Do you have pain when running? Q and A at Fleet Feet with Dr. Ron Miller of Pursuit Physical Therapy

Do you experience pain with running?

This is not the time to have a running injury in the middle of training season.  If you are having pain with your training, stop into Fleet Feet Orlando this Saturday November 2nd 11am-1pm and next Saturday November 9th for 11am-1pm for a FREE question and answer period.  Dr. Ron Miller will be there to answer all of your questions regarding your injury.  Don't miss this free opportunity!

For more information about Pursuit Physical Therapy, our running injury program, and what others are saying about us visit PursuitTherapy.com.

Are you tired of running in pain? Let me tell you how I went from not running, having knee pain at week 1, to running 9 miles pain free in week 2!

So, I have been wanting to get back into running lately and hopefully to run in my first half marathon in 2 months.  I used to be a very active runner but have not ran seriously in the past 4 months, with an occasional 2 miles run.  I decided to get active and more involved in local running groups and have joined USA FIT Orlando as a member and a sponsor.  2 weeks ago I committed to running a 9 mile run with a patient of mine and with the group.  What was I thinking?  At 1 week, I attempted to run 6 miles after a few small pain free runs, and experienced an acute flare up of left knee pain.  3 days later, I was able to run 9 miles pain free!

This case shows the importance of addressing your running pain early and to solve the problem of your pain, not to treat the pain.  So what caused the left knee pain?  Eventhough, I had knee pain, I did not have a knee problem.  My problem, or the true cause of my pain, was left hip muscle weakness.  My whole left leg is weaker when compared to my right leg.  My left hip muscle weakness was causing altered knee biomechanics at my knee, thus resulting in patellar tendon pain, during, after, and for 2 days after my run.  Below is a picture that shows an example of what occurs with hip muscle weakness and its result at the knee.

I also had trigger points in my left quad and lateral leg.  The cause of trigger points is a topic for another blog posts, but when overloading a weak muscle, trigger points occur, and can have an affect on my knee pain.  Many people attempt stretching, but stretch of my IT band was not my problem.  My bigger problem was that I was scheduled to run 9 miles in 2 days but I was having left knee pain still, even 2 days after my run.  So what did I do to get pain free in 2 days and be able to run 9 miles pain free?

1)  2 days of rest

I did not continue to run in pain and just hope that the pain would go away.  Another thing is, DO NOT TAKE A PAIN RELIEVER OR ADVIL AND RUN.  This is a definite DO NOT DO for all of my runners.   There are numerous side effects of taking anti-inflammatories when running.  If I would have ran in pain I would have just exacerbated my pain and then I probably would have not been able to run my 9 miles in 2 days.

2)  Avoid over training

Simply stated.  No need to train in pain.

3)  Addressed the cause of my pain

I immediately started foam rolling to my lateral left leg and left quad to resolve the trigger points.  I started to address my left hip muscle weakness with exercises at home and in the clinic.  I also added some eccentric training to my left quad in a pain free range of motion.  This was correcting the cause of my pain.

http://www.youtube.com/watch?v=nsZiCStiJqg&list=PLwLS88Fgo0BkQ0Yre4XbsnOymp9NDC0yx&index=2

On Saturday morning, 3 days after my injury, I was pain free but I did not want to re-aggravate my injury.  My goal was just to complete the 9 mile run pain free since I have just started running and was not trained.  I was not concerned with my time but just wanted to complete the distance and workload.  I ran a 4 minute run, 1 minute walk for 9 miles.  I completed the run pain free and had no complaints!

At Pursuit Physical Therapy we specialize in the treatment of running injuries and we understand what it takes and the importance of training for a race.  There is no need to run in pain, and if addressed early, you can solve the problem that is causing your pain and get back to pain free running in just a few days.  We have also designed a proven Running Injury Program specifically for runners!  Feel free to call us at 407-494-8835 to schedule a consultation or visit us at PursuitTherapy.com today!  Get back to pain free running now!

5 Tips for Pain Free Running: Avoid Heel Strike

1.  Avoid Heel Strike

Many beginner runners ask me how they should be running.   Running training should be focused on 1 of 2 things:  1)  injury prevention or 2)  performance.  So the main purpose of this post is to focus on injury prevention and treatment.  So I promote runners to avoid a heel strike and to try more of a mid foot strike when running with pain or recovering from an injury.    Landing with a midfoot strike has been associated with decreases in peak impact loads and a decrease in knee pain (patellar-femoral symptoms).  Below is a diagram from a breakthrough article in Nature   that shows landing forces with different striking patterns.

Notice the lack of the sharp increase spike with a mid foot strike.  One of the main points to take away from the article is the decrease in force and lack of transient impact with strike with a mid foot strike.  This difference and benefit of barefoot vs shod running is for another post, but these two articles show great evidence to help support a mid foot strike to help prevent injury and decrease impact forces to the legs.   I personally tried this and loved the way it feels when running vs with a heel strike. Tune in next week for Tip #2!!!  For more information about running injuries, our Running Injury Program, and about Pursuit Physical Therapy, call us at 407-494-8835 or visit us at PursuitTherapy.com.  Exercise is medicine!

Regards,

Ron Miller, DPT OCS

Pursuit Physical Therapy on the Radio! Tune into am 740 The Game

Tune into am 740 The Game from 9am-12 throughout the week, starting labor day weekend, to hear the new Pursuit Physical Therapy radio commercials!  Also, on Fridays, we will have a call in live-talk and ask a question to our very own Dr. Ron Miller about sport injuries, rehab, and prognosis of injuries.  Visit www.thebeatofsports.com or 740 The Game for more information.  For more information about Pursuit Physical Therapy, our specialty programs, and what we can treat, visit us at PursuitTherapy.com

Running Injury and Heel Pain Program!

Do you ever wake up with pain in the heel of your foot first thing in the morning? Do you ever get heel pain when running or just pain when running? If so, you may have plantar fasciitis, the most common type of heel pain.  Many running injuries and heel pain can easily be prevented with the proper treatment and education.  We have designed a proven and evidenced-based running injury and heel pain program that allows patient to get pain free in fewer visits!  What does this program entail?  

1.  Evaluation with accurate diagnosis and with prognosis

2.  4 Step Recovery Treatment Plan

3.  1 hour treatment sessions with One-on-One Patient Care with Board Certified Specialist

4.  Individualized Home Recovery Program

5.  Free pair of shoes at Track Shack or Fleet Feet!

6.  Final visit to running shoe store with Dr. Ron Miller!

7.  2 month consultation period after completion of program

8.  No surgery! No Injections

This is the most complete evidenced based program yet! For more information visit us at www.PursuitTherapy.com or call us at 407-494-8835.  Don't be in pain any longer and get back to doing the activities you love!

Simple Tips to Preventing Golf Injuries

Here are some simple changes and adjustments that you can make to help prevent golf injuries:

1)  Proper Club Fitting

Proper fit clubs can decrease stress to your body during the golf swing, help avoid poor swing biomechanics and avoid altered postures.

2)  Play Golf Consistently

I don't think most golfers will have a problem with this one.  Playing golf consistently will avoid long times of breaks and golf related activities

3)  Push your Golf Cart

Pushing your cart instead of pulling will cause less stress and torque to your body and help prevent injury

4)  Use a Longer Putter

This may decrease stress and strain while putting and avoid increased flexion when playing around of golf

5)  Use a Dual Backpack Strap

Carrying a golf bag with a single strap may be hazardous to the low back, shoulder, and ankles.  Using a double back strap will allows for proper distribution of weight across both shoulders

6)  Warm up prior to playing golf

A 10 minute warm up prior to playing golf has shown a >50% decrease risk of injury.

Making some simple adjustments can help prevent injuries when playing golf and help you enjoy pain free golf.  For more information contact Pursuit Physical Therapy at 407-494-8835 or visit us at www.PursuitTherapy.com, and check out our Golf Treatment Program that analyzes golf swing analysis, movement screen, injury prevention, and rehabilitation to address any golf related injuries and injury prevention.  Get back to a pain free golf swing today!

Fit Body Boot Camp Orlando and Injury Prevention

Are you a member of Fit Body Boot Camp Orlando?  Fit Body Boot Camp is a new fitness and weight loss training method that is sweeping the nation.  I had the opportunity to attend a training session at the Orlando location, and I love the training style!  This is the perfect workout: high intensity, total body involvement, functional movements, cardiovascular, and overall a short duration (30-45 minutes).  This is the perfect workout to help you lose weight, decrease body fat, and maintain muscle, and you don't have to plan anything!  Just show up and the trainers will take care of the workout.  I thoroughly enjoyed the workout even though my legs were sore for days!  Great job to Kerry and Andrea for opening a great gym, for their community involvement, and for spreading health and fitness throughout Orlando.

Proper biomechanics and flexibility is going to be essential to help prevent injuries from occurring with this type of training.  Just for example when squatting or even with a deep squat, you must have the proper flexibility and strength to complete the task with proper form.  When form and biomechanics become poor, this may increase the risk for injury.






Below is an example of a functional deep squat that you should be able to perform without any compensation.  How many of you can perform this?

This training may also predispose people to getting many overuse injuries such as knee pain, foot pain, and other tendinitis injuries.  Proper stretching, warm-up, and again flexibility will all be essential to help also decrease injury rates.

So what can you do to help prevent injury when training hard to reach your personal goals?  Here are 5 strategies you can do to decrease your chance of injury:

1)  Warm-up prior to high intensity workouts.  A simple 5-10 minute light warm-up should be fine.

2)  Stretch involved muscles.  Such as calves, hamstring, and quad muscle.  Stretching should be done for a 30-90 second hold!  If you do not like to stretch foam rolling is also a great way to reduce trigger points in muscle, increase flexibility, and decrease pain.

3)  Avoid Over Training.  Especially, if you have just started working out.  Slowly progress yourself to 3x a week and continue until you can perform training 4-5x a week.  Weight loss from decreased body fat does not occur over 1-2 sessions.  If it does, it is probably just water weight.  It takes a long time(> weeks) and your are changing your lifestyle so there is no rush to over train.

4)  Be aware of joint pain vs muscle pain.  Muscle pain is OK and this is just something that comes with exercise and training.  FUN FACT:  The muscle soreness the day after the workout is not lactic acid build up.  Lactic acid is removed within hours after your exercise.  The soreness the day after is called DOMS (delayed muscle soreness) and it is caused from muscle damage from exercise with is necessary for your to get stronger.  If you experience joint pain consult your local medical professional, example Pursuit Physical Therapy!, sooner rather than later.  The sooner the better and the more chronic the pain is the longer it takes to get back pain free!

5)  Follow a healthy diet with plenty of sleep.  It is amazing to see how the body feels and heals as you continue to train hard, when you eat healthy vs bad.  Has anyone ever done the same workout multiple times but when you happen to drink alcohol and eat bad after, how much worse and sore you feel the next day?  There is a difference.  Eat as a function of attaining your goals!

I hope these can help you decrease your injury risk and allows you to keep training at Orlando Fit Body Boot Camp!  For more information about Fit Body Boot Camp Orlando visit their website at http://www.fitbodybootcamp.com/fl/orlando-fitness-boot-camp/ and check out their client appreciation night on August 2nd here.  Pursuit Physical Therapy and Dr. Ron Miller will be there to answer any questions regarding proper training techniques, current pain and symptoms, and to perform free functional assessments.

Do you have pain when Running? Do you have a plan to treat your injury?

Do you experience pain from running?  Does your pain persist after you stop running?  The answer is to address the problem that caused your injury and get it treated!  Don't cover up your pain with medications and other "tricks" and run through you pain.  Definitely do not run while taking NSAID medications, as there can be many side effects and health concerns associated with this.

“There is no magical drug, machine, shoe, tape, or tip that will fix your injury”
-Bruce Wilk, The Runner’s High and author of The Running Injury Recovery Program 

At Pursuit Physical Therapy, we have created a Running Injury Program that is designed to specifically for runner's and to get them back to pain free running as soon as possible.  We have a 4 step process that will give you a guideline to return to running.  Feel free to visit our website for more information at www.PursuitTherapy.com and even sign up for our 5 Steps to Resolve your Heel Pain handout!   We want to get you back to pain free running and solve your problem now!

A Runner's Clinic at Fleet Feet Orlando with Ron Miller of Pursuit Physical Therapy

Come join Ron Miller of Pursuit Physical Therapy on August 8th at Fleet Feet Orlando for a Runner's Clinic about the BIG 3 running injuries!  RSVP at the Fleet Feet website.  Get back to pain free running now!

Top 10 Reasons to go to Pursuit Physical Therapy: BONUS: Better Outcomes, Faster Results, Period!

BONUS:  Better Outcomes, Faster Results, Period!

Perhaps the most essential and significant reason for any patient to not hesitate in seeking out therapy at Pursuit Physical Therapy is quite straight forward and unpretentious—Patients see better outcomes, exponentially quicker results, and most important to the patient, Pursuit Physical Therapy adapts and customizes to each individual to ensure they get back to their activities and passions faster, pain free!  We get results!

For example, here is a case:  A patient complains of left Achilles pain after Cross Fit training.  Patient was pain free after one treatment session and home exercise program by the end of the 1st week.  After the second treatment session, the patient was pain free with exercise, and returned to Cross Fit workouts and running pain free at the end of the 2nd week.  Pain free and back to training in 2 weeks!  Visit www.PursuitTherapy.com for more information and call us at 407-494-8835 to schedule today!

  

How do you Diagnose Plantar Fasciitis?

The diagnosis of plantar fasciitis can be made with a reasonable level of certainty in the clinic by an experienced clinician after a history and examination.  Diagnostic testing (x-rays and MRI) usually do not need to be ordered to diagnose plantar fasciitis and normally should not be ordered unless the diagnosis is uncertain or the patient is not responding to treatment.

Signs and Symptoms of plantar fasciitis are:
1.   insidious onset of pain under the plantar surface of the heel upon weight bearing after a period of non-weight bearing
2.  This pain in the plantar heel region is most noticeable in the morning with the first steps after waking or after a period of inactivity
3.  In some cases, the pain is so severe that it results in an antalgic gait.
4.  Heel pain will lessen with increasing levels of activity (ie, walking, running), but will tend to worsen toward the end of the day
5.  The history usually indicates that there has been a recent change in activity level, such as increased distance with walking or running, or an employment change that requires more time standing or walking
6.   In most cases the patient will initially complain of sharp, localized pain under the medial heel as in the picture above

There are some other differential diagnoses that can be ruled out during the examination that include:  stress fractures, bone bruise, heel fat pad atrophy, nerve entrapments, and referred pain from the lumbar spine.

The good news is that >80% of plantar fasciitis symptoms resolve within a 12 month period.  But who wants to wait 12 months to be pain free!  Schedule your visit at Pursuit Physical Therapy 407-494-8835 and resolve your heel pain now!  No injections, no medication, no surgery, no problem!  We can get you back to the activities you love pain free!

What are the Risk Factors that can cause Plantar Fasciitis?

The cause of plantar fasciitis is multi-factoral and actually poorly understood, but here are some risk factors that have been proven to contribute to the cause plantar fasciits:

1.  Decreased ankle range of motion.  A decrease in ankle dorsiflexion has been shown to be a high risk factor for plantar fasciits.  This can be caused by dysfunction at the ankle joint or due to calf muscle tightness.  Many people are lacking the amount of range of motion(ROM)  needed.  The picture below shows an example of normal ROM

2.  Obesity and being overweight.  Increased body weight is a well established risk factor for plantar fasciitis because the increase weight causes and increase in stress to the plantar fascia.

3.  Work related prolonged standing.  Individuals who spend prolonged period of standing, walking, and work related weight bearing on their feet have an increased risk for plantar fasciitis.

4.  Training errors.  Overtraining, plyometrics, too rapid increase in distance, increase in intensity all can lead to the onset of plantar fasciitis.










There are many risk factors that many people believe to be the cause of plantar fasciitis but the presence of these factors to not always lead to the development of heel pain and plantar fasciitis.  Some of these factors are:

1.  Having flat feet or a high arch.  The research on this is not always consistent.  The risk of developing plantar fasciitis may increase with having a high arch or flat feet.  This is not always the cause though and this means that just because you may have flat feet does mean you will get plantar fasciitis.  Below is a picture of flat (hyperpronated) foot.  You can see how the arch is collapsed against the floor.

2.  Having a bone spur.  The presence of a heel spur is common is people without heel pain, and again, just because you have a bone spur on an x-ray does not mean that you will get heel pain or plantar fasciitis.  Bone spurs have found to be more common in older individuals, people with osteoarthritis, and those who are overweight.

Summary:

By understanding these risk factors you may be able to prevent plantar fasciitis from occurring or at least understand what factors have led you to experience your heel pain.  Remember just because you may have one of these factors doesn't mean you will get plantar fasciits.  Stay tuned to our next posts about diagnosis, prognosis, and what treatments are the best for plantar fasciitis.  If you are experiencing heel pain or plantar fasciitis symptoms contact Pursuit Physical Therapy now and get out of pain!

Here is an example of what one of our patients said who was experiencing plantar fasciitis:

Great physical therapist, I've tried EVERYTHING for my plantar fasciitis and gotten numerous injections, but Ron was the first doctor to actually look at my foot and asses the actual cause and show me how to fix it rather than just tell me to stop running and have it come back again!  I would definitely recommend him to anyone with any kind of sports injury!  He's great, PLEASE go see him!!!! He will be worth your time.  Best doctor I've seen hands down!  My foot is so much better! I'm running virtually pain free for the first time in 6 months.

What is Plantar Fasciitis?

Have you ever experienced a sharp pain in the bottom of your heel when you step out of bed first thing in the morning?  Do you get heel pain when you run or from a long day standing at work?  Well, it is most likely a condition called plantar fasciitis and it is estimated over 2 million people experience plantar fasciitis each year.  The plantar fascia is a tight band of connective tissue that supports the arch of the foot.  Plantar fasciitis is thought to be caused by biomechanical overuse to the plantar fascia, thus creating microtears at its insertion of the heal.  Some experts have deemed this condition not an true tendinitis, implying that its etiology is a more chronic degenerative process versus acute inflammation.  Usually people will complain of a sharp pain on the bottom of their foot or pain closer towards their heel.

People state that walking, first stepping out of bed in the morning, walking after prolonged sitting, and running will cause their pain.   Usually people will report a decrease in pain after a warm-up or some stretching.   If you have a questions or concerns about plantar fasciitis feel free to visit www.PursuitTherapy.com or call 407-494-8835.  Stay tuned to see what are risk factors, diagnosis, and what is the best treatment!

Top 10 Reasons to go to Pursuit Physical Therapy: 8. We Save You Time and Money

8.  We Will Save You Money and Time

Here at Pursuit Physical Therapy, we are dedicated to saving our patients their valuable time and money.   If you compare our private pay model vs an insurance based model, you still save money and time with our treatment approach.  Remember, there are no co-pays, unmet deductibles, and no miscellaneous bills with us.  Just one flat rate and you get better results in fewer visits.  If there is a possible way to use insurance benefits—such as flexible spending accounts—or for possible reimbursements, we will assist you to the absolute fullest ability. We can provide you with detailed paperwork for submitting claims to insurance companies. Also, there are applications available to apply your physical therapy sessions to your insurance deductible.  Call 407-494-8835 or visit www.PursuitTherapy.com to schedule today!

Why Do I Have Low Back Pain When I Golf? Can Physical Therapy Help?

This is for all of the great fathers out there for Father's Day, who are probably on the golf course right now, and who will make it home in time to watch the end of the U.S. Open!  Are you noticing that your golf scores are higher lately?  Are you starting to get low back pain (LBP) when golfing?  Have trouble beating your friends on the gold course now because of LBP?  Well, this is the blog post for you regarding golf and low back pain!  Do you know that common site of injury among professional and amateur golfers is the low back. Low back pain (LBP) is the most common injury and makes up roughly 25-50% of golf injuries.

Many of you are probably on the golf course right now with your friends, but what do we know about golfers with low back pain? Research shows that golfers with LBP have poor neuromuscular control to rotate at increased speeds. This is essential to a complex and powerful movement such as the golf swing. This is why after experiencing LBP it is essential to start physical therapy to retrain this neuromuscular control associated with the golf swing and to make sure your LBP does not return.  Not only is it about the low back when talking about golf and LBP, but what occurs at the hips and pelvis is also relevant.  Research has shown the low handicap golfers have increased pelvis rotation speed, increased hip muscle strength than high handicap golfers!  Both of these factors can be addressed with physical therapy.

The modern swing (vs the classical golf swing) is more popular with most golfers due to its increased power and distance produced. Increasing the hip to shoulder ratio with the modern swing can be problematic due to the increased stress placed on the low back, which may also predispose you to LBP. Also, the increase lateral bending and "reverse C posture" with your follow-through, as shown in the picture below, may also cause you to have LBP. 

These are factors all can be identified, treated, and be prevented from causing you to have LBP when playing golf.  Golfers with LBP have been shown to have decreased trunk and hip range of motion (ROM). What do you think happens when you perform a golf swing but you don't have enough ROM? The body will compensate at another joint causing increased and unwanted stress/load to the adjacent joint, predisposing it to injury.  For example, look at the importance of lead hip internal rotation needed for your follow through in this picture below. This could be one of many factors that is causing your LBP.

Many golfers suffer from LBP and this is something that physical therapy can help with.  Doing something as simple as warming up for 10 minutes prior to golfing can decrease your chance of injury by 50%!  Don't settle for having LBP ruin for golfing scores and the time you should be enjoying.  Call Pursuit Physical Therapy today at 407-494-8835 and be seen by our Titleist Performance Institute Certified clinician now!  We can help treat your LBP, address any biomechanical impairments that are influencing your pain, and get you back to pain free golfing! 

Visit our website at www.PursuitTherapy.com and even see what our golf specialty program has to offer.

Top 10 Reasons to go to Pursuit Physical Therapy: 7. Direct Access and No Physician Script Needed

7.  Direct Access and No Physician Script Needed

It is a misconstrued concept that a patient in pain or discomfort must first see a medical physician to be evaluated and then referred to physical therapy.   In Florida you have direct access so you can go directly to your physical therapist and there is no need to deal with waiting weeks to be seen, spending money on unnecessary diagnostic imaging, and taking another pain medication.  Patients have direct access to immediate care at Pursuit Physical Therapy—there is never a need to waste up to two weeks  or more on an ‘assumed diagnosis’ as well as the costs to cover co-payments and specialist fees. If you have an ache or ailment that is inconveniencing your normal routine, don’t settle for the pain any longer because Pursuit Physical Therapy can see you right away, no need to wait—and the only specialist you will need to see, is ours.  Call 407-494-8835 or visit www.PursuitTherapy.com today for more information

Top 10 Reasons to go to Pursuit Physical Therapy: 5. Patient Satisfaction

5.  Passion for Patient Satisfaction

Patient care and satisfaction will always come first, guaranteed. At Pursuit Physical Therapy, each specialist is continuously passionate and apprehensive of their patients as well as their individual requirements and personal ambitions. Our specialists stay up to date with innovative techniques and most current physical therapy approaches possible; passionately, continuously, striving for optimal patient care is fundamental within this practice!  Look at what are patients are saying about their experience at Pursuit Physical Therapy on our testimonials, Yelp, Google Places, and Facebook pages.