Why MRI Results Don't Always Correlate With Pain

 
 

Injuries are a common occurrence in sports and active living. Whether it's a sprained ankle on the running trail or a nagging back pain that hinders performance, finding an accurate diagnosis often leads to more advanced diagnostic tools. Magnetic Resonance Imaging (MRI) has become a go-to tool for visualizing the body's inner workings, providing detailed images of muscles, ligaments, and bones.

MRI provides a detailed look at muscles, ligaments, and bones, revealing injuries that might not be visible in other diagnostic tools.

But what if an MRI result doesn't tell the whole story?

An MRI can reveal abnormalities that seem to correlate with pain, yet many individuals with similar findings experience no discomfort at all. Conversely, intense pain might exist without any significant MRI findings. This disconnect between what's seen on the screen and what's felt in the body can lead to confusion, misdiagnosis, and even unnecessary treatments.

The Complexity of Pain

A recent research study in Germany investigated the association between lumbar degenerative MRI findings and low back pain (LBP) in a large population-based cohort. The researchers examined 3369 participants, analyzing their lumbar MRI scans and tracking their low back pain status over six years. The study found that 76.4% of participants had at least one MRI finding, and 8.3% had five or more different MRI findings. The study concluded that the MRI degenerative findings examined do not have clinically important associations with low back pain. The effects were almost all less than one unit on a 0 to 10 pain scale, indicating that MRI results may not be as reliable as once thought in predicting or understanding low back pain.

 

Pain is influenced by more than just physical factors; understanding the complete picture is crucial for accurate diagnosis

 

Pain is a multifaceted experience influenced by physical, psychological, and social factors. An MRI only provides a snapshot of the anatomical aspect, ignoring other crucial elements like emotional stress or lifestyle factors that might contribute to the pain. A thorough physical examination and patient history are essential to diagnosis and often provide more insight into the patient's condition than the MRI alone.

At Resilience Physical Therapy, we recognize the complexity of pain and use a comprehensive approach, considering the patient's symptoms, history, goals, and overall condition in our treatments.

  • Our treatments are tailored to the individual's specific needs and goals, ensuring that the care is aligned with their unique situation.

  • We go beyond treating symptoms and work on improving overall function and performance.

  • Besides just treatment, we equip our patients with the knowledge and tools they need to take control of their recovery.

Reference: Kasch R, Truthmann J, Hancock MJ, Maher CG, Otto M, Nell C, Reichwein N, Bülow R, Chenot JF, Hofer A, Wassilew G, Schmidt CO. Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Spine (Phila Pa 1976). 2022 Feb 1;47(3):201-211. doi: 10.1097/BRS.0000000000004198. PMID: 34405825.

The Benefits of Choosing an Out-of-Network Physical Therapy Practice

 
 

Why Are You Out-of-Network With Most Insurances? 

We get asked this question all the time by patients, and we want to help you make a more informed decision about your care. By knowing the benefits of going out-of-network for your physical therapy and the limitations of traditional in-network-based clinics you will have a better understand on why we prefer an Out-of-Network treatment model.

What You Get At An In-Network Based Clinic

In many conventional PT clinics, the scene is all too familiar. Large rooms filled with rows of tables and numerous patients are a common sight. In these settings, it's not unusual for physical therapists to juggle multiple patients at a time due to high patient volumes and insurance reimbursement constraints. 

To manage their busy schedules, many clinics employ support staff who aren't skilled clinicians to assist with your physical therapy treatment. As a result, each patient often receives only a fraction of the physical therapist's attention during their appointment. This could affect the continuity and quality of care, as switching between multiple care providers during a session may not be the most beneficial approach for a patient's recovery process.

Insurance limitations also come into play. For instance, some insurance plans require referrals or authorizations before you can start your treatment. There may also be visit limits, and once you reach them, the insurance will not cover any more sessions, even if you haven't achieved your fitness goals. Additionally, you might have to meet a certain deductible amount before your insurance starts covering your PT sessions, meaning you're paying full price out of pocket until you reach that threshold.

Traditional PT clinics often recommend a frequency of 2-3 visits per week for several weeks to months, which can be time-consuming and interfere with your work schedule, family time, or other obligations. This structure and its limitations often lead to a less personalized, less effective form of care, which might not align with a patient's individual needs and goals.

Why You Should Consider Going Out-Of-Network For Your Physical Therapy Care

One-on-One Time

You are not just another appointment in your physical therapist's schedule. This approach facilitates undivided attention, meaningful communication, and a comprehensive understanding of your needs. With this focused attention, you are likely to require fewer visits, as each session is utilized to its maximum potential.

Direct Access to Skilled Clinicians

You will always work with a physical therapist, ensuring that a skilled clinician administers your treatment. By providing continuous, quality care, your therapist can make on-the-fly adjustments and ensure you gain the most value from your visits.

Independence from Insurance Limitations

Without the constraints of insurance companies, treatment decisions are made entirely based on your specific needs, not what an insurance policy dictates. This means no waiting for authorizations or referrals and no abrupt end to therapy due to visit limits.

Fewer, But More Productive Visits

Since you're receiving focused, one-on-one care, you often need fewer visits than at a traditional PT clinic. This translates into less time commuting to PT, a more efficient recovery process, and getting back to doing what you love faster.

Direct and Open Communication

You will have direct communication with your PT. You can ask questions or express concerns between visits, enhancing your understanding of your treatment and reinforcing your home exercise program.

Active, Targeted Treatment

Unlike traditional PT clinics, which often rely on passive treatments to pass time, you will receive a more active and targeted approach. These include exercises, manual therapy, and education that address the root cause of your problem.

Access to Preventative Care

Insurance companies do not typically cover wellness, maintenance, and injury prevention services. You will have access to preventative care, which can save you time and money in the long run by helping you stay active and healthy.

 
 

While insurance-based physical therapy clinics have their place, they often lack the personalized care and direct therapist-to-patient relationship important to a successful recovery journey.

At Resilience Physical Therapy, we value spending more quality time with each patient, providing personalized and effective treatment plans, fewer visits, and better outcomes. If you are looking for all that in a physical therapy clinic, we may be the right fit for you!

Get Back To Running: Treating Plantar Fasciitis

What is Plantar Fasciitis?

https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/multimedia/plantar-fasciitis/img-20006161

Plantar fasciitis is an overuse injury that results from the degeneration or thickening of the collagen fibers in the plantar fascia. The plantar fascia is a band of fibrous connective tissue that runs from your heel bone (calcaneus) to the bases of your toes (metatarsals). It plays a vital role in stabilizing your foot's arch while standing, walking, and running.

The repetitive stress placed on the plantar fascia during running can lead to degeneration and breakdown of the tissue, resulting in pain and discomfort. Although the term "plantar fasciitis" implies inflammation, the condition is more about the degeneration of the tissue rather than inflammation.

Causes of Plantar Fasciitis in Runners

Plantar Fasciitis makes up 5-18% of injuries caused by running [1]. As a runner, it's crucial to recognize the factors that can contribute to the development of plantar fasciitis.

Some common risk factors include [2]:

  1. Weakness in the foot/ankle muscles

  2. Wearing worn-out or improper running shoes

  3. Increasing running volume too quickly

  4. Increasing running mileage

  5. Tight calves and Achilles' tendons

  6. Spending excessive time on your feet (e.g., due to a standing job)

  7. Having excessively high or flat arches

  8. Limited ankle dorsiflexion (pointing ankle upwards)

Symptoms of Plantar Fasciitis

If you're experiencing plantar fasciitis, you may notice some common symptoms, such as [3]:

Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82. PMID: 21916393.

  1. Pain along the arch and sole of the foot, particularly on the inside edge of the heel

  2. Morning pain that's worse when taking the first steps out of bed but gradually fades as you move around

  3. Pain when pressing along the sole of the foot or stretching the fascia

  4. Development of heel spurs in some cases

Foot and Ankle Pain After Running

Different Causes of Heel or Ankle Pain After Running [1]:

  1. Plantar Fasciitis: As previously mentioned, plantar fasciitis is a common cause of heel pain in runners. The degeneration of the plantar fascia tissue can contribute to pain in the heel area.

  2. Achilles Tedonopathy: Achilles tendinopathy presents as aching posterior heel pain. This is caused by irritation of the Achilles tendon, which connects your calf muscles to your heel bone. Most patients with this condition have pain, swelling, and tenderness on the Achilles tendon 2 to 6 cm above its insertion into the calcaneus. 

  3. Ankle Sprain: Lateral ankle sprains are more common in runners. Pain is usually on the outside of the ankle and can be caused by the ankle rolling inwards during an initial foot strike.

Addressing Heel Pain After Running:

  1. Identify the Cause: The first step in addressing heel pain after running is to identify the root cause by having a comprehensive running assessment to evaluate your running technique, gait, and foot mechanics. This assessment may include video analysis to identify any factors contributing to plantar fasciitis, such as overpronation, excessive foot strike force, or inefficient running form. A functional tests may also be performed to assess your lower limb strength, flexibility, and mobility.

  2. Modify Your Running Routine: Reducing your running volume, incorporating rest days, and adjusting your running form can help alleviate heel pain. Additionally, consider incorporating low-impact cross-training activities like swimming or cycling to maintain your aerobic capacity while giving your heel a break.

  3. Choose Proper Footwear: Wearing the right running shoes for your feet can help reduce the impact on your heel and alleviate pain.

  4. Perform Proper Warm-Up and Cool-Down: Implementing a thorough warm-up and cool-down routine that includes dynamic stretches, muscle activations, and mobility drills can help prep your body for running and minimize the risk of heel pain.

  5. Strengthen and Stretch: Incorporate specific exercises and stretches for your feet, calves, and Achilles tendon into your routine. This can help improve your overall foot and lower leg strength, flexibility, and mobility, reducing the risk of injury.

Here are some examples of foot strength and stretches you can add into your training:

Consistency and patience are key when it comes to treating plantar fasciitis. At Resilience Physical Therapy, we can help you develop a individualized treatment plan that addresses the underlying causes of your plantar fasciitis, such as muscle imbalances, bio-mechanical issues, running form etc. so you can increase your chances of getting back to your regular running routine.

References:

  1. Arnold MJ, Moody AL. Common Running Injuries: Evaluation and Management. Am Fam Physician. 2018 Apr 15;97(8):510-516. PMID: 29671490.

  2. Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019 Jun 15;99(12):744-750. PMID: 31194492.

  3. Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82. PMID: 21916393.

Exercises to Restore Knee Mobility and Strength

Knee pain can occur in runners and other athletes who undergo high impact and stress on their joints during training and/or competition. Ignoring symptoms can lead to other injuries and may even force an athlete to miss extended time.

Here are some exercises that can help restore knee range of motion, strength, and stability:

🔸SL Fire Hydrant w/ Wall Support

 
 

🔸Rear Foot Elevated Split Squat Hold

 
 

🔸Single Leg bridge

 
 

🔸Couch Stretch

 
 

Disclaimer: These exercises might not help your condition since every injury is multifactorial. Contact us to see if we can help!

Runners: Landing and Force Production Exercises

Running is a series of single-leg jumps from one leg to the other. Training our muscles and tendons to absorb impact and produce force when our feet hit the ground can help improve running speed and prevent injuries.
_
Here is a progression of landing and force production exercises you can add to your training:


1️⃣ Bilateral Leg Snap Downs

 
 

Cues: Raise both arms over your head while going onto your toes. Perform a small hop and quickly bring your arms down by your side, landing in a knees-bent, hip-hinged position with both legs. Make sure to pause at the bottom. 

2️⃣ Single Leg Snap Downs

 
 

Cues: Raise both arms over your head while going onto your toes. Perform a small hop and quickly bring your arms down by your side, shift your weight onto one leg and go into a knees-bent, hip-hinged position. Make sure to pause at the bottom, keeping the landing feet, knee, and hip aligned.

3️⃣ Double-Leg Drop to Broad Jump

 
 

Cues: Stand on an elevated surface, step off with one foot, and land onto both legs with knees bent and hips hinged. As you land, jump forward as far as you can with both legs.

4️⃣ Single-Leg Drop to Broad Jump

 
 

Cues: Stand on an elevated surface, step off with one foot, and land onto one leg with knees bent and hips hinged. As you land, jump forward as far as you can with that leg. Try to keep your knees aligned with your toes when landing.

If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!

4 Rehab Exercises For Shin Splints

Medial Tibial Stress Syndrome or shin splints is an overuse injury characterized by pain or tenderness on the inner side of the shin bone (tibia) closer to the ankle. This pain is caused by repetitive stress from the muscles/connective tissues surrounding the shin bone (tibia), leading to inflammation around the bone. This is one of the most frequent injuries occurring in runners with a rate of 13.2-17.3%

Here are four exercises that I like to incorporate into an athlete’s treatment plan:

1️⃣Ankle Dorsiflexion Mobilization

 
 

2️⃣Wall Supported Banded Single-leg Fire Hydrants

 
 

3️⃣Single-leg Hip Airplanes

 
 

4️⃣Single-leg Bridge Holds

 
 

If you are currently dealing with shin splints or experiencing pain when running, we can help!

Shin splints: How to reduce injury risk and return to running

What is Medial Tibial Stress Syndrome, aka Shin Splints?

Medial Tibial Stress Syndrome or shin splints is an overuse injury characterized by pain or tenderness on the inner side of the shin bone (tibia) closer to the ankle. This pain is caused by repetitive stress from the muscles/connective tissues surrounding the shin bone (tibia), leading to inflammation around the bone. This is one of the most frequent injuries occurring in runners with a rate of 13.2-17.3%.

What potential factors can put you at risk of developing Shin Splints?

  • Improper running/training plan

  • Compensatory running mechanics during the stance/swing phase such as increased pelvic drop, knee valgus, internal rotation of the hips, and subtalar joint pronation

  • Muscle weakness and/or joint mobility limitations

How can we reduce the risk of Shin Splints and get back to running?

If you are currently dealing with shin splints or experiencing pain when running, we can help!

References:

  • Lopes, A.D.; Hespanhol Junior, L.C.; Yeung, S.S.; Costa, L.O.P.; Hespanhol Junior, L.C.; Yeung, S.S.; Costa, L.O.P. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012, 42, 891–905.

  • Menéndez C, Batalla L, Prieto A, Rodríguez MÁ, Crespo I, Olmedillas H. Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. Int J Environ Res Public Health. 2020 Oct 13;17(20):7457. doi: 10.3390/ijerph17207457. PMID: 33066291; PMCID: PMC7602098.

Improving Rotator Cuff Stability: Shoulder Taps

The shoulder tap exercise targets the rotator cuff muscles and other muscles around the shoulder isometrically. This makes it an excellent entry point to improve shoulder stability, especially if dealing with an injury such as shoulder impingement or rotator cuff strain/tendinopathy

When performing shoulder taps, ensure your chest is positioned over your hands, keep elbows fully extended, and neutral spine. Make sure to keep body sway to a minimum

Here is a shoulder tap exercise progression:

🔸Perform 3 sets of 10-12 reps on each arm

 
 

1️⃣Shoulder Taps on Knees

 
 

2️⃣Shoulder Taps on Elevated Surface

 
 

3️⃣Shoulder Taps in Push-up Position

 
 

4️⃣Shoulder Taps in Bear Crawl Position


If you are experiencing shoulder pain or currently dealing with an injury, we can help!

Training Your Muscles Eccentrically For Downhill Running

Eccentric exercises mimic the muscle lengthening action we rely on when running downhill. Performing eccentric strength training has been shown to limit the effects of exercise-induced muscle damage caused by downhill running and maximizes strength production.

Here are some eccentric exercises to incorporate into your training:
🔸Perform movements slow and controlled, focusing effort on the way down
🔸3 sets of 8-10

1️⃣Eccentric Single-Leg Box Squat

 
 

2️⃣Eccentric Anterior Step-Down with Slant Board

 
 

3️⃣Eccentric Single-Leg Hamstring Curl with Foam Roller

 
 

4️⃣Eccentric Single-Leg Hip Thrust

 
 

5️⃣Eccentric Single-Leg Heel Raises

 
 

6️⃣Eccentric Single-Leg Soleus Heel Raises

 
 

If you are experiencing pain when running or currently dealing with an injury and need help, contact us for a discovery call!

References: Douglas J, Pearson S, Ross A, McGuigan M. Chronic adaptations to eccentric training: a systematic review. Sports Med. 2017;47(5):917–41.
Saunders PU, Pyne DB, Telford RD, Hawley JA. Factors affecting running economy in trained distance runners. Sports Med. 2004;34(7):465–85.
Barnes KR, Kilding AE. Strategies to improve running economy. Sports Med. 2015;45(1):37–56.

Reverse Nordic Curls To Improve Tight Hip Flexors

The Reverse Nordic Curl is a great way to strengthen the hip flexors eccentrically and address hip tightness due to muscle weakness

When performing this exercise, keep your rib cage down when performing this exercise, and engage your core to maintain a neutral spine throughout the motion. Start with band assist and progress to no assistance when you can maintain proper form.


1️⃣Reverse Nordic Curls with Band Assist

🔸Perform 3 sets of 8

 
 

2️⃣Reverse Nordic Curls

🔸Perform 3 sets of 8

 
 

Give these a try! If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!

C-Section Scar Care Management Part 1

C-section is one of the only major surgery that no one refers to physical therapy for post-op rehab. The procedure cuts through at least seven layers of fascias and muscles. Still, OBs only check whether the scar is healed at a 6-week check-up, and does not provide education about scar tissue management, check your core strength, or advise on how to regain core stability. The world needs more education about this issue!

Why is scar tissue management critical?

It prevents tissue adhesion, hypertrophic scars, or keloids from developing, improves the flexibility of the tissues, and decreases the area's sensitivity. You can initiate the process once your scar is healed.

Here are steps for scar tissue management:

Perform 5x once a day
🔸Circling above, below, and on the scar
🔸Pulling different directions above, down, and on the scar

 
 

Do you have any questions about scar tissue management, or are you suffering from numbness around your scar area or pain in your low back/hips/pelvis? We are here to help! Please Schedule a discovery call and see if we’re the right fit!

3 Exercise Variations To Improve Ankle Stability

Why should you train ankle stability?

Single-leg ankle stability is essential for any sport that involves running, accelerating, decelerating, and lateral motions. Improving SL ankle stability is especially important for returning to sport after a repetitive stress injury such as plantar fasciitis, post tib tendonosis, and medial tibial stress syndrome (shin splints)

Here are 3 single leg RDL exercise variations that will challenge your ankle stability:

🔸Perform 3 sets of 8 repetition
1️⃣SL RDL balance with arm
2️⃣SL RDL to knee drive
3️⃣SL RDL with hip rotation

 
 
 
 
 
 

If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!

Plyometric Exercise Progressions For Running Speed and Efficiency

Why should you start doing plyometric exercises?

Plyometric exercises are a great way to improve your rate of force development and energy storage through your tendons. This translates into faster and more efficient running by increasing your maximal force output when your foot hits the ground.

Here is a plyometric exercise progression starting from easiest to hardest:

 

Jump Lunges w/o Switch

 
 

Jump Lunges w/ Switch

 
 

Single Leg Sprint Jumps

 

If you are interested in working with us, schedule a free discovery call!

When Is It Not Okay To Run With Pain?

Every runner wants to be able to run pain-free but in reality that is often not the case. Sometimes you can have aches/soreness from yesterday's strength workout or interval run. Maybe you overdid it on your last long run and now you have some knee pain. A question that comes up a lot is "is it okay to run with pain?", especially now that marathon training is underway and you don't want to fall behind on your training plan.

Here are some guidelines for when you shouldn't push through pain during your runs:

❌Pain that alters your running mechanics
❌Pain that gets worst during running
❌Pain that persists more than 24 hours after running
❌Having to take anti-inflammatory medications for your pain

*These guidelines work for most runners but not all. Many factors can cause pain while running and this needs to be evaluated case by case. The last thing you want to do is run on a bone stress injury.

If you are experiencing pain and unsure if you should continue running or you're currently dealing with an injury, schedule a free call!