The Classic Ankle Sprain – How To Diagnose, Treat, And Avoid Reoccurrence

There are a few things in life that make me consistently sad. Movies where an animal gets hurt make me sad. Closing down the outdoor pool after Labor Day makes me sad.

When patients tell therapists “oh, I just have weak ankles”, we get sad. Ankles don’t do pull-ups. Ankles don’t fuel up on protein powder and creatine. Ankles don’t faint in the sun because they have the vapors. People don’t suffer from ankle pain simply because their ankles are inherently just “weak”.

What is true is that previous incidence of ankle sprain is the biggest risk factor for future occurrence. What does that mean? If you have rolled your ankle once, you are statistically more likely to have a second, third, fourth (you get the picture) ankle injury. Seems kind of cruel and unfair, right?

However, just because something is statistically true doesn’t mean it will actually be true for you. Statistically, as an American woman in my 30s, I will have 1.87 kids. Actually, I have 3 cats and 5 chickens. Statistically, I will spend $1,700 on clothes per year. Actually, I can tell you that I hate, hate, HATE shopping. I signed up for Stitch Fix for a hot 3 months and still found the act of trying on clothes in the comfort of my own home time consuming, annoying, and just a big fat hassle. Statistically, I will live to be 82yrs old. Actually, if you remind me a couple of decades from now, I’ll invite you to my 90th birthday party and we will eat funfetti cake with extra frosting. Statistics are just that- statistics. They are helpful for knowing trends and then, if those trends are adverse, taking steps to avoid them.

So, you’ve had an ankle injury before? Don’t be a statistic. Know what happened, how to treat it, and how to buck the trend. Knowledge is Power, remember?

A Little Ankle Anatomy

First, it is helpful to know a little bit of basic ankle anatomy:

mortise-and-tenon jointThe ankle is considered a mortise-and-tenon joint, which is a woodworking term that describes the type of fit shown below. The “tenon” is comprised of the bones of the shin: the tibia on the inside and the fibula on the outside. These long bones house the “mortise”, or a smaller bone called the talus. The talus is dome shaped, thankfully, which allows for plantarflexion and dorsi-flexion (pointing and flexing, respectively) of the ankle.

The ankle is stabilized by the tendons of many muscles, most notably the posterior tibialis, anterior tibialis, peroneus longus, and peroneus brevis. Ligaments (which connect bone to bone) also provide further stability on the inside and the outside of the ankle as they fan away from our ankle bones.

An ankle can be injured in a variety of different ways, thus causing a variety of different symptoms. However, the most common ankle injury is called an inversion sprain. It occurs when the ankle quickly and unexpectedly rolls to the outside, hence its colloquial term “a rolled ankle”. The vast majority of all ankle injuries are inversion sprains…but why?

How An Ankle Sprain Happens

rolling your ankleImagine that you are rushing down the stairs, laundry basket in hand, and you accidentally step on an unexpected object, like a toy. Due to the shape of the bones, the tenon and mortise joint has the most laxity when the ankle is plantarflexed (toe pointed).

And remember those two long bones, the tibia and fibula? Well, the fibula extends further down toward the ground than the tibia. Therefore, as you step onto the toy with a pointed foot, your lose ankle wobbles. Your foot is literally forced to the outside by the relatively longer inner bone. This places a quick and potentially injurious stretch to the tendons and ligaments of the outside of the ankle.

Replace that toy with a hidden tree root during your trail run, a clump of raised grass on the soccer field, or an unexpected rock at the bottom of a curb. The same sequence of events could occur.

The ATFL is the thinnest ligament and thus the most prone to injury during an inversion ankle sprain. However a number of soft tissue structures can be over stretched, including the posterior talofibular ligament (PTFL), the calcaneofibular ligament (CFL), and the peroneal longus and brevis tendons. Ligaments can be partially or completely torn, and an ankle sprain is usually graded as type I, II, or III, depending on the severity of injury. In very severe cases, bones of the ankle can literally “knock” together causing a bone bruise. Tendons can also be stretched so quickly and forcefully that they can tear a small piece of bone off from where they attach. This is called an avulsion fracture.

All of this can result in swelling, bruising, and difficulty walking or performing your favorite hobby without pain. Scary, right?

Ankle Sprain Treatment

Once you know you have injured your ankle, and that you DON’T want to become a statistic, the next step is to get treated. The most common treatment techniques that physical therapists use to speed recovery and reduce pain caused by inversion sprains are:

  • Joint and soft tissue mobilization. An inversion sprain can cause small displacements of certain bones in the foot, most notably the fibula and the navicular bone. Restoring normal movement and positioning of these joints with hands on treatment can be extremely helpful in reducing pain and restoring normal movement patterns. Additionally, skilled manual therapy to the overstretched soft tissue can reduce inflammation and speed the healing process.
  • Taping. Certain taping techniques can be very beneficial in reducing pain after an inversion sprain, and I am not talking about the big bulky techniques that require $5 worth of athletic tape per attempt. The most effective techniques require a few simple strips and can be per-formed on your own if you have a therapist who is able to teach you.
  • Gentle strength and ROM exercises. It is never advisable to continue pushing through pain; if you are experiencing ankle pain with running, cycling, working out, etc. you need to avoid that activity until you body has healed sufficiently. However in most cases, it is equally un-advisable to immobilize your ankle and do NOTHING. This will cause joint stiffness, muscle atrophy, and apprehension of movement that will make your return-to-normalcy much longer and more cumbersome. If you can do a certain range of motion pain free, you should do it! A skilled physical therapist can help you find strengthening and range of motion exercises that are appropriate and beneficial for your specific injury.

Ankle Sprain Prevention

The next step? You guessed it…PREVENTION! Don’t buy into that “you just have weak ankles” nonsense. You don’t have a weak ankles, you have non-rehabilitated ankles. The most common interventions we teach our patients in order to avoid re-occurrence of ankle sprain include:

  • Balance Training. Studies show that unconscious proprioceptive deficits occur after acute ankle sprains. English translation? One’s ability to maintain their balance on an injured leg suffers greatly after an ankle roll. Why does this matter? Keep in mind that an inversion sprain is basically a quick loss of balance, resulting in a twisted ankle. Having increased difficulty maintaining one’s balance can result in another ankle sprain, and then another, and then another. That’s why previous incidence of ankle sprain is the highest predictor of future sprain. Disrupt the cycle! Balance training must be pain free and progressive, meaning that it should get harder as your ability improves. If you sprained your ankle 1 month ago, you shouldn’t be doing the same exercise that you did the day after you injured it. Consult with your physical therapist to build a program that is specific to you.
  • Hip Strengthening. Hip strength is a HUGE component of balance. Small muscles in your hip work to fine tune the placement of your lower leg in space, keeping it aligned as it should be. When you step on that toy, that tree root, or that unexpected rock these hip muscles react to correct your center of balance thus preventing a wobbly foot and potential ankle roll. These muscles can be trained to be quicker, stronger, and more reactive. Therefore balance, like strength, can be improved through training. When patients tell me “I have bad balance” what I really hear is “I have poor reactive hip strength”.
  • Core Strengthening. Core strengthening compliments balance and ankle injury prevention just like hip strength does. In fancy PT terms we lump this training together and call it “lum-bopelvic control”.

Of course there are other ways that one can injure their ankle, and thus other ways that ankle pain must be diagnosed, treated, and prevented. Stay tuned for our next blog post “I Didn’t Sprain My Ankle, So Why Does It Still Hurt?”

Heal Your Body, Strengthen Your Life

Stay healthy, stay active, and don’t be a statistic.
Your friends at Jackson County Physical Therapy

Diastasis Recti:

The Five Things You Need To Know About Abdominal Injury

diastasis rectiLet me preface by explaining what this blog post is NOT- this blog post is NOT a “you can do it!” rah-rah suggestion to “get your body back” and/or “drop that baby weight” for a flatter tummy, a bathing suit body, or any other ridiculous-ness. You just grew and birthed a human being. Nice work. I think you have the right to focus on your new life, your own well being, and the health of your child rather than the visual appearance of your stomach.

What this blog post is- this blog post is an explanation of how abdominal injury can occur during pregnancy, how it can be identified, why it can pose a risk to your long term health, and what you can do to prevent that.

Phew. Now that we have that clarified, let’s move on.

Pregnancy and childbearing is an extreme sport. I am still filled with wonder as to how my mother underwent an incredibly difficult 18hr labor with my older brother, and then was mentally and physically able to turn around and do it again with me. Shaun White’s got nothing on you, mom.

1. What is a diastasis recti?

During this 9 month extreme sporting process, the abdominal muscles undergo an immense amount of strain as a woman’s belly grows. The connective tissue (or linea alba) of our most superficial abdominal muscle (the rectus abdominis) can separate under this strain. When the linea alba separates to an appreciable extent this is called diastasis recti.

Diastasis recti occurs to some extent in approximately 2/3rds of all pregnant women, which is why this blog post is focused on that population. However, diastasis recti can also occur in men and newborn babies. Should this guy be concerned about his abdominal separation? Yeah, yeah he should. So all you Y chromosomes, read on…

2. When does diastasis recti occur?

Diastasis recti can occur anytime the linea alba is stressed abnormally and repetitively, such as during pregnancy. It can also occur over time with heavy weightlifting, yo-yo dieting, or after doing certain exercises with poor form (cough cough, crunches, I’m looking at you).

3. How can I tell if I have diastasis recti?

Diastasis recti is relatively simple to test for. Start by lying on your back with your knees bend and your feet flat on the floor. Keep your head and stomach muscles relaxed as you palpate your abdominal muscles along your midline. Start at your chest and work down toward your belly button, scanning for gaps or changes in the muscle.

Next, place two fingers just above your belly button with your fingers pointing straight to the floor. Lift your head off of the ground a small amount, which will naturally and gently engage your core. If your fingers sink into a hole, repeat the movement. Count how many fingers fit lengthwise into the hole.

1-2 fingers is considered normal, 2-3 fingers is considered a mild diastasis recti, and 4-5 fingers is considered severe.

Confused? Check out these short videos to self test. The first video shows how to test, but does not show a diastasis recti. The second shows a patient who does have one.

4. Why should I be concerned if I have diastasis recti?

The symptoms of diastasis recti extend far beyond the visual change in your stomach’s appearance. Diastasis recti can compromise the integrity of your core musculature leading to consequences such as incontinence, difficulty lifting, low back pain, and increased likelihood of developing a hernia.

If you have a diastasis recti, you can make your symptoms worse by performing certain movements or core exercises. It is therefore is essential to identify whether you have an abdominal separation, and take steps to reduce it.

5. Who can help with my diastasis recti, and how can I fix it?

In most cases, diastasis recti can be corrected with a very specific core and exercise routine. The details of one’s routine will depend on the depth, location, and severity of their abdominal separation. A non-specific, generic core routine may actually exacerbate your symptoms and level of separation. It is essential that physical therapist, athletic trainer, or knowledgable personal trainer guide your progress.

The good news? A little bit of knowledge goes a long way. Contact your trusted physical therapist and begin your recovery process today.

Heal Your Body, Strengthen Your Life
Your friends at Jackson County Physical Therapy

Why you don’t have sciatica

…and what you can do about it anyway.

sciatic nerve at pelvis
sciatic nerve at pelvis

I am going to come right out and say it without a sugar-coated intro. More often than not, “sciatica” is what your medical professional tells you you have when they are too distracted, busy, or unskilled to provide you with an accurate diagnosis.

Patients plop down on my table and announce “I have sciatica” as if they have acquired it like the common cold. Whenever this happens, I can feel the red wisp of annoyance start to travel through me. Not because my patients are being difficult, but because they have been grossly misinformed.

We assume as medical practitioners that an accurate description of a patient’s symptoms is somehow beyond that patient’s comprehension. We tell them they have sciatica because it is easier than taking the time to describe how strength, joint integrity, and soft tissue restriction may be causing a complex cascade of events that gives them pain. We prescribe them pills. We give them vague suggestions to lose weight, to improve their posture, and to avoid aggravating activities without any real direction. Anything to get them out of our office quickly and somewhat satisfied.

You have sciatica, sir. Next please.

Sciatica has become the medical equivalent of saying “pain somewhere below the belly button”. Imagine a scenario in which you are experiencing knee pain and schedule an appointment with your orthopedist. You cough up a hefty copay, spend the majority of your afternoon in the waiting room, and then your doctor waltzes in to poke at you a few times and announce “your knee has been hurting because you have knee pain”.

How angry would you be?

Yet when the diagnosis is a bit fancier and more medical sounding we accept it without hesitation. Sciatica. It’s so sexy and mysterious, how could we possibly question it?

Ask questions, my friends. Not only because knowledge is power, but because knowledge leads you closer to staying off of pain meds, resuming your favorite hobbies, and finding a successful treatment plan. Although they say that “any question is a good question”, we all know that some are undoubtedly better than others. So which questions should you ask?

1. What is sciatica?

What does sciatica actually mean? First, it is important to understand that sciatica is not a diagnosis; it is a broad, umbrella description of symptoms that one may experience when their sciatic nerve becomes irritated.

These symptoms nearly always occur on one side of the body, or are worse on one side than the other. They can include: radiating pain down the back or outside of the leg, a feeling of numbness and/or tingling in the leg or foot, weakness in the affected leg, pain with standing or walking, and pain with prolonged sitting. Symptoms of sciatica may or may not be accompanied by low back pain. In severe cases, loss of bowel and bladder control may occur.

Fun, right?

poor posture

2. What causes sciatica?

If this question popped into your head, GOOD FOR YOU. Why did your sciatic nerve become irritated in the first place? This can occur for a number of reasons, such as:

  • Compression or chemical irritation of the nerve. The sciatic nerve can become compressed as it exits your spine, specifically between L4 and S3. A herniated disc, an unstable spinal segment, a bone spur, or poor postural habits can all compress or irritate the nerve roots which comprise the sciatic nerve.
  • Myofascial guarding. The sciatic nerve can become compressed by the muscles that it travels near, under, and sometimes through. Muscle injury or stiffness in the quadratus lumborum, deep hip rotators, the infamous piriformis, or the lateral hamstring are common culprits.
  • Prolonged sitting. Sitting for long periods of time can compress the sciatic nerve at the ischial tuberosity (AKA “sit bone”) causing an acute injury to the nerve.
  • Poor movement patterns. This can include running form, walking form, or even the way that you may prefer to stand. Have you ever noticed that it just feels better to lean on a specific foot when you are having a conversation? Do you like to turn one foot out when standing in line, but not the other? Do you prefer to sleep on one side? All of these patterns can contribute to bodily asymmetries which change the stretch or compression on one side of your body.
  • Weak core or hip muscles. The muscles which stabilize your pelvis and lumbar spine also protect the sciatic nerve by maintaining a neutral length without unnecessary stretch, compression, or twisting. Weakness in these stabilizing muscles can predispose you to injury with repetitive or sustained activity like standing, biking, running, or walking.
  • Neural tension. Nerves need to slide and glide throughout your body in order to be healthy, happy, and well functioning. If nerves become bound down, adhered, or tethered at any point along their path we call this neural tension. Neural tension can eventually feel like general stiffness, fatigue, or ache in one limb. It can also give strength and sensation loss of the muscles and skin that the nerve innervates.

3. Why do I have sciatica?

The next question you should be asking is this; specifically, what unique factors are happening in your body that are leading to irritation of your sciatic nerve? And why your left side versus your right, or visa versa? Bodily impairment and pain is never random. It is never a coin toss. There is always a reason one body part hurts and not another and especially why one side hurts and one does not. Having a general idea or theory is essential to a full recovery.

A physical therapist is educated to evaluate your strength, range of motion, and movement patterns in order to help you determine the best treatment AND root cause of your injury. Repeat: root cause or your injury. The analogy is as follows- if you suffer a deep cut to a major artery you will want to apply pressure to slow the loss of blood (treatment) but will need to close the wound to solve the issue (root cause). You wouldn’t just go about your life tying and re-tying tourniquets about your nearly severed limb.

A physician will likely send you to a physical therapist anyway, so why not save yourself some extra time and an extra copay? In Oregon, you can come directly to a physical therapist without a doctor’s referral thanks to Direct Access law.

This is not to poo-poo the value of immediate symptom reduction. There are circumstances where medication may be completely appropriate. You have leg pain and are steadily getting better with physical therapy, but still need to go to work, raise your kids, and mow the lawn at some point this weekend? Yeah, I get that. There is no need to be a martyr all day every day. Sometimes medication and/or injections can help you do what you need to do while you find a more long term solution.

4. What can I do to treat sciatica without surgery or pain meds?

Symptoms of sciatic nerve pain can be very effectively treated with manual therapy and specific strengthening and stretching exercises. The specific exercises will depend on your unique posture, strength, mobility, and situation. However most programs tend to include:

  • core strengthening
  • hip strengthening
  • joint mobility work
  • neural gliding exercises
  • soft tissue mobilization
  • specific stretching exercises
  • activity modification

Surgery is very, very rarely indicated for symptoms of sciatic nerve irritation. I, for one, will avoid any surgery at any reasonable cost. That being said, if you are having loss of bowel and bladder control that is related to your leg pain, this indicates that compression to the nerve root is severe. In this case, your doctor will be able to guide you towards an appropriate course of action.

So faithful readers, understand that you do not have to live with pain. Understand that the diagnosis of “sciatica” is not an irreversible epidemic that you have no control over. Ask questions, get answers.

Heal Your Body, Strengthen Your Life
Your friends at Jackson County Physical Therapy

Foam Rolling – Mobility Work Or Masochism?

Foam Rollers
Foam Rollers

I find that many athletes think they need to use the foam roller as intensely as possible to produce the maximum amount of pain. After 30 seconds of pure agony, they put the foam roller back in the closet and consider themselves sufficiently “rolled” for the month. What a shame!

If this describes you, you need to read on.

Effective foam roller use can prevent injury, maximize performance, and improve your general well being. Episodic 30 second torture episodes will, well, only make you really hate foam rolling. Let’s create a healthy foam roller relationship full of mutual respect and understanding.

I think it helps to first understand WHY foam rolling is helpful. Consider this. A muscle is not a single rubber band that contracts uniformly. Rather, a muscle is a series of small units which can contract somewhat independently of each other. These units are called sarcomeres. Due to overuse, poor body mechanics, posture, etc. a cluster of sarcomeres can stay contracted forming a trigger point. Colloquially, most people call this a “knot”. A knot will shorten the length of the muscle as a whole, causing further deterioration of flexibility, joint mobility, and movement quality. A knot also has the potential to radiate pain to a different area of the body, similar to a nerve. A knot is NOT what you want! (you’re welcome, all you pun lovers out there)

Addressing these specific areas of muscle tightness with a foam roller can effectively prevent such symptoms. Furthermore, foam rolling BEFORE stretching may allow you to stretch further and more comfortably. Personally, after a 2 hour run or 5 hour bike ride the LAST thing I want to do is bend over and try to touch my toes. However, if I preface stretching with a gentle roll-session on my friendly foam roller? Heck yeah, that’s recovery at it’s finest, baby!

Now that you know why foam rolling is all the rage, you should familiarize yourself with The Foam Roller Kamasutra. There are multiple positions and techniques to address just about any muscle on your body. Know as many as possible! I’m a loud proponent of foam roller use and I’m constantly learning something new. If you are totally in the dark on how to use your cylindrical friend, consider making an appointment with your physical therapist for an educational visit that will benefit you for a long time to come.

So roll shamelessly in the middle of the gym floor! Embrace the weirdness of contorting yourself in your shortest running shorts! FOAM ROLL ALL THE MUSCLES!!!

Heal Your Body, Strengthen Your Life.
Your friends at Jackson County Physical Therapy

Creaky Knees Due to Osteoarthritis

To exercise or not?

If you clicked on this link you may be one of the millions of people in the United States that suffers from knee pain due to the development of osteoarthritis. Osteoarthritis is by far the most common type of arthritis and it is estimated to affect 302 million people worldwide with the most common region being the knee, hip, and hands. Now, you may have done some researching of your own to find out how to help your knee pain and gone down the rabbit hole on the internet to find some new creams or maybe YouTube stretches or exercises to help out. Unfortunately, most of these things probably didn’t have a positive long-term effect. Many people can relate and literally share the same aches or pains due to OA (osteoarthritis).

Knee osteoarthritis comes in various stages and different reasons. First, the most basic explanation of knee OA is the wearing away of the articular cartilage that lines the bones that make up your joint which are the femur and tibia. The degenerative process is progressive with resulting bone remodeling, synovial fluid inflammation (joint lubricant) and osteophyte (bone spur) formation but can be effectively managed without surgery if not already at a severe stage. You may have developed this arthritis over time without any injury or you had a prior accident causing trauma to the joint which set the stage for earlier formation of OA. Either way, Physical Therapy is an effective treatment approach to decrease pain and improve your ability to move.

Physical therapists are trained to be able to recognize and diagnosis knee osteoarthritis after an examination. We are able to individualize treatment plans that are unique to the presentation of the patient’s impairments and implement range of motion, strengthening, and flexibility exercises along with hands on therapy. Since OA is progressive it is important to establish an exercise program that prevents immobility without over stressing the joint. The most recent management guidelines for osteoarthritis of the knee, hip, and hand established by the American College of Rheumatology/Arthritis Foundation strongly recommended exercise for all patients.

Along with exercise, other categories that received a strong recommendation include weight loss, self-management programs, and Tai chi. Seeing your Physical Therapist will set you on your way to finding the right prescription of exercises so that you can effectively manage your condition and return to moving without knee pain. Summer is right around the corner and that means warmer days filled with hiking, biking, jogging, or whatever you enjoy. Schedule an examination with JCPT to give you the guiding force to set you on your way. Motion is lotion!

Heal Your Body, Strengthen Your Life
Your friends at Jackson County Physical Therapy

Kolasinki SL, Neogi T, Hochberg M, Oatis C, Guyatt G, Block J, Callahen L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey W, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello G, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research Vol. 72 No. 2, February 2020, pp 149-162.



One of the most common areas that we treat as physical therapists is the hip. In fact, patients often complain of back or leg pain which is truly a result of hip dysfunction. It is easy to overlook how many structures cross the hip, how high our hip bones travel, and how intimately related the joint is to our pelvis and lumbar spine.

Hip pain can range from sharp and intense to dull, achy, and omnipresent. These symptoms can arise from a sudden injury or developed over years. Hip pain can even present as low back or groin pain. The .cause and thus symptoms of hip injury differ greatly from person to person, however, the common theme is that hip pain is one huge bummer.

Although each individual’s injury is truly unique, we tend to see some common themes in patients who suffer from hip pain. If these tips help you, GREAT! If they do not fully resolve your symptoms, do yourself a favor and schedule an individualized physical therapy assessment. Keep in mind that hip pain is NOT normal, and you don’t have to live with it!

The five most common causes of hip pain:

1. An unlevel pelvis

an unlevel hip

She’s an incredible endurance athlete, but those hips don’t lie.

Patients often tell me “oh, I have one leg that is longer than the other.” Are you sure? Although it is possible for someone to have one leg with a femur that is actually longer than the other, it is uncommon. More often, muscles are tighter on one side or an individual stands in an asymmetrical posture which makes one leg seem longer. Do you have one leg that you typically like to stand on, and it just feels uncomfortable to lean on the other? Look down and see what that does to your pelvis. One side is up and one leg looks shorter, right?

Over time, muscles on one side can become short and tight and the pelvis can begin to elevate, rotate and/or shift to one side. This puts the hip joint and the associated muscles in a different position compared to the opposite hip. I always like to make the point that there is a reason that one side begins to hurt versus the other…it’s not just a coin flip! Determining that reason and addressing it is an essential component to recovery.

2. A tight psoas, or hip flexor

Not to be dramatic or anything, but I believe that the psoas is the window to the soul. It is an epicenter for so many injuries that I have become somewhat obsessed with it, and it is one of my personal missions to teach others how to properly stretch the psoas.

Why does a tight hip flexor, or psoas, matter? The psoas is able to flex the hip (as in bring your knee closer to your chest) but it is also able to rotate, side bend, and extend the spine because it attaches to the front portion of multiple vertebra. How crazy is that? So a stiff psoas can compress your hip joint, decrease hip range of motion, cause an unlevel pelvis, contribute to back pain, decrease nerve space….the list goes on and on. Who knew one little muscle could cause so much mayhem?

3. Weak or inactive gluteal muscles

The hip is a ball-and-socket joint, meaning that the head of your femur (the ball) sits in a cup-shaped portion of the pelvis called the acetabulum (the socket). This configuration gives the hip a ton of mobility, but also a lot of complexity. If muscles aren’t working properly around the entire joint the ball can sit off-kilter in the socket and problems arise. One example of this would be a tight psoas, pulling the ball forward. Another would be tight, weak, or inactive gluteal muscles, pushing or allowing the ball to move forward inappropriately.

Although strengthening the glutes and learning how to fire them properly is a very generalized approach to treating hip pain, it often works! Check out this video from Garrett Mclaughlin for ideas on a basic hip strengthening program.

4. Tight or inhibited gluteal muscles

All of our muscles have a normal “resting length”, meaning the length the muscle prefers to exist at in order to contract strongly and perform optimally. Try jumping by just using your calf muscles. Keep your knees straight and hop up and down like you are jumping rope. Take note of how high you can bounce. Now try to do the same jumping exercise by starting on your tiptoes, which is a shortened position for the calf. Stay on your tip toes and don’t let your heel come down at all as you try to jump. Now how high can you go? Can you get off the ground at all without cheating?

Tight gluteal muscles will be similarly weak and dysfunctional. You may have proper strength, but if your butt is all knotted up then good luck getting it to properly stabilize your pelvis. (A trip to Cindy Duron, anyone?)

5. Poor movement patterns and habits

running terrible

Here is where I swallow my pride and post pictures of myself running terribly in order to prove a point. I’d love to pretend that because I am a physical therapist I magically move perfectly, never get injured, and have perfect biomechanics. Shockingly…not the case. I’ve had a longstanding left hamstring and hip injury for years. Why the left side and not the right? As I said before, there has to be a reason. Overuse injuries don’t land on one side like the flip of a coin.

both feet on the ground

Take a look at me when both feet are off of the ground. My hips are level left to right, which is the ideal position for running. When hips are level in this plane it minimizes the force that goes through our joints and soft tissues.

left leg stance

When I am in stance phase on my right leg, my hips remain fairly level. Not perfect, but not too bad. This indicates that my right gluteal muscles are strong-ish and function properly.

When I am in stance phase on my left leg however, my left glutes and stabilizers are a hot mess. Yikes, ouch, and yuck. My left glutes just didn’t want to get out of bed today. Can you see how this would stretch the outside of my left hip with every step? The inside of my left knee? Compress the outside of my left knee and stretch my IT band? Make my right leg have to bend further to swing through and not stub a toe? With EVERY. SINGLE. STEP?!? Bleh. Just gross.

Like I said, overuse injuries are never a coin flip; there is a reason and we are here to help you find that reason and treat the problem.

Have you struggled with hip pain, or just tried to live with it? Don’t. Ain’t nobody got time for that. Find out what’s going on and what you can do about it.

Heal Your Body, Strengthen Your Life.
Your friends at Jackson County Physical Therapy

The Importance of Exercise for a Healthy and Strong Immune System

During times of uncertainty when life is constantly evolving, it can be difficult to know what you can do to stay healthy. Although social distancing and staying at home are the best practices, it is just as important nowadays to find ways to move your body and exercise.

As long as you follow social distancing guidelines, going on walks, bike rides, hikes, and other outdoor activities are safe and recommended. As I will discuss, it will help you not only strengthen your muscles and bones but your immune system as well.

Exercise immunology is a relatively new area of research, with most of the studies coming out in the past 30 years; these studies have proven that the immune system is very responsive to exercise. The best kind? Moderate to vigorous exercise for a duration of 30-60 minutes. This stimulates the exchange of active immune cells between your blood and tissues, including immunoglobulins, anti-inflammatory cytokines, neutrophils, natural kill cells, T and B cells.

Doing this type of exercise regularly has a summation effect on your immune system, meaning that if you maintain a consistent workout schedule of 3-5 times per week, it will enhance your immune defense activity in the long run (no pun intended).

The proof? Randomized clinical trials have repeatedly demonstrated the relationship between consistent moderate exercise and decreased incidence of illness. Several studies also show that regular physical activity can decrease incidence rates of influenza and pneumonia 1.

However, keep in mind that moderation is key. Extreme exercise training programs have been correlated with decreased immune cell metabolic capacity, negatively affecting the immune system for a range of several hours up to several days. One study looked at 2,311 runners who competed in the LA marathon, and showed that 13% of the endurance athletes reported illness the week afterward. Other studies have shown athletes in heavy training are at increased risk of developing an upper respiratory tract infection. This just means that although you may have more time to work out, it’s not necessarily the time to go all in. Keeping exercise at a consistent and moderate is perfect for boosting your immune system along with a healthy diet and adequate sleep1.

This concept is especially important for those experiencing immunosenescence, which is the gradual decline of the immune system because of natural aging. Immunosenescence has been associated with infections, autoimmune diseases, and metabolic diseases. However, evidence has shown that regular exercise can thwart the onset of immunosenescence during the aging process. In fact, one study showed that women aged 70+ who were active in endurance events had significantly higher levels of immune system supporting cells compared with women of the same age who were sedentary1.

In summary, regular physical activity at a moderately challenging level of intensity and duration will help give your immune system a boost. If you’re already going on regular walks, hikes, or bike rides, keep it up! You can also find many exercise programs offered online or streaming through your local gym.

We at JCPT applaud your motivation and understanding of self-care especially during the current covid-19 pandemic. Do what you find the most rewarding and fun for your chosen activity. Just be safe, and avoid crowded trails or paths. If you feel confused about how to start or maintain an effective exercise regime during these trying times, feel free to reach out. We offer both in person and telehealth options for consultation and guidance.

Heal Your Body, Strengthen Your Life.
Your friends at Jackson County Physical Therapy

What is a physical therapist, and how can they help me?

physical therapist hands

Although I love my profession, I have to admit that physical therapists are terrible at educating the public on what we actually do. I’ve heard people refer to me as anything from a personal trainer to a personal torturer. Although I have to admit it’s a clever spin on the abbreviation “PT”, we are neither personal trainers nor personal torturers. In fact, I’m going to go out on a limb and say that most of us are in fact very, very nice people.

All jokes aside, what exactly is a physical therapist, or PT? And what do they do?

PTs are trained to evaluate, diagnose, and treat a variety of muscular and skeletal injuries, neurological disorders, or what I like to call Problems with a capital P. Ideally, we love to see people before something becomes a Problem. If our patients give us the opportunity, we are statistically very effective in preventing Problems. Problems can result in pain, immobility, unfavorable lifestyle modifications, loss of independence, surgery, medication, and avoidable healthcare costs… yuck! Let us save you a load of “yuck” and the healthcare system a load of money.

Speaking of the healthcare system…it’s a scary, uncertain time out there and here at Jackson County Physical Therapy we want to acknowledge that. It’s very understandable if you are nervous to schedule an in-person appointment with anyone at this time, PTs included. Although telehealth visits do not allow for hands on treatment they do allow for the safe transmission of information without transmission of less desirable, things like Covid-19.

Patients are often surprised at how a simple exercise or bit of professional advise can address a nagging Problem. We can demonstrate exercises and discuss strategies through video without the need for masks, hand sanitizers, and any of the other items that you inevitably cannot find in the grocery store right now. Even for a technology dunce like myself, these visits are easy to coordinate with your computer, smartphone, or tablet by simply clicking a link that we send to your email. Consider setting up a telehealth visit so that a physical therapist can point you in the right direction at a time where you may find yourself with a bit of extra time.

I will not list every single condition that we treat, as it will inevitably be incomplete. I will, however, say that if it aches, hurts, burns, tingles, feels numb, feels weak, feels uncoordinated, makes you dizzy, is swollen, doesn’t move enough, moves too much, pops, clicks, gives way…we can probably treat that. And if we can’t? We are educated, trained, and board certified in order to tell you where you need to go and who you need to see, in person or via screen, to be properly treated. That is why we earn a Doctorate in Physical Therapy and why you can, in the majority of all cases, come directly to see us without your physician’s referral. And yes, your insurance will pay for it.

Contact Jackson County Physical Therapy if it sounds like the education and training of our physical therapists may benefit you and your quality of life. In addition to treating Problems, we are also incredibly nerdy, passionate, and pumped to spread the word about WHAT WE DO.

Stay safe out there my friends,
The Jackson County Physical Therapy Crew

Physical Therapy Provides an Alternative to the Rising Use of Opioids

As you may have seen during the Superbowl, Opioid use is spiraling out of control in the United States, and those suffering from pain conditions need an alternative. Some are heralding physical therapy as a safe and effective alternative to treating pain, without the threat of addiction.
To spread the message that conservative, nondrug approaches can effectively manage pain, the American Physical Therapy Association (APTA) has joined others in the federal, state, local and private sectors to address the prescription drug abuse and heroin epidemic. They collectively advocate that a multidisciplinary clinical approach—including physical therapists serving on the care team alongside physicians and other healthcare providers—can improve quality of life for patients with acute and chronic pain.

According to the Centers for Disease Control and Prevention, physicians wrote 259 million opioid prescriptions in 2012, which translates to one bottle of pills per American adult. The American Academy of Pain Medicine reports that pain disorders are on the rise, affecting more Americans than diabetes, heart disease and cancer combined. The commonly prescribed opioids OxyContin and Vicodin act quickly to get pain under control, but these drugs can also be harmful and addictive when abused.
An individualized physical therapy plan aims to reduce a patient’s pain and associated disability, improve function, and promote health and well-being. A physical therapist performs a comprehensive evaluation, after which they address chronic pain with a combination of movement exercises, manual therapy, and education about pain science, body alignment and movement. Physical therapists help patients understand the underlying cause of pain.

Addiction to opioids is not a new phenomenon, but it has escalated to new proportions. The number of Americans dying each year from drug overdoses has surpassed that of motor vehicle crashes. More than half of patients prescribed opioids for chronic pain continue to take the painkillers five years later, according to a 2011 study published in the Journal of General Internal Medicine. In fact, a staggering four in five new heroin users started out misusing prescription painkillers, according to a National Center for Health Statistics Data Brief.

Jackson County Physical was founded in 1995 and currently has four locations: Medford, Ashland, Eagle Point and Phoenix. We are a full service physical therapy clinic that does not utilize Physical Therapy Assistants. All appointments are 45 minutes, hands on, one-on-one.