Runners are especially susceptible to hamstring pain. This is due to the eccentric nature of slowing down the leg before your foot hits the ground while running.

Most often you have a strain at the musculotendinous junction: where the muscle attaches to the tendon that then attaches to the bone.

You can have a proximal hamstring tendinopathy (PHT): this is where there is a degeneration of the tendon at the site where it attaches to the butt bone called the ischial tuberosity.

You can also have a strain of the muscle belly itself. There are 3 muscles of the hamstring: The biceps femoris (most often associated with hamstring injuries), semimembranosus and semitendinosus.

So what does it feel like?

• Typically PHT presents with pain well localized to the tendon origin at the ischial tuberosity

• Early morning stiffness may be present (as is common in tendinopathy)

• Latent pain is common, meaning you can feel fine during an activity but you can have a delayed increase in symptoms later on or even the next day.

• Pain may be present at the start of activity and ‘warm up’ and settle in as the activity progresses. And then you may have latent pain.

PHT should not have wide-spread symptoms, numbness or tingling or have back pain associated with it. See more about this in the differential diagnosis section.

Aggravating and easing factors

• Usually PHT is aggravated by sitting, stretching, lunging and deep squat positions, uphill running and faster running sessions (although if irritable even slow running on the flat can be sore)

• This is because those positions and movements compress the tendon at the site of the ischial tuberosity or place too much load on the tissues.

  • Check out this IG on how to make sitting more comfortable for PHT

• It’s usually more comfortable standing and walking (although can be sore with brisk walking or hill walking)

Things to ask yourself:

• How long can I sit for?

• What pace can I run at without having discomfort?

• How long can I run before I get discomfort?

• How fast can I walk?

• Can I run flat without a problem but adding in sprints or hill work aggravates my symptoms?

I always like to note how Distance, Pace and Frequency change my pain so I can track and train my athletes accordingly.

Other issues that can present like PHT or hamstring strain, aka Differential Diagnosis:

• Lumbar spine disorders can refer down into the buttock and posterior thigh when the nerves that exit out through there are irritated.

• Hip: some hip disorders can also have a similar pain pattern

• Piriformis: when tight or irritated it can compress the sciatic nerve, referring pain down the buttock and leg

• Posterior hip impingement: when the hip doesn’t glide as it should and pinches.

Make sure you are being put through a very detailed examination to rule out other possible diagnoses so that you get accurate rehab.

So now you’re probably wondering why this happened or is happening to you.

Most injuries occur when too much load is applied to a specific tissue. Sometimes the load is too much, such as an increase in training volume, adding in more hills or more speed word. But sometimes your tissue tolerance can go down with stress, illness, fatigue, nutrition or hydration issues.

You really want to get in to see a medical provider as soon as possible so you have a chance to get better fast.

If this becomes a chronic condition you have to start looking at and as needed addressing  running mechanics, muscles weaknesses and/or stiffnesses.

Stages of Hamstring Rehab

I want to emphasize that that every athlete is different and will progress through and respond differently to these stages. The rehab process can take roughly 6 months but can take longer in certain cases.

Stage 1

This is when the tendon is more acute and will respond well to isometrics in mid-range.

Typically we want 1 or 2 exercises done 4 or 5 times with 40-45 second holds (2 or 3 times per day).

For example: The hamstring Bridge: perform 40-45 seconds 4-5 times and can be done 2-3 times/day.

Progress to stage 2 when able to tolerate stage 1 exercises with minimal pain, roughly a 0-4 on a 0-10 pain scale with minimal to no reaction the following day.  The exercises will need to be tested in a controlled setting to know exactly how you are going to react and if it is the right reaction. Many patients will need time working at stage 2 before symptoms will settle and tolerate more compressive positions.

Stage 2

Heavy Slow Resistance training (HSR) 3 to 4 times per week, typically starting at 15RM and progressing to around 8RM. We would ideally like to strengthen the hamstrings with 3 exercises involving minimal hip flexion, we work into more hip flexion in stage 3.

May include

– Double or single leg bridge

– Prone hamstring curl or a nordic curl

– Straight leg pull down or hip extension against pulley machine/ theraband

– Hamstring curls on a yoga ball

Can sprinkle in non-hamstring specific exercises to fully address the kinetic chain and give the hamstrings a chance to rest between exercises.

Stage 3

Progress to stage 3 when the exercises are tolerable with pain less than 3-4/10. Stage 3 is to increase the hip flexion position and start to bring the hamstring into a stretch and compress position. For example:

– Step ups

– Hip thrusts

– Shallow range deadlifts, progressing into range as tolerated then onto single leg

– Lunges

Again, mix these up with other exercises to address the whole kinetic chain and any other movement faults. We can also start to address running mechanics and a return to run plan during this stage.

Stage 4

Not all patients need to progress to this level and those who do need to progress slowly. This would be appropriate for sports and athletes who require agility and speed such as soccer players, sprinters and hurdlers.

We typically start by introducing 1 plyometric exercise within the session and see how symptoms respond. Then we will gradually add exercises as tolerated and progress the range of motion at the hip and hamstring as needed.

Stage 5

– plyometric exercise examples

– Ladder drills

– Bounding, progressing to hill bounding or straight leg bounding

– A skips and B skips

– Sport specific work like cutting and change of direction exercises

We can also start to play around with the speed at which you perform your HSR exercises.

Keep in mind that we aren’t done when we get here though, maintaining what has been achieved is vital in keeping yourself healthy. The tendon is very needy and pain is frequently recurrent when athletes stop their rehab or stop following their training plan. So keep up the good work and you should be all set!

If you have hamstring pain and want to get yourself fixed, set up a call with us today!

Thank you for reading!!!

Rebecca Smith, PT, DPT

So, what’s the pelvic floor? The pelvic floor refers to a group of muscles that sit like a bowl, within the bony pelvis and has the following functions:

1.     Support the pelvic organs above

2.     Houses our reproductive organs, urinary system and digestive system

3.     Control bladder and bowel function

4.     Contribute to sexual functions of arousal and orgasms

5.     Provides stability to your hips and low back

6.     Pumps blood and lymphatic fluids from the pelvic area

The muscles of the pelvic floor also work directly with the diaphragm to provide support to our core canister which is super helpful when working out, carrying children, performing daily activities or for performance in sport.

The back, hips, abdominal muscles diaphragm and pelvic floor are very closely connected and we really cannot work on one without considering the others. We always talk about working out our “core muscles” and maintaining a strong “core.” Well think about the pelvic floor as the “floor of our core!”

NORMAL FUNCTION of the pelvic floor:

You should urinate roughly 5-8 times/day during waking hours, and should be able to hold urine for 2 hours without pain, discomfort, or leakage of urine.

Waking up 0-2 times/night to use the restroom

No leakage of urine, stool, or gas with or without activity

Able to control urinary and fecal urge/delay these urges as needed

No pain with urination or defecation

Urine should take 8-10 seconds

Average for all mammals: 20-30 seconds normal time for urine stream

Pelvic floor should be able to relax and contract (squeeze)

Ability to experience pleasure during sexual activity

Pain free intercourse

BM Range from 3x/day to 3x/week

Signs of abnormalities

Difficulty voiding BM and urine

Unable to fully void (straining to empty bowel or bladder); inconsistent stream

Difficulty controlling urine, fecal matter and gas (incontinence)

Urgency, urinary frequency more than 2x per hour

Pressure, heaviness, feeling of dragging, bulging inside of vaginal canal; feeling of insides falling

Pain with insertion (includes tampon usage and gynecological examinations) or intercourse (dyspareunia, vulvodynia, vaginismus), pain with orgasm, pain following intercourse

Splinting or use of hands/fingers to help evacuate bowels

Difficulty or lack of orgasm

Hip, jaw or lower back pain and other MSK pain

Changes in menstruation

Pelvic pain with activities (prolonged sitting, standing, lifting, exercise). Pelvic pain can radiate to lower abdominals, low back, inner thighs, and perineum.

Let’s talk more about incontinence…

Pelvic floor dysfunction is stopping 46% of women from exercising! And at a time where metabolic syndrome is at an all-time high, we need to make sure as many people are working out as much as possible without any barriers.

There are 2 categories of incontinence: Stress and Urge

Stress incontinence is when leaking occurs during a stressful activity or when load is applied through the pelvic floor:

Such as leakage while jumping, running, lifting weights, coughing, sneezing or laughing.

Urge incontinence is when you suddenly have and intense urge to go to the restroom, cannot wait, and experience urine leakage prior to reaching the bathroom in time.

Just because something is common, does not excuse it and does not make it normal. Do all of your friends pee when they laugh? Common but NOT NORMAL. Peeing with running or jumping? Common but NOT NORMAL. There is a misconception that if it is common, then it must be normal and there is no need to get help regarding the condition. Understanding what to expect after certain experiences, such as with menopause or after childbirth, can help differentiate between what is to be expected and normal of that condition and what is not normal and should be treated.

It takes a woman an average of 7 years before getting to the right provider to treat their pelvic floor dysfunction and we would love to see that greatly reduced. That can happen by increasing education and continuing to talk about these conditions. So if you want to learn more set up a phone call with us so we can answer your questions today!

Have you ever tried to open your mouth and it got stuck? Do you have a sore and painful jaw? How about neck pain and facial pain?

It sounds like you could be suffering from TMD, which is short for temporomandibular dysfunction, aka jaw problems.

Here is a little bit of an anatomy lesson on the jaw: The jaw is made up of two bones, the temporal bone and the mandible. The joint is tiny but does have a disc that rolls and glides with mouth opening and closing.

The primary muscles of chewing/closing, also known as mastication, include the masseter, temporalis and the medial and lateral pterygoid. Any of these muscles can contribute to jaw and neck pain and will be evaluated and treated as needed.

The jaw is innervated by branches of the Trigeminocervical and there is wiring overlap with the C1-C3 spinal nerves which innervate the neck.

Okay, now for the dysfunction part.

TMD commonly presents as pain in the jaw but can also include clicking, catching, lock jaw on either opening or closing and/or tension in the muscles. The jaw however, is very closely connected to the neck and you can’t really look at one without considering the other.

Posture is important in this clinical population because a forward head puts a posterior and inferior force on the mandible and requires the muscles that close the jaw to remain in a tensed position when they should be relaxed. It would be like walking around all day holding a bowl of soup in your hand; over time that bicep and elbow are going to get very cranky with you.The forward head can also lead to an anterior displacement of the tiny little disc that sits in the TMJ joint which will change the way the joint functions.

Just like any joint, the TMJ can have dysfunction within, called intra-articular, or outside of the joint, called extra-articular, or both!

Extra-articular examples can include:

• Muscle guarding, overuse, increased resting tension

• Bad habits such as teeth clenching, grinding, nail biting, gum chewing

• Trauma: such as dental work

• Referred pain to the head, neck and face

• Tenderness and trigger points in the muscles at the jaw

Intra-articular examples:

• Trauma: direct hit to the face

• Joint clicking or popping

• Grinding, grating or crepitus

• Movement deviations, jaw tracking problems

• Catching or locking either open or closed

What will your PT look for?

• Pain presentations/pattern: time of day, stress levels, eating related pain

• Joint deviations: C or S curves

• Joint mobility: stiffness or painful joint movement

• Range of motion: looking for full range availability as well as symptoms with range of motion, including pain, clicking, deviation

• Palpation of the joints and muscles of the neck and jaw: SCM, suboccipitals, UT, Temporalis, masseter, pterygoid, joint line

• Posture and breathing patterns

Treatment:

• TMJ manipulation/mobilization

• Cervical Manipulation/mobilization

• Dry-needling

• Soft tissue mobilization

• Strength training

• Breathwork for diaphragm function

People with chronic neck pain have lower force/strength availability meaning that improving their neck strength is so important!

To address your TMJ, first we’d calm it down, then we’d figure out the root cause of the problem to give you long term relief, then build you back up so your jaw is resilient for life!

Formerly known as the Female Athlete Triad, RED-S has been updated to include males and also takes into consideration that many females are maintaining normal menstrual cycles with oral contraceptives, so a loss of a menstrual cycle as inclusion criteria is no longer valid.

Relative Energy Deficiency in Sport, or RED-S, describes an energy deficit where an athlete is burning more fuel (calories) than they are taking in; as well as the subsequent consequences associated with this deficit.

Think of your bank account and imagine a mismatch between money going in and money coming out. If you don’t have the money available you will have to borrow it from somewhere else.

In regards to your body, when energy intake is less than energy expenditure, some part of you is paying the bills: it could be that bones are not reforming, glycogen is not being replenished or tendons are not healing. You may not notice the damage in the short-term, but there will be a consequence eventually.

There are a few different scenarios that can land an athlete in this situation which are mostly unintentional. These may include a restrictive diet, disordered eating patterns or excessive exercise. Even a deficit of 250-400 calories/day for 5 days can contribute to hormone dysfunction!

Common symptoms to look out for that can signify RED-S are:

~Decreased concentration and coordination

~Missed periods

~Increased injuries

~Impaired judgment

~Depression and or anxiety

~Decreased muscle strength

~Decreased endurance

~Loss of sex drive

~Decreased immunity

~Decreased protein production

~Compromised cardiovascular system

~Decreased energy stores

~Changes in mood

~Changes in libido

~Bone density changes

~Changes in hormonal reeducation and reproduction dysfunction

~GI upset

Males have slightly more wiggle room than females. Female bodies are more protective of the reproduction role and if body fat drops, hormones will be affected.

Negative training effects are noticed faster in males than females, speculation that this can be due to statistically higher training volumes in males vs. female counterparts. Whereas, females tend to get a majority of the medical symptoms.

Unfortunately, there are a lot of contributing factors for which people unintentionally fall into this trap. The major one being that there is not a lot of accurate information when you research your body’s needs. If you google resting metabolic rate, which is a baseline caloric need of someone at rest, for a 25 year old female it can range anywhere from 1800-2500 calories. Which is a huge range!

We start to see hormonal dysfunction occur within as little as a 250-400 calorie deficit, over the span of 5 days, so you can easily see how people slip into a calorie deficit that can cause problems, without even realizing it.

One suggestion would be to get regular blood work to see what their Vitamin D, Iron, calcium and baseline hormone levels are. Bloodwork is a great measure of overall health and nutritional levels for vital vitamins, hormones and nutrients.

Athletes also need to keep an eye on their ferritin levels which is not always included in a regular blood panel. Ferritin is the iron storage protein. Anemia can occur when there is a low hemoglobin level, which carries iron, or in Ferritin. Anemia can have a profound impact on training and performance. Notably, when iron is low, you put your body into an anaerobic state, which means you have to burn more fuel to maintain your resting metabolic rate. Ironically though, your appetite goes down when you’re anemic, despite your increased needs.

Rebecca McConville, a sports nutritionist and performance expert, recommends athletes get blood work done before starting a training block as well as 2 weeks after a big race to see how the nutrition plan for that training cycle worked.

Overall, guessing can be dangerous or harmful to your health and performance. Your best bet is to stay informed and be proactive by:

~Getting regular blood work done

~Doing the math on your specific caloric needs by calculating your fat free mass and using the following formula: Energy available (goal is 30-45) Energy Intake (EI),  Energy Expended (EE), Fat-free mass in kg (FFM)

EA = (EI-EE)/FFM (in kg)

For example a 154 pound runner, 18% body fat, 126 pounds FFM or 57kg

EI = 2800, EE = 800  so the EA would be 35

(2800-800)/57 = 35

OR

EI = (EA x FFM) + EE so if a goal is to be at 40 for EA

EI = (40 x 57) + 800

EI  should be roughly 3,080 calories

~Eating a whole food balanced diet and not restricting certain food groups (unless you have an allergy or have been advised by a doctor or dietician and work directly with a registered dietician to know exactly what your needs are.)

To conclude with some wise words from Rebecca McConville…“What’s the downside to being fed?”

So you are injured…well damn that sucks. But now what?

It’s definitely difficult to stay motivated when you are injured and unable to  do your normal thing. Not only are you going to feel like you are losing your fitness but also a bit of your identity as an athlete and your social time that you get with your friends.

But here are some tips to focus on when you are down so you can stay healthy, rehab quickly and come off the injury stronger, even better than before, by focusing on what you still CAN do, not what you can’t.

Focus on

1. Strength: Can’t run? Well now is a great time for you to focus on your strength. Depending on the location and type of injury there will be plenty of options. Sometimes the missing strength is the reason you sustained an injury in the first place, so focusing on how to rehab the injury and keep it from returning in the future is such a great place to start. Some of my athletes have returned stronger, faster and as an overall better athlete after an injury because they had the time to focus on their strength.

2. Mobility: Focusing on your mobility at this time is vital, you either want to maintain what you had before the injury or gain what you might have been missing. Unfortunately, certain injuries can put you into prolonged positions that can shorten other soft tissue. For example, if your shoulder is in a sling you want to make sure you stretch out of that forward chest/head posture. If you are using crutches, you want to stretch the hip into extension and maintain good hamstring flexibility. Maximize your time in these positions as tolerated.

3. Nutrition: When injured you need to make sure you are consuming enough calories to support the healing process and ensure those calories are coming from whole foods. It’s easy to get in the dumps when you are injured. You may start eating food that you wouldn’t normally eat, either for comfort or because you don’t think it matters since you can’t train…But it matters!

4. Sleep: Getting optimal sleep is vital right now for the healing process. Aim for at least 8 hours/night.

5. Manage Stress: Stress is stress and if you are needing to heal, external stressors can limit that ability. Try using meditation, journaling, talking with a loved one or therapist, setting boundaries for yourself and doing things you enjoy that relax you.

6. Aerobic Fitness: Maintaining your aerobic fitness is important for both the healing process (blood flow, homeostasis, hormone regulation, tissue quality) and your overall fitness. Aerobic work will maintain your mental health, happiness, mood and identity as an athlete!!! Aim for at least 20 minutes to get these benefits in zone 1 or zone 2.  Examples of aerobic activities: If you can’t run can you bike, swim, aqua Jog or row? Can’t bike because of a knee injury? Well the assault bike or echo bike allows you to use your good leg and your two arms! You have to get a bit creative depending on your injury but that’s what your coach or PT can help you with.

Stay healthy friends! If you are having a hard time understanding what you need to focus on contact us today for a phone call or to set up an appointment.

407-476-6613

Dr. Rebecca Smith, PT, DPT, Cert-DN, TPI M2

Insurance can be expensive and frustrating for both consumers & providers. When we pay a lot for insurance, we want to get something back in return. And we want something good in return. Is that too much to ask?

Unfortunately good insurance does not mean you will get good medical care.

I absolutely love my job but after working for 10 years at an in-network facility, the amount of instances patients were denied services, or their treatment was delayed due to paperwork and insurance hang-ups is astronomical. Over the years, reimbursement for therapy services has gotten less and less, which has backed most, if not all, in-network facilities into a corner. They are required to see more and more patients per therapist each day just to make ends meet. If you have ever been to an in-network facility before, maybe a few of these forced practices sound familiar:

• 2-3 (if not more) patients at a time per therapist

• Limited time working with your therapist

• Exercise/drills supervised by therapy techs/assistants

• Multiple modalities (ice, heat, e-stim, ultrasound) performed each visit (and billed for all)

• Multiple treatments per week

There are many different kinds of tissues in the body and they all heal at different rates. While the initial inflammatory response to an injury begins immediately after an injury occurs, the time it takes for a tissue to fully heal can range from a couple of weeks to several months.

The time depends greatly on a variety of things such as an individual’s age, overall health status, severity of tissue damage, and what tissue is involved. Most notably – how much blood supply is directed toward the affected tissue and how well the body can move fluids through the area. This is why muscles will heal much faster than cartilage.

While a tissue may be healed enough to begin returning to normal activities in a few weeks, there is likely some degree of the tissue healing process continuing in the background for months to even years later.

Below is a list of the traditional tissue healing timelines. Remember that these can vary:

Muscles – 2 to 4 weeks

Tendons – 4 to 6 weeks

Bone – 6 to 8 weeks

Ligaments – 10 to 12 weeks

Cartilage – 12 weeks or longer

Nerves– 3 to 4 mm a day

We, as physical therapists, often times get asked, “How can I heal faster?” Or “How can I make this process go by quicker so I can get back to XYZ?”

And the answer is most often delivered with a shrug, a glance up toward the ceiling, and a physical therapist’s favorite line – “It depends.”

What we DO know is how to increase the rate of blood flow to the injured tissue faster than how it natural runs in the body. This can be achieved through movement, manual therapy, and lifestyle factors that influence this vital process (stay tuned for my next blog for this information).

At the end of the day, consultation with a physical therapist on injury prevention & management will give your body it’s best chance at healing.

If you live in Orlando and are curious on how to prevent, treat, and manage an injury using physical therapy – please give us a call today at 407-476-6613

Or click the button below to schedule a call or an appointment

Megan Ford, PT, DPT, CF-L1

References:

Leong NL, Kator JL, Clemens TL, James A, Enamoto-Iwamoto M, Jiang J. Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration. J Orthop Res. 2020;38(1):7-12. doi:10.1002/jor.24475

Tissue Healing Times and wound healing phases. Physical Therapy Web. https://physicaltherapyweb.com/tissue-healing-timelines/. Published December 20, 2020.

I graduated from PT school in Boston, MA in 2010 and entered the workforce feeling like I knew everything a PT needed to know. After about 30 seconds of working I realized I knew next to nothing

PT school is fantastic for getting you ready for the BOARDS and to understand the basics, but I knew I was going to have to invest much of my own time and money in order to become the physical therapist I knew I wanted to be. I have taken countless courses in manual therapy, sports and orthopedic management, running and crossfit related courses and after working in physical therapy for almost 10 years I finally had the ability to get educated in and certified in dry-needling. My whole professional world changed at that moment.

What Is Dry Needling?

Dry needling is a treatment that involves inserting a thin mono-filament needle, without the use of injecting medications, into muscles, ligaments, tendons, subcutaneous fascia and scar tissue. The needles can also be inserted into peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromuscular pain syndromes. Physical Therapy uses the dry-needling to target intra-myofascial trigger Points MTrPs to alleviate myofascial pain. Needles are typically left in for 10-30 minutes and typically connected with electrical stimulation, electroacupuncture.

Several studies have demonstrated the ability of dry needling to cause immediate improvements in musculoskeletal pain by targeting these trigger points and eliciting a local twitch response. The proposed mechanisms of pain relief supported by research include:

• Normalization of local chemical environments surrounding active trigger points.

• Activation of our body’s natural opioid pain controlling pathways.

• A local increase in blood flow to create a “washout” effect and reduce inflammation.

• This treatment results in an anti-inflammatory immune reaction, decreases muscle tension, and leads to self-healing and internal balance

• Promote tendon healing by increasing collagen proliferation.

These effects of dry needling have been demonstrated across orthopedic, neurologic, sports, and post-surgical populations to improve range of motion, pain, performance, and increase local blood flow and oxygenation to surrounding tissues.

I often get asked if it is the same as acupuncture…

Both dry needling and acupuncture use a similar instrument (a needle) to perform a treatment. Acupuncture is literally translated into “needle penetration”. There are many techniques that are shared procedures among a variety of healthcare professions. The use of dry needles by a physical therapist does not make them an acupuncturist just as the use of corrective exercise work by a chiropractor does not make them a physical therapist.

BUT the philosophies and reasoning behind why the treatment is being performed are vastly different.

• Acupuncture is based in Eastern medicine and uses needles to balance “chi”, which is defined by acupuncturists as “life’s energy”.

• Acupuncturists believe chi travels through channels, or meridians, and that this flow can become stagnant or disrupted resulting in illness and disease.

• Acupuncturists insert needles into very specific points along the patient’s meridians to re-establish the flow of chi and these points do not change from person to person or based on how/where the patient’s symptoms are presenting.

• Acupuncture points are associated with an ancient conceptual but anatomically non-exist system of meridians which carry Yin (spirits) and Yang (blood).

• Dry needling is based in Western medicine and uses needles to stimulate trigger points within the muscle.  It is very anatomically specific and closely associated with the location of patient symptoms. TrP are firmly anchored in the anatomy of neural and muscular systems.

Click to watch a sped up video that demonstrates one method to perform dry needling for neck pain

What Exactly Is A Trigger Point?

Commonly described as a taut band of skeletal muscle located within a larger muscle group, trigger points fall into 2 categories, active or latent. An active trigger point is described as a palpable nodule that can cause local or referred pain without being touched or pressed on, and a latent trigger point is essentially the same thing only it does not cause any symptoms except when pushed on.

Several theories exist in the scientific community regarding how trigger points form and what exactly their role is in the development of pain. Some of these theories include:

• Sustained low level muscle contractions associated with stress and postural strain can lead to the formation of trigger points due to increased low level muscle contractions which can be a leading source of pain.

• Another theory as to why trigger points form that I commonly experience in the clinic is direct trauma. Whether this is calf pain from trying to hit a PR on your 5K, shoulder pain from performing MURPH, or hip pain while training for your first 70.3, this trauma can lead to the formation of trigger points causing significant pain to continue after normal soreness subsides.

When inserted into a TrP the needle elicits a local twitch response that subsequently provides a very strong neural impulse to the TrP circuit to break the vicious cycle so that the pain is relieved.

Who can benefit from Dry-needling?

Really anyone as long as there are no contra-indications. There are a variety of different pain cycles and tissue diagnoses that can greatly benefit from TrP DN. These include but are not limited to the following:

Knee OA

Lateral Hip Pain

Plantar Fasciitis

Achilles Tendinopathy

Hamstring Tendinopathy

Runner’s knee

Low back pain

Neck pain

Cervicogenic headaches

Shoulder pain

Golfer’s elbow

Tennis Elbow

Carpal Tunnel

Dry-needling may sound incredible but it is not a magic pill. While it can give you quick relief, it is only a small part of the puzzle. It is a great tool in the hands of a skilled physical therapist to alleviate pain that would otherwise keep you from sleeping, moving or performing an exercise and help propel you forward on the road to healing.

BUT, the biggest benefit will come from education on where the injury originated from, mobility, strength, and overall health to keep your injury from returning.

If you live in Orlando and are curious on how you might benefit from dry-needling and physical therapy please give us a call today at 407-476-6613

Rebecca Smith, PT, DPT, Cert-DN, TPI M2

References: Dunning et al. Dry Needling: A literature review with implications for clinical practice guidelines. Physical Therapy Reviews 2014 Vol. 19 (No. 4) 252-260

Calf strains: The calf complex is the considered to be incredibly important for distance runners. Also known as the Triceps surae, the calf complex is made up of the medial and lateral heads of the gastrocnemius and the soleus muscle. Medial head has been shown to the the most significant contributor to plantarflexion and the most active portion of the calf complex during running. It is not surprising that it is a common injury that can side-line runners for weeks, months or even years.

There are different types of pain and impacts that pain can have on a runner and the way to manage that runner will vary based on where they are along this spectrum. A runner can experience acute and sharp pain that can cause the runner to have pain with running and even impaired walking as well as impact their activities of daily living. Or a runner can experience a more subtle and persistent nagging pain. Some runners can continue to run through this and have no impact on their activities of daily living. This scenario can result from overload, muscle fatigue, weakness and/or a combination of these.

No matter where you are along this injury/pain spectrum most often there needs to be a change in the load on the calf complex for some time with some training modifications. First we need to offload the irritated and sensitive tissue, then we need to gradually load the tissue back up so it is stronger and more resilient in the future. When there is an injury to the calf complex we often need to modify training to reduce load on the injured tissue while simultaneously finding the right time and dosage to load the tissue back up to promote healing.

Running mechanics, shoe changes and training errors are most commonly contributing factors to CMC injuries and increasing the strength of the calf complex can assist in improving the load tolerance of that tissue and reduce risk for injury.

The medial head of the gastroc is commonly injured in runners so here is a nice way to train that gastrocnemius back up and slowly progress the exercises to increase the load tolerance of the calf.

The exact progression of exercises and return to running must be individualized to each person. Tissues respond positively to moderate progressive loads so increasing that tissue tolerance is a must.

As you are in the acute phase the first few exercises will be appropriate:

Isometrics: Can be analgesic can slow muscle atrophy and reduce any swelling. Restore normal muscle recruitment improve contractility, endurance and load tolerance. 5 reps of 30-45 second holds, start with two legs and progress to one.

When there is still some discomfort and weakness start with double leg heel raises to keep the muscle moving, promote blood flow, add some tension and improve healing

Double leg heel raises: includes the contraction and relaxation phase and the muscle complex moves through a greater range of motion. Goal is to perform 3 sets of 8-12 reps with good control.

Double leg heel raises with weight: Progress as tolerated to add increase load.

Subacute and progressive loading phase:

Tissue sensitivity has decreased and the tissue is ready for progressive loading to increase tolerance and reverse pathological tissue changes

Progress to single leg heel raises and again add weight as tolerated

In the later stages of rehab plyometric activities need to be reintroduced to ensure that the injured runner is tolerant to the loads and movements similar to the loads and movements experienced while running.

A safe and gentle way to reintroduce plyometrics is to start with the beginner hops without actually leaving the ground. This allows for the stretch shortening cycle to be introduced to the calf but at a lower load. Goal is to perform 4 set of 20 seconds.

As the runner gets stronger and more confident they can start to play around with leaving the ground and progress to full double leg hopping at various heights

Goal: progress to 60 seconds hopping on both legs, add in side to side and forward/backwards hopping to challenge the frontal and sagittal planes.

Once the runner can tolerate these you can progress to single leg hopping. Single leg hopping can be performed in once spot to start and then progressed to forward/backwards and side-to-side to work into the frontal and transverse planes.

At a certain point the runner will also be able to gradually reintroduce running. This can be done with a run/walk style of programming and will be specific to that individual and modified as needed.

Check out these exercise videos on Instagram or by clicking the link here

Are you an injured runner and aren’t sure how to get back after an injury? Stop guessing and let’s assess. Schedule your free talk with a doc, Dr. Rebecca Smith, PT, DPT, today by clicking the link HERE or clicking the button below.

Rebecca@corevaluesptorlando.com ⁣⁣⁣⁣

corevaluesptorlando.com⁣⁣⁣ ⁣⁣⁣⁣

407-476-6613⁣⁣⁣ ⁣⁣⁣⁣

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Core Values Physical Therapy: Empowering athletes and active adults to take ownership of their health and invest in the future of their bodies⁣⁣⁣⁣⁣⁣⁣

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The Core Values 3 step process:⁣⁣⁣⁣⁣⁣⁣

1. Calm the injury down⁣⁣⁣⁣⁣⁣⁣

2. Find the specific cause that is contributing to your problem⁣⁣⁣⁣⁣⁣⁣

3. Build you back up and teach you how to prevent it from coming back

This is not medical advise and is for educational purposes only. This is not intended to diagnose or treat. Please perform at your own risk⁣⁣⁣