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Combating Achilles Tendonitis in Runners

Achilles Tendonitis in Runners

We often see Achilles tendonitis in runners at our clinic. Elite male distance runners have a 52% risk of developing it in their lifetime. If left untreated, Achilles tendonitis can lead to significant pain and limit your ability to run.

What is Achilles Tendonitis?

Achilles tendonitis (or tendinopathy) is an overuse injury. It results from repetitive micro-tears in the long tendon that connects the heel bone to the calf muscle. This degradation causes swelling, inflammation, and pain in the back of the leg above the heel. 

Treating Achilles Tendonitis in Runners

There are several ways to treat Achilles tendonitis. For mild cases, the pain may respond to self-care options. If not, physical therapy can help with stretches and exercises to improve strength and mobility. There are also more invasive medical procedures for severe cases.   

At-Home Care

Runners can start by treating their pain at home with the RICE method—rest, ice, compression, and elevation. It’s always good to wear supportive shoes and avoid walking barefoot. Seek medical attention if the pain doesn’t disappear in a day or two.

Physical Therapy for Achilles Tendonitis 

A physical therapist will start by assessing your individual needs. Then they will identify possible factors that lead to injury and come up with management strategies. Gentle exercise and range-of-motion treatments can help you reduce pain and regain function. Next, your PT will work with you to develop a recovery plan to get you up and running safely. 

Other Medical Interventions

One medical option is an injection that breaks up scar tissue on the tendon. Surgery is the last resort when all other treatments fail. Talk to your health care provider to determine the right treatment plan. 

How to Prevent Achilles Tendonitis

Many runners will experience Achilles tendonitis in their lifetime. And it’s crucial to take steps to reduce the risk. One of the most common factors leading to Achilles tendonitis is a sudden increase in training, so you should try increasing duration and intensity gradually. Follow these tips when running to maintain a healthy Achilles tendon.

  • Wear supportive shoes
  • Stretch daily 
  • Increase training slowly
  • Get adequate rest
  • Cross-train

Can I run with Achilles tendonitis?

Achilles tendonitis is an overuse injury, and exercise can worsen the symptoms. But that doesn’t mean you have to stop running altogether. Instead, in mild and moderate cases, you can take precautions to reduce the risk of exacerbating the injury:

Warm up with a dynamic warm up before running.
Set a moderate pace and stop if you experience significant pain. 
Follow each run with stretches, icing, and proper rest.

When to See a Doctor for Achilles Tendonitis 

Achilles tendonitis in runners is a severe problem. However, prevention, treatment, and maintenance will help you stay on your feet. See your medical provider if at-home remedies don’t alleviate pain in a few days. At Churchill Orthopedic Rehabilitation, our running program provides individualized support and feedback to help runners prevent and recover from injury. Schedule an appointment online today.

Management and Prevention of Bone Stress Injuries in Runners

Bone Stress Injuries in Runners

Runners are constantly putting strain on their bodies. When the bones cannot withstand the repetitive loading, runners may develop bone stress injuries. These common injuries occur at a rate of 20% annually, with higher instances in females. Biological and biomechanical factors are at play. When runners are experiencing pain due to an injury, they require a thorough evaluation from a healthcare provider that includes their medical history and a physical examination, and they may be referred for imaging such as an X-ray or MRI. Timely evaluation is crucial for runners, as delayed diagnosis and treatment of bone stress injuries can lead to further injuries such as stress fracture and complete fracture. 

What causes bone stress injuries in runners?

bility to resist the load. Running creates repetitive loading that can cause micro-damage to the skeleton. BSI results when this damage accumulates faster than it heals.

Managing Bone Stress Injuries in Runners

The primary treatment goal for runners experiencing bone stress injuries is to return them to their pre-injury functioning and running in the shortest time possible. However, we don’t want to risk further tissue damage or recurrence. Thus, runners with BSI need management strategies to reduce load-bearing in the future. Three steps for managing BSI in runners are identifying risk factors, activity modification, and physical conditioning. 

1. Identifying Risk Factors

Identifying risk factors is the first step to managing BSI. Look at training factors such as frequency, duration, and intensity of running, as well as changes such as new shoes, different running surfaces, and new physical activities outside of running. Dietary considerations such as calcium or vitamin D deficiencies are also risk factors for BSI, so runners may benefit from working with providers such as nutritionists to optimize diet.

2. Activity Modification

The next step in managing a BSI is to work on activity modification, which may involve temporarily decreasing the frequencing, duration, and intensity of running to give the body time to rest and heal. During initial recovery, the goal is to be pain-free during activities of daily living. In cases of more severe or significant BSIs, patients may need to temporarily use assistive devices such as canes, crutches, or braces.

3. Physical Conditioning

During rehabilitation, the injured runner can gradually reintroduce physical activities for maintenance. Patients should begin low-impact cross-training such as cycling, swimming, or antigravity treadmill training as soon as possible. Conditioning is an essential step towards a return to running, as it helps the body build muscular strength and endurance required for a high-impact activity such as running.

Prevention of Bone Stress Injuries

Bone stress injuries can have recurrence rates higher than 20%. So, once a patient has fully recovered, it is essential to have an injury-prevention plan in place. Each runner will need an individualized training plan to maintain gains while preventing injury. Increasing bone-loading cycles too quickly can lead to re-injury. When developing prevention measures, runners need to consider the impact that shoes, shoe inserts, and running surfaces can have on their running mechanics. Harder surfaces such as asphalt create a higher risk of BSI than soft surfaces like grass or rubber.

Nutrition also plays a role in bone injury prevention. For example, calcium increases the rigidity of bones, and vitamin D promotes calcium absorption. A study published in Physical Medicine and Rehabilitation found young female runners with high calcium and vitamin D consumption had significantly more bone mass density than those with lower dietary consumption. 

Developing a Training Program

Proper training is the key to preventing bone stress injuries in runners. When athletes increase training too quickly, they raise their risk of injury. Still, there is no “one-size-fits-all” algorithm for developing a running program. Considerations include multiple, complex factors such as training frequency, duration, and intensity as well as running surface, shoes, technique, and so on. At Churchill Orthopedic Rehabilitation, our individualized runner’s program provides one-on-one support to get athletes back on their feet with optimal recovery and maintenance. To make an appointment, call our office at 201-833-1333.

Vulvar Pain: Causes, Factors, and Treatment

Vulvar Pain

Do you experience burning or soreness outside the vagina? You’re not alone. Vulvar pain can happen to women of all ages. It’s most common in young women and again around menopause. The pain can come and go for months at a time. Don’t ignore these symptoms. Seek medical treatment right away.

What causes the vulva to hurt?

The vulva is a sensitive area, so many different conditions cause inflammation and pain. For example, yeast or bacterial infections lead to itching and burning. Sexually transmitted diseases such as herpes also create pelvic pain. Chronic pain with no underlying cause may be a condition called Vulvodynia. 


Vulvodynia is chronic, unexplained pain around the vaginal opening that lasts for three months or more. It may feel like burning, aching, stinging, or rawness. You may feel pain all over the vulva or just in one place. The discomfort may be constant or only crop up at certain times. For example, sexual activity or tampon insertion sometimes triggers pain at the vestibule. Vulvodynia has adverse effects on women’s sexual relationships and quality of life. Fortunately, treatment is available.

Vulvar Pain Factors

While environmental factors such as infections cause pain in the vulva, genetics are also at play. Certain risks for developing chronic pain are hereditary. So, if your mom experienced it, you are also more likely to develop it as well. Likewise, psychological stress is associated with pain sensitivity. For example, women with Vulvodynia are four times more likely to have anxiety. Hormonal changes and quality of sleep also play a role. 

Pelvic Floor Muscles

Hyperactivity of the pelvic floor muscles is an indicator of Vulvodynia. Overactive muscle contractions create inflammation and sensitivity around the vulva. Too much muscle tone will decrease the blood flow and oxygen to the area, leading to lactic acid build-up. Improving the condition of pelvic floor muscles goes a long way in relieving pain

Vulvar Pain Treatment 

One of the best treatments for Vulvodynia is pelvic floor physical therapy. The therapist provides a comprehensive approach to pelvic health through manual therapy and education. In addition, your PT may recommend home exercises or vaginal dilators to stretch the vagina. Your doctor can also prescribe a topical cream to relieve pain. Many women find relief from physiological stressors through Cognitive Behavioral Therapy and relationship counseling. Surgery is a very last resort when no other treatments work. 

Seeking Treatment

Vulvar pain is an underdiagnosed issue that affects many women. Most patients improve with treatment, but complex underlying factors mean each person needs an individualized treatment plan. The first step is talking to your gynecologist or healthcare provider.

At Churchill Orthopedic Rehabilitation, our women’s health expert can assess your pain and work with you to determine the best course of action. You don’t have to live with chronic pain—schedule an appointment online today.

When Should Runners Stop Strength Training?

Runners Stop Strength Training

We know that a good training regimen includes strengthening and stretching. But how much is too much? You don’t want to be sore on marathon day. Plus, there’s the risk of injury or pulled muscles with any exercise. So, when should runners stop strength training before their race? 

What happens when runners stop strength training?

When athletes taper before a race, the muscles recover and maintain gains for a couple of weeks. This recovery means the muscles get stronger for a little while. As a result, runners can see significant performance improvement even after stopping their strength training. 

When to Stop Strength Training

Before a marathon or triathlon, runners should taper strength training. You want to stop making gains and instead focus on injury prevention. Plus, the correct timing gives you an edge on race day. A meta-analysis from the American College of Sports Medicine says that some runners showed significant improvements with very short tapers of less than a week. In contrast, others reported improved performance for up to four weeks. Overall, the sweet spot is about two weeks before your race. 

How to Taper

There is a wide range of tapering strategies out there when it comes to race training. And different methods work for different athletes. The point is to decrease accumulated fatigue while enhancing physical performance. The same meta-analysis concludes that exponentially decreasing training volume for about two weeks is an “efficient strategy to maximize performance gains.”

Finding a Balance

In the end, runners need to balance between recovery and retaining performance gains. Each athlete is different, and the right program varies from person to person. Some runners stop strength training a week before the race. Others taper much earlier than that. For your custom running program with personalized feedback, schedule an appointment online today with our running specialist, Carley Schleien, PT, DPT. 

How Physical Therapy Treats Genito-Pelvic Penetration/Pain Disorder

Genito-Pelvic Penetration/Pain Disorder

Sexual dysfunction influence a woman’s quality of life and relationship with her partner. For example, women with genito-pelvic penetration/pain disorder (GPPPD) have painful involuntary contractions of the pelvic floor muscles during vaginal entry, such as vaginismus and dyspareunia. The causes of GPPPD involve both physiological and psychological factors. These conditions may be present from the first experience with penetration, such as tampon insertion. In other cases, the symptoms develop later in life. 

How does Physical Therapy treat Genito-Pelvic Penetration/Pain Disorder?

Pelvic floor physical therapy works to modify the tone of the pelvic floor muscles through evidence-based techniques such as muscle training, manual therapy, as well as electrical and ultrasound stimulation. The PT may also guide a patient through the use of vaginal dilators to increase penetration tolerance. 

Pelvic Floor Muscle Training 

Muscle training works to strengthen pelvic floor muscles and relieve pain. For example, Kegel exercises improve symptoms that stem from weak muscles. Along with training from the physical therapist, biofeedback can help patients become more aware of their pelvic floor muscles by providing feedback on the exercises. The PT can guide patients in using vaginal dilators, which gradually stretch the vagina and improve mobility. Your physical therapist will be able to determine if you need to strengthen your pelvic floor, stretch your pelvic floor, or both.

Soft-tissue Mobilization

With manual therapy, the PT performs a series of external and internal techniques on the affected muscles. For example, she gently stretches the pelvic floor muscles to stimulate myofascial release. Likewise, massage and pressure reduce referred pain from latent trigger points. The therapist can also soothe external tension in the pelvis through connective tissue manipulation. 

Muscle Stimulation 

The physical therapist stimulates the pelvic floor muscles through thermotherapy, electro-stimulation, and therapeutic ultrasound. The application of heat relaxes the muscles and increases tissue resilience. Electro-therapy uses a low-grade current to stimulate the muscles to contract. 

Referring for Genito-Pelvic Penetration/Pain Disorder 

Pelvic floor physical therapy is an essential element in a multidisciplinary treatment approach. A PT spends time with the patient and can identify the underlying causes of Genito-pelvic penetration/pain disorder. Our pelvic floor specialist, Dr. Rachel Feldman, is well versed in women’s health. To make a referral, call our office at 201-833-1333.

Patellofemoral Pain Syndrome: Treating Anterior Knee Pain in Runners

Patellofemoral pain syndrome

Patellofemoral pain syndrome, or runners knee, is one of the most common causes of anterior knee pain. It makes daily activities like climbing stairs difficult for patients. While the syndrome is most common in athletes, females, and young adults, it can particularly affect runners. 

What Causes Patellofemoral Pain Syndrome?

It’s called runner’s knee because overuse from athletic training is a significant factor. Repetitive stress or sudden changes in activity can spark pain. In addition, misalignment of the knee cap, or patella, also plays a role. When the knee bends, abnormal tracking of the knee cap within the knee joint can lead to pain. Other factors include anatomical features such as foot deformities, different leg lengths, and being knock-kneed or bow-legged. 

Non-surgical Treatment

Rest, ice, and elevation go a long way for short-term relief. For some patients, orthotics and athletic taping can temporarily improve pain.

Many patients will benefit from physical therapy to strengthen the muscles in their legs, especially the powerful muscles of the hip and thigh. Ultimately, a physical therapist will create a plan of care individualized to each person, which may include manual therapy, exercise, and education about running techniques and joint loading principles.

Surgical Treatment

A vast amount of research exists that does not recommend surgical treatment for runner’s knee. Currently, there’s insufficient evidence to show improved clinical outcomes with surgery over less invasive strategies. For example, a meta-analysis from the BMJ revealed a lack of rigorous studies evaluating the effectiveness of surgery to treat Patellofemoral Pain Syndrome. Thus, physicians should rarely consider surgical interventions and only after all other measures have failed and imaging identifies features such as lesions, tendinopathy, or synovitis. 

Preventing Patellofemoral Pain Syndrome

The number one way to prevent runner’s knee from occurring or reoccurring is to maintain proper strength and flexibility of the muscles around the knee. For example, patients can incorporate hamstring and quadricep stretching and exercises into warm-ups, cool-downs, and cross-training. Runners also need to be cognizant of increasing training gradually and maintaining a healthy body weight to avoid over-stressing the knees.

Referring Patients for Care

Non-invasive treatments should be the first line of defense when a patient presents with pain in the front of their knee. Next, focus on rehabilitation exercises and prevention. At Churchill Orthopedic Rehabilitation, our experts can create a treatment plan tailored to each patient’s needs. Our running program gives athletes techniques to maintain conditioning and prevent injury. To schedule an appointment for physical therapy, call our office at 201-833-1333.

Painful Penetration: Symptoms, Causes, and Treatments

Painful Penetration

Some women experience painful penetration. As a result, they may be unable to wear tampons or enjoy sexual relationships. Several interconnecting factors involving muscles, tissues, joints, bones, nerves and skin may be involved. If you are experiencing pelvic pain, pay attention to what your body tells you and seek help.

Is it normal for sexual penetration to be painful?

Although it is unfortunately common for women to report that intercourse is painful, it is NOT “normal” and it is something for which there are treatment options. Sexual intercourse should not be painful. It is important to communicate with your partner—talk about what hurts and what feels right. Enjoy plenty of foreplay before attempting penetration. Some women find home remedies such as water-soluble lubricants, ice packs, or warm baths can reduce symptoms. For ongoing pain, seek help from a medical professional. Pelvic floor physical therapy has helped many women.

Painful Penetration During Intercourse

The medical term for pelvic pain associated with sexual intercourse is “dyspareunia.” There are many different physical and emotional factors at play here. For some, dyspareunia comes from hormonal changes and vagina dryness from menopause, breastfeeding, or medications. For others, the pain stems from infections, illnesses, or inflammation. Women can also experience dyspareunia due to emotional factors. In these cases, effective treatment includes cognitive-behavioral therapy (CBT) along with pelvic floor physical therapy.

Vaginal Muscle Spasms 

Vaginismus is when the muscles of the vagina tense up at attempted penetration. Experts aren’t exactly sure what causes it.

Symptoms of vaginismus include:

  • Discomfort or pain during vaginal penetration.
  • Inability to use tampons or tolerate pelvic exams.
  • Painful intercourse.

Treatment focuses on teaching the muscles to relax. Treatment may include vaginal dilator therapy, which uses rounded, silicone inserts to stretch the vaginal tissue progressively. Many women find relief through pelvic floor physical therapy.

Getting Help for Painful Penetration 

Many women feel uncomfortable talking about pelvic floor pain, and embarrassment prevents them from seeking help. But, you are not alone, and treatment is available. The most important thing you can do right now is talking to a medical professional. You don’t have to live with painful penetration—our women’s health expert can help. Schedule a consultation today.