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1. Body mechanics: Proper body mechanics and loading strategies are crucial to prevent acute and chronic overuse injuries. It can even improve performance and speed with running, cutting and jumping activities.
2. Strength and conditioning: Safe strength and conditioning with appropriate recovery time can have huge effects on an athlete’s performance and keeping them on the field.
3. Education: Educating patients and athletes on a specific, individualized training protocol is crucial. Once a musculoskeletal injury takes place, that athlete is at higher risk for the same injury. Many coaches and parents are aware injury prevention programs exist, but few are implementing them into their training.

My goal is to educate and perform injury prevention techniques to stop injuries before they happen, but also give the best care possible when injuries occur. Through my personal experience I’ve developed a passion for working with athletes in all stages of rehabilitation so that they may return to their sport and have a better quality of life. At some of my lowest points, having a compassionate, knowledgeable physical therapist made the biggest difference.

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Running is one of the most common recreational sports worldwide and injury rate can be as high as 66%, with over half of these injuries due to overuse.  Luckily, these injuries can be treated very effectively with conservative care and physical therapy! Back when I was in graduate school for physical therapy I decided to give the barefoot running fad a try with the lofty expectation of running an ultramarathon. Unsurprisingly, this didn’t go well for me and I developed pain in my achilles tendon and knees. I went through this frustrating cycle of running causing pain, resting and feeling better, and trying to get back to running, which again caused pain. In one of my classes I learned the true cause of these injuries and how they need to be treated, and they finally started to get better. I still have never run my ultramarathon, but I have been able to compete in other races pain-free and we are hoping that this information can help you do the same.

So, what are the most common running injuries? Let’s delve into the top three.

#1: Achilles Tendonitis

Achilles tendinopathy (formerly referred to as tendinitis) is a complex, but common, problem. In the early stage overuse causes inflammation of the tendon at the attachment to the heel, causing stiffness, pain especially with first steps in the morning or after prolonged inactivity, and a limited ability to do normal activities. This inflammation subsides after a few days of rest and the tendon begins healing, however this process is commonly incomplete and requires further care to fully heal.

So, for anyone who has experienced chronic achilles tendon pain, you probably know that if you aren’t exercising you feel pretty good! After all, not irritating an unhealed injury feels pretty good. But once you start running again this pain cycle seems to repeat itself; increased pain and swelling for a couple days that settles with rest but is continually re-aggravated with exercise. It’s a frustrating process because to regain full function without pain the tendon needs to be exercised in a very specific way. Check out our post next week that highlights this process!

#2: Plantar Fasciitis

Plantar fasciopathy (previously known as fasciitis) is a very similar problem to achilles tendinopathy, however it occurs in the plantar fascia. The plantar fascia is a very thick, strong band of connective tissue on the bottom of your foot that goes from your heel to your toes and helps to stabilize your foot, provide muscle attachment, and generate propulsion during the push-off phase of the gait cycle. Plantar fasciitis is caused by microtearing of the plantar fascia that initially results in inflammation but then, like achilles tendonitis, the inflammation settles, and the fascia can begin healing. Also, like achilles tendonitis, this process tends to require further care beyond the point where pain has subsided to allow for full healing. Keep in mind that chronic plantar fasciopathy is NOT the result of inflammation, so anti-inflammatory medications, injections, ice, etc. typically will have little to no benefit!

#3: Patellofemoral pain syndrome (Runner’s Knee)

Patellofemoral pain syndrome (PFPS), or commonly called Runners Knee, is caused by a couple of factors that act together to cause pain and stiffness around your kneecap. Runner’s Knee is classically related to poor strength and stability in the hips and quadriceps muscles. Weakness in these areas causes your knee to collapse inward (as seen in the photo below) because you do not have the adequate strength to support your body weight. When you run, the amount of force that your legs must sustain can be upwards of 6-7x your body weight with every step!  You can imagine that if your knee is not in the appropriate alignment excess strain will be placed on the knee joint and the kneecap and will start to cause inflammation around the kneecap that causes pain.

There is also a thick band of connective tissue on either side of your kneecap that works to prevent your kneecap from dislocating by keeping it centered in front of your femur. Pain and inflammation around the kneecap can cause these tissues to get stiffer which can cause increased compression of your kneecap on your femur as seen in the image above. Keep in mind that this does not occur all at once; the knee joint is an incredibly strong joint and running as actually been shown to make you less likely3 to develop knee arthritis and does not4 cause progression of pre-existing arthritis! Runner’s Knee is a very mechanical problem, meaning that by correcting your knee and hip alignment and improving strength you can decrease the irritation on the patellofemoral joint and run without pain!

So, there you have it! Achilles tendinopathy, plantar fasciopathy, and patellofemoral pain are the three most common running related injuries and typically occur from overuse and starting/progressing an exercise program too quickly. Ignoring these conditions can lead to ongoing pain that will affect your ability to run. Therefore, if you are struggling with any of these injuries seek out the help of a physical therapist! A skilled PT can help you identify the underlying source of your pain and provide you with the information you need to get back to running.

Next week we will discuss the three most common causes of these problems and share the most common quick fixes so you can stay active and enjoy this Oregon summer!

1. van Mechelen W (1992). Running injuries. A review of the epidemiological literature. Sports Med;14(5):320-35. Review. PubMed PMID: 1439399.
2. Messier SP, Martin DF, Mihalko SL, Ip E, DeVita P, Cannon W, Love M, Beringer D, Saldana S, Fellin RE, and Seay JF (2018). A 2-year prospective cohort study of overuse running injuries: the runners and injury longitudinal study (TRAILS). Am J Sports Med; 1.
3. Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. JOSPT, 47(6); 373-390.
4. Lo GH, Musa SM, Driban JB, Kriska AM, McAlindon TE, Souza RB, Petersen NJ, et al. (2018). Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis institute. Clinical Rheumatology,

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A concussion is defined by the American Academy of Neurology as a trauma-induced alteration in mental status that may or may not involve loss of consciousness. Often times concussions can be easy to miss given they donâ€t always result in unconsciousness and there isnâ€t always other signs of trauma such as scratches or bruises to the face. A concussion is usually a result of direct trauma to the head. However, it can also result from a hit to the body causing the soft brain tissue to be shaken against the inside of the hard skull. Common ways to get an concussion are car crash, bike accident, fight, playground injury, or sports activities.

Immediate signs and symptoms of concussion are extremely variable due to the fact that many different parts of the brain may be affected. Classic symptoms may include a vacant stare, delayed verbal expression, inability to focus, disorientation, stumbling and other in-coordination, nausea, vomiting, headache and dizziness. If any of these symptoms are present, contact your health care provider immediately. Luckily, the majority concussions are fully resolved within 1 week, and the person will have no lasting issues.

If symptoms are still present after 6 weeks, the person is considered to have post concussive syndrome. Symptoms can persist for weeks to months, or even years after the injury. Such circumstances can greatly affect a persons ability to work, go to school, play sports and cause chronic deficits in memory and concentration, headaches, poor balance, fatigue, light and sound sensitivity, mood changes, sleep disturbances, and amnesia.

The best treatment for post concussive syndrome depends on the symptoms that are persisting. Following sports concussion, up to 79% of patients report dizziness and 56% report problems with balance. Post-concussive dizziness and balance disorders may arise from injury to different parts of the brain and the inner ear. A vestibular physical therapist is specially trained in the assessment and treatment of dizziness and balance deficits, and can help in implementing specific exercises and treatments to improve dizziness and balance issues. In addition, athletes who sustain a concussion may aid from structured physical therapy to recover strength, agility and power necessary to return to sports.

In more complicated or prolonged cases, multiple providers are often involved in the full recovery from a concussion. Medications and environmental changes are sometimes needed to improve sleep quality and quantity. If the person has visual deficits or headaches during reading, specific eye exercises can be prescribed to improve eye tracking and focus. Speech therapists and occupational therapists can assist in improving memory and recall. A neuropsychologist (a doctor who specializes in the brain/ behavior relationship) or an orthopedic physician are often involved in the overall management of the concussion, can prescribe medications to address symptoms, and help determine when recovery is complete.

While not all concussions are preventable, you can reduce your chance of injury by:

• Wearing a seat belt every time you drive or ride in a car or other motor vehicle.
• Never driving when you are under the influence of drugs or alcohol.
• Wearing a helmet and safety equipment when you play sports such as football, baseball, hockey, or during other activities like biking, skateboarding, skiing, and horseriding.
• Wearing a helmet when driving or riding on a motorcycle, scooter, snowmobile, or ATV.
• Make your home safer to prevent falls.

Reduce your childâ€s chances of getting a concussion:

• Use child car seats and restraints correctly.
• Teach your child bicycle safety
• Teach your child how to be safe around cars and streets.
• Teach your child playground safety.

If you think you or your child may have a concussion, donâ€t ignore the symptoms. Returning to activity too early can exacerbate the symptoms and prolong the recovery. It is important to get evaluated by a knowledgeable doctor or physical therapist, to devise a treatment strategy to return you to your normal self!

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• Pain is often a result of abnormal forces or mechanics on tissues. Because it is a traumatic or repetitive position, movement, or activity that can cause pain, a specifically applied mechanical load or force can also be a part of the solution.

• At Advance Sports and Spine Therapy, our therapists utilize a research proven assessment system that can be used to evaluate all musculoskeletal problems including but not limited to neck and back pain, upper and lower extremities, sciatica, sacroiliac joint pain, arthritis, and degenerative joints/discs.
• Our evaluation process is an ongoing active assessment and treatment. We generally do not utilize hot/cold packs, ultrasound, electrical stimulation, or other passive treatment modalities.
• Our assessment determines postures or movements that may be aggravating or provoking and finds 1-2 exercises that will directly influence your primary symptom. You won’t go home with a laundry list of exercises.
• Our treatment allows the patient to learn principles of management and empowers them to self treat and control their symptoms, decreasing their dependency on medical intervention. If skilled manual therapies are needed (joint mobilization, manipulation, soft tissue mobilization), they are often coupled with exercises that the patient can independently simulate at home.
• No one specific treatment is applied for a condition (no cookie cutter treatment for low back pain). Rather, individual treatments are determined by the therapist based on assessment findings and an individual plan is developed in collaboration with the patient.

What is ASTYM?

• Soft tissue treatment that regenerates tissues that have become dysfunctional (tendons, ligaments, muscles) and can reduce or eliminate unwanted scar tissue resulting from surgery or injury, which may cause pain and/or restrict movement.
• Instruments are run firmly along the skin in the direction of the muscle, tendon, ligament.
• The instruments will glide over healthy tissue, but you will feel bumps where the tissue is dysfunctional, non-invasively stimulating the bodies regeneration response.
• Based on where dysfunctional tissue is found, specific exercises are prescribed to either stretch to align tissues or resistance exercises to strengthen the new tissues.

What are the MedX machines?

• Specialized equipment to test and strengthen the low back and neck musculature
• Provides resistance over a full range of isolated low back or neck motion, or over a selected limited range.
• Develops strength and endurance of the neck and back with patient specific protocol
• Individual patient data can be compared to population ‘norms’

What is Functional Movement Screen (FMS)?

• Grading system to assess and document functional movement patterns
• Used to assess for increased or decreased risk of injury or re-injury with sport or occupational activity
• Functional limitations and asymmetries can be identified
• Once identified, appropriate corrective exercises are prescribed

What do all those letters mean?

Our physical therapists have a wide range of specialty training. Below is a list of what the alphabet soup behind each of our names mean:

• PT-The regulatory designator for physical therapist. Only PTs should be providing and overseeing the delivery of physical therapy services.
• DPT-Doctor of Physical Therapy, the educational degree conferred .
• Dip MDT-Diploma in Mechanical Diagnosis and Therapy-Highest educational level achieved through McKenzie Institute International.
• Cert MDT-Certified in Mechanical Diagnosis and Therapy
• COMT-Certified Orthopaedic Manual/Manipulative Therapist
• CMPT-Certified Manual Therapists
• CSCS-Certified Strength and Conditioning Specialist
• CK-FMS-Certified Kettlebell-Functional Movement Specialist
• SFG: Strong First Girya-kettlebell certified instructor

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Earning both his Masters in Science and a Doctorate in Physical Therapy from Pacific University, he has since gone on to earn the following advanced post graduate certifications:

• MDT Certified Mechanical Diagnosis and Therapy through McKenzie Institute International
• COMT: Certified Orthopedic Manipulative Therapy through the North American Institute of Orthopeadic Manual Therapy.
• OCS: Orthopedic Certified Specialist through the American Physical Therapy Association
• Astym through Performance Dynamic
• Strong First Kettlebell Certification
• RYT-Registered Yoga Instructor 200 hours

Noel is also involved with several committees within the Oregon Physical Therapy Association. His passion for quality care has fueled a desire to assist with much of the government affairs within the profession. Currently, Noel practices out of our West Linn location. When He’s not in the clinic, you can find him working on his yoga flow or teaching kettlebell classes!

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