly stretches out the ligaments on the exterior portion of the ankle.  The main purpose of these ligaments is to keep the ankle stable.  Over time the ankle eventually heals, but these ligaments are now less taut which results in the ankle feeling less stable, which leads the person more prone to spraining their ankle in the future.

This shows the ligaments and the muscles of the ankle.

This shows the ligaments and the muscles of the ankle.

There are several risk factors for developing ankle sprains. First of all women are 25% more likely to sprain their ankle than men. People who demonstrate less range of motion in their ankle joint are also at risk for developing a sprain.  People who are very active or athletes are more likely to develop a sprain, especially if the sport is field hockey, volleyball or football.  Whenever we are walking or running on uneven terrain we are at greater risk for developing a sprain, a good example of this is someone hiking on a rocky slope.  Lastly, one of the greatest risk factors for developing a sprain is a previous history of ankle sprains.

There are 3 main grades of ankle sprains.  Grade 1 means that one or multiple ligaments were stretched out.  This causes inflammation and swelling and usually a moderate amount of pain, but the person can still usually bear weight through the affected leg.  In grade 2 sprains the ligaments are actually partially torn.  The symptoms are usually worse, bruising/redness can also be present and the person will usually have difficulty bearing weight through the ankle.  Grade 3 sprains are where the ligaments are fully torn.  Typically these types of sprains are the most painful and in some cases require surgery. A person with a grade 3 sprain almost always has difficulty bearing weight through their ankle.  Chronic ankle instability is a condition where a person’s ankle becomes so unstable they are repeatedly spraining their ankle even while walking on a level surface.  This condition can make performing recreational activities nearly impossible and in some cases can make a person at risk for falling.

For a grade 1 sprain resting, icing, compressing and elevating the ankle will reduce the swelling and inflammation.  Also actively using the muscles in the ankle will also reduce the swelling.  This can be accomplished by writing out the alphabet every waking hour with the affected ankle in a non weight bearing position.  Because of the strong risk factor of developing chronic ankle instability even a grade 1 sprain may require physical therapy.  This will include balance training, using an air cast or taping to aid in stabilizing the ankle and to also provide the user with feedback for if/when the ankle beings to “roll” again.  Although a therapist cannot tighten the ligaments after they are stretched out the physical therapist can incorporate exercises that focus on strengthening the muscles around the ankle joint, which will increase the stability of the ankle.

For grade 2 sprains a similar plan of care will be developed, but the recovery time is usually longer.  For grade 3 sprains surgery may be performed, but a person who is not an athlete can attempt conservative management before surgery.  Once pain, swelling and inflammation are no longer present the physical therapist can use functional performance assessments to test whether the ankle is stable enough for the person to return to activity or their sport.  For more information on physical therapy services visit www.totalperformancept.com.

If you have recently injured your ankle call Total Performance Physical Therapy for a consultation today.

Arthritis and the role of physical therapy

Hip Osteoarthritis (OA) is a common condition that has the potential to hinder a person’s quality of life and prevent a person from performing activities they once loved.  Hip OA is largely a degenerative condition which is usually a result from repetitive forces on the hip.  Over a long period of time these forces wear down the tissue within the hip joint.  This tissue is called cartilage and its purpose is to cushion and protect the joint.  As the tissue or cartilage is slowly eroded away small bone spurs can form.  After the cartilage is fully eroded bone to bone contact will occur and this may result in pain while performing functional activities such as squatting, ascending or descending stairs or while running.  The pain is usually but not always worse in the morning and there may be noticeable painful clicking when performing activity.  The severity of symptoms can range from very mild to quite severe.

The muscles surrounding the hip need to be kept strong to help limit pain.

The muscles surrounding the hip need to be kept strong to help limit pain.

There are several risk factors for developing hip OA.  As we age we are more likely to develop all types of arthritis.  Also there are genetic factors that make certain people more prone to developing arthritis.  People who sustain trauma to the joint or have surgery on the joint are more likely to develop arthritis.  Obesity also increases the risk of developing hip OA.  If a person’s occupation involves repetitive movement involving the hip this may also increase the likelihood of developing hip OA.

Approximately 11% of adults 35 or older will develop hip arthritis.   Although, a large percentage of adults will develop hip OA the majority of people are unaware of the benefits of physical therapy.  Far too often people will either become less active in order to curb the pain or decide to have a total hip replacement before ever attempting a conservative approach.  The most passive treatment involves using heat on the affected area.   Although this approach may results in a temporary reduction in pain physical therapy can significantly improve patient’s pain and also increase the range of motion and function of the hip.

To treat hip OA a physical therapist will usually focus on techniques that move the hip joint in various positions while stretching the muscles around the hip joint.  The purpose of this is to maximize the amount of range of motion in the joint which can restore motion in the hip and reduce the patient’s pain levels.  In addition, the muscles around the hip are also strengthened through various exercises.  By strengthening the muscles around the hip this will help stabilize the hip joint and will help reduce the amount of pressure sustained by the hip joint. The physical therapist will also provide an individualized home exercise program and education on how and when to return to activities that are causing discomfort.  Aquatic therapy has also been proven to be effective in reducing pain and restoring function of the hip. Exercising while submerged in water reduces the forces on our joints, which may be ideal for a patient with severe OA or for a person who has a low pain tolerance.

Physical therapy provides patients with the ability to continue managing their symptoms in a more active manner rather than taking medications daily.  Furthermore, physical therapy may also delay or in some cases prevent a person from undergoing a total hip replacement, which is very invasive and expensive procedure that may have complications.  If you have been struggling with hip pain call Total Performance Physical Therapy today!

Shin Splints

Medial tibial stress syndrome (MTSS) is commonly referred to as shin splints. This syndrome is common in athletes and individuals who perform repetitive activities such as running. MTSS is considered an overuse injury or a repetitive-stress injury of the shin. When you participate in any repetitive activity such as running that involves the muscles of your lower leg including the tibialis anterior and tibialis posterior, there may be excessive stress put on the shin bone itself as well as the muscles attached to it, including the two listed above. This often occurs when there is a sudden increase in trainings such as increasing the intensity or frequency of the activity.

The most common symptoms associated with MTSS include diffuse lower extremity pain along the shin bone with exertion, such as running or increased walking distance or speed. One may also feel tenderness along the shin bone and surrounding muscles.  There are many causes when it comes to MTSS, some include increased training regimens, running on uneven or crowned surfaces, and running downhill. Each of these may cause MTSS because they place more stress on the shin bone itself and therefore, the muscles attached to the bone itself.

Physical therapy is a great option when it comes to MTSS or shin splints. Your physical therapist will perform a thorough evaluation and examination of your lower extremity and determine any impairments you may have, some including lower extremity weakness, swelling, tenderness or trigger points in musculature, and any abnormalities in your foot and ankle positioning. Trigger points often develop in the tibialis anterior or tibialis posterior due to the increased demand and stress placed on those muscles. Your physical therapist may perform deep tissue massage to reduce those trigger points and return the muscles to a more normalized state so they can begin to function properly. It is often recommended that you rest from any activity that aggravates your symptoms due to its ability to prolong and worsen your symptoms. Ice is also beneficial with MTSS to reduce any inflammation in the area and reduce any pain or soreness felt following manual therapy techniques such as massage and trigger point release. If any muscle tightness is noted, your therapist may also give you a stretching program to increase any lost range of motion due to the tightness. Your therapist will give you an exercise program that you can perform at home to carry over gains made at your treatment sessions. Your therapist may also initiate different modalities to help reduce pain and aid in the healing process. Electrical stimulation may be used to help block pain signals and relax the muscle tissue. Another modality that is often used is ultrasound. This type of ultrasound involves sound waves that increase permeability of the surrounding tissues to increase blood flow to the area which helps start the healing process. Ultrasound may also provide deep heating effects to warm the deeper layers of the tissue before your treatment session.

If you are experiencing any symptoms noted above, contact Total Performance Physical Therapy today to schedule an appointment!

Trigger Points

What are they?

Trigger points are taut bands of skeletal muscle that develop following either acute trauma or repetitive micro trauma. Following an injury, the muscles near the injured tissue, joint, or bone have to work over time to compensate for the injury itself. Due to the muscles working harder than normal, the stress on the muscle fibers increases, causing the muscle fiber to become taut and therefore, it becomes a trigger point. People most likely feel pain directly on the trigger point and sometimes feel pain radiating to a specific region associated with specific muscle trigger points. Over time this pain may result in a loss in joint range of motion involving the muscle that is involved. Research shows a body map of common areas that trigger points occur as well as the pain referral pattern associated with each trigger point.

stretching anytime anywhere

Why they form?

According to one research article, there may be many mechanisms on how trigger points are formed. Unfortunately there is not enough research and evidence to suggest one main cause of trigger points. Research suggests that possible causes of trigger points may include lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems. These may individually predispose the development of micro trauma and therefore cause trigger points. Again, these are all possible contributors to the development of trigger points and each individual’s case may vary. In addition, if someone participates in work related or recreational activities that require repetitive stress on muscles, that may also predispose them to trigger point development. Lastly, acute sports injuries that cause sprain or repetitive stress on tissues such as baseball pitching may cause trigger points.

Physical Therapy to treat Trigger Points-

Physical therapists are trained in manual techniques to help reduce and rid muscles of trigger points. During an examination by a physical therapist, they will apply pressure on the muscles involved and feel for evident tissue changes, such as trigger points.  When a therapist comes across taut band or a firmer area in the muscle, they may apply deeper pressure to see if it reproduces your pain at that site and determine if it radiates to another area. Some examples of muscles involved and pain referral areas include shoulder pain when trigger points are present in upper extremity muscles, back pain when muscles involving the lower extremity muscles such as the gluteals, and lastly, if trigger points are present in the upper back and neck region, neck pain is often present and one may experience tension headaches. Again, every person does vary and may not follow these exact patterns.

Once the interview and examination is completed, the physical therapist will have a better idea of the possible cause of trigger point development. You may be asked to stop any specific activities that apply repetitive stress to your muscles to allow those muscles to normalize and heal. Physical therapists will also apply soft or deep tissue massage to the areas with trigger points to release those trigger points completely or partially relax the trigger point and muscle to allow for proper muscle action and recruitment. Once the trigger points are released or reduced, the muscle can now properly fire, allowing for a reduction in pain you may have been feeling. It is important to note that it may take multiple visits to your physical therapist to fully release all trigger points due to the demands of your muscles in your work, recreational, or daily activities. Along with manual therapy to release the trigger points, your therapist will also give you exercises to address any underlying strength or balance deficits. For more information on physical therapy services visit www.totalperformancept.com.  Lastly, there is equipment you can purchase such as a foam roll to use at home to help reduce trigger points throughout your muscles. By using the foam roller, the pressure from your body weight and the firmness of the foam roller can help to apply pressure to the trigger point areas and help the progress of releasing those trigger points.

Call Total Performance Physical Therapy today to schedule your appointment!

Good Morning, Foot Pain! I mean plantar fasciitis

Plantar fasciitis is the most common condition involving foot pain seen by healthcare professionals today.  According to a study done in 2011, plantar fasciitis occurs in approximately 2 million Americans annually.  Also, some researchers believe that plantar fasciitis accounts for 8% to 15% of foot complaints in nonathletic and athletic populations.  These statistics show how common and prevalent plantar fasciitis is today.

Plantar fasciitis is a condition in which the plantar fascia, a band of tissue on the bottom of your foot, is either inflamed or degenerative.  The plantar fascia is responsible for supporting the arch of the foot and when the plantar fascia is disrupted or inflamed, it can no longer do its job. When the plantar fascia does not do its job, the muscles around the plantar fascia must work harder and if they are working harder, those muscles may undergo changes so physical therapists may also address the tissues and muscles surrounding the plantar fascia itself.

This is the plantar fascia.  An inflammation of this will cause heel pain called plantar fasciitis.

This is the plantar fascia. An inflammation of this will cause heel pain called plantar fasciitis.

Common signs and symptoms of plantar fasciitis include sharp pain under the heel as well as along the arch of your foot. Pain is typically at its worst first thing in the morning and many people explain that their worst pain is during their first step out of bed in the morning. Pain is typically felt first thing in the morning because of the position of the leg, ankle, and foot during sleep. When sleeping on your stomach your ankles are typically fully plantarflexed and while lying on your back, bedding may cause the feet to assume the same position. In addition to first step pain in the morning, one may have increased pain after resting or sitting for a long period of time due to the plantar fascia maintaining a static position.

Causes of plantar fasciitis include any repetitive activity that is constantly stretching and increasing the tension on the fascia. This repetitive activity can cause small tears in the fascia as well as making the fascia irritated and inflamed, which in turn causes pain. An example of a repetitive activity would be long distance running because of the constant and repetitive impact of the foot on the ground. In addition, any occupation that involves standing and walking most of the day can be a cause of plantar fasciitis.  Improper footwear that does not support your foot and arch may also lead to plantar fasciitis so proper footwear is key, especially if you are on your feet for a majority of the day.

Physical therapy is a great treatment option for plantar fasciitis. Physical therapists can diagnose plantar fasciitis through a thorough examination and evaluation as well as obtaining a very thorough history about your symptoms, when the pain began, when the pain is better, and when the pain is worse.

stretching anytime anywhere

Physical therapists have many options when it comes to treating plantar fasciitis. Examples of some treatment techniques include ultrasound for deep heating and tissue healing, plantar fascia stretching to increase the extensibility of the fascia, calf muscle stretching and foam rolling to increase the extensibility of those muscles if they are tight and causing pain at the plantar fascia, trigger point release, and soft tissue mobilization to loosen up the tissues of the foot that may be causing increased stress on the plantar fascia. Recent research does show great success treating plantar fasciitis with lower extremity stretching in combination of trigger point release to reduce pain.

Physical therapists will also give you a home exercise program to continue progressing your recovery from the clinic to home. Therapists may give a home exercise program that involves lower extremity and plantar fascia specific stretches as well as teaching you to self-massage the plantar fascia to keep the tissue loosened up throughout the day. In addition, your physical therapist may also give you exercises to strengthen the muscle of the foot and ankle to help support your arch when the plantar fascia is not doing its job.  For more information on physical therapy services go to www.totalperformancept.com.

If the above treatment techniques do not resolve your issue completely, physical therapists are capable of prescribing and fabricating special foot orthoses to wear in your shoes to help support the arch of your foot since the plantar fascia is not able to at the time of injury. There are also braces that can be worn while you sleep to keep your foot and ankle in proper alignment as to avoid the positions that may cause pain or discomfort throughout the day.

Call Total Performance Physical Therapy to schedule your appointment today!

How to heal a pulled muscle

There is a lot of controversy regarding the proper way to manage a muscle strain after an injury. Wherever you are, there are always individuals surrounding you recommending what they think are the tried and true methods of healing from a muscle injury. I have heard many different methods being recommended, making it difficult to select which is the most appropriate. So, what is the best method: Icing? Heating? Stretching? Massaging? Running it off? All of the above?

How muscle strains occur

There are a variety of mechanisms that can cause a muscle strain. Muscle strains occur when the muscle is overstressed and resulting tears arise in the muscle fibers. A muscle strain can take place at the junction between the muscle and the muscle tendon or in the muscle belly.  Muscle strains are commonly called pulled muscles due to the overstretching mechanism that can lead to muscle strains. The most common mechanism of injury is during an eccentric contraction. An eccentric contraction is a type of muscle contraction where the muscle lengthens while placed under tension. Activities such as lowering objects against the force of gravity are considered eccentric contractions. A muscle strain can also occur during abrupt forceful motions such as accelerating, decelerating, or cutting activities.

Strains are classified into categories based on the severity of the injury. A grade 1 muscle strain is a mild strain with damage to less than 5% of the muscle fibers. A grade 2 strain is considered a moderate strain with a greater amount of fibers involved but less than half of the muscle tissue is damage. A grade 3 strain occurs when greater than half of the muscle fibers are torn. Finally, a grade 4 strain is the complete tearing of the muscle.

Symptoms of a muscle strain involve sudden pain during activity. A popping sensation is commonly reported during muscle strain injuries. The involved muscle may be tender to touch and bruising can often be observed over injured tissue. The severity of symptoms vary based upon the grade of muscle injury. Lower grade injuries may have symptoms of a knot in the muscle while higher grades may produce symptoms of extreme pain or inability to use the involved musculature.

Treating muscle strains

The treatment of muscle strains begins right after the injury occurs. Termination of the harmful activity should be completed in order to decrease the damage to the involved tissues. Icing and gentle massage should be performed to decrease inflammation and to decrease the tensing up of the muscle fibers. Icing should be performed for 20 minutes every hour initially after the injury. The muscle should not be stretched immediately after the injury. Stretching the already overstressed muscle can cause more damage to the tissue. Over the counter anti-inflammatory medication can be used during this time to decrease inflammation and pain. The injured extremity should also be elevated to decrease inflammation. Once symptoms have alleviated and the muscle is healed, a program focusing on strengthening, increasing flexibility, and decreasing muscle spasms should be initiated. Muscle strains can become chronic injuries if the underlying deficits that caused the muscle strain initially are not addressed.

Prevention of muscle strains

There are numerous activities that can aid in the prevention of muscle strains as well as overall injuries. By engaging in a stretching program muscle flexibility can improve to decrease the risk of overstretching a muscle that is shortened and not at an optimal length. Muscle imbalances can cause muscle strains so addressing these imbalances is imperative to the prevention of muscle injuries. Muscle imbalances occur when a muscle group on one side of a joint is stronger than the opposing muscle group. For example, the quadriceps muscle group is stronger than the hamstrings, which leaves your hamstrings more prone to injury. By strengthening the weaker muscle group you can prevent the over stressing of that muscle group that will eventually lead to tears. Lastly, a proper warm up can decrease the risk of a muscle strain by allowing the gradual increase of blood delivery to muscle tissues. This allows muscles to be more pliable and decreases injury.

When a muscle strain does arise physical therapy can help get you back into your favorite activities. Through physical therapy patients are evaluated to determine underlying mechanisms that have caused the injury to occur. During therapy muscles will be strengthened and biomechanics will be corrected to rehabilitate the current injury and prevent future injuries from arising.  For more information on physical therapy visit www.totalperformancept.com.

Call Total Performance Physical Therapy today to schedule your appointment!

Pain, pain go away

In pain and don’t understand why?  Normally live an active lifestyle, but now have to slow down due to this discomfort?  Feeling extreme pain in certain muscles of your body, but cant quite place your finger on it?  When will it all end?  The pain you maybe feeling, can be attributed to little nodules in your muscle that you have developed.  Have no fear, a cure is here. These nodules or bumps are called trigger points and you should consult a physical therapist to help in the alleviation of this problem.

What is a trigger point?

Trigger points are tight band/section of skeletal muscle fibers that are hypersensitive to touch and deep palpation.  These trigger points cause intermittent pain that may radiate to another area or stay localized.   There are approximately 620 trigger points in the human body that can be classified as either, active and latent.  Active is when pain is referred either locally or to another location.  Latent is a trigger point that is not referred, but may be exacerbated by pressure to the muscle.

How is it caused?

Trigger points are normally caused by an overloading of muscle (in activities such as weight lifting, running, or other strenuous activities), trauma, infection, smoking, and radiculopathy.  Repetitive and overcompensated movements may also be a contributing factor to the development of trigger points.  Trigger points can only be found in muscle tissue where there is a small contraction, which can a pull on the tendon attached to the joint and resulting in pain at the joint.  There may be weakness associated with these painful muscles.


Dr. Heather Moore’s extensive experience in examination and evaluation techniques of trigger points allow her to look for the specific signs/symptoms, pain patterns, and negative tests through palpation.  These trigger points could feel like a hard nodule or bump in your muscle.  When pressing on this nodule, you will feel pain, which may often cause a twitch response in that muscle.  MRIs can also be used in the diagnosis of a trigger point, showing an area of muscle tissue that is tighter than the surrounding muscle fibers.


Soft and Deep tissue massage, pulsed ultrasound, electrical stimulation, ischemic compression, spray and stretch air coolant, Low light laser therapy, and stretching are various methods of treatment used at Total Performance Physical Therapy.  Utilizing the “Atomic Elbow,” as quoted by her patients, Dr. Moore chooses deep tissue massage and ischemic compression as her preferred method of treatment.  From her many years of experience, this has been efficient and effective in her efforts to rehabilitate her patients back to a pain free level of function.  Once this pain has been diminished and there is a decreased number of trigger points that have been identified in the muscle tissue, strengthening, endurance, and range of motion exercises will be progressed in order to achieve the patients goals for their recovery.

Don’t be afraid!

Bruising and soreness is normal for a few days after treatment.


Dr. Heather Moore loves this product, not only is she a fan of using this treatment with her patients, but she uses it on herself to relieve TPs and pain levels.  All types, shapes, and sizes can be found at Total Performance Physical Therapy in North Wales during therapy or for purchase. #tppt

Rest- Ice, Ice, and Ice

Since we are not naive and understand that people have a hard time letting go of the activity that ultimately cause them this discomfort, we educate patients on the need to slow down activity level to a minimum allowing proper healing, relaxation of muscle tissue, and pain relief.  Icing the area post activity and throughout the day is imperative to decrease of inflammation and decrease pain, which ill be so vital to a better prognosis in your recovery.  Slowly as physical therapy begins and continues to work, activity modifications and intervention progressions will be made by your therapist to allow for a return to running and activities that you enjoy doing before feeling these debilitating pain.

Call Total Performance Physical Therapy today to schedule your appointment.  #tppt

Got shin splints? Physical therapy can help: A testimonial!

I am a 39-year old female who discovered running in the past few years. I first started to have symptoms with my right IT band and looked for a treatment on the internet. The IT band did resolve for a while but then I started with a shin split in my left leg. I went to a chiropractor who recommended rest, massage and laser as the treatment. When I started to run again, I began having pain in my shin again but this led me to Dr. Heather Moore in June 2012.  Dr. Moore’s office is beautiful, clean, comfortable and well organized.

After my evaluation, it was refreshing to finally find the answer to why I was having these injuries while running. Dr. Moore determined my hips were weak and I was having compensation injuries. From the beginning, I was given individual attention rather than feeling like I was just one the many patients that day or time. My goal was to be running again for a 1/2 marathon on September. I started with strengthening exercises and took a break from running. Dr. Moore worked with me to determine a schedule to ease me back to running. I was happy to have her pacing my return running because I would have rushed it!

As a result of Dr. Moore’s work with me, I was able to complete the Rock n’ Roll 1/2 marathon with a personal record!

Call Total Performance Physical Therapy today to get rid of your shin splints!