The meniscus is a tough, rubbery, C‐shaped piece of cartilage that rests between the tibia and femur in the knee. Each knee has two menisci (plural of meniscus), with one on the inner (medial meniscus) and one on the outer side (lateral meniscus) of the knee. Both menisci perform the same function: absorb shock and stabilize the knee. As we mentioned in our first post, meniscus tears occur commonly from twisting or turning too quickly on a bent knee, often when the foot is planted. But older adults can also experience degenerative meniscus tears, in which the meniscus has weakened and thinned over time, which makes it more vulnerable to tear from minor trauma.

Many people incorrectly assume that surgery is necessary for all meniscus tears. Although this may be true for some tears in certain patients, it is not always the case. The treatment for meniscus tears depends on the size, type, and severity of the tear, and many patients have successful outcomes with conservative (non‐surgical) treatment alone. Nearly all conservative treatment programs involve physical therapy, which is intended to help patients regain their lost physical function and overcome the resulting impairments from the damage to the meniscus.

Patients indicated for physical therapy program who commit to their program can often expect to experience a complete recovery and eventually return to sports. But many patients who stand to benefit from physical therapy still undergo av surgical procedure called arthroscopic partial meniscectomy (APM). This procedure involves a surgeon using small incisions to guide a camera and surgical instruments to remove part of the damaged meniscus, and it is currently one of the most commonly performed surgeries in the world. Millions of arthroscopic knee surgeries are performed worldwide each year, although it’s not clear if APM leads to better outcomes than conservative treatments like exercise and physical therapy.

Highlighting the value of physical therapy with research

Two recent studies published in 2020 compared the effectiveness of conservative interventions like exercise and physical therapy to APM for patients with meniscus tears. Both studies were systematic reviews with meta‐analyses, meaning researchers systematically searched for and then analyzed all published medical literature on this topic.

Study #1 In the first study, researchers identified 6 randomized‐controlled trials (RCTs; the gold standard for evaluating specific interventions), which featured data on 879 patients, to include in the analysis. These trials evaluated whether APM followed by structured exercise therapy or exercise therapy on its own was more effective for patients with a degenerative meniscus tear.

Results showed that APM followed by structured exercise therapy was more effective structured exercise therapy alone in terms of pain control and physical function within 6 months; however, there were no differences between these two groups by 12 and 24 months. These findings suggest that while there was an advantage of surgery in the short term, exercise alone led to similar outcomes in the long term, and could therefore be a viable option that avoids the costs and potential complications of surgery.

Study #2

In the second study, researchers included 10 RCTs in the analysis, which featured data on 1,525 patients with a degenerative meniscus tear. In most of these studies, patients were randomly assigned to either undergo APM or participate in an exercise therapy program, while one study compared APM to steroid injections and another compared APM to a surgery in which no structures were repaired.

In all studies, no significant difference in knee pain was observed between the conservative group and APM group at any follow‐up evaluations. In 8 of 10 studies, no significant differences were observed in knee function between the conservative and APM group. The main finding of this review is that arthroscopic surgery for degenerative meniscal tears does not lead to superior outcomes compared to exercise therapy at least for a medium‐term follow‐up.

These studies show that many degenerative meniscal tears can be successfully managed with exercise and physical therapy, as surgery does not appear to elicit better overall outcomes.

Knee pain has a way of reminding patients of its presence at regular intervals throughout the day. For many individuals that are affected, knee pain is the first thing they notice upon waking up in the morning, and it is often felt during many daily activities—like walking up stairs, getting in and out of a car, and bending down to pick up items—until bedtime.

Some patients may respond to knee pain with what might sound like a logical solution: try to move the painful knee as little as possible to avoid further pain and aggravation. This approach may seem sensible, but in truth, it will more harm than good. Limiting your knee movement equates to less overall mobility, and with that comes reduced flexibility and weaker muscles surrounding the knee. This will in turn lead to an increased risk for injuries and other problems in the future if the behavior continues.

Instead, the goal should be to focus on keeping the knee mobile and increasing the strength of the muscles that surround the knee, particularly the quadriceps (muscles in front of the thigh), hamstrings (muscles in the back of the thigh), and the gastrocnemius (one of the calf muscles). Strengthening these muscles will lead to better support and stability of the knee joint, which is fundamental for overcoming knee pain. With this in mind, we strongly recommend the following exercises to treat and prevent knee and thigh pain:

Our top 4 exercises for knee and thigh pain

1. Sit to stand transition
   • Sit toward the edge of a chair with good posture
   • Tighten your abdominal muscles
   • Shift your weight slightly forward and stand up
   • Slowly lower back to starting position
   • Repeat for 2 sets of 12 repetitions, once every other day
2. Step ups (forward)
   • Start by standing straight with a step—or similar object—in front of you
   • Step up onto the step—or object—while keeping your knee lined up over the middle of your foot
   • Repeat for 2 sets of 12 repetitions, once every other day
3. Step ups (lateral)
   • Start by standing straight with a step—or similar object—in front of you
   • Step up onto the step—or object—while keeping your knee lined up over the middle of your foot
   • Return to the starting position
   • Repeat for 2 sets of 12 repetitions, once every other day
4. Forward Lunge
   • Start by standing up straight
   • Lunge forward, making sure to keep your knee lined up over the middle of your foot
   • Return to the starting position
   • Repeat for 2 sets of 12 repetitions, once every other day

By regularly performing these four exercises, you’ll gradually improve your strength, flexibility, and balance. As a result, these improvements will help alleviate any knee or thigh pain you’re experiencing, boost your overall physical function, and reduce your risk for future issues. But for knee or thigh pain that persists after committing to these at–home exercises, your next step should be to see a physical therapist. Read our next two posts for a several examples that show why physical therapy is the best choice for most cases of knee and thigh pain.

Certain regions of the body are simply more likely to be painful than others, and the knees are very high on this list. Knee pain ranks behind just back pain as the second most common condition involving the muscles and bones, and in adults aged 65 and older, it is the greatest cause of disability.

The knee is the largest and one of the most complex joints in the body, and this complexity is a main reason why it is so vulnerable to injury. The nearly constant use of the knee during all standing, walking, and running activities also plays a major role.

The knee is a hinge joint that’s responsible for bearing weight and allowing the leg to extend and bend back and forth with minimal side–to–side motion. It primarily joins the thighbone (femur) to the shinbone (tibia), but also includes the kneecap (patella) and other lower leg bone (fibula). The patella is a small, triangle–shaped bone that sits in the front of the knee within the quadriceps muscle, and it’s lined with the thickest layer of cartilage in the body to protect it from the significant forces of regular movements.

Separating common knee diagnoses from red flags

If pain develops in the knee or thigh, you may be unsure what to do next. For mild pain that’s manageable, it’s common—and recommended—to wait a week or two and see if it subsides on its own or after trying some pain–relieving modalities like ice. But for severe knee or thigh pain and pain that persists or gets worse over several weeks, you should seek out help from a medical professional.

Physical therapists are movement experts who can effectively treat most types of knee and thigh pain with a comprehensive treatment approach that focuses on addressing deficits with targeted interventions. Certain causes of knee pain, however, may require the expertise of other healthcare professionals to safely manage. To help you differentiate between the two, below are some of the most common knee diagnoses that physical therapists treat, followed by a few key red flags that suggest an underlying condition is present that requires additional care:

Common knee diagnoses

• Knee osteoarthritis: an extremely common disorder in which the cartilage lining the ends of bones in the knee gradually wears away, which reduces its ability to absorb shock, thereby increasing the risk for these bones contacting one another; usually leads to pain, stiffness, and swelling that make it difficult to walk and move the knees normally
• Patellofemoral pain syndrome (runner’s knee): accounts for 16–25% of all running injuries and involves the patella rubbing against the groove of the femur, which causes a dull pain behind or around the patella; this pain is often aggravated by running, squatting, climbing stairs, or sitting, and may also be accompanied by swelling or a “popping” of the patella when bending the knee
• Patellar tendinopathy (jumper’s knee): caused by repetitive strain to the patellar tendon, which attaches the bottom of the patella to the top of the tibia; leads to pain and stiffness at the front or below the patella and/or in the quadriceps, as well as an aching sensation that’s usually brought on after exercise
• ACL tear: the anterior cruciate ligament (ACL), which helps stabilize the upper leg bone to the knee, can be damaged or torn when an athlete suddenly cuts or changes direction; ACL tears are most common in football, basketball, and soccer, and usually sideline athletes for extended periods of time
• Meniscus tear: tears of the meniscus, a tough piece of cartilage that absorbs shock and stabilizes the knee, typically occur from twisting or turning too quickly on a bent knee, often when the foot is planted; degenerative meniscus tears may also occur in older adults; symptoms include pain, swelling, and difficulty extending the knee
• Iliotibial band syndrome: an injury in which the iliotibial band—which runs from the hip to the top of the tibia—becomes irritated or inflamed from rubbing against the patella, leading to pain on the outside of the knee or hip that usually arises after running
• Hamstring strain: the three muscles in the back of the thigh form the hamstring; any of these muscles can be pushed beyond their limits in sports that involve sprinting, running, or lots of stretching; soccer, basketball, tennis, and football are some of the most common culprits
• Quadriceps strain: involves a partial or complete tear of one of the four quadriceps muscles—which are located in the front of the thigh—or their tendons; this injury is common in sports and usually occurs when an athlete is trying to accelerate and the muscles are placed under more force than they can withstand

Red flags

• Extreme bruising, swelling, or throbbing pain
• Significant bone pain, which may suggest a bone tumor
• Persistent swelling and pain that develops without any recent injury
• Lacerations
• Signs of infection (eg, pus or fluid, redness, fever, blisters, worsening swelling)
• Inability to place any pressure on the injured leg

We hope this guidance helps you determine whether physical therapy is the right call if you’re experiencing knee or thigh pain. In our next post, we provide you with 4 effective exercises you can perform on your own that will help to prevent and treat this type of pain.

Most patients will make a complete recovery after sustaining an initial ankle sprain, but this is not always the end of the story. Up to 70% of patients who experience a lateral ankle sprain will go on to develop a condition called chronic ankle instability, a condition in which there’s an increased risk for repeat ankle sprains and recurring symptoms (pain, weakness, giving way) in the future. Patients with chronic ankle instability experience changes in the function of their nervous system that may lead to decreased postural control, joint position awareness, and more ankle instability. The combined result of these changes is a higher risk for a second ankle sprain to occur, and with each additional sprain, this risk continues to rise.

This underlines the importance of proper rehabilitation after the first ankle sprain, which can significantly reduce the risk for chronic ankle instability. As we’ve discussed, the best way to accomplish this is through a personalized rehabilitation program with a physical therapist. All rehab programs are personalized for each patient, but most will include a variety of interventions like strengthening and stretching exercises, manual (hands–on) therapy, and balance training.

Combining manual therapy and exercise–based rehabilitation improves outcomes

Physical therapy is also the best option if chronic ankle instability develops, and a recently published study shows why. For the study, researchers aimed to determine whether adding manual therapy to an exercise–based rehabilitation program resulted in greater improvements in patient–reported outcomes than exercise–based rehabilitation alone.

To answer this question, they performed a search of several databases and screened the results using specific criteria. Of the 28 studies that were identified, only three fit the inclusion criteria. The three included studies involved either two or three treatment groups that all performed exercises, with one group in each study also receiving manual therapy from a physical therapist. The exercises featured in these studies were primarily designed to increase ankle strength and balance, and one of the exercises included was the single leg balance exercise described in second post. All exercises increased in difficulty each week as the program progressed.

A thorough review of these studies showed that adding manual therapy to exercise–based rehabilitation led to greater improvements in patient–reported outcomes compared to exercise–based rehabilitation alone. The quality of all three studies included was rated as high, which further strengthens their findings. As a result of this high–quality evidence, an A grade recommendation was given that there is likely a benefit of adding manual therapy to an exercise–based rehabilitation program for chronic ankle instability.

Therefore, if you’ve recently suffered a first or repeat injury, or if you’re dealing with any other type of ankle or foot pain, we strongly recommend that you come in for a visit and get started on a rehabilitation program that will reduce your risk for future complications.

As we mentioned in our first post, ankle sprains are extremely common, especially for athletes. In fact, if you’re actively involved in sports, there’s a rather strong chance that you will sprain your ankle at some point in your career. Ankle sprains account for up to 45% of all sports injuries, and approximately 25,000 people sprain their ankle every day. The sport you play will also affect your odds, as basketball, football, and soccer all have the highest rates of sprains. This mainly has to do with the movements that are common in each sport, as basketball involves lots of jumping and cutting, which are both largely responsible for ankle sprains.

Ankle sprains involve the ligaments of the ankle joint, which are flexible bands of tissue that connect one bone to another. Ligaments are elastic and can be stretched to a certain length and then return to their original position, but they have a limit. When any of the ankle ligaments are stretched beyond their maximum range of motion, damage will occur, resulting in an ankle sprain. Ankle sprains are generally categorized into the following three groups:

• Grade 1 (mild): ligament(s) stretched but there is no tear; symptoms involve mild pain and tenderness, some swelling and stiffness
• Grade 2 (moderate): most common type of sprain; ligament(s) partially torn; symptoms include significant swelling and bruising, moderate pain, and trouble walking
• Grade 3 (severe): ligament(s) completely torn; symptoms involve severe swelling and pain, especially while walking, instability of joint, extreme loss of motion, possible difficulty bearing weight on foot

Depending on its location in the ankle, a sprain can be further categorized as either lateral, medial, or high. Lateral ankle sprains take place on the outside part of the ankle, which is the most common site for a sprain (about 80% of all sprains). High ankle sprains are less common (up to 15% of sprains) and are often seen in football, downhill skiing, and other field sports, while medial sprains are the least common (about 6%).

Evidence to support the benefits of early physical therapy after an ankle sprain

After experiencing an ankle sprain, it’s essential to take some time off and address the immediate symptoms of pain and inflammation with the RICE method (rest, ice, compression, elevation). However, after most symptoms have subsided, patients should begin physical therapy as soon as possible. This approach is recommended because it can help patients recover quicker and avoid future ankle sprains, as well as chronic ankle instability, a condition in which individuals are more prone to continue spraining their ankle.

The benefits of early physical therapy for lateral ankle sprains have been highlighted in a recently published study called a scoping review. For this study, researchers performed a search and identified 37 articles that evaluated the effectiveness of early rehabilitation for lateral ankle sprains. Among the studies included were 5 systematic reviews and 7 randomized controlled trials, both of which are considered high quality types of research.

After reviewing these studies, researchers found that undergoing early dynamic training after a lateral ankle sprain led to a shorter time to return to sports, increased functional performance, and a lower rate of self–reported re–injury. Therefore, athletes and other patients that sprain their ankle should strongly consider seeing a physical therapist as soon as possible to increase their chances of a faster recovery and a lower risk for additional injuries in the future.

In our final post, we’ll review another study that shows why seeing a physical therapist is also a smart choice for patients with chronic ankle instability.

Whether you spend most of your day sitting at a desk or on your feet, and whether you’re extremely active or you rarely exercise, your feet and ankles may hurt for various reasons. These structures are built for durability to withstand the weight of your entire body, but as with all other structures, they have limits. When pushed beyond this threshold, pain will often develop in the foot or ankle, either immediately or over time.

But if you injure your foot or ankle or start noticing pain in those regions, it might be difficult to determine if you should seek out treatment or wait it out. You may also be aware that physical therapy is an available option for some painful conditions, but not know if it’s right for yours. Below, we offer some guidance on when it’s appropriate to visit a physical therapist and when you might need to see another healthcare provider.

Understanding which conditions are best suited for physical therapy

If your foot or ankle is bothering you, assessing the answers to a few key questions can help you decide whether you should take action and if a physical therapist is right for you. Among the first questions to ask should be if your pain is a new occurrence or something you’ve been dealing with for a long while, as well as how severe your pain is.

For mild pain that you just started noticing, it’s probably safe to wait a short while—about a week or so—to see if it resolves on its own. But if you’ve recently suffered a traumatic injury that’s interfering with your ability to get around throughout the day, seeing a physical therapist is usually the right call. One exception is if you’ve suffered from a broken bone, which will usually require more immediate medical attention at a doctor’s office. Fractures are considered red flags, which we’ll discuss in more detail later in this post.

If you’ve been dealing with foot or ankle pain for a long while, particularly pain that gets worse with physical activity, visiting a physical therapist is once again the best choice you can make. Physical therapists are movement experts that can usually make a diagnosis based on a thorough physical examination and detailed interview, and we use this information to develop personalized treatment programs to address any impairments identified.

There are three foot and ankle conditions in particular that are extremely common and respond well to physical therapy: ankle sprains, Achilles tendinitis, and plantar fasciitis. Each of these is described in more detail below:

• Ankle sprain: ankle sprains are the most common sports–related injury in both children and adults; this injury typically occurs when an individual twists their ankle or lands awkwardly, which can push ligaments beyond their limits; pain, swelling, tenderness, and difficulty bearing weight are all signs of ankle sprain
• Plantar fasciitis: this condition results from inflammation of the plantar fascia, a thick band of tissue that connects the heel to the toes; when this tissue is overstrained from repeated activity—like running—it becomes inflamed, which leads to a stabbing pain near the heel that’s most noticeable upon waking up; plantar fasciitis is the most common cause of heel pain
• Achilles tendinitis: another overuse injury related to inflammation of the Achilles tendon, which connects the calf muscle to the back of the heel; it’s most common in runners who do lots of speed training, uphill running, or who rapidly increase their training intensity or duration, and it leads to heel pain that usually comes on gradually as a mild ache in the back of the leg or above the heel

Other causes of foot and ankle pain that can effectively be treated with physical therapy include the following:

• Shin splints: a condition that develops when any of the muscles that support the shinbone are overworked, usually from repeated activities; leads to pain in the middle or bottom third of the inside of the shin, which usually gets worse with activity and decreases with rest
• Intrinsic muscle strain: the intrinsic muscles are several smaller muscles located on the bottom of the foot, which support the arch of the foot and are sometimes referred to as the “core” muscles of this area; any of these muscles can become strained from overactivity, which leads to symptoms like those of plantar fasciitis
• Heel bursitis: each heel has a bursa, which is a fluid–filled sac that cushions and lubricates the tendons and muscles that slide over the bone; this bursa can become inflamed from rapid increasing the intensity of one’s workout schedule, and the symptoms are often similar to those of Achilles tendinitis

Identifying red flags that suggest the need for other interventions

Although most causes of pain in the foot and ankle can be identified and managed by a physical therapist, there are certain signs—or “red flags”—that suggest a more serious problem is present that requires further investigation from other healthcare professionals. As we mentioned above, one of these is a foot or ankle fracture, which typically results from a severe injury that may involve high speeds, a fall from a height, or a crushing force. If you’ve experienced an injury of this sort that’s led to severe pain, swelling, and bruising, you should go to the emergency department, urgent care center, or your primary care doctor for more immediate medical attention.

The same goes for any foot or ankle injuries that involve an open wound, particularly if there are signs of infection, such as worsening pain or swelling, redness, or pus. These cases require an evaluation from a primary care doctor or another appropriately trained healthcare provider. Similarly, if a tumor is detected or suspected in the foot or ankle—such as chondrosarcoma, the most common cancer in this region—you should consult with an oncologist immediately. Other red flags include:

• Extreme bruising, swelling, or throbbing pain
• Inability to bear weight on the foot
• Pins and needles or numbness in both lower legs
• Bowel and bladder dysfunction
• Urinary incontinence

If you notice any of these red flags, see your primary care doctor as soon as possible. However, if you do see a physical therapist, you can take comfort in knowing that he or she is also trained to identify red flags and will direct you to the appropriate healthcare professional when necessary. And after completing treatment for the underlying condition that has been flagged, most patients will still benefit from a course of physical therapy to help them regain their strength, flexibility, balance, and physical function.

In our next post, we’ll describe some effective exercises to reduce your risk for foot and ankle pain.

The knee is the fourth and final region of the body we’re going to examine, as it ranks up there with the back, neck, and shoulder as one of the most common regions in which pain develops. Knee pain is especially common in athletes of sports that involve lots of cutting motions and is the leading cause of disability in older adults, but sports and advanced age are far from the only factors that can increase the risk for knee problems.

The knee is the largest and one of the most complex joints in the body, and its complexity is one of the main reasons it’s so vulnerable to injury. The frequency with which it’s used also plays a significant role. The knee is a hinge joint that’s responsible for bearing weight and allowing the leg to extend and bend back and forth with minimal side–to–side motion. It primarily joins the thighbone (femur) to the shinbone (tibia), but also includes the kneecap (patella) and other lower leg bone (fibula). The patella is a small, triangle–shaped bone that sits in the front of the knee within the quadriceps muscle, and it’s lined with the thickest layer of cartilage in the body because of the massive forces it takes on.

In children and adolescents, most cases of knee pain are caused by traumatic injuries that typically occur in sports with lots of cutting movements like basketball, football, and soccer. Sprains of the ligaments and strains of the muscles and tendons are most common, but the meniscus, ACL, and other ligaments can also be torn from strong forces upon the knee. Later in life, some knee issues occur less often while others become more likely to emerge. Knee osteoarthritis accounts for most cases of knee pain in older adults, affecting about 45% of this population. Common symptoms include pain, stiffness, and swelling that makes it incredibly difficult for these individuals to walk and move the knees normally.

The risk for traumatic injuries (eg, sprains, strains, and tears) also remains high for adults that stay active in sports and physical activities, and the risk overuse injuries tends to increase with older age because of the gradual breaking down of structures that occurs over time. Common overuse injuries of the knee include the following:

• Patellar tendinopathy (jumper’s knee): results from repeated strain of the patellar tendon that attaches the bottom of the patella to the top of the tibia; symptoms include pain and stiffness at the front or below the patella and/or in the quadriceps, and an ache that typically develops after from exercise
• Patellofemoral pain syndrome (runner’s knee): involves the patella rubbing against the groove of the femur and accounts for up to 25% of all running injuries; common symptoms are a dull pain behind or around the patella, which may be aggravated by running, squatting, climbing stairs, or sitting
• Patellar instability: a general term used to describe intermittent pain that comes with the feeling of the patella moving excessively or being unstable; symptoms are pain that’s felt under, around, or most commonly, in front of the patella
• Iliotibial band syndrome: an injury in which the iliotibial band—which runs from the hip to the top of the tibia—becomes irritated or inflamed from rubbing against the patella; symptoms include pain on the outside of the knee or hip that usually arises after running

For knee pain that doesn’t improve with at–home exercises, see a physical therapist

If you find yourself dealing with knee pain, either from a traumatic incident or due to sustained damage over time, one of the first steps you can take is to try managing it on your own at home with some targeted exercises. These include stretching exercises like the quadriceps stretch, hamstring stretch, calf stretch, and knee range of motion exercise, and strengthening exercises like the wall sit, bridge exercise, single–leg heel raise, and partial lunge. If these exercises fail to produce notable improvements, the next step is to see a physical therapist, preferably sooner than later.

Physical therapists frequently see patients with all types of knee–related conditions and are adept at creating treatment plans that are tailor–made for each patient’s specific condition, abilities, and goals. A typical treatment program for knee pain will include the following:

• Strengthening exercises to build back up the weakened muscles of the leg
• Stretching and range of motion exercises to increase flexibility and regain normal mobility
• Plyometrics, or jump training (especially for patients recovering from ACL tears)
• Recommendations on how to modify activities to minimize the risk for future injuries
• Exercises to improve body awareness, balance, and neuromuscular control, which is the body’s ability to stay strong and stable during all movements
• Activity–specific training for athletes and active individuals

Research has shown that physical therapy can significantly improve patient outcomes and help them avoid knee surgery in certain cases. One powerful study called a randomized clinical trial found that physical therapy led to similar improvements in physical function when compared to surgery for patients with meniscus tears, while a follow–up analysis of this trial showed that physical therapy is more cost–effective than surgery for meniscus tears. A systematic review and meta–analysis of 14 studies also found that manual therapy, an important component of most knee treatment programs, is likely to be effective and safe for improving pain, stiffness, and physical function in patients with knee osteoarthritis.

As we’ve shown you in these posts, seeing a physical therapy is nearly always the smartest, safest choice you can make if you’re dealing with pain or dysfunction in these four regions or anywhere else in the body. Therefore, if pain is holding you back from living your life or being as active as you’d like to be, we invite you to come in for a visit and witness first–hand what physical therapy can do for you.

On behalf of our staff, Happy Holidays, and we’ll see you soon.

Shoulder pain can be one of the most disabling problems to deal with. Whether or not you realize it, you use your shoulder almost constantly, as it permits practically any movement that involves your arms. This is why any issue that causes pain and prevents your shoulder from moving normally can be a major burden to your daily life.

Behind the back and neck, the shoulder is the third most common site that pain occurs in the body, as about 67% of people will deal with it at least once in their lives. The primary reason is that the shoulder is the most flexible and mobile of all joints—and the only joint that can rotate a full 360°—but this extreme flexibility also makes it vulnerable to numerous injuries. Below is a summary of the most common shoulder–related conditions, many of which involve the rotator cuff, a group of four muscles and tendons that form a “cuff” and support the head of the upper arm bone:

• Shoulder impingement syndrome: involves any of the rotator tendons or other structures being trapped (or impinged) by two bones, which leads to shoulder pain, weakness, and difficulty reaching up behind the back
• Rotator cuff tendinitis (shoulder tendinitis): results from irritation or inflammation of a rotator cuff tendon, leading to pain and swelling in the front of the shoulder and side of the arm; most common cause of shoulder pain
• Rotator cuff tear: results when a rotator cuff tendon detaches from the bone, either partially or completely; can occur either traumatically or gradually, which is usually the case in older patients
• Shoulder bursitis: inflammation of a fluid–filled sac in the shoulder called the bursa, which occurs from regularly performing too many overhead activities; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
• Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, which causes the shoulder capsule to thicken and tighten around the shoulder joint; symptoms include pain and stiffness that makes it difficult to move the shoulder

Physical therapists use various interventions to facilitate recovery from all shoulder diagnoses

Regardless of what shoulder condition is present, in most cases, the best course of action is a comprehensive course of physical therapy. Physical therapists are movement experts whose goal is to guide patients back to full strength and function with an exercise–based approach. They accomplish this by first identifying the source of pain and any associated impairments and then designing a personalized treatment program that targets these areas of weakness and teaches patients how to regain their abilities through movement.

Most treatment programs will involve some combination of pain–relieving interventions, flexibility and strengthening exercises, manual (hands–on) techniques administered by the physical therapist, and education on how to avoid future shoulder issues. But the specific approach used will vary depending on the condition present, its severity, and the patient’s abilities and goals. What follows is a summary of the interventions typically used for the five shoulder conditions mentioned above:

• Shoulder impingement syndrome
  • Stretching exercises
  • Strengthening exercises that target the rotator cuff and scapular muscles
  • Manual therapy, which typically includes soft–tissue massage
• Rotator cuff tendinitis
  • Stretching and strengthening exercises, including external and internal rotation, forward flexion shoulder raises, pendulum exercises, and scapular squeezes
  • Education on how to improve posture and avoid habits that will further aggravate the shoulder
• Rotator cuff tear
  • Passive treatment like ice, heat, and ultrasound to alleviate pain
  • Strengthening exercises that target the pectoral and upper back muscles
  • Education on how to avoid positions and movements that can further aggravate the shoulder, like sleeping on the side and carrying heavy loads
• Shoulder bursitis
  • Stretching exercises like Codman’s pendulum swings and active range of motion exercises
  • Strengthening exercises that target the scapular and core muscles
  • Ultrasound and other pain–relieving modalities
  • Posture education
• Frozen shoulder
  • Treatment for frozen shoulder depends on the current stage of the condition, from stage 1 (pre–freezing) to stage 2 (freezing), stage 3 (frozen), and stage 4 (thawing)
  • The bulk of treatment consists of manual therapy and stretching and strengthening exercises, which increase in intensity with further stages of the condition; activity–specific training is usually added at stage 4

Similar to what we’ve seen for back and neck pain, there is no shortage of research that supports physical therapy as effective solution for many shoulder–related disorders. One systematic review published earlier this year found that stretching exercises, strengthening exercises, and other physical therapy techniques reduced pain and improved range of motion in patients with frozen shoulder. Another systematic review published in 2018 identified moderately strong evidence to support exercise therapy for rotator cuff tears, while a long–term study found that surgery was no better than nonsurgical treatment for patients aged 55 and older with a rotator cuff tear up to five years later.

Although many people shrug off painful shoulder symptoms at first, leaving it untreated can lead to additional pain, disability, decreased quality of life, time out from work, and ongoing frustration. This is the main reason we strongly encourage you to see a physical therapist at the first sign of shoulder pain and get started on your way to a complete recovery.

Most of us can recall one or more occasions when the day got off to a rough start because of a stiff neck. This can be explained by the fact that the neck ranks among the most common locations for pain in the body. Statistics vary on just how many people encounter neck pain, but recent evidence suggests that its lifetime prevalence is between 20–70% and that 10–20% of individuals are affected by it at any given time. The likelihood of having neck pain also increases as you get older, and different conditions are more common at certain ages.

When neck pain occurs in children and adolescents, as with back pain, it most likely results from a strain or sprain. Neck muscles and ligaments are quite flexible at these younger ages, but they can still get pushed beyond their limits. When this happens, it is typically from maintaining bad postures for extended periods of time or sleeping on the neck wrong. Patients with neck strains and sprains usually complain of pain and discomfort in the back, side, or front of the neck that limits their movement and activity.

Neck strains and sprains remain common later in life, but several other neck conditions also enter the fold, often due to unavoidable age–related changes. For example, the structures that make up the neck become weaker, the intervertebral discs lose some of their height, and the joints in the neck adapt to other changes in the body. Eventually, these changes make the structures of the neck slightly less effective, which can lead to other neck conditions developing, many of which are known to also occur in the back. Some of the most common disorders include:

• Cervical spinal stenosis: narrowing of the spinal canal in the cervical portion of the spine, which puts pressure on the spinal cord and spinal nerve roots
• Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues in the neck
• Cervical osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints in the neck; it typically leads to pain and stiffness, while weakness and numbness may also occur in some cases
• Cervical spondylosis: a general term used to describe any pain related to age–related changes in the spine; can occur in the neck or back

These conditions typically develop between the ages of 40–60 but can be seen even earlier in certain individuals. Symptoms can also vary significantly, as some people experience regular pain and physical limitations, while others may have signs of age–related changes but fail to notice any impairments.

If neck pain doesn’t subside with home remedies, see a physical therapist first

These neck conditions can potentially lead to pain, muscle tightness and spasms, decreased ability to move your head, and even headaches in some cases. Some individuals may experience relief after trying simple home remedies—like using ice or heat, performing targeted stretches, and exercising in a pool—and avoiding further aggravation of the spine. But many others will continue to be affected by painful symptoms that usually hinder their enjoyment of life.

For patients that fail to improve on their own, the next step is usually to consult with a healthcare professional, and many will go to their primary care doctor first. Doctors may recommend medication, additional testing, a referral to a specialist, or some combination of these interventions, but evidence is lacking to support many of the popular approaches used for neck pain.

Physical therapy, on the other hand, is supported by an abundance of research showing that it’s effective for reducing patients’ costs and their use of healthcare. The reason is that physical therapists usually begin treatment during the first session and target the impairments identified with a variety of movement–based interventions that are intended to alleviate pain and increase physical function. A typical physical therapy treatment program for neck pain will include the following:

• Stretching exercises: your physical therapist will teach you exercises for the neck designed to relieve your symptoms and allow you to return to normal movement
• Strengthening exercises: specific muscle groups of the neck will be targeted with specific strengthening exercises
• Posture education: since using proper posture will prevent your condition from worsening, your therapist will provide specific guidance on postural improvements
• Manual therapy: your therapist will also use their hands to perform various techniques to relieve pressure in the neck
• Functional training: as you progress in your treatment, functional exercises will be integrated to help you return to your job, sport, or other daily activities

Supportive research includes studies showing that physical therapy can lead to less pain and disability, as well as lower overall treatment costs for those who consult with a physical therapist early due to reduced odds for receiving an opioid prescription, spinal injection or imaging test. Therefore, patients with neck pain should strongly consider seeing a physical therapist, and preferably sooner rather than later. Doing so will allow you to get started on personalized path to recovery right away while avoiding additional referrals, diagnostic tests, and other interventions that are usually expensive and/or unnecessary.

Every week we send out a post to educate you about common injuries and painful disorders, and if you read our posts regularly, you may have noticed a recurring theme: seeing a physical therapist first and fast is the best choice you can make if you’re experiencing pain that’s holding you back from enjoying life. We emphasize this point because we believe it’s the most important message our patients should be aware of, and we regularly provide examples of why this is true and evidence to support it. With the end of the year approaching, we’d like to bring this message to front–and–center one last time by summarizing the posts that have described the four most common regions in the body where pain occurs and how physical therapy can help.

To kick off these posts, we’re going to look at the back.

Most of us are bound to experience back pain at some point

While it’s not a complete guarantee, there’s a strong chance that you’ll experience back pain at some point in your lifetime. About 8 of 10 people are expected to encounter low back pain at least once, making the spine the most common location for pain in the body. How you experience low back pain and how it affects your life will depend on your age, habits, and health, and it’s important to realize that some cases can be avoided while others are primarily out of your control.

For children and adolescents, most cases of back pain result from strains and sprains of the muscles and ligaments of the back, which can occur either from a single injury or from damage that accumulates over time. Children that participate in various sports year–round without taking enough time to recover are one patient group that has a higher risk for low back pain than others. There’s also been an increased rate of back pain in adolescents due to the obesity epidemic, as the extra weight puts stress on the immature spine and throws off posture, which forces the lower back to work harder to stay upright.

As the body ages, other problems arise due to age‐related changes that are often out of one’s control. One of the more common changes that occurs with age is that the intervertebral discs that rest between the spinal bones (vertebrae) eventually begin to dry out. These discs are soft and squishy earlier in life, which allows them to effectively absorb shock. But over time they lose some of their height and strength and can no longer take on as much impact. Other changes that usually start to occur in middle age include a narrowing of the space surrounding the spinal canal and a weakening of the joints that connect the vertebrae together. As a result of these age‐related changes, several other conditions become more likely to develop, such as:

• A herniated disc: occurs when some of the softer jelly‐like substance of the intervertebral disc pushes out through a tear in its tougher exterior, which may or may not cause symptoms
• Spinal stenosis: the name for the narrowing of the spinal canal, which can put pressure on the spinal cord and lead to pain
• Spondylosis: a general term used to describe any pain related to age‐related changes in the spine, which becomes more common with aging

Osteoarthritis and osteoporosis also become more common in later life. Osteoarthritis occurs when the protective cartilage that surrounds the vertebrae thins away, which makes the bones more vulnerable to rub against one another, often resulting in pain. Osteoporosis is a condition that causes bones to become weak and brittle, which increases the chances of fractures in the back. Further adding to the potential for back pain in older age is the loss of flexibility that many individuals experience. Reduced flexibility often has a negative impact on activity levels, which can create a vicious cycle of less movement and a higher risk for injuries like back pain.

Why physical therapy is the best solution for all causes of low back pain

If you find yourself affected by an episode of low back pain that doesn’t improve on its own, you’ll likely need treatment, and physical therapists are best equipped to provide this for you in a safe and effective manner. Physical therapy uses a variety of movement‐based interventions to address low back, some of which are executed independently by the patient, with guidance, and others that the therapist carefully performs on the patient. The ultimate goal of each component of treatment is to teach patients how to move better in order to reduce their pain levels, increase function, and prevent further recurrence.

Seeing a physical therapist as the first point of care for low back pain can also help patients avoid other expensive or unnecessary interventions in the future. Research has shown that individuals who undergo early physical therapy are less likely to have surgery or injections for their pain, and it has also been found to reduce costs, healthcare use, opioid use, and improve health care efficiency.

Each low back pain treatment program is tailored specifically to the patient’s needs, abilities, goals, and preferences, but there are certain features that are common in most plans. A typical treatment program for low back pain will consist of the following:

• Passive interventions (performed by the therapist)
  • Ice and/or heat therapy
  • Ultrasound
  • Manual (hands‐on) therapy
• Active physical therapy (performed by the patient)
  • Stretching exercises for the buttocks, back, spine and hamstrings are helpful for keeping joints flexible and should be done twice a day
  • Strengthening exercises are needed to build the muscles in the back and core, and should be done for 15‐20 minutes every other day
  • Low‐impact aerobic exercises like walking, biking, and swimming are also important and should be done for 30‐40 minutes, three times a week
  • Education: physical therapists will also provide tips and guidance on how to improve your posture and make other necessary changes that may be contributing to your pain

Low back pain is one of the most common conditions in all of healthcare, and it often becomes a burden for the countless individuals who are affected. But if you see a physical therapist first and fast, you’ll greatly improve your chances of having a successful outcome with lower costs and a reduced risk for invasive and expensive procedures.