Does your Growing Athlete have Knee Pain?

Patellar Femoral Pain Syndrome, otherwise known as PFPS, is common in adolescent athletes especially those who participate in sports year-round. This diagnosis presents itself with generic soreness in and around the front of the knee and/or kneecap. Since most athletes in their teens have growth spurts, their bones grow faster than their muscles. This causes an imbalance with the forces around the knee causing abnormal motion of the kneecap. Typically, this will cause pain with prolonged standing, negotiating stairs and athletic activity in general.

Physical therapy is one of the few avenues available to reduce the pain and accelerate a return to sports with full function. The typical plan of care is as follows:

  1. REDUCE SWELLING: Modalities, such as ice, heat or electric stim can help
  2. INCREASE FLEXIBILITY:  Chances are good that the ligaments surrounding the knee (IT Band, lateral retinaculum) haven’t kept up with the bone growth and are therefore very tight.  As a result, the patella moves laterally (to the outside) when running or walking, creating extra friction, and often pain.  Stretching the tight ligaments allows the knee cap to return to its normal tracking pattern and will reduce pain.
  3. STRENGTHEN WEAK MUSCLES:  As the therapist works to stretch tight ligaments, the patient must also strengthen key muscle groups, such as quadriceps, hamstrings, gluteus medius, gluteus maximus. These muscles help to stabilize the joint which provide increased endurance with sport-related activities and also help to keep the patella moving smoothly.
  4. ADD PLYOMETRICS:  As pain and swelling is alleviated, it is time to introduce a plyometric program, such as agility or sport-specific training.  This is the final step with therapy to help the athlete ease their transition back to his/her sport. This last step challenges the athlete with higher functional tasks in order to simulate game or field conditions. Quick steps, lateral jumps, and ladder drills are just a few of the techniques that a therapist may use to help move a young adult toward reentry to their sport or activity.

Don’t wait and deal with pain! Come in and see a physical therapist today.

Heel pain? Read this.

Achilles Tendinitis can happen to both runners and non-runners alike.  People suffering from achilles tendinitis typically experience pain and soreness located on the back of the heel where our achilles tendon attaches our calf muscle to our heel bone (calcaneus).  The achilles tendon, sometimes called the heel cord is the largest and strongest tendon in the body.  It comes from the 2 big muscles in our calves (Gastrocnemius and Soleus) and helps us to come up on our toes when we walk or run. 

 Some of the symptoms of achilles tendinitis include stiffness in the back of the heel along with pain and soreness when there is pressure on the heel.  Often times, the back of your shoe can rub the sore spot and aggravate the area.  If the tendinitis lasts for a long time it can result in a thickening of the tendon and chronic achilles tendinitis places individuals at a greater risk for a rupture or tear of the tendon.

There are several possible causes of Achilles tendinitis but the most common is overuse of the tendon.  Runners and athletes are at a higher risk of developing achilles tendinitis as a result of increased forces placed on the tendon.  Sudden increases in activities such as running and jumping can also cause the tendon to become inflamed.  Tightness in the ankle and tendon can make an individual more prone to developing achilles tendinitis.  In addition, people with very flat feet who overpronate (ankles collapse inward) are also more prone to developing achilles tendinitis. 

Treating achilles tendinitis includes resting the tendon by decreasing activity or by immobilizing the ankle through a cast or walking boot.  Icing the heel cord for 10-15minutes throughout the day is a helpful way to reduce the inflammation present in the tendon.  Just make sure to place a towel / cloth between the ice and the skin to avoid skin irritation.  Other treatments include wearing a Dorsal Night Splint (DNS) to help promote a gentle stretch of the achilles while you are sleeping.  Sometimes, NSAIDS are needed to help reduce pain and inflammation in the achilles.  As the symptoms decrease, it is important to begin a stretching and strengthening program to help improve the integrity of the tendon and prevent the chances of having the issue reoccur.  In severe cases, surgery may be required to help repair the tendon.

If you are having difficulty treating the pain and soreness on your own, physical therapy can be effective in guiding you with appropriate stretches and strengthening exercises for the achilles.  In addition, PT can assist you in returning to the things you love including running and walking.

Finally, the best way to treat achilles tendinitis is to avoid it all together.  A proper warm-up of 5-10 minutes of very light activity to get your blood flowing is important.  Follow that with some gentle calf stretches and heel raises to ensure that the achilles tendon is ready for action.  And finally, remember to wear good supportive athletic shoes whenever you are going to be active.


What Can be Done about Bunions?

We have all seen them.  The painful looking big toe that is twisted and misshapen, sticking out from a flip flop.  Bunions (or hallux valgus) are the most common problem affecting a person’s forefoot (front of the foot), and can significantly impact the quality of life for those suffering from the problem.  Studies have shown that approximately 23-35% of people are affected by bunions and that those rates increase for individuals over the age of 60.

A hallux valgus deformity typically includes a medial shift (moving towards the inside of the foot) of the first metatarsal joint and a lateral shift (moving towards the outside of the foot) of the big toe.  There has been debate about whether footwear can cause the deformity, however the most common cause of the issue can be traced back to bad genes (yes, blame your parents) and results in biomechanical instability of the joint due to arthritic changes or laxity (looseness) of the ligaments around the joint.

Symptoms include:

-swollen, inflamed tissue around the joint
-mild to severe pain in the big toe
-difficulty tolerating footwear
-pain with pushing off the big toe or rising up on the toes

So, how can physical therapy help?  There are a number of ways that physical therapy can aid in reducing some of the symptoms associated with painful bunions.  First, your physical therapist will be able to provide information regarding footwear and modifications that can be made to footwear.  Certain types of shoes (such as high heels) can make the pain worse by increasing the pressure on the painful joint.   A large toe box, toe spacers, splints, and metatarsal pads are all options that can be used to help alleviate pain.

Secondly, stretching the muscles in the back of the leg can help to decrease the amount of stress that is placed on the foot.  Tightness in the back of the leg can lead to increased pressure on the ball of the foot and can make symptoms more severe.

Finally, moving the joint (mobilization) can help to reduce some of the stiffness found in the joint and can be an effective way to reduce pain.

Unfortunately, sometimes physical therapy is not enough to reduce pain levels and improve motion in the joint, and surgery cannot be avoided.  Following a bunionectomy surgery, physical therapy is an essential part of your recovery to help restore motion to the foot and big toe, and will help improve your gait mechanics so that you can return to the activities that you love.

Osgood-Schlatter Disease

knee pain

Osgood-Schlatter Disease (OSD) is a common cause of knee pain in active adolescents. Historically, it was more often diagnosed in boys between the ages of 10-19, however as more girls are starting to participate in sports at an early age, that is changing.  Patients will typically experience pain and swelling just below the kneecap, most notably after performing activities that involve running or jumping.  Children who often participate in sports and activities which require consistent running and jumping are at a higher risk for developing OSD. It is typically described as a “painful bump” just below the knee cap.

SOURCE OF PAIN: OSD is caused by a pulling of the patellar tendon on the tibial tubercle which is located on the shin bone (tibia). Growth spurts make kids more vulnerable due to the rapid changes in bone, muscle, and tendon growth which may not occur at the same time. When certain muscles are stronger than others, this will place unusual stresses on the growth plate, which is a layer of cartilage where the bone grows. This cartilage is rapidly changing in the several years of bone growth throughout adolescent years. The area of “soft” cartilage in children becomes “hardened” as the child grows and becomes solid bone by full maturity. The growth plate at the bottom of the femur (thigh bone) serves as a place where tendons attach muscle to bone. The quadricep muscles form into the “patellar tendon” which attaches to the tibial tubercle. When a child is constantly activating their quadriceps muscle while performing sports, this pulls on the patellar tendon and subsequently on the tibial tubercle. This repetitive pulling can cause inflammation at the growth plate which can lead to a more prominent tibial tubercle.


  • Pain that worsens with exercise
  • Swelling or tenderness under the kneecap
  • Tightness of the quadricep and hamstring


  • Ice: Ice the knee for 15-20 minutes at the area of pain immediately after activity will help to decrease swelling
  • Rest: Take a short break from the activity and give it time to rest.
  • Stretch: Tightness in the quadricep and hamstring can be alleviated by performing stretches before and after activity.

If pain continues after trying these treatments, you may benefit from further evaluation by a physical therapist. A physical therapist will evaluate you and develop a plan of care. Your program will be a combination of strengthening the leg muscles and stretching to reduce tightness and restore any lost range of motion. Knee pain caused by OSD is treatable and should not limit you from doing what you love!

Ankle Sprain

Drew foot analysis-small

A broken or sprained ankle is one of the most common injuries among all age groups.  An ankle break is commonly caused by twisting/rotating your ankle, rolling the ankle, tripping/falling, or impact from a car accident causing one or more of the ankle bones to chip, crack, or break. The classification of the break is determined by the area that is broken, ranging from simple breaks to more complex. A more severe break will cause the ankle to become more unstable. Symptoms may include immediate and severe pain, bruising, tenderness, inability to bear weight on the injured foot, and/or deformity (bone is out of place).

A sprain, on the other hand, is when the ligaments (fibrous tissue holding the ankle joint in position) become disrupted or torn. The most common causes of an ankle sprain include exercising on an uneven surface or playing a sport that requires cutting, rolling, and/or twisting action of the foot (running, basketball, tennis, football, soccer, etc.). Sometimes with a sprain you can hear or feel a “pop”, which is the ligament tearing. Sprains are classified by three grades which indicate how much damage has been done.
Grade 1 Sprain (Mild)
– Slight stretching or tearing of ligament(s)
– Mild tenderness/swelling

Grade 2 Sprain (Moderate)
– Partial tear of ligament
– Moderate tenderness/swelling
– On medical exam, the joint is abnormally loose

Grade 3 Sprain (Severe)
– Complete tear
– A lot of tenderness/swelling
– Substantial instability

For a grade 1, and some grade 2 sprains, a good first step is home treatment of R.I.C.E., which stands for Rest, Ice, Compression and Elevation.  In addition, it is important to schedule an appointment with a medical professional as soon as possible.  Through Direct Access, you may not need a physician’s referral to schedule an appointment directly with a certified physical therapist.  This often provides quicker access to care and therefore a faster recovery.

An evaluation by a physical therapist can help identify the type and severity of an ankle sprain by performing specific tests, palpation of the affected area, and identifying areas of laxity or weakness.  A therapist will also screen for more serious causes of pain and swelling (such as a fracture) and refer the patient to the appropriate physician should additional testing or imaging be required. Seeing a physical therapist can help speed the recovery of an ankle sprain which is typically 2-8 weeks depending on severity of the sprain.  A physical therapist will not only restore range of motion, flexibility and strength, but also improve balance, as well as provide instruction about how to safely return to a specific sport, occupation or hobby. While ankle sprains usually recover quickly, it is important to ensure full strengthening of the area and restored balance through a comprehensive physical therapy program, as recurrent ankle sprains and chronic instability have been reported in as many as 80% of cases.

Commitment to a home exercise plan following PT is a key to maintaining good muscle strength, balance and flexibility, which will help prevent re-injury and chronic problems.  And don’t forget…once you have put the time and effort into your recovery, follow these precautions to prevent future injury:

  • Warm up thoroughly before exercise or physical activity.
  • Pay attention when walking/running/working on uneven surfaces.
  • Wear proper footwear.
  • Slow down or stop when you feel pain or fatigue.

Plantar Fasciitis

Pain in the female footPlantar foot pain, commonly referred to as plantar fasciitis, is a very common condition experienced in both the athletic and general population. The muscles, tendonsand ligaments of the arch and underside of the foot are placed under enormous amounts of stress with walking and weight bearing activities. Although the foot is naturally designed to accommodate these stresses, there are many factors, that place an individual at increased risk for plantar foot pain. These include improper footwear, faulty foot mechanics, poor flexibility, weakness, and obesity.

Typically, plantar foot pain will begin gradually with activities and be relieved with rest. Over time, as the soft tissues become tighter and more irritable, the pain will become more intense and occur more frequently.  It is likely due to this gradual onset and escalation of symptoms, that there is a common misconception that the pain will just get better on its own. Without proper early identification and treatment, the pain can become very debilitating, making ordinary tasks like getting out of bed and walking, feel very difficult.

The muscles of the underside of the foot are small, but very strong. They are designed to withstand large loads placed on them as they support the arch of our foot.  However, once they start becoming irritated from abnormal stresses placed upon them, they will tighten and become less flexible. This places them at even greater risk for continued damage and weakening. It is the classic example of a vicious cycle.

The first line of defense prescribed is often ice, rest, and gentle stretching of the plantar fascia and calf.  Early treatment for your foot pain increases the likelihood that you will make a quick recovery.  If your symptoms last longer than 2 weeks, it is a good idea to have your foot evaluated.

A thorough evaluation from an orthopedic physical therapist is instrumental in determining your specific gait mechanics, foot posture, areas of reduced flexibility, muscular weakness, and other factors that are causing you to have plantar fasciitis.

You will be instructed on proper exercises and stretches that will be most helpful for your foot posture, activities and symptoms. Hands-on treatment from your physical therapist is necessary to reduce adhesions in the plantar fascia and foot muscles, lengthen the tight muscles, and restore normal mobility to the arch. Advice on orthotics, proper footwear and night splints is routinely offered.

One hands-on approach that is available for plantar foot pain is Active Release Techniques (ART), a specific form of soft tissue treatment that addresses the underlying adhesions and scar tissue that impairs arch mobility and muscular flexibility. ART certified providers are specifically trained in how to identify areas of tightness in the muscle tissue and how to effectively treat those areas.  Fast, effective pain relief follows when individualized treatment is initiated for plantar fasciitis.

Successful treatment is rarely a “one size fits all” approach. See a physical therapist if you are suffering from foot pain.

Shin Splints

Drew outside runners1 (2)Shin splints are a common running injury that many people experience when getting back into training after taking a break. Shin splints are also common when runners quickly increase mileage or run on surfaces they are not accustomed to. Continuing to run through this injury may lead to heightened pain or increase the likelihood of acquiring a more serious condition. It is important to understand how to identify this injury and to take steps that will ensure optimal recovery.

How do I know I have Shin Splints?

Shin splints are more technically known as Medial Tibial Stress Syndrome (MTSS). The pain caused by shin splints, or MTSS, is from excessive stress placed on the muscles of the lower leg. This stress leads to pulling on the Tibia (lower bone) of the leg, causing irritation to the bone and connective tissues of the leg. These stresses are often due to weak or tight muscles of the calf and shin – and that, paired with repeated use – sparks irritation, causing pain.

Generally pain is felt in the lower inside part of the leg 1-5 inches above the ankle, or 5-7 centimeters lower than the knee on the outside part of the calf. The pain is usually not localized to one specific area. If the pain is specific to one point and does not subside with rest, it is important to seek a medical evaluation from a physical therapist or physician for the possibility of a stress fracture.

Actions to take.

With suspected shin splints, the first step is to allow your body to rest. Take a few days off from running, apply ice to the irritated area in order to reduce inflammation, and begin gentle stretches for the calf muscles. As the pain diminishes it is beneficial to continue stretching and begin incorporating lower leg strengthening exercises, such as heel raises. Once pain subsides and strength is gained, you may begin a gradual return to running; go shorter distances and run on softer surfaces (such as grass or cinder trails).

These are the basic tenets of recovery; however, for the greatest gains, and to reduce the possibility of re-injury, it may be beneficial to seek treatment from a physical therapist. Physical therapists will be able to address all strength or flexibility limitations, and can also help you learn about other possible contributing factors.

Bobby Longenecker, DPT

Knee Pain

knee pain

Knee pain is common and can stem from knee joint, kneecap, or cartilage issues. Depending upon the location of the knee pain, there could be swelling and you may experience difficulty walking. Other symptoms could include:

  • Locking of the knee
  • Swelling
  • Inability to squat
  • Difficulty going up or down stairs
  • Inability to straighten (extend) the leg

Not all knee pain stems from severe knee injuries (tears and breaks); in fact, overuse and arthritis are common culprits of knee pain. Even if you haven’t experienced an acute knee injury, you may need to receive treatment. Who wants to live in pain, after all?

Significant discomfort, swelling, and an inability to bend your knee (or extend it) are clear indicators you should head to a health care professional right away.

Your recovery may be in reach with strength exercises and monitored stretching – sure beats surgery! (Remember, Direct Access helps you get treatment, fast.) Learn about more treatment options here. Questions about knee pain? Feel free to e-mail us at

Brian Hartz, DPT, OCS, CSCS