Active Care Rehab

Meniscus Injury

meniscusA meniscus is a crescent shaped fibrocartilage that divides a joint. In the knee the menisci are C shaped and  provide structural integrity to the knee when it undergoes stress. The knee menisci are commonly injured during twisting activities and during collisions involving inward or outward movements of the knee.

The lateral meniscus is less commonly injured than the medial meniscus. Small tear in the meniscus can and should be treated conservatively. A lateral meniscus tear presents as pain in the outside of the knee that is worse with twisting and especially going down stairs.  Due to its connection to the lateral meniscus the popliteus muscle, located behind the knee, commonly causes posterior knee pain when the lateral meniscus is injured. A medial meniscus tear presents as pain in the inside of the knee that is worse with twisting and especially going up and down stairs.

Swelling and/or stiffness will appear in the knee when a tear is present. If the knee locks in extension or flexion and popping and clicking are present a more serious tear maybe present. An MRI with contrast maybe necessary to determine the extend of the tear.

Non-contact meniscus injuries occur due to lack of hip and ankle stability. When the foot and ankle can not control knee motion correctly increased stress is placed on the menisci. Eventually the stress overtakes the strength the joint and injury occurs.

Conservative treatment for meniscus injury starts with restoring proper joint motion loss whether flexion, extension or both. This can be accomplished with joint mobilization exercises and Active Release Technique. Once joint motion is restored and pain is under control, focus should begin on correcting the hip and/or ankle imbalances that predisposed the individual to the meniscus injury.


Yours in health,


Dr. Justin Hildebrand

Active Care Rehab

To Barefoot Run or Not

barefoot 1Barefoot running has become popular and does have advantages. But does this mean that you should ditch your shoes and hit the pavement with no protection. To answer these we must look at the pros and cons of barefoot running.

Barefoot running, unlike exercising in shoes, allows your foot muscles to do their jobs. Your intrinsic or deep foot muscles are supposed to help stabilize the foot while allowing them to form to the terrain around you. These muscles are traditionally weak or overused due to today’s footwear. High heels or raised heels can shorten the foot causing the foot muscles to tighten along with the joints. Wearing the wrong shoe, motion control or minimalist when not needed, can weaken the foot muscles.

Barefoot running encourages forefoot striking instead of heel striking. Forefoot striking is a more natural running form and is more efficient, so less energy is used. Any runner, beginning or advanced, understands that running efficiently is very important. Although, forefoot striking is natural, those accustomed to heel striking or rearfoot running experience an increase in Achilles tendon injuries when running barefoot.

Barefoot running leaves your feet open to the terrain. This exposes the runner to higher risk of puncture wounds, infection and other potential injuries. Having a clean field, trail, track or sidewalk is not an easy thing to find. Most running tails contain rocks and other dangerous obstacles that can cause serious injury to an unprotected foot.

Barefoot running depletes the fat pads located in the heels. Studies have shown that running barefoot or in minimalist shoes causes the depletion of the protective fat pads located in the heels. This syndrome is also common in the over weight individual. Decreasing the fat pad can cause irritation to the heel bone and nerves causing pain and symptoms mimicking plantar fasciitis. Heel cups like, Tuli’s Classic Gel Heel Cups, Regular (Under 175lbs), can help if this issue develops.

Barefoot running can be beneficial if done correctly and your foot is prepared. I advise my athletes to start by walking around the house barefoot or in a minimalist shoe and than start walking in a safe area outside. While in the beginning phases of walking barefoot, rehabbing the foot muscle should be a priority. Click here for exercises. Strengthening insoles can  be helpful as well. After walking and rehab, one can transition to light running and work up to 3 miles in barefoot or minimalist.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab

Achilles Tendinitis

AchillesAchilles tendinitis plagues many active individuals (runners to bikers) and the on the go hard worker. In fact, in a military study 10 of the 69 cadets who participated suffered an Achilles overuse injury. The Achilles tendon is placed  under intense strain everyday, with every movement. During running the tendon can be placed under forces seven times greater than body weight. It is no wonder that it is injured so frequently.

This injury is associated with pain in the back of the lower leg from the heel to five inches above. Achilles tendinitis, more appropriately called tendinosis, can occur in the high arched and low arched individual. Most commonly the injury is due to overuse rather than an accident. Chronic tightness in the calf muscles cause increased stress on the tendon. The Achilles begins to tighten and become sore over time and eventually the injury ensues.

Instead of using heel lifts and orthotics, rehabilitative insoles and gentle lengthening of the calf is a better approach. Aggressive stretching can cause increased stress on the tendon and increase the damage to the structure. Relieving trigger points in the muscle bellies with massage or foam rolling followed by gently dynamic, multi-planar stretching appears to be the best protocol for recovery.  If pain is worse in the morning a Active Ankle Dns Dorsal Night Splint Small (men 5-10 Women 5-9 1/2) can be helpful during the early stages of recovery.

If you are having Achilles pain or suffer from Achilles tendinosis a Graston, Active Release Techniques or soft tissue manipulation trained Chiropractor or therapist can be beneficial. Click here to see my rehab exercises for Achilles tendinosis.

Yours in health,

Dr. Justin Hildebrand

Manual Therapy

Reoccuring Muscle Injury?

Everyone deals with an injury at some point throughout life. Most will occur when adding a new activity to their routine (shoveling snow in the winter), doing something they should not (thinking they are 18 again), or trying to go to heavy to fast. These injuries will heal with RICE: Rest, Ice, Compression, and Elevation,  or with a few visits to their chiropractor.

What about the injuries that just seem to always come back, the ones that never completely go away? What causes reoccurring muscle strains or pulls? Why do we seem to always pull the same hamstring or strain the same shoulder? To answer this we need to look at how Active Release Techniques (ART) explains muscle injuries.


When injuries occur the body lays down scar tissue to patch the site of injury. If enough time and care is given to the site than the body will replace this scar tissue with normal, fully functioning muscle tissue. If we continue to stretch, work, use or even eat inflammatory foods the scar tissue will thicken causing the muscles to become shorter and weaker since they can not contract as they should.

You can think of your muscles like roads. When a hole or divot occurs in a road, the city sends out a crew to patch it up. If it is aloud to dry and become part of the road than the road becomes smooth again. If more and more cars drive over the patch the more likely the patch will change shape and need more asphalt to fill the divot. Our muscles work in a similar way.thDHPAWTFS

When our muscles become short and weak tendons become stressed and tendinitis can set in. Range of motion of joints become decreased, strength is lost, and pain can increase and even occur in others areas. The cycle continues over and over, causing reoccurring chronic injuries.

How do we stop the cycle?

Myofascial release techniques like Active Release and Graston. These techniques help heal the tendons and muscles in pain and help eliminate the scar tissue that has developed causing the pain. So, if you have a recurring injury or next time you just pull a muscle find an ART or Graston specialist in your area and scrap the scar tissue before it really becomes a problem.

Yours in health,

Dr. Justin Hildebrand

Active Care Rehab

Corrective Exercise: Fighting Injury Reoccurrence

I recently read a quote by former Kansas City Chief Art Still, “Regular exercise may be the single most important lifestyle activity that will make people healthier.”1(web-link to mag) As true as that statement is, those of us in pain my not be able to get the exercise needed to be healthy. This brings me to today’s topic: Corrective Exercise.

Corrective Exercise may be the single most important activity when dealing with an injury. Many therapies, physical rest, and treatments can decrease pain associated with injury.  However, if one does not correct the cause and subsequent muscle imbalance that lead to the injury, the pain will likely reoccur. A Corrective Exercise regimen will target the dysfunction, muscle weakness, and overactivity that predisposed one to injury and decrease the likelihood its recurrence.

Injury occurs due to excess stress placed on a joint or muscle. Repetitive activity or movement causes overuse of specific muscle groups and this overactivity inhibits opposing, or antagonistic muscles. When a muscle is overused, or injured the body, lays down scar tissue in response. This scar tissue can cause decreased range of motion, nerve entrapments, and decreased blood flow. Pain results at immediate site, but more often pain is experienced in another joint.

Since Kansas City has a high rate of knee surgeries, medial or inner knee pain can be used as an example. Quadriceps and/or hip flexor dominance produces weakness in the hip stabilizing glute muscles. During activity such as going down stairs, jumping, or running, stress is placed onto the knee since the hip stabilizers are not functioning at optimal strengths. This commonly places the knee in a position that stresses the medial meniscus and ligaments, leading to pain. Many therapies and treatments can decrease the pain, but unless the muscle imbalances are addressed, the pain will likely return.

The National Academy of Sports Medicine (NASM) breaks corrective exercise into 4 categories: Inhibit Lengthen, Activate, and Integrate.2 An effective corrective exercise program will contain these principles and progress though the stages. This process will address the overactive muscles, the tight muscles, the weak muscles, and finally incorporate the whole body to reduce chance of reoccurrence of injury.

  1. Inhibitory techniques are used to reduce tension or decrease activity in muscles. This can be accomplished by myofascial release techniques performed by a DC, DO, PT, etc. or by self myofascial release with the use of a foam roller. These techniques are Active Release Technique (ART), Graston Technique, FATKR, and many others.
  2. Lengthening techniques are used to increase length and range of motion of the tissues and joints. These techniques can be as simple as stretching (static or tri-planar) or neurological. Practitioner lengthening techniques are Post-Isometric Relaxation (PIR), Post Facilitated Stretch (PFS), Post Neuromuscular Facilitation and others.
  3. Activation techniques are used to reeducate and increase activation of underactive tissues. This techniques range from functional rehab to positional isometrics.
  4. Integration techniques are used to retrain the collective function of all muscles involved in movement. This is done through functionally progressive movements using dynamic exercises. Integration is the last step and involves whole body movements.

A good, effective corrective exercise program is given to incorporate all facets of the problem, not just to alleviate the pain. By eliminating pain, and addressing the cause of the pain, one can enjoy an exercise program to become a healthier and happier individual. After all, “Regular exercise may be the single most important lifestyle activity that will make people healthier.”

Yours in health,

Dr. Justin Hildebrand

 1. Still, Art. “Six ways regular exercise can help overall health.” Kansas City Sports & Fitness. March 2012. Pg 10: Print.

2. NASM. NASM Essentials of Corrective Exercise Training. Lippincott Williams & Wilkins; 1 Har/Psc edition (September 25, 2010).