August 2021 COVID Update – COR continues to follow COVID safety protocols

Category: Newsletter

4 Ways to Qualify for the NYC Marathon

Qualify for the NYC Marathon

The New York City Marathon is one of the biggest running events in the world. Unfortunately, it’s also one of the hardest ones to qualify for. Many runners see it as a personal challenge to run in this event. There are several different ways to qualify for the NYC marathon, such as qualifying based on time or entering through New York Road Runners.

Qualifying by Time

Competitive runners of all ages and genders can qualify for the NYC marathon based on the time they take to run other qualifying races including half marathons and marathons. The New York Road Runners (NYRR) website lists qualifying charts for full and half marathons for men, women, and non-binary based on age groups. For example, men ages 18-34 have a qualifying time of 2:53 for the full marathon and 1:21 for half. On the other hand, women over 80 need to come in at least 6:35 for a full marathon or 2:50 for a half marathon.

Road Runners Club 9+1

Local runners have the opportunity to also gain entry through the 9+1 program. Each year, the Road Runners Club hosts over 30 opportunities designed to enable runners to earn their spot. NYRR members need to compete in at least nine qualifying races and volunteer at one event for guaranteed access. 

Lottery Drawing

The NYC marathon accepts rolling applications year-round. Then they hold random drawings every two months. There are three drawing pools for local, national, and international applicants. Having different pools allows coordinators to ensure the geographic diversity of runners. The chances vary from year to year, depending on how many runners apply for the lottery. For example, in 2020, applicants had a 2.3% chance of winning the drawing. 


Runners can also gain entry through charity and international partners. Participating charities offer some spots in exchange for fundraising a certain amount. In addition, the global Travel Partners Program guarantees entry for those living outside of the US with the purchase of the Travel Package of flights and hotel stays in the New York area. International runners can buy the package from an official International Tour Operator.

Preparing for the Marathon

Training for a marathon takes dedication and top physical fitness. Our COR Running Program features personalized biometric feedback from a professional physical therapist. We’ll work with you to design an individualized training program based on your specific needs. Schedule a consultation online today.

What is The Effect of Aerobic and Anaerobic Fitness on Sports Performance?

aerobic and anaerobic fitness

Athletes need high levels of aerobic and anaerobic fitness to achieve maximum sports performance. Both types of exercise benefit the body, but they use energy differently. For example, aerobic metabolism uses oxygen to produce ATP energy for the cells and boosts cardiovascular health. On the other hand, anaerobic metabolism is a non-oxidative process that results in lactic acid. As a result, an athlete who uses both types of training achieves greater benefits. 

How Does Aerobic Capacity Affect Performance? 

Peak oxygen uptake, also called maximum oxygen volume (VO2max), is a good indicator of aerobic fitness. An athlete with higher peak oxygen uptake can use oxygen more effectively and generate more ATP energy. Aerobic, oxygen-dependent, metabolism supplies most of the ATP energy used in sustained cardio exercises such as jogging and cycling. Increasing aerobic capacity enhances an athlete’s cardiovascular fitness. Better blood flow brings more oxygen and nutrients to muscles, improving flexibility, endurance, and overall sports performance

How Does Anaerobic Fitness Affect Performance?

Anaerobic exercises include intense physical activity for short bursts such as sprinting, high-intensity interval training (HIIT), and resistance training. When athletes perform these muscular activities, the body uses energy already stored in the muscles. Anaerobic metabolism makes much less ATP and causes lactic acid build-up instead. As a result, anaerobic training improves muscle endurance by increasing tolerance for lactic acid and strengthening fast-twitch muscles.

What is the Relationship Between Aerobic and Anaerobic Fitness?

Some sports involve short sprints and sustained movements, such as soccer and basketball. With such activities, the body switches between anaerobic and aerobic metabolism. Research shows that a combination of aerobic and anaerobic training may improve endurance more than one alone. For example, distance runners who also use resistance training tend to have better overall running economy.

These two types of metabolism affect each other in mutually beneficial ways. For example, anaerobic exercise can positively impact an athlete’s aerobic capacity. Likewise, aerobic capacity helps muscles recover after anaerobic workouts such as HIIT training. 

Sports Performance Training

When working with elite athletes, providers are always looking for ways to maximize performance. One way to do that is by maximizing aerobic and anaerobic fitness. An experienced physical therapist can work one-on-one with patients to develop an individualized training plan. Churchill Orthopedic Rehabilitation has the experience and know-how to take sports performance to the next level. To refer a patient, call our office at 201-833-1333.

How Fear of Movement Impacts Sports Performance

Fear of Movement Impacts Sports Performance

The old adage says if you fall off a horse, get right back on. But it isn’t always easy for recovering athletes to return to the game. Fear of movement impacts sports performance more than people may realize. When patients are afraid of re-injury, they compromise their athletic conditioning and rehabilitation. Thus, a person-centered approach considers psychological and physiological factors when treating injured athletes. 

What is the Fear of Movement? 

The fear of movement (kinesiophobia) is when an athlete is afraid of re-injury. This fear leads to avoidance and escape behaviors which negatively impact sports performance. Kinesiophobia was first defined by Kori et al. in 1990 as “an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury.”

Two Paths: Avoidance and Confrontation 

There are two paths an athlete can take following a painful injury—avoiding pain or confronting pain.


It is natural to want to stay away from pain. Fear-avoidance, however, is a maladaptive response to injury. When the fear outweighs the risk, it negatively impacts recovery and performance. Research published in Clinical Orthopaedics found that “an increase in athletes’ fear-avoidance was associated with a decrease in physical function.” Therefore, the authors suggest that clinical interventions take the impact of fear-avoidance into account when treating injured athletes. 


Fear of movement is a barrier to recovery. As clinicians, we need to encourage recovering athletes to get back in the game and be as physically active as their condition allows. Start by educating the patient to explain the cause of the pain. Cognitive Behavioral Therapy (CBT), alongside Physical Therapy, can help them face their fears and return to normal functioning. 

Measuring Fear of Movement

Clinicians use various scales to measure athletes’ emotions about returning to sports and identify psychological barriers to recovery.

  • Athlete Fear Avoidance Questionnaire (AFAQ) is a 10-question self-assessment that rates thoughts and feelings about injury on a scale from 1 to 5. 
  • Injury-Psychological Readiness to Return to Sport Questionnaire (I-PRRS) is a self-report on athletes’ confidence on a scale of 0-100
  • Re-Injury Anxiety Inventory (RIAI) covers 28 statements about anxiety about returning to sports.
  • Emotional Responses of Athletes to Injury Questionnaire (ERAIQ) evaluates fears about returning to sports. 
  • Return to Sport after Serious Injury Questionnaire (RSSSIQ) measures how fear of re-injury has interfered with sports performance after returning. 
  • Tampa Scale for Kinesiophobia (TSK) includes statements rated on a 5-point scale (0 to 4) related to fear of injury.

Fear of Movement Impacts Sports Performance 

Fear of movement impacts sports performance and rehabilitation outcomes. A person-centered approach to physical therapy recognizes that there is more to healing than physical recovery; athletes need to feel safe as well. At Churchill Orthopedic Rehabilitation, we consider the whole person. We work with patients one-on-one to determine an optimal treatment plan that meets their physical and emotional needs. To refer a patient, call our office at (201)-833-1333.

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.