Active Care Rehab

Squats, Not Kegels for Pelvic Floor Dysfunction

images6X49OM13Most pregnant women have probably been told they need to strengthen their pelvic floor and do their kegel exercises. Today I would like to share an article that shines a new thought on this concept. The author suggests that preforming a deep squat will actually lengthen and help women become aware of how to actually use their pelvic floor.

Stop Doing Kegels: Real Pelvic Floor Advice For Women (and Men)

It is important for all women (pregnant or not) and men to address the pelvic floor if pelvic pain is present. For more info on pregnancy related pain and treatment see my article and exercises.

Active Care Rehab

Suffering From Shin Splints?

thSuffering From Shin Splints?

If you are suffering from shin splints try this exercise (link above). This will help strengthen your Tibialis Anterior the main muscle on the front of your shin and the muscle responsible for flexing your foot (opposite of pointing your toes). For more info on shin splints see my article here.

Active Care Rehab

Lower Cross Syndrome and Anterior Hip

LCSLower cross syndrome is named for the crossing tightness and weakness that occurs in the lower back, core, and hip muscles.  In LCS, tightness of the low back muscles crosses with tightness of the iliopsoas (hip flexors) and rectus femoris (main quad muscle). Weakness of the deep abdominal muscles crosses with weakness of the gluteus maximus and medius.

This pattern of imbalance creates joint dysfunction, particularly in the lumbar spine, pelvis, hips, and knees. Specific postural changes seen in LCS include anterior pelvic tilt, increased lumbar curve, and knee straightening. Stress is increased on the low back and hips due to tight muscles and can cause pain in the low back when running, walking, and standing for long periods of time.

LCS is common in females, individuals that sit for most of the day and individuals that perform repetitive activities such as running and jumping. Many common injuries that plaques the active person can stem from LCS. Treatments for lower cross syndrome consist of postural training, Active Release/Graston on overactive muscles, and rehab exercises for underactive muscles. Additional home treatments for Lower Cross are foam rolling the quad and anterior hip muscles, Nature Made High Potency Magnesium 400 mg – 150 Liquid Softgels
for overactive and sore muscles, and anti-inflammatory nutrition for proper healing. Anti-inflammtory book.

Foam Roll

In Lower Cross Syndrome the anterior hip is chronically tight and lacks motion due to muscle overactivity and posture. If one can not move through the anterior hip, the low back has to become hypermobile or have too much motion. This can lead to low back pain and inhibition or weak core muscles.

The anterior hip consists of the large muscle of the quadriceps, Rectus Femoris, and the large hip flexor, Psoas. When these muscles become chronicalant hiply tight, the anterior hip capsule or ligaments begin to shorten. Now the hip can not translate or move through its proper range of motion and the gluts are put into a weakened, elongated state. The lumbar spine compensates by increasing its curve which causes the core muscles to weaken and shut off.

This process leads to overuse of the low back and pain, glut and core weakness, and hip impingements. If you have hip or low back pain, and/or Lower Cross Syndrome the click here to see this weeks exercises.

Yours in health

Dr. Justin Hildebrand

Active Care Rehab

Cervical Disc and Neck Pain

Dr. Justin Hildebrand

This week we are going to discuss the cervical (neck) disc herniations. The cervical spine or neck consists of seven vertebrae and five disc which allow the spine to be flexible.

When the discs (much like the Lumbar Spine) become irritated they can begin to migrate posterior or backwards and cause pain. When the disc migrates it can become a bulge or herniation.

A herniated disc usually is caused by wear and tear of the disc. Today, we speed this process up due to postures such as rolled shoulders and forward head posture. These positions place a large load on the lower neck and place the disc under increased pressure.  Herniated discs are much more common in people who smoke, Cervical or Lumbar.

Herniated discs in the neck can cause pain, numbness, or weakness in the neck, shoulders, chest, arms, and hands. Early signs are pain in…

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Active Care Rehab

Shin Splints and Ankle Injury Prevention

With the the new year approaching and many new years resolutions to be active, injury prevention should be on everyone’s mind. Many lower extremity conditions can develop through training, competition and overuse. Some common lower extremity conditions that plague the weekend warrior and even the avid runner are shin splints, plantar fasciitis, IT band syndrome, and various bursitis’.

These conditions commonly share biomechanical dysfunctions: weak foot intrinsic muscles, ankle instability, overactive calves, and weak glutes are just a few. Shin Splints, also known as medial tibial stress syndrome, result from too much force being placed on the shin and connective tissues that attach the muscles to the bone.  Symptoms are pain and tenderness along the inside of the shin during activity and at first generally calms down after exercise.  In chronic or long-standing cases, pain may persist after the activity.

Risk-factors for shin splints are tight calves, unstable ankles, weak anterior tibialis and having flat feet. Running on hard surfaces and participating in activities with sudden starts and stops may increase your risk for developing shin splints. Treatments for shin splints consist of stretching, Active Release and/or Graston, and functional rehabilitation of the feet, ankles and leg muscles. One can prevent this leg pain by choosing the correct shoe wear for their feet, cross training and varying their running surface. Strengthening insoles  can be helpful.

The ankle is a joint primarily made up of 3 bones and many ligaments. The muscles of the lower leg and feet act to stabilize the ankle along with their primary functions. When imbalances occur in these muscles ankle stability is lost and the chance of injury greatly increases. Commonly, the calf becomes overactive, weakening the anterior tibalis and changing the arches of the foot. Dorsiflexion or foot rising is lost causing the toe raising muscles to be recruited. These overactive muscles begin to produce extra stress on the shin. Over time stress pulls on the tibia leading to pain.

As the muscle imbalance grows the ankle becomes more unstable. The ankle ligaments are continuously stretched and pushed to their limits. At this point, ankle sprains and strains can occur. So if you are dealing with shin splints or “weak ankles,” click here to see exercises that maybe beneficial to you.

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).