Motion Stability's Blog


Shin Pain When Running? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

Shin splints are very common in runners. It is usually due to some type of muscular imbalance such as tight calves, poor glute strength, and possibly poor footwear and running mechanics. Please consult with a Physical Therapist and also a running coach to assess your mechanics.



When Doing Squats, How Do I Avoid A Stiff Back? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

If your squatting is causing your low back to feel stiff it indicates that either your form, the amount of load or repetition, or the sequence of muscle contractions are incorrect and not safe for your back. With your form – there are many proper ways to squat, but people we see that have back pain or stiffness after lifting typically let the back arch or round too much. It may be the angle your squatting at, but it may also mean that your spine is more structurally unstable than you may think it is. Have a qualified practitioner observe your form to look for any inefficiencies.

In regards to load or repetition – even if your form is perfect eventually your back can wear out due to excessive weight or overdoing the number of times that you squat. I would recommend finding out the repetition, sets, or weight that you feel like you back just begins to stiffen. Next time you do squats, do less than that so your back does not stiffen. As you improve your form and the proper muscle sequence you should notice that you can increase your weight and repetitions gradually without worsening your back stiffness.

Most importantly – back stiffness can occur with squats due to improper muscle sequence. With a squat, the trunk and back muscles should all activate to provide stability to your spine. The muscles that should provide the most power and movement in the squat are your gluteal / buttock muscles. The primary joint that moves in the squat should be the hip – which is controlled by the glute muscles. But what we see are patients that use their knees or back more – causing the quadriceps or back muscles to be used more. This develops an improper sequence of muscle firing patterns and ultimately places more stress on your back as your form and coordination of movement is inefficient. You should contact a skilled health practitioner such as a Physical Therapist to assess the strength and control of your hip, back, and leg muscles if your back stiffens while squatting.



Could Uneven Shoulders Indicate Any Issue? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

Uneven shoulders can be observed in a couple of planes. One of the most common observations is when one shoulder looks higher than the other. This could indicate either a structural, muscular or neural imbalance.

Structurally, the patient may have a leg length discrepancy or a scoliosis that causes the shoulders to be raised on one side.

Muscularly, the shoulder blade or scapula has multiple muscles that stabilize it in position. Muscular imbalances can easily occur that cause certain muscles of the scapula to pull it in a certain direction. For example, in many single arm-dominated sports such as baseball or tennis, the dominate arm tends to over-develop the latissmus dorsi which is your ‘wing’ muscle. With more muscular development it actually pulls the shoulder blade down. In standing postures, most of these athletes will look like their shoulder is lower on the same side. This can create problem for the lowered shoulder, especially when the arm is required to repetitively raise over their head. With the shoulder lowered it takes greater work of the opposing muscles to raise the arm overhead. Over time, it can cause poor shoulder mechanics and lead to injury of the shoulder.

When someone has chronic nerve symptoms in their neck and arm due to a radiculopathy or pinched nerve in their neck, many times you may see that the shoulder on the same side looks elevated. This is due to the adaptation of the muscles to shorten or spasm to elevate the shoulder girdle and allows more room for the nerve to conduct. Patient’s with this pattern often feel tight in their neck and upper shoulder. When they try to stretching the muscles it makes their nerve symptoms worse. This happens because the muscle is not tight but in protective spasm keeping the nerve from being injured further. In this case it is important to treat the nerve first before trying to lower the shoulder girdle.



What Can I Do to Prevent an ACL Injury? by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

An ACL injury is usually due to the knee going into excessive valgus (knee turning inwards) and/or some type of rotary /pivot force. Many people focus on training the musculature around the knee such as the quad and hamstrings. This does help, but one must also consider the stability of the joints above and below – which would be the hips and ankle/foot complex.The knee can be viewed as a junction between two different stilts. If the hip is not stable or has excessive mobility, or the foot / ankle is not supportive such as excessive flat feet or stiff ankles from an old ankle sprain – it can place excessive valgus force at the knee – possibly leading to increased stress to the ACL.
Training thus should consist of hip and thigh training that does not promote internal rotation/valgus to the knee – such as gluteus medius / lateral hip stabilization, as well as improving ankle mobility/foot stability exercises. Once proper movement patterns are established, progression to higher level plyometrics, as well as sports specific training should be introduced.



What Can I Do For Plantar Fasciitis? by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

Pain in the arch or heel of your foot is commonly diagnosed as ‘plantar fasciitis’. However, there are several reasons that can cause pain at the bottom of the foot.

Plantar fasciitis: Usually due to an over-stretched arch. Treatment by taping, manual therapy, orthotics, and use of night splints can provide short-term relief. Long term prognosis is based not only treating the plantar fasciitis itself, but also restoring proper mechanics of the entire leg.

Nerve Pain: The tibial nerve, which is a branch of the sciatic nerve can cause symptoms in the bottom of the foot. The key to treatment in nerve injuries is to determine why and where the injury occurred and treat the nerve accordingly.

Muscle Trigger Points: According to Travell and Simmons, muscle trigger points in the calf and foot muscles can cause referred pain to the foot. Soft tissue techniques and intramuscular manual therapy can be used.



Play Golf? Avoid Lower Back Pain With These Stretches. by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

There are numerous studies that have come out recently that show the loss of lead leg internal rotation of the hip in the golf swing has a high prevelance of low back pain in golfers. This is due to the lead leg in the golf swing acting as your swivel / finishing point in the swing. With limitations in the hip, the back has to work harder to finsh the swing. 

You should work on the foam roll to loosen the lead leg hip musculature, knee to chest and pirformis stretches can also help.

Standard back stretches can help alleviate your back after golf, but consider the causitive reasons why your back is hurting in the first place. I work at a Nike Golf Performance Center called Terminus Club (www.terminusclub.com) we utilize 3D Motion Capture Reality systems to analyze your swing, as well as utilize a Physical Therapist to determine the physical limitations of the body. From there we tailor your swing based upon who you are as an individual and not just the way a PGA Tour swings.



Will I Need Physical Therapy After Hip Replacement Surgery? by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

It is recommended that you work with a skilled Physical Therapist after hip replacement surgery. The Physical Therapist will coordinate with the operating surgeon to improve your hip range of motion, strength, and progress your weightbearing and walking on your hip appropriately. They will also demonstrate to you safe and proper movement with your hip with functional activities such as sitting to standing, getting in / out of cars, and progress you back to your other functional and recreational goals.



Custom Orthotics and Low Back Pain by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

The way the foot contacts the ground significantly affects the way your back absorbs compression to the spine. People who are flat foot footed can lead to decreased hip stability and motion. This is due to the foot not being able to provide proper support each time you step or stand on them. Over time the entire leg musculature, most importantly in the gluteal muscles lose their ability to provide proper support. This can lead to increased stress to the back…like jamming your thumb into a wall a thousand times over…you back gets ‘jammed’ or compressed.

Proper orthotic fitting can help the feet be placed in better alignment and thus provide proper support for the rest of the legs and ultimately the spine to be in a more efficient position to function during the day.

You should also consider that the bottom of the feet are highly sensitive with proprioceptive receptors..which detect spacial awareness. If the foot has better sense of its position, typically the rest of the body will also have better proprioception and spatial stability. It is thought that poor proprioception can make people more susceptible to injury. Orthotics can provide better proprioception.

There are many theories of how orthotics should be made. Please consult with various health practitioners to see what their opinions are about the design of the orthoses.



Can high-arched feet have any complications? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

People with high-arches typically have less give in their foot as compared to those with flat arches. It can affect different body parts. With a more rigid support at the arch there tends to be greater forces dispersed at the heel and ball of the foot. Whether it be callouses, neuromas, or spurs many times they are formed due to excessive forces on that area. People with high-arches also tend to walk on their outside of their foot This makes them have more weight-bearing forces to along the outside of their legs. Commonly you see associated problems with ankle sprains, lateral knee pain such as iliotibial band syndrome (ITB), or lateral hip pain. There is also a tendency for people with high-arches to be generally stiff in their joints and muscles. This is due to a greater amount of ground reaction forces not being absorbed in the foot and sent higher into the legs, back and trunk as weight-bearing occurs.

Physical Therapy typically focuses on improving the soft tissue and joint restrictions that are associated with the rigid / high-arched foot mechanics. Use of proper shoe wear and possible orthotics can help reduce the stresses on people’s feet as well.



How do I manage my back pain on a daily basis? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

First, remain positive. Many people dealiing with chronic back pain can become discouraged and even depressed that their pain does not let them do what they want to do. This can lead to a fear-avoidance belief that takes them away from doing activities that they physically should be able to do. 

From there it is important to establish 2-3 activites during the day that cause back pain – such as sitting, standing, or household activities such as vacuuming. It is just as important to determine the time in which the pain begins. Many patients will complain of pain with a prolonged/sustained activity after 10-20 minutes. What this means is that the muscle endurance of your body is fatiguing quickly and pain begins 10-20 minutes later as increase stress to your spine is occuring.

Like a marathon runner who is hurting and conditioned to run 2 miles. The runner knows well enough not to run 20 miles thereafter, as they will end up hurting themselves. They will instead train to run 2-3 miles until they can condition themselves to increase their distance without hurting worse.

Likewise, with chronic back pain, it is important to stay active, but stay just short of the time that your pain exacerbates itself. As a physical therapist can teach you ways to decrease your pain and improve your stability and movement, slowly you will be able to improve your time in activities that used to hurt you early on. As things progress, you will gain the confidence to do things you couldn’t do before with less pain. We call this ‘pacing’.