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The true source of your back pain—is it really what you think?

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The true source of your back pain—is it really what you think? n

Do you have back pain and are thinking about getting an MRI? Or maybe you got your MRI and you believe the results spell dread?

The relationship between MRI changes and low back pain may not be so clear-cut. In fact, research shows that changes on an MRI don’t necessarily correlate to pain, while many patients with pain show no abnormalities on MRI. Before jumping to any conclusions, read on for more detail on the complex relationship between what your image shows and whether is it ultimately driving the pain and symptoms you are experiencing.

First, if you’re experiencing back pain, you are not alone. Pain in the lower back is one of the most common musculoskeletal complaints. In fact, 8 out of 10 people will experience low back pain over their lifetime. About 1 out of 4 people experience chronic low back pain (lasting longer than 3 months). Any structure of the lumbar spine that is innervated by nerve endings can cause both low back pain and/or referred pain, which is felt in one or both lower extremities. Some of the more common potential structures that may be involved include muscles, ligaments, vertebrae, facet joints (joints connecting the vertebrae), dura mater ( a membrane that surrounds and protects the spinal cord), and nerve roots.

So how could my imaging be wrong?

Imaging is useful in detecting fractures, abnormal tissue growth (i.e. cancer), inflammation/ bleeding, as well as serious compression of the spinal cord or nerves, which can help direct appropriate treatment. However, 99% of people with low back pain will not have any of these serious conditions. A large percentage will, however, have incidental findings on imaging which are normal anatomical variants, as well as normal age-related changes. In these cases, imaging is much less helpful in identifying the true cause and directing treatment. In fact, several studies have found that pain in the lower back is more strongly associated with factors such as life dissatisfaction, neuroticism, hostility, extroversion, and poor sleep quality than it is with findings on imaging. Thus, obtaining an imaging report can sometimes cause more harm than good. Research shows that patients who undergo lumbar MRI generally have worse outcomes than similar patients who do not have to image. Much of this is attributed to psychological factors, misinformation, and negative emotional responses. One common example is the finding of “dark” T2 signals within the disc on MRI. This is most often a pain-free and benign condition. However, it is labeled degenerative disk disease (DDD) leading many patients to believe their spine is “deteriorating.” In turn, these inappropriate beliefs can lead to a decrease in activity, anxiety, lifestyle changes, a perception of increased pain, changes in motor patterns, and unnecessary surgeries.

So, what exactly does the evidence say?

The exact nature of the relationship between imaging and pain is unclear, largely due to abnormal imaging findings in large numbers of people without pain (false positives). This means that many of the “abnormal” findings are indeed commonly occurring and natural parts of the aging process. One of the more common findings in the lumbar spine is disc degeneration, which is a natural process beginning fairly early on in life. In fact, more than one-third of healthy, normal adults in their 20’s present with degenerative discs on imaging. In some individuals, the rate of degeneration is quicker than others due to a combination of genetic and autoimmune factors, as well as resorption and biomechanical factors. In any case, the volume of intervertebral disc tissue naturally decreases over the lifespan.

Currently, the best available evidence demonstrates the following key concepts:

  1. Changes in diagnostic imaging are seen in many individuals with NO pain or symptoms.
  • Imaging studies (MRI & CT) show herniated disc material in up to 76% of people with NO low back pain or sciatica.
  • One-third of patients without pain have some type of “abnormality” in their lumbar spine (disc degeneration, disc bulge, facet hypertrophy, or nerve root compression).
  • Several studies have shown that professional athletes (gymnasts, volleyball players, wrestlers, weightlifters, skiers, etc.) have a higher prevalence of disc degeneration and other lumbar abnormalities, but do not have a higher incidence of back pain. In fact, athletes had significantly higher rates of changes on MRI (75-82%) when compared with age-matched non-athletes (54%). However, both groups had very similar rates of reported back pain (50% vs 44%)
  1. A large percentage of people with pain do not have correlating changes on imaging.
  • Less than half of patients who have pain in the lower back also have an “abnormality” identified in their image—this means that the majority who have pain have no associated anatomical changes.
  • One study involving horseback riders demonstrated an unusually high prevalence of lower back pain, but no conclusive MRI evidence to point to disk degeneration, spondylolysis, spondylolisthesis, or pathologic changes of the paraspinal muscles of the lumbar spine—imaging offered no explanation for their symptoms.
  • In one long-term follow-up study, 80% of athletes and 40% of nonathletes reported pain at baseline. Fifteen years later, 71% of athletes and 75% of non-athletes reported pain. At both points, athletes and non-athletes had similar rates of disc degeneration and the majority of the abnormalities seen on follow-up MRI were already present at baseline. This means that despite very few changes on images, the non-athlete group almost doubled in reports of pain—once again imaging could not identify the cause.
  1. Research has shown MRI findings are not related to the intensity of pain or extent of disability, (i.e. larger herniation does not equal more pain).
  • Several studies have found that both vertebral endplate changes and large extruded disc herniation (both believed to be causative factors in low back pain) are equally distributed between healthy subjects and those with disabling back pain. This means that as many patients without pain as those with pain had these changes on MRI and the changes did not correlate with severity of sciatica.
  1. Those with both pain and identifiable changes should be cautious, as the changes may not be the direct cause of the pain.
  • Even when abnormalities are identified, it is difficult to determine whether they are the direct cause of pain, as evidence has shown that many anatomical variations on MRI are not associated with symptoms
  • Many patients undergo unnecessary surgery to correct an incidental finding on imaging and still have pain because the original cause was something other than what was identified and wasn’t addressed (poor posture, decreased core stability, muscle spasm, etc.)

As one can see the current research on medical imaging does not support the notion that what is seen on the image correlates strongly with what the patient is experiencing. In fact, it has been shown that a thorough physical examination leading to a mechanical diagnosis can be just a sensitive and specific in identifying the cause of your symptoms. An evaluation by a qualified Doctor of Physical Therapy can help reveal the underlying biomechanical deficits that may have contributed to your condition and prevent it from recurring in the future. Some of the benefits of physical therapy include pain relief, increasing mobility, strengthening of the core and lumbar stabilizers, and increasing balance and functional movement.

At Fox Physical Therapy, our board-certified therapists specialize in treating and relieving low back pain. Contact us today to find out how we can help you feel better.

Hamstring Strain Rehabilitation Tips

Hamstring Strain Rehabilitation Tips

Don’t let a hamstring strain turn into a recurring injury!

Dr. Braulio Espinosa

Chances are if you play a sport that requires repetitive kicking then you are familiar with the term hamstring strain or “pulling a hamstring”. Hamstring strains account for 12–16% of all injuries in athletes with a re-injury rate reported as high as 22–34%. Hamstring strains are a very common and nagging injury typical seen in athletes who perform high speed sprinting, repetitive kicking and explosive movements associated with acceleration and change of direction. This injury accounts for 38% and 28% of the lower extremity injuries seen in high school and college football respectively and makes up the highest percentage of total injuries in rugby. The high incidence of injury in this muscle group may be partly due to the fact that the hamstrings cross over two joints (the hip and the knee) and are therefore subject to much greater reaction forces at multiple points along the lower extremity chain. The hamstrings are a colloquial term used to describe three distinct muscles, two on the medial side (semimebranosus, semitendinosis) and one on the lateral side (biceps femoris). All three muscles are responsible for bending the knee and extending back the hip, two actions that are crucial for sprinting, jumping, and kicking. These muscles originate from the hip and turn into tendons that with two attaching to the inside of your leg bone and one attaching to the outside, crossing the knee joint. A muscle strain is a term used to describe damage or a tear to the muscle/ tendon. Like most injuries, a strain can range from a simple overstretch injury all the way to a complete tear of the muscle.

How do they happen?

What most of the literature agrees upon is that hamstring strains are typically caused by a non-contact injury secondary to forceful stretching. Building off this point; when analyzing running technique it has been shown that peak stress on the muscle occurred during a terminal swing phase of the sprint (see image), suggesting that this period may pose the greatest risk for injury. It is during this phase that the hamstrings are working to decelerate the leg while also controlling the degree to which your knee straightens. What this essentially means is that the type of contraction the hamstrings have to perform must switch extremely rapidly from slowing down the leg while it is straightening (the point of peak stress and stretch to the muscle) to then actually driving your hip back to propel you forward. Several research studies support that this rapid change from deceleration to acceleration by the hamstrings is when the muscle is most vulnerable to injury.

Severity of Strains

The severity of muscle strain injuries is generally categorized as Grade I: very mild tear of the muscle with minor strength loss, Grade II: partial tear of the muscle with mild bruising and significant strength loss that limits functional performance, and Grade III: complete tear of the muscle/tendon and severe disability with day to day activities. Complete tears like a grade III are rare, constituting about 1% of all hamstring strains. What is commonly observed with grade I and II strains is that in the middle of sprint, hurdle, jump, or kick the athlete will feel a tightness or pulling type pain in his posterior thigh that will cause him to stop physical activity.

Do not let this become a chronic issue!

The scary thing about hamstring strains is that the rate of re-injuring the muscle is very high, meaning that it can easily transition to a chronic problem if not correctly addressed. Across the board, the absolute biggest risk factor for having a hamstring strain is…. a previous hamstring strain. In fact, a study done on 500 amateur soccer players showed that a previous hamstring strain has been shown to increase the risk of a recurrence up to six times as much. The logical question is why does this happen? Since the symptoms of a grade I and grade II hamstring can be uncomfortable /annoying but tolerable during activities of daily living, the athlete often prematurely returns to activity after rest. This may lead to repeatedly unsuccessful efforts to return to sports without letting the muscle heal adequately. Thus, the muscle is not strong enough to tolerate the usual demands of sport which leads to another strain, or worse, a complete tear.

How can physical therapy help?

Risk factors shown to correlate with an initial hamstring strain are decreased hamstring flexibility, poor muscular strength/ endurance, poor core stability, lack of proper warm-up, inability to disassociate the trunk from the lower extremities, and poor lumbar posture. Our board-certified Doctors of Physical Therapy at Fox Physical Therapy will be able to identify any of these aforementioned deficits during the biomechanical evaluation. From there a plan of care will be implemented to correct the impairments quickly and efficiently. Remember the biggest risk to recurring hamstring strains is having that first hamstring strain, so even if you are not injured we can help to identify possible risk factors ensuring you stay at peak performance levels. Don’t wait until you break down to seek treatment. That’s the equivalent of letting your car break down on the side of the road before finally getting an oil change.

In the event that you do sustain a hamstring strain, physical therapy becomes of the utmost importance to guide and progress the athlete through his/her rehabilitation and prevent an acute injury from becoming chronic. Current literature supports that clinical diagnosis of a grade I/II strain by an experienced physical therapist is as reliable and valid as ultrasound and MRI, meaning that one does not necessarily have to wait to go to a doctor and then wait again to get an MRI in order to begin the rehabilitation process. In Florida, anybody can directly access their Physical Therapist without the need for referral.

Cervicogenic Headaches

Do You Suffer From Nauseating Headaches?

If you experience strong headaches in the morning or after work you could be experiencing Cervicogenic Headaches

Are you experiencing headaches in the morning or after a long day of work? Do you notice pain localized to the back of the head where the junction with the neck begins, the front of the head, or behind one or both eyes? This and many other symptoms can be a sign you are experiencing what is called Cervicogenic Headaches. These headaches consistently get misdiagnosed as migraines. Part of the reason is many of the symptoms are similar including nausea, dizziness, and sensitivity to light and sound. These headaches are often stemming from an issue with the joints, muscles or nerves of your neck (cervical spine).

Common symptoms may include:

  • Reduced neck range of motion
  • Upper neck pain in conjunction with a headache
  • One-sided headache pain that presents in a “rams horn” pattern
  • Nausea
  • Blurred vision
  • Dizziness
  • Light/sound sensitivity.

How to Treat Cervicogenic Headaches

These headaches can quickly be diagnosed by a trip to your Orthopedic Physical Therapist. Through a biomechanical analysis and mechanical special testing designed to pinpoint the structures at fault, your physical therapist will be able to identify the true cause of your pain.

Treatment options include spinal manipulation, mobilizations of the spine, myofascial release, correction of faulty posture mechanics, contract/relax stretch, strengthening of the deep neck muscles, and education on self-treatments. We focus on correcting the mechanical generator of your pain, not simply offering quick fixes or temporary relief.

Schedule Your Consultation Today

If you have been experiencing any of the above symptoms do not hesitate to give us a call. There is no reason to suffer through another day of work with a nauseating headache. The board certified therapists at Fox Physical Therapy specialize in identifying disorders of the head and neck. We take pride in using only the latest in evidence-based treatments to fix the root cause of your problems.

Click here to schedule an appointment.

Learn How to Remedy Plantar Fasciitis

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Do You Have Plantar Fasciitis?

Learn how these 4 simple at-home exercises can help you remedy the pain caused by Plantar Fasciitis.

By: Stephanie Beckel, DPT and Eric Alexander, DPT, OCS, Cert. MDT

If pain occurs with your first steps in the morning, chances are you may have plantar fasciitis. In fact, plantar fasciitis is the single most common foot condition treated by healthcare practitioners, affecting about 2 million Americans each year. This type of injury is especially prevalent in runners, as studies have found that over 30% of runners struggle with this condition. The good news is that greater than 95% of cases will heal non-surgically with the correct application of skilled physical therapy by a state licensed doctor (DPT).

So what exactly is the plantar fascia?

The plantar fascia consists of three bands of dense connective tissue that run along the bottom of the foot. All three bands originate from the calcaneus (heel bone) and then spread out as they run forward to connect to the base of each phalynx (toes). This fascia is responsible for tightening during the push-off phase of walking to elevate and support the medial arch, so that the foot may become a rigid lever propelling the body forward.

Plantar Fasciitis describes a condition that is often associated with overuse, resulting in a chronic degenerative process. The condition begins with repetitive strain, which leads to microtears ultimately inducing an inflammatory response. Over time, this leads to degeneration of the plantar fascia, primarily at its attachment site to the heel. When looked at under a microscope, there is evident thickening and fibrosis as well as damaged collagen and calcification of the fascia.

Plantar Fasciitis Symptoms:

Symptoms include pain in the medial heel, usually most noticeable with first steps out of bed in the morning, standing after a period of inactivity, and also after prolonged weight-bearing. Pain is also present with deep palpation of the heel at the insertion of the plantar fascia.

While 80% of heel pain stems from plantar fascia, several other conditions can mimic this pain and may need to be ruled out. In one retrospective study of 250 individuals with plantar heel pain, the majority were diagnosed with plantar fasciitis. The next most common diagnosis was fat pad atrophy (approximately 15%). Those with fat pad atrophy were more likely to have pain primarily after long periods of standing, pain at night, and lacked the characteristic first-step pain in the morning. Les common conditions include Ankylosing spondylitis, Reiter’s syndrome, and osteoarthritis. If symptoms are in both heels, rheumatoid arthritis becomes a likely culprit in women, while ankylosing spondylitis or Reiter’s is more common in men. For patients with a history of diabetes, an abscess in soft tissue must be ruled out. Rarely the condition may be caused by entrapment of nerves (usually the first branch of the lateral plantar nerve or the medial calcaneal nerve), proximal plantar fibroma, lumbar herniation causing S1 radiculopathy, or a hidden fracture. These conditions can be ruled out during the evaluation process with your physical therapist.

Risk Factors:

There are several categories of risk factors, some of which can be mediated and others which are more difficult to change. Anatomic risk factors are those that are inherent characteristics that you may be born with. These include flat feet, high arches, or a shortened Achilles tendon. Limitations in hamstring flexibility and the difference in leg length have also been associated with this condition. Biomechanical risk factors are those that describe faulty movement patterns. These include an inward roll of the foot (overpronation), poor alignment of the lower extremity, limitations in ankle dorsiflexion, and weak plantar flexor and intrinsic muscles of the foot. The condition also frequently occurs after a recent increase in activity, such as a recent increase in walking mileage or training for a run, so make sure to increase activity slowly. Lastly, there are environmental risk factors, which are often the easiest to eliminate. These include poor footwear, walking barefoot, hard surfaces, unusually long weight-bearing, lack of stretching, and being deconditioned/ overweight.

How can physical therapy help?

A full biomechanical evaluation is warranted in all cases of plantar fasciitis. Often times it is not the tissue at the bottom of the foot that is faulty, but something up the chain that is driving increased or aberrant forces through the fascia on the bottom of the foot. What is often seen clinically is dysfunction in the calf musculature, weak stabilizers in the lateral hip preventing proper control of the femur, and stiffness through the thoracic and lumbar spine driving aberrant forces through the chain from a top-down fashion. These are just a few examples of biomechanical faults that may be present. Failure in addressing the cause of the biomechanical dysfunction and only treating the irritated tissue will lead to failed treatment. Addressing deficits of the entire lower extremity often result in improved biomechanics and correction of the underlying cause of dysfunction. Some of these interventions include correction of gait mechanics, joint mobilizations to improve the mobility of the first metatarsalphalangeal joint (big toe), talocalcaneal/talocrural (ankle), knee, and hip, as well as stretching to restore optimal muscle length to the calf, thigh, and hip. Important areas to strengthen in order to limit pronation and reduce impact when the foot hits the ground include the tibialis posterior and fibularis longus (directly limit midtarsal pronation via eccentric contraction), tibialis anterior (eccentrically controls ankle plantarflexion), quadriceps femoris (eccentrically limits knee flexion), gluteus medius (eccentric control of hip adduction and internal rotation). At Fox Physical Therapy all of our board certified Doctors of Physical Therapy will help to identify the true cause of your pain and teach you how to prevent it from ever coming back.

Here are a few home treatments you can start right now. Many of these techniques will treat the painful site at the heel directly. Remember that to truly rid yourself of this issue work up and down the chain is needed as well. This is where a visit to a skilled Doctor of Physical Therapy can get the help you need.

Tips for at Home Treatment

Tip #1: Calf and arch stretch with a towel. Perform 3 sets pulling back on the foot for 30 seconds before going to sleep and before first steps in the morning.

Tip #2: Stretch of the plantar fascia stretch with cross-friction massage. Stretch the big toe up and massage bottom of the foot for 1 minute, 3 times before taking first steps. This can also be done throughout the day by placing the heel on the ground and the ball of the foot on the wall and leaning forward.

Tip #3: Roll plantar fascia over a can or ball. Perform for 1 minute (3 times with 30 rest in between) before going to sleep and before first steps in the morning. You can also roll over a frozen water bottle as needed for control of pain and inflammation.



Tip 4:
Use the toes of the painful foot to pick up a dry paper towel, drop and repeat for 2 minutes. Also, scrunch a towel using only your toes.

Contact us today and let us get you back on your feet!

If you or someone you know is suffering from foot pain, the board-certified Doctors of Physical Therapy at Fox Physical Therapy can provide a complete evaluation, including biomechanical screening to identify deficits and underlying causes. No two people are the same and therefore it is essential to have a plan of care that is specific to your needs. Individualized treatment programs can help to relieve plantar fasciitis and prevent it from coming back.

Must Read If Your Are Considering Spinal Surgery

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Are You Considering Surgery for Sping Pain?

In continuation of our last blog post on medical imaging in regards to spine pain, we continue with a look at using medication or considering surgical interventions for controlling symptoms.

Read the original blog post, click here.

So, what about medication to help with spine pain?

Because low back pain can be excruciating, many doctors prescribe opioids for pain relief. These are narcotics and include common brand names such as OxyContin and Vicodin. In the U.S., narcotics are currently the most commonly prescribed drug, and more than half of these prescriptions are for the treatment of low back pain.

Before deciding to use these prescription drugs, it is important to understand that they alter the chemistry within the brain and have the potential to become highly addictive. Opioid addiction is responsible for more than 14,000 death per year. In as little as two weeks, the body may develop tolerance requiring increased doses and leading to withdrawal symptoms once the medication is removed. Research does show that using opioids for a short time can provide modest pain relief (up to 30%).

However, opioids provide minimal to no improvement in function. In other words, these drugs have not been shown to expedite return to work or improve functional outcomes. Moreover, long-term use has been associated with worsening disability and increased sensitivity to pain (hyperalgesia). This is because long-term use causes a reduction in the ability to tolerate pain naturally, which may mean the pain is experienced long after the original cause has healed. Other side effects include constipation, nausea, sedation, increased fall risk, fractures, depression, and sexual dysfunction. Therefore, if you decide to use these medications, current recommendations include using the lowest possible dose for the shortest amount of time.

One viable alternative to opioids includes anti-inflammatory drugs (NSAIDS), as several high-quality studies have shown they are just as effective if not superior to opioids in reducing pain and improving function with much less risk or potential harm. 

Considering surgery?

Here’s why you should explore all options and consider physical therapy before making your decision:

Surgery is almost always a last resort. The preoccupation and misconceptions associated with disc herniation found on imaging have led to many unnecessary surgeries, sometimes resulting in even worse outcomes, particularly when the herniation is not the true source of pain. Surgery carries inherent risks of complications, including infection, bleeding, and the possibility of permanent nerve damage. Significant complications occur in approximately 20% of patients. Depending on the type of procedure, the surgeon may have to cut through bone, muscle, fascia, or ligaments. Even with successful procedures, these structures take time to heal and can potentially cause scar tissue leading to pain and restricting motion. Muscles may shut down temporarily and motion may be limited for a period, which may lead to additional pain and stiffness since healthy discs require the motion for proper nutrition. The stiffness and muscle guarding may also cause other compensations in motor patterns in an effort to protect the spine. This can cause undue stress to other tissues, ultimately leading to further pain and dysfunction. Likely, physical therapy will be prescribed post-surgery and it will generally take some time to regain full function.

What can conservative care offer me?

For all these reasons, surgery is generally recommended as a last option after all other conservative treatments have failed. Research has shown that long-term outcomes after an appropriate bout of physical therapy are generally equivalent to, if not superior to outcomes after surgery. In most cases, low back pain can be addressed and relieved via physical therapy, as research shows that that therapy leads to greater pain relief and decreased drug consumption. In fact, many insurance companies require a course of physical therapy and other more conservative measures before authorizing funds for surgery. This is because the evidence shows that addressing the issue with physical therapy is successful most the time, saving both patients and their insurance companies money and eliminating potentially expensive and debilitating complications. In addition, trying therapy first is never a waste because in cases where surgery is ultimately required patients who have completed “prehab” (therapy prior to surgery) ultimately have better outcomes and faster recoveries.

We hope this small series of imaging, medication, and surgery has cleared up some preconceived myths about low back pain.

At Fox Physical Therapy, our board-certified Doctors of Physical Therapy specialize in mechanical diagnosis and treatment of spine symptoms. Contact us today to find out how we can help you feel better.

Do You Have Pain in Your Knee Cap? It Could be Patellofemoral Pain Syndrome

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Patellofemoral Pain Syndrome is Causing Major Issues for Athletes Living in Miami

Read our  physical therapy tips for overcoming knee pain caused from Patellofemoral Pain Syndrome

By: Eric Alexander DPT,OCS,MDT,CSCS

If you are an active individual there is a good chance at some point in your life you have experienced knee pain. In one report, over the past 30 days, at least 1 in 5 adults in the United States have cited some form of knee pain¹. One of the more common types of knee pain is called patellofemoral pain syndrome (PFPS). This is basically an umbrella term for knee pain that occurs at and around the patella, also known as the knee cap.

The knee cap is a bone contained within a tendon that facilitates movement at the knee. The knee cap slides within a groove in the femur during flexion and extension at the knee. It is thought that pain originates when the patella begins to ‘mal-track’ through this patellar groove in the femur and causes uneven forces through the bony surfaces. The mal-tracking is commonly attributed to muscular imbalances in the hips, thigh, and lower leg. Common populations presenting with PFPS include runners, bicyclists, and young athletes. Pain can typically intensify by sports, walking, running, stair climbing, or sitting for a long time, often called the “Movie-Goers Sign.”

One research article, in particular, has demonstrated the importance of lateral hip strength in relation to knee alignment with activity². College athletes were followed over the course of an athletic season. The athletes who experienced knee and ankle injuries throughout the season all shared two things in common: a weakness of the hip abductors and external rotators of the hip. Any weakness of these muscles during activity can allow your knee to drop-in towards the midline during motion, known as genu valgum, facilitating mal-tracking of the patella and PAIN.

The muscles in question are the gluteus medius, piriformis, and smaller external rotators of the hip. There are a few key exercises that you can add to your normal exercise routine that will help strengthen these muscles in question. These exercises include:

Side-lying Leg Raises

Hip External Rotation Clamshells

Side Planks

Three sets of fifteen reps (3×15) of the side-lying leg raises and clamshells coupled with two sets of thirty to sixty-second holds (2×30-60”) in the side plank position will target these muscles and assist in strengthening. Perform these exercises three to four times a week for six to eight weeks to allow for appropriate strength gains.

If you are experiencing knee pain or know someone who does, Fox Physical Therapy board-certified therapists deliver full biomechanical screens during the evaluation process to specifically identify which structures are at fault. Schedule you consultation today at 305-735-890 or click here.

Resources:

1. Centers for Disease Control and Prevention. QuickStats: Percentage of Adults Reporting Joint Pain or Stiffness, — National Health Interview Survey, United States, 2006. MMWR 2008:57(17);467.
2. Leetun, DT, et al. Core Stability Measures as Risk Factors for Lower Extremity Injury in Athletes. Medicine & Science in Sports & Exercise. Vol. 36, No. 6, pp. 926–934, 2004.