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Physical Therapy Wellness Blog

Physical Therapy For The Shoulder

Physical Therapy for Rotator Cuff Injuries

By Rotator Cuff

What is the Rotator Cuff?

Rotator cuff injuries are the most common types of shoulder injuries. 

The rotator cuff is a group of four muscles that connect your shoulder blade (scapula) to your arm (humerus) and help stabilize the shoulder joint. These muscles work together to help you lift your arm overhead and rotate your arm in and out. The four muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. 

There are different types of injuries to the rotator cuff. The less serious and more common injuries are called shoulder impingement and rotator cuff tendinitis. Shoulder bursitis is a condition that does not directly affect the rotator cuff tendons, but it can occur in conjunction with impingement and tendinitis. The more serious injury is a rotator cuff tear. 

Types of Rotator Cuff Injuries

Shoulder Impingement

Impingement in the simplest terms means something is being “pinched”. This could be a rotator cuff tendon, shoulder ligament, or your bursa. All of these structures go under a bone called the acromion which is a part of your shoulder blade (scapula). When you move your arm in certain positions, the items underneath the acromion can become pinched or compressed, causing an increase in pain and inflammation. 

Rotator Cuff Tendinitis

When the rotator cuff tendons are being compressed, they become inflamed and irritated. Since they are surrounded by bone, when they swell, this increases the pressure inside your shoulder joint. The goal for rotator cuff tendinitis is to decrease the inflammation and allow the tendons to heal. 

Shoulder Bursitis

Bursas are small fluid-filled sacs in multiple areas of the body that help reduce friction. Your shoulder bursa is located in the space between your rotator cuff tendons and the acromion. When you lift your arm in certain positions, this space becomes narrowed, and the bursa can become inflamed and begin to swell. 

Rotator Cuff Tear

When shoulder impingement and/or tendinitis goes untreated, it can lead to a more serious condition called a rotator cuff tear. This is due to the tendon(s) being irritated and getting less blood flow over time, potentially causing the tendon(s) to develop small tears or holes. There are different types of rotator cuff tears, depending on how severe the injury is and how many tendons are involved. 

1. Partial Rotator Cuff Tear

This type of injury means that only part of the tendon is torn. This typically involves the supraspinatus muscle, which is located on top of the shoulder blade. Repetitive arm motions over time can cause fraying of the tendon, which leads to pain in certain motions. It is possible to heal a partial tendon tear without needing surgery. However, it is important to seek medical help to prevent these types of injuries from progressing to a full thickness tear.

2. Full Thickness Rotator Cuff Tear

Full thickness tears mean that the tendon is completely torn in half. This can involve only one tendon (more common) or multiple tendons (less common, more severe). This type of injury requires medical intervention including cortisone injections, physical therapy, and potentially surgery. They can be diagnosed through an MRI.

What Causes Rotator Cuff Injuries?

There are multiple causes of rotator cuff injuries.

The most common cause is overuse. Jobs that involve more repetitive arm motion such as cleaning, construction work, painting, or lifting heavy objects put increased strain on the rotator cuff. Certain sports such as golf, tennis, baseball, weightlifting, and swimming can also place stress on these shoulder muscles. However, general wear and tear over the years can also cause the tendons to break down and potentially tear. Tendons start to lose their elasticity as they age, so it is easier for older adults to injure their rotator cuff tendons than someone in their twenties.

In addition to overuse conditions, here are other common causes of rotator cuff injuries:

Common Causes:

  • Repetitive overhead movements
  • Weakness in rotator cuff muscles
  • Lack of blood supply
  •  An injury such as a fall
  •  Poor posture
  • Thickening of the bursa or ligaments  
  •  Osteoarthritis and/or bone spurs in shoulder joint
  • Anatomy differences in the shape of the acromion, which can decrease the space underneath the acromion (subacromial space)

Signs and Symptoms of Rotator Cuff Injuries

Shoulder Impingement

Pain is typically located in the front of the shoulder and extends to the side of your arm. Patients also can report pain in the back of the shoulder.  


-Pain in front of shoulder


-Limited shoulder mobility


Typically pain is reproduced with certain arm movements including reaching behind your back, extending your arm overhead, and moving your arm out to the side. You most likely will also experience some weakness in your shoulder muscles if trying to lift an object in these positions. Throwing a baseball and cleaning windows is often challenging and painful. Most patients also report pain and difficulty sleeping on the side of the painful shoulder. 

Rotator Cuff Tear

Pain is more severe in a rotator cuff tear, and the pain may be present at rest and not only with certain movements. Typically more significant weakness is noted with a rotator cuff tear, and it may be difficult to raise your arm. The type of pain present in a rotator cuff tear also may depend on if the tear is acute (short-term) or chronic (long-term). 

  1. Acute Rotator Cuff Tear: 
    1. A specific quick arm movement or injury such as a fall caused the rotator cuff tendons to tear
    2. Can cause extreme sharp or immediate pain
    3. Pain can be present at rest 
    4. Significant loss of arm strength 
  2. Chronic Rotator Cuff Tear:
    1. May not have been caused by a specific injury 
    2. Typically occurs over time, starts as shoulder impingement until it progresses to a tear in the tendon
    3. Starts as mild pain and then may become more widespread and constant

Physical Therapy for Rotator Cuff Injuries

In the majority of cases, shoulder impingement and partial rotator cuff tears can be successfully treated conservatively through Physical Therapy. Complete rotator cuff tears can also be treated through PT to help reduce your pain and improve your range of motion and strength. 

During your first session, your PT will ask you multiple questions so he/she can figure out what is the underlying issue of your pain. These questions could include:

  •     What arm movements cause your pain?
  •     Is your pain worse in the morning or at night?
  •     Is your pain always present or is it caused by a single movement?
  •     When did your shoulder symptoms begin?
  •     What activities are you unable to perform due to your shoulder pain?

The initial goal of PT is figuring out what is the source of your shoulder pain, whether it be rotator cuff related or another type of shoulder injury. This will help create a treatment plan that was designed specifically for you. Typical PT sessions will include:

  • Pain Management: Your PT will help determine which movements cause your pain and help you avoid them in the beginning of treatment to decrease your symptoms. 
  • Range of Motion and Stretching Exercises: Often your shoulder motion becomes limited due to pain. Your PT will prescribe you stretches for your shoulder to help regain your mobility to help you reach up and out to the side without pain. 
  • Strengthening Exercises: The rotator cuff muscles are typically weakened which makes it challenging to perform your daily activities. Your PT will give you strengthening exercises for your rotator cuff and postural muscles to reduce the strain in your shoulder. 
  • Manual Therapy: Hands-on treatment also assists in loosening your tight shoulder muscles and improving the stiffness in your shoulder joint. Dry needling is also an effective approach for relieving low back pain!

You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of shoulder pain.


Injuries to the rotator cuff are extremely common, and our physical therapists are specifically trained to help relieve your symptoms. Regardless if you have had shoulder pain for years or just started experiencing shoulder pain recently, we can assist in alleviating your pain! Click here or fill out the form below to schedule an appointment!

Physical Therapy For The Knee

Physical Therapy for Knee Pain

By Knee

Do you have knee pain?

The knee plays a large role in your everyday life. It helps you walk, stand, run, jump, navigate stairs, and sit down and stand up from a chair. The knee joint must take the primary load of your body weight, so it is no wonder why it is commonly injured! 

The knee can be painful in all different age groups, and there are multiple causes of knee pain. There can be a specific injury that caused the knee to become painful, or the pain can come on suddenly without any known cause.

What Causes Knee Pain?

There are various causes of knee pain, but to simplify things, we can divide the causes into three main types: sudden/traumatic injuries, overuse injuries, or underlying conditions.

Traumatic Injuries

  • Typically occur in younger population (ages 15-40)
  • Acute injury (pain begins immediately)
  • Commonly see increased swelling and inflammation
  • Pain is linked to a specific event:
    • Fall
    • Sudden twisting motion or a sharp turn
    • Blow to the knee
    • Car accident
    • Sports injury (foot is planted and knee twists)

Examples of Traumatic Injuries:

  • Ligament Injuries (tear or sprain)
    • ACL Injury
  • Tendon Injuries
    • Patellar Tendonitis, Quadriceps Tendon Tear
  • Meniscus Tears
  • Muscle Strain
    • Hamstring Strain, Calf Strain, Quadriceps Strain
  • Fracture
    • Patellar (kneecap) fracture, Tibial Plateau fracture (top of shin bone)

Overuse Injuries

  • Can occur in any age group, but most common in ages 25-50
  • Typically there is no specific injury that causes knee pain
  • Pain can either start out gradually and then get worse over time or can become extremely painful all of a sudden
  • Due to repetitive stress due to poor body mechanics, muscle imbalances, and/or tight muscles

Examples of Overuse Injuries:

  • Patellar Tendinitis (Jumper’s Knee)
  • Runner’s Knee (Patellofemoral pain)
  • IT Band Syndrome

Poor body mechanics:

The knee also can become painful due to issues at the hip or ankle joints. If there is hip weakness, this can change the alignment of the hip which can then cause excess stress at the knee joint. The same thing can occur at the ankle joint, especially when someone over-pronates. We often see that the ankle or hip is the culprit of the dysfunction, but the knee is the victim of the pain!

Underlying Conditions 

  • Common in older population (age 55 and up)
  • “General wear and tear”
  • Pain can occur suddenly or gradually over time

Examples of Underlying Conditions:

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Pseudogout

Signs and Symptoms of Knee Pain

Symptoms for knee pain can depend on the underlying cause of the pain. Some common symptoms that patients often report are:

  • Stiffness
  • Swelling 
  • Clicking or popping
  • Catching sensation
  • Knee giving out or buckling

The location of your pain can also give clues to what is causing your pain. 

ACL Tear

ACL stands for Anterior Cruciate Ligament, and this ligament connects the thigh bone (femur) to the shinbone (tibia). This ligament helps stabilize the knee by preventing the shinbone from sliding forward. Damage to this ligament can occur when someone plants their foot and pivots, quickly changes directions while running, or landing from a jump with a hyper-extended knee. 

Injuries to the ACL often occur in the athletic population, specifically in sports such as soccer, tennis, basketball, and skiing. Common symptoms of an ACL tear include hearing a pop in the knee followed by intense pain and swelling. Patients also report a feeling of instability in the knee. 

Meniscus Tear

The meniscus is a rubbery piece of cartilage that cushions the knee joint and acts as a shock absorber. You have a medial meniscus in the inside of your knee and a lateral meniscus in the outside of your knee. 

The meniscus can frequently become injured and tear due to twisting movements. This can occur in the younger population during sports injuries, and often one of the cruciate ligaments is also torn. Meniscus tears can also occur in the middle aged population. As you age, your cartilage begins to thin down, making it easier to tear the meniscus with less intense activity. 

Common symptoms include hearing a pop, catching, locking, swelling in the knee, stiffness, and decreased ability to straighten your knee. 

Runner’s Knee (Patellofemoral Pain Syndrome)

Pain in the front of the knee and around the kneecap is extremely common. The patellofemoral joint is the joint where your kneecap (patella) meets your thigh bone (femur). There are various causes to pain on and around the patella including:

  • Structural issue in the joints 
  • Having knock-knees or bow-legged
  • Tightness in the thigh and calf muscles
  • Weakness in the hip and/or ankle muscles
  • Muscle imbalances causing the kneecap to become stiff
  • Overuse or excessive training

Symptoms may include pain in the kneecap while you are walking, running, jumping, going up or down stairs, squatting, or kneeling. Pain can also occur if you sit for a while and then stand up. Patients can also report clicking, grinding, or instability in the knee joint.

Muscle Strain or Injury

Muscles surrounding the knee such as the quadriceps, calf, and hamstrings muscle can become injured and cause pain in the knee. Injuries to the muscles can occur suddenly due to a specific injury or gradually over time. 

An acute injury to a muscle can occur if you suddenly trip, fall, or twist your knee. You can also injure your muscles if you are fatigued and overstretch your muscle, often during a sporting event. Often you have heard someone say they “pulled a muscle”, and this refers to a muscle strain. Muscle strains often result in localized swelling, pain when attempting to stretch the muscle, and muscle spasms.

Muscle injuries can also occur over time and are not linked to a specific injury. If you recently started a new type of exercise or workout routine, the muscles in your thigh and lower leg can become overworked and develop trigger points (knots). Trigger points cause a muscle to become weakened and can refer pain to the knee. 


You have cartilage at the end of your thigh bone (femur) and at the end of your shin bone (tibia). Cartilage acts as a cushion for your joints, but as you age, cartilage begins to break down and thin out. As it wears away, the joint space narrows and becomes more “bone on bone” which causes your knee to feel stiff and very painful. 

There are various stages of osteoarthritis (OA) in the knee, and most people often do not realize that they have OA in the early stages. But as the condition progresses, the inflammation increases and bone spurs (osteophytes) can also occur. 

The most common symptoms of osteoarthritis are:

  • Gradual onset of knee pain which becomes worse over time
  • Knee stiffness, especially first thing in the morning or after prolonged sitting
  • Loss of knee range of motion
  • Increased swelling or enlargement of the joint
  • Pain standing up from a chair

Tips for Managing Your Knee Pain

Physical Therapy for Knee Pain

In the majority of cases, knee pain can be successfully treated through Physical Therapy. Even if you were told by your doctor that you were a candidate for knee surgery, give PT a try first! Meniscal tears, ligament tears, and osteoarthritis can be treated through PT to help reduce your pain and improve your range of motion and strength. 

During your first session, your PT will ask you multiple questions so he/she can figure out what is the underlying issue of your pain. These questions could include:

  •     What leg movements cause your pain?
  •     How did your knee symptoms begin?
  •     Did you injure your knee or did the symptoms begin gradually?
  •     Did you start any new workout routines such as running or weight lifting?
  •     What activities are you unable to perform due to your knee pain?

The initial goal of PT is figuring out what is the source of your knee pain, whether it be a muscle strain, ligament damage, meniscus tear, osteoarthritis or another type of knee injury. This will help create a treatment plan that was designed specifically for you. Typical PT sessions will include:

  • Pain Management: Your PT will help determine which movements cause your pain and help you avoid them in the beginning of treatment to decrease your symptoms. 
  • Range of Motion and Stretching Exercises: Often your knee motion becomes limited due to pain. Your PT will prescribe you stretches for the muscles around your knee to help regain your mobility and allow you to move your knee with less pain. 
  • Strengthening Exercises: The quadriceps and hamstring muscles are typically weakened which makes it challenging to perform your daily activities such as walking, navigating stairs, and standing up from a chair. Your PT will give you strengthening exercises for your weakened muscles in the thigh and hip to reduce the strain in your knee. 
  • Manual Therapy: Hands-on treatment also assists in loosening your tight knee muscles and improving the stiffness in your knee joint. Dry needling is also an effective approach for relieving knee pain!

You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of knee pain.


Knee pain is very common, and our physical therapists are specifically trained to help relieve your symptoms. Regardless if you have had knee pain for years or just started experiencing knee pain recently, we can assist in alleviating your pain! Click here or fill out the form below to schedule an appointment!

Physical Therapy for the Elbow

Physical Therapy for Tennis Elbow

By Physical Therapy, Rehabilitation, Tennis

What is Tennis Elbow?

Tennis elbow is one of the most common upper body orthopedic injuries, especially when it becomes warmer outside and people pick up a new recreational activity. Although the name implies that this condition only occurs in tennis players, this is not always true! It is more common in tennis or racquet sports athletes, but it can also occur in anyone who performs repetitive arm motions through their job, recreational, or home activities. 

Tennis elbow, or lateral epicondylitis, refers to pain on the outside (lateral) part of your elbow, often made worse with increased activity. The lateral epicondyle is the end of the humerus bone (upper arm bone), and your forearm muscles that extend your wrist and fingers (extensor muscles) attach to this bone. The tendon of these forearm muscles, called the common extensor tendon, can become inflamed with overuse. If left untreated, the pain can become worse over time. 

Lateral Epicondylitis is the inflammation or irritation of the common extensor tendon, causing pain in the forearm or outside part of the elbow.

What Causes Tennis Elbow?


Typically, lateral epicondylitis is caused by repetitive overuse and overstretching of your forearm extensor muscles. The most common muscle affected is the extensor carpi radialis brevis (ECRB). When the forearm extensor muscles become overworked, they can develop trigger points or knots in the muscle. These knots are due to the build up of lactic acid and lack of stretching post activity. Trigger points can refer pain and cause weakness in the muscle. The more knots that develop and the tighter the extensor muscles become, the more that the tendon can become irritated.

This excess strain can result in tiny tears in the tendon where it attaches to the lateral epicondyle. This causes acute inflammation in the tendon, often leading to an increase in pain. 

If left untreated, lateral epicondylitis can become a chronic condition and get worse over time. Due to the overuse, scar tissue can develop and thicken the tendon. At this stage, there are typically no inflammatory cells, and we call this condition “Lateral Epicondylalgia”. 

Other Causes

  • Starting a new activity 
    • Rock climbing, tennis, water sports, CrossFit
  • Going too hard too fast
  • Improper technique or equipment while playing racquet sports
  • Prolonged use of hand or wrist
  • Typing or mousework at a computer
  • Painters, plumbers, machine operators
  • Excessive gripping or twisting activities
  • Lifting heavy objects
  • Forceful activities 
  • Unknown 
  • The pain can begin randomly, and we call this “insidious onset”

Signs and Symptoms of Tennis Elbow

  • Usually starts out gradually and become worse over time
  • Pain and tenderness on the outside part of your elbow
  • Pain may radiate into your forearm or wrist
  • Pain or weakness with gripping activities
  • Weakness or cramping in the forearm with recreational activities 
  • Difficulty with opening a jar 
  • Pain when lifting a heavy object or child
  • Stiffness in the elbow

Tips for managing pain if you think you may have lateral epicondylitis

  • Modify your activities
    • This includes taking a rest break from tennis, lifting, or any other activity that is painful
    • Remember, tendons take time to heal! Taking a few weeks off after the pain begins is typically recommended for a tendinitis injury
  • Try ice or anti-inflammatory medications
  • Perform stretches for your forearm, especially before and after increased activity
    • You can watch our video where we instruct on these specific exercises.
  • Massage your forearm muscles 
    • You can use your opposite hand to massage the muscles on the back of your forearm
    • You could also use a handheld massage gun to gently loosen these muscles
  • Applying a compressive brace on your forearm
    • This helps release the amount of tension on the tendon on your lateral epicondyle

What happens if my pain doesn’t improve?

Physical Therapy for Tennis Elbow

If your pain lasts longer than a few weeks and doesn’t seem to be improving, it may be time to try Physical Therapy for tennis elbow! 

Lateral epicondylitis is not always a “one size fits all” condition. There can be other factors contributing to your pain including numbness/tingling in the forearm, pain on the inside part of your elbow (medial epicondylitis/golfer’s elbow), and possibly shoulder and/or wrist pain. Our Physical Therapists will evaluate your elbow and determine the best plan and treatment approach specifically for you.

Don’t forget, you can refer yourself to Physical Therapy!

What Can I Expect during a PT Session? 

  • Pain Management: Your PT will help determine which movements cause your pain and help you avoid them in the beginning of treatment to decrease your symptoms. 
  • Range of Motion and Stretching Exercises: Often your wrist and elbow motion becomes limited due to pain. Your PT will prescribe you stretches for the muscles around your elbow to help regain your mobility and allow you to move with less pain. 
  • Strengthening Exercises: The forearm extensors and flexor muscles are typically weakened which makes it challenging to perform your daily activities such as gripping, typing, and lifting. Your PT will give you strengthening exercises for your weakened muscles in the forearm and hand to reduce the strain in your elbow. 
  • Manual Therapy: Hands-on treatment also assists in loosening your tight forearm muscles and improving the stiffness in your elbow joint. Dry needling is also an effective approach for relieving lateral elbow pain!

You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of elbow pain.


Lateral elbow pain is very common, and our physical therapists are specifically trained to help relieve your symptoms. Regardless if you have had elbow pain for years or just started experiencing this pain recently, we can assist in alleviating your pain!

If you’re experiencing pain in your elbow, please contact us by using the form below and we can get you scheduled with one of our dedicated physical therapists!

Physical Therapy For The Back

Physical Therapy for Low Back Pain

By Health, Low Back, Physical Therapy, Rehabilitation, Spine

Low Back Pain

Out of all of the orthopedic conditions that Physical Therapists treat, low back pain is the most common. Low back pain can occur whether you are young or old, and it can last a few days or be off and on for years. It can be aggravated by a single event such as bending over, a car accident, or the pain can sneak up gradually over time.

Because low back pain can present many different ways, it is not a “one size fits all” condition. There can be issues with the joints in your spine, and this can cause stiffness in the bones in your low back. You could also be experiencing low back pain with possibly some weakness or numbness and tingling in your lower leg. Your low back could be taking 

too much of the load during activities due to weakness in your core and hip muscles. Whatever the cause, Physical Therapy for low back pain can help you return you back to function!


What Causes Low Back Pain?

As mentioned above, there are MANY different causes of low back pain. Here is a brief overview of the most common causes.

Common Causes:

  •     Disc and Nerve-related Conditions:

      Herniated Disc

      Lumbar Radiculopathy


  •     Degenerative Conditions: common over the age of 50

      Lumbar Spinal Stenosis

      Degenerative Disc Disease


      Facet Joint Syndrome



  •     Myofascial Conditions: common in individuals 20-50 years old

      Muscle Strain or Spasm

      Ligament Sprain



  •     More Serious Conditions:



      Kidney Disease



Signs and Symptoms of Low Back Pain

Your pain might be in the center of your low back right above your belt line, it could be off to one side, or it could even begin to radiate down into your buttock region. The pain area could be a pin-point location or span across a larger region. Symptoms could vary between sharp or stabbing pain, throbbing pain, a dull ache, or shooting pain. The pain could be constant or come and go depending on the time of day or your activity level. You might not even be experiencing pain, but rather you feel more stiffness and an uncomfortable feeling in your low back.

The time limit and how frequently you experience your symptoms also helps define your low back pain. The main three categories of pain are:

1)    Acute Low Back Pain (pain that has lasted less than 3 months)

2)    Chronic Low Back Pain (pain that has lasted more than 3 months)

3)    Recurrent Low Back Pain (multiple periods of 3 month episodes of acute low back pain that comes and goes)

*If you are experiencing any symptoms that are more severe such as loss of bowel or bladder, progressive and severe weakness in both legs, decreased sensation in your groin area, or unexplained weight loss, please see your doctor immediately.

Tips for Managing Your Back Pain

Acute Low Back Pain

Typically resting for a short period of time can help calm down your symptoms initially. Ice can be used any time your back becomes hot and inflamed, such as after a fall or after a sudden movement that caused a sharp pain. Heat is commonly used after a car accident or repetitive activities that cause your back to ache and throb afterwards. Sometimes alternating heat and ice or using creams such as IcyHot or Biofreeze can also help you find some relief.

The most important thing to remember is that resting for a little bit after injuring your back is okay, but bed rest for multiple days is not recommended! The longer you stay inactive, the tighter your muscles and joints can become, and this can cause you more low back pain. Especially if you have been involved 

in a car accident, it is essential to keep moving!

If you recently aggravated your low back, it is also best to avoid prolonged positions such as sitting or staying in a crouched position for a long period of time. Additionally, attempt to avoid any heavy lifting or  repetitive squatting movements until your pain begins to decrease.

If you have been suffering with low back pain for more than two weeks and cannot find any relief, it may be time to consult your doctor or refer yourself to Physical Therapy.

Recurrent or Chronic Low Back Pain

Perhaps you have been suffe

ring with low back pain for years and have tried multiple different treatment options with no relief. Clearly something is causing your pain to keep coming back, and Physical Therapists are trained to come up with solutions to allow you to have more pain-free days.

Physical Therapy for Low Back Pain

In the majority of cases, low back pain can be successfully treated conservatively through Physical Therapy. During your first session, your PT will ask you multiple questions so he/she can figure out what is the underlying issue of your pain. These questions could include:

  •     What movements cause your pain?
  •     Is your pain worse in the morning or at night?
  •     Does your pain get gradually worse during the day or is it caused by a single movement?
  •     Do you have numbness or tingling down your leg or in your foot?
  •     When did your symptoms begin?
  •     Have you tried any other treatments before today?

The initial goal of PT is figuring out which movements cause your pain and avoiding them in the beginning of treatment to decrease your symptoms. Your PT can then find stretches or positions that feel good and help alleviate your low back pain. Once your pain decreases, you can begin performing your regular activities again. Typically strengthening exercises for your core and hip muscles is also necessary to reduce the strain in your low back muscles. Manual therapy (hands-on treatment) also assists in loosening your tight muscles and improving the stiffness in your back joints. Dry needling is also an effective approach for relieving low back pain!

You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of low back pain.


There are numerous treatment options for low back pain including injections, pain medications, chiropractor, massage, or possibly even surgery. If you have tried any of these treatments but nothing has helped, give PT a try! We see patients every day with low back pain, and we would love to help alleviate your pain!

If you’re experiencing Low Back pain, please contact us by using the form below and we can get you scheduled with one of our dedicated physical therapists!



Your Sleeping Positions Are Making You Tight and Sore

By Uncategorized

Guest Blogger Steven Griffin, DPT

Do you often feel restless during the night and wake up with neck, shoulder, back, or hip pain? Do you feel like you can’t find a comfortable position? Have you tried multiple pillows or even a new mattress and still have the same old problems?

Sleeping is critically important to our functioning as human beings. Consistent disturbances in sleep can be the source of many issues, including but not limited to: mood, concentration, and memory issues, weakened immunity, increased risk for heart disease, high blood pressure, or diabetes, and decreased tissue growth and repair. A good night’s sleep is of dire importance for us to stay healthy.

Poor sleep quality can be caused by a number of factors. Emotional or mental stress can cause one to lie awake or toss and turn for hours. A poor sleeping environment such as too much light or noise can prohibit us from feeling rested. But what often gets overlooked is that how we position ourselves in bed can also impact the quality of our sleep. Improper positioning can stress muscles, ligaments, tendons, and other tissues. Furthermore, as humans, our bodies do not like to be in one position for long periods. This is why we often get the urge to stand up and stretch when sitting and why we find ourselves shifting around when we have been standing. However, we do not have much conscious control of our positioning while sleeping. Many times, waking up stiff or tight is a result of subjecting tissues to non-neutral positions all night long.
In general, there are three types of sleepers – back, side, and stomach sleepers. Although you might employ a combination of these, most people have a preferred position. Each position can present its own unique issues, but there are strategies to prevent these issues from having a lasting effect on your body and improve your sleep quality. The following paragraphs will cover what can cause problems in each position, and how you can combat these problems or prevent them from occurring altogether.

Back Sleepers
Ultimately, sleeping on your back with everything in a straight line is the best option if done correctly because all of your joints and muscles are in an anatomically neutral position. But, most people aren’t comfortable sleeping like a corpse, so there are issues that can arise with back sleeping.

Problem #1: You have too much pillow support. Having an extremely fluffy pillow or even more than one pillow can put the neck into excessive flexion, setting you up for tight muscles and possible disc issues. It’s also likely that if you work a desk job, you have been sitting in this position all day–so you’re living your entire life in this position, which will almost undoubtedly lead to neck pain.
Solution #1: Get a flatter pillow or remove excess pillows. This will reverse the excess flexion in the neck and optimize cervical muscle length.

Problem #2: You have too much extension in your lower back. Lying with your legs out straight often creates a significant amount of arch in your lower back, which over time stresses the joints of the spine and cause shortening of spinal musculature. This can lead to low back pain or stiffness.
Solution #2: Put a pillow or a wedge under your knees. This will reduce the arch in your back, keeping it in a more neutral position all night.

Problem #3: Your sheets are tucked too tightly over your body. This will force your feet into a point all night long, leading to tightness in the calves–which may predispose you to things like plantar fasciitis or cramping.
Solution #3: It might seem obvious, but untuck your sheets at the side and/or the bottom. This will reduce the pressure on your feet and allow them more room to move around under the covers.

Side Sleepers
Many people, including myself, prefer to sleep on their side. This position is usually fine as long as you have a supportive mattress and pillow, but there are still problems that can arise when sleeping on your side.

Problem #1: You do not have enough pillow support. In contrast to having too much when on your back, many people do not use enough support when on their side. This is especially true for people with broad shoulders, as the relatively larger distance from the mattress to their head is larger. Without proper pillow support, the neck will be forced into a side bend towards the pillow, and prolonged positioning like this is very likely to lead to some neck stiffness down the road.
Solution #1: Increase your pillow support by doubling up your current pillow, adding a second pillow, or buying a more supportive pillow so that your neck is as neutral as possible.

Problem #2: You sleep with your bottom hand under your head. Cradling your head in your hand may feel nice at the time, but this puts your shoulder in relative internal rotation all night long. This problem is compounded by the fact that most of us sit with our shoulders rounded forward much of our day, so sleeping this way ensures we rarely move out of this position. In addition to the internal rotation, this can also produce compression through the shoulder joint, and these two in combination can cause issues like impingement.
Solution #2: Put your arm under the pillow instead of under your head. This is a compromise in which you still get the cradling feeling but decrease the internal rotation of your shoulder. Also consider rolling back slightly to decrease some of the compression directly through the shoulder joint.

Problem #3: You sleep curled up in the fetal position, causing increased hip flexion and internal rotation. If you sit a lot at your job, this excessive hip flexion is likely one that you spend too much time in every day. This increases tightness in the hip flexors and stresses the gluteal muscles, which can ultimately lead to back pain, bursitis, or gluteal tendonitis.
Solution #3: Bring your knees down and sleep with a pillow between your knees. This will decrease the amount of hip flexion and bring your hips into a more neutral position.

Stomach Sleepers
This is typically not a position I recommend people sleep in because of the effect on the neck and the lower back. But, if you must, please consider the following potential problems and their solutions.

Problem #1: Your head is in excessive rotation. Because suffocating yourself in the pillow clearly isn’t an option, you have to rotate your head to almost its end range when sleeping on your stomach in order to breathe. Imagine sitting like this all day and how stiff and sore you would get. This position places a tremendous amount of stress on the joints and muscles in the neck, and can often lead to soreness or a “crick” in the neck.
Solution #1: Place a pillow under the arm towards which you are turned. This creates a decrease in the relative rotation of the neck by rotating the rest of the trunk towards that side as well.

Problem #2: If you like to sleep with your hands under your head, then your shoulders are in excessive elevation and internal rotation. This shortens muscle groups that are already tight in most people and can lead to stiffness of the neck and pain in the shoulders.
Solution #2: Unfortunately, there isn’t a great solution to this problem if you want to stay on your stomach. If you’re willing to compromise, then you can flip onto your back and sleep with your hands under your head. This will put your shoulders in more external rotation and also take the excessive rotation out of your neck as well.

Problem #3: You have too much extension in your lower back. This occurs because of the elevation of your head and neck on a pillow relative to the rest of your body. This excessive extension causes prolonged compression of the lumbar vertebral joints and shortening of the paraspinal muscles, which can lead to back pain.
Solution #3: Remove the pillow and sleep without support. This will reduce the amount of extension in both the lower back and the neck and decrease the pressure on the vertebral joints. Conversely, you can place a pillow under your hips to better align your lower back with your neck.

I bet you didn’t know there were so many ways to sleep incorrectly, did you? I often find with my clients that if they are having trouble progressing as quickly as they would like to in their recovery, how they sleep can be a missing piece of the puzzle. Since we spend so much time in bed and many people are not aware of their positioning during this time, it is always worth a look to assess and improve your positioning throughout the night. This can help you achieve a better night’s sleep and feel better throughout your day.

Osteoarthritis: What Does It Mean and How Can Physical Therapy Help?

By Uncategorized

Guest Blogger Steven Griffin, DPT

Physical Therapy for Osteoarthritis

Have you been suffering from joint pain for a few days, months, or even years? Does this pain feel like an aching sensation that might get sharp with certain activities? Do you notice some creaking or cracking in joints as you move them? These are some common descriptions of symptoms in those who are experiencing arthritic pain.

Osteoarthritis (OA) is the condition in which the cartilage lining the ends of bones begin to wear down. This is a natural and unavoidable part of the aging process, and the amount of U.S. adults with OA in the hand, hip, or knee is over 20 million (Neogi). Many people with OA experience pain, a sensation of pressure or grinding in their affected joints, decreased range of motion, strength, and an inability to perform some of their daily activities.

Many of my clients who are over the age of 50 come in after seeing their physician and tell me that they were diagnosed with arthritis in a painful joint after their MD looked at the X-rays. The truth is, most people at that age have some visible degenerative changes on imaging in many, if not all, of their joints. Whether or not they experience pain, or if arthritis is actually the source of the pain, is another story entirely. There have been many studies that conclude that asymptomatic individuals can have abnormal findings on X-rays or MRIs, as well as other studies indicating that symptomatic individuals can have completely normal findings on imaging. Although this is another topic of discussion, it is important to rule out other causes of pain, such as acute pain from an accident, muscle pain, referred pain from another body structure, or even pain that is tied to emotional stress. Once you have ruled out other causes and have combined imaging with other objective tests that point to OA, then it is much more likely that OA is the source of your pain.

Understanding how osteoarthritis causes pain is important in understanding how physical therapy can be useful for treatment. Decreased cartilage on the articulating areas of a joint cause abnormal pressure on bone tissue. This can lead to decreased blood flow, growth of bone spurs, development of microfractures, and a state of fairly constant bone repair and remodeling. This state of constant repair often results in  a continued cycle of inflammation within the joint, which ultimately leads to an over-excitability of pain receptors. Oftentimes pain will occur during daily activities involving use of the affected joint, so people will in turn avoid the activity, making them weaker and eventually unable to perform the activity. This cycle is then repeated and over time, people may notice they are unable to do simple things like stand up out of a chair or climb stairs without severe pain.

I often get the question, “How is PT going to help my arthritis? I thought cartilage doesn’t grow back.” No, articular cartilage does not regenerate, and unfortunately, physical therapists do not have a magic cartilage wand. What PT does do, however, is help you determine the sources of your pain, reduce inflammation in the affected joint, and address modifiable risk factors. I educate my patients about the appropriate levels of activity for their individual goals, work to improve their strength and flexibility, and address faulty movement patterns that put their joints at increased risk. Another important focus is modifying certain activities or positions to make them more efficient or manageable for a specific impairment. Finally, there are several manual therapy techniques that I perform to help reduce overall pain, such as joint mobilization, soft tissue massage, dry needling, and more.

If you have been diagnosed with pain related to OA, it is important for you to know what the appropriate actions are to take so that you can reduce its effects on your daily life. A skilled physical therapist can help you reduce pain and determine which of your modifiable risk factors can be improved. From that point, the two of you can conceive a plan moving forward to keep you living the life that you want without the fear of constant pain.  


Data obtained from the following article:

Neogi, Tuhina, and Yuqing Zhang. “Epidemiology of OA.” Advances in Pediatrics, U.S. National Library of Medicine, Feb. 2013, 


Runners: Forget R&R – How About Some S&S?

By Uncategorized

Guest Blogger Steven Griffin, DPT

Strength and Stability Training for Runners

If you are a runner, one of the worst feelings in the world is sustaining an injury while training for a big race. An even worse feeling is having this injury slow your time down significantly or even knock you out of the race all together. Overuse injuries are notorious in the endurance athlete population, particularly in runners. One of the reasons for this is that many runners do not incorporate any kind of exercise variety into their training program. Coupled with the very high volume of activity, the lack of cross-training predisposes these athletes to many different kinds of overuse injuries that can turn chronic if the underlying issues are not addressed.

One common strategy that runners use when dealing with overuse injuries is R&R, or rest and relaxation. While R&R has its place, I often implore my runners to try what I call S&S, or strength and stability training. This type of cross-training can have numerous benefits for runners, including improving form, multiplanar strength, tissue resiliency, and kinesthetic awareness.

To understand how S&S training can help you, you must first understand the basics of how most overuse injuries affect your body. High-volume training coupled with subtle weaknesses in certain muscle groups can cause a breakdown in your running form. These weaknesses often occur in some of the stabilizing muscles such as the gluteal muscles or the muscles that support the arch of the foot. In the short term, you may not notice the effects of form breakdown, but over tens of thousands of steps, even a slight decrease in your running economy causes increased pressure and demand on your muscles, tendons, joints, and bones. Complicating matters is that many athletes will train through the injury, resulting in increased tissue damage, increased chance to develop a chronic injury, overall prolonged recovery time, and more missed training days in the long term.

S&S is also critical for runners who always feel tight; no matter how much you stretch your tight muscles, they never seem to loosen up. This is likely because your muscles aren’t physiologically shorter, but that your muscle weaknesses are causing instability in certain joints. Your body is a master at protecting itself against what it perceives as potential threats to its well-being, and so it uses the muscles that directly affect that joint as a “protective spasm,” keeping the joint from moving or shifting in various ways. If this is your issue, correcting these weaknesses is likely the underlying solution to your chronic tightness.

Incorporating strength and stability into your training has numerous benefits, including, but not limited to, the following:

  1. It improves strength and endurance of stabilizing muscles in the lower extremities. This will in turn improve overall running economy and take pressure off of tissues that compensate for weaknesses in these areas.
  2. It subjects tendons and bones to increased loading. This will improve tendon strength and bone density, decreasing risk for common running injuries like tendonitis or stress fractures.
  3. It improves proprioception, or the ability to sense where different body parts are in space. This helps running economy and also can prevent acute injuries like ankle sprains.
  4. It also improves overall function in daily activities not related to running, such as squatting, lifting objects, climbing stairs, etc.

S&S training comes in many different varieties. If you are considering incorporating this into your routine, then you may choose to try weight lifting, yoga, Pilates, body weight training, resistance band exercises, functional training, TRX classes — the list goes on! If you can implement a large variety, that will only magnify the benefits that you get.

If you are a runner suffering from an overuse injury, then you should consider seeing a physical therapist at Druid Hills PT. Your therapist can determine the sources of your injury, analyze your running form, and advise you on the appropriate cross-training strategies based on your individual needs and goals. And if you are not currently injured, consider implementing some S&S training to prevent future injury and help you reach your running goals.

Three Strategies to Prevent Stiffness If You Sit All Day

By Health

Guest Blogger Steven Griffin, DPT

Prevent Stiffness When Sitting

As technology has advanced in the past 30 years, the number of desk jobs has increased all over the world. While this has made us a more efficient and productive society, it has also encouraged a sedentary lifestyle that has a significant impact on our bodies. If you are someone who is required to sit all day for your job, particularly if you are looking at a computer screen while doing so, then here are three strategies that you need to implement to stave off stiffness and pain:

Change positions as often as you can.

The longer you sit, the more time gravity has a chance to take a toll on your body. You end up either slouched back in your chair with no support to your lower back, or you have your shoulders rounded forward and upper spine bent. Preventing this from happening  over several hours is almost impossible, so getting up every 30-60 minutes for 3-5 minutes at a time helps combat gravity’s effects on your body. If you have the ability to switch to a standing desk for parts of your day, that’s even better.

Reverse your posture.

This doesn’t mean sitting ramrod straight all day every day – that would lead to its own set of problems. This simply just means occasionally doing exercises throughout the day that facilitate the opposite movement of sitting. Three simple ones that you can perform anywhere, including work, are as follows:

  1. Scapular Squeezes – Simply squeeze your shoulder blades together (without hiking them up towards your ears). Hold this for 3 seconds and repeat 10-20 times.
  2. Chin Tucks – This doesn’t mean bringing your chin to your chest. I like to describe it as you’re pretending to pull away from someone you don’t want to kiss, or you’re trying to make a double chin. Hold this position for 3 seconds and repeat 10-20 times.
  3. Doorway Stretch – Find a doorway and put your arms on either side of the frame. Stagger your stance and lean forward so that your weight is mostly on your front foot and you feel a stretch in the chest and front of the shoulders. Hold this for 20-30 seconds and repeat 3 times.


Exercising outside of work has numerous health benefits. It allows you to gain postural muscle strength and flexibility that will help you avoid gravity’s toll on your body. It also introduces some cardiovascular benefits that are virtually nonexistent if you are sitting all day. Exercise is also a proven stress reliever, and we’ve all had those stressful days at the office that can weigh on us mentally and physically.

One caveat: you must do something that isn’t sitting-based. Do not go to the gym and ride a stationary bike every day. Walking, running, lifting weights, yoga, Pilates, or anything that gets you out of that sitting posture is recommended.

Consistently performing these strategies might seem like a lot of effort. But if you prioritize them, it will eventually become habit and you will feel much better at the end of those long days. Trust me, your body will thank you.

Benefits of Physical Therapy for the Aging Population

By Aging, Health, Rehabilitation

Guest Blogger Steven Griffin, DPT

It’s a fact of life: as we age, our bodies are not quite as resilient as they used to be. Strength, endurance, flexibility, cardiovascular and pulmonary function, bone and joint health, and other physical functions begin to decline. You may have noticed that you or someone you know is having difficulty walking, bending over, lifting objects, climbing stairs, or other daily activities due to pain, weakness, or inflexibility. However, aging does not necessarily translate into dysfunction throughout our daily lives. The effects of aging can be slowed, and one of the best ways to combat these effects is through regular exercise and body maintenance.

The benefits of exercise are numerous for all ages. Some of those major benefits are as follows: 

  1. Cardiovascular health – Stressing the heart through exercise improves circulation, activity endurance, lung function, and energy levels.
  2. Muscle strength and endurance – Our muscles, even as we get older, adapt to the stresses they are subjected to. Improving strength and endurance through exercise can translate into easing daily activities like walking, standing up from a chair, picking things off the ground, and lifting heavy objects.
  3. Reducing musculoskeletal pains – Pain can arise when muscles, joints, nerves, or other structures aren’t working the way they are supposed to. Specific exercise to address body impairments related to these structures can help prevent or reduce pain.
  4. Social wellness – Going to exercise classes, the gym, playing sports, or just walking with a group is a good way to interact with your family and friends which plays a huge role in mental and emotional health.

Although these are some of the major benefits, they are by no means the only benefits of exercising. When I work with clients, I often hear them say things like “I’m too old to do that” or “I just have to accept the fact that I’m getting old.” I believe this is the wrong mindset. As an expert on the human body, I know that exercising can help slow the aging process. I often respond to those clients’ claims with the following: “You don’t stop doing physical activity because you got old, you got old because you stopped doing physical activity.”

Now, where does physical therapy come into this? What if you are having pain that is preventing you from exercising? What if you want to exercise but you aren’t sure what you should be doing? Physical therapists are extensively trained in both pain management and exercise programming. If you are suffering from pain, weakness, difficulty with daily activities, low energy levels, or any combination of these, then you should consider making an appointment at Druid Hills Physical Therapy. A highly skilled physical therapist on staff will evaluate your needs and select the appropriate interventions based on their findings.

These are your golden years. Don’t let the fact that you are getting older get in the way of living the life that you want to live. You may find that you are capable of things that you previously thought were only possible for the much younger version of yourself. Make your appointment today, and start your journey towards a more active and enjoyable life!

Dry Needling: How and Why It Works

By Health, Outpatient Surgery, Rehabilitation, Surgery

Guest Blogger Steven Griffin, DPT

Why Dry Needling Works

We’ve all been there at some time or another. You’ve been staring at the computer for hours, slumped over in your chair and shoulders up to your ears, carrying all of the stress from the impending deadline at work or the test that you have to take tomorrow. You’ve noticed that a headache is starting to come on, but you shrug it off, attesting it to simply staring at a screen for too long. The only problem is that it doesn’t go away once you leave the computer, and you feel like you have tons of “knots” or “kinks” in the top of your shoulders and into your neck that need to be worked out.

Not a desk kind of person? Maybe you decided to break out the tennis racket for the weekend because the weather was so nice. You had a blast, but when you wake up Monday morning, you notice this dull aching pain that is radiating from your shoulder blade into your upper arm that you can’t quite pinpoint. You may even notice a feeling of tightness in the shoulder, or possibly even some tenderness if you poke around.

In either of these scenarios, it’s likely that your pain is being caused by myofascial trigger points. These trigger points are those painful “knots” in the muscles and can be caused by many things, like poor posture during standing, sitting, or sleeping; over-exertion; direct trauma; or protective spasms. Regardless of how they come about, trigger points can be a nagging source of pain and tightness for many people, and sometimes simply stretching isn’t enough to oust them.

Fortunately, there are treatments–in combination with proper movement–that can help alleviate the issue. One of these is trigger point dry needling. Dry needling involves the use of a very thin needle that directly enters into the trigger point. This causes a cascade of biochemical events in the muscle fiber and allows it to release, reducing pain.

What exactly happens in the trigger point during dry needling that causes it to release? The research isn’t conclusive, but the three main theories are:

  1. Increased neurotransmitter activity at the muscle causes prolonged contraction which causes sensitization of the tissues and therefore pain. Needling to the area increases the pH in the muscle fiber and decreases neurotransmitter activity, which then decreases the  muscle contraction and the pain.
  2. Prolonged muscle contraction causes decreased blood flow, which causes decreased tissue healing and therefore increased pain. Needling to the trigger point improves blood flow and, with it, tissue healing and pain.
  3. Sustained muscle contraction puts pressure on nerves which causes pain. Needling to the area helps release the contraction and therefore decreases pressure on nerves and decreases pain.

There’s nothing like a little science to get you amped up, is there?

You may be saying to yourself, “This definitely sounds like something that may help me, but where can I have it done? What can I expect?” Luckily for you, there are physical therapists who have had years of experience studying and treating the human body, as well as countless hours of practice with dry needling. Druid Hills Physical Therapy has an expert dry needling therapist on staff.

When having the procedure performed, you can expect a deep aching feeling  or pressure, and you may even feel the muscle twitch. That twitch response is the muscle fiber letting go of the sustained contraction that has you feeling your pain. Side effects are rare, but the two most common are muscle soreness (which should just feel like a workout type soreness) and minor bruising.

If you are suffering from trigger point pain, then dry needling can help you. Your physical therapist is an expert in analyzing movement and performing a comprehensive treatment of the musculoskeletal system. A combination of dry needling, other appropriate manual therapy techniques, and specific exercise should have you feeling much better in no time!

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