But I Love These Shoes!

Ok, maybe I am treading on sacred ground as a male writing about this topic, but here it goes…



Last week I opened my downstairs closet to see 16 pairs of my wife’s shoes very neatly organized on newly purchased shoe racks. To some of you reading this, that may seem like a rather small sample size of footwear. But to the average guy, understanding why it is necessary to own 16 pairs of anything will forever be a challenge. That being said, I am not going any further down the “Men are from Mars and Women are from Venus” path. I can only get myself into trouble.


Instead, I am going to focus on the science of walking on high-heeled shoes. Yes, I said “science.” Some culturally and (perhaps) stylistically in-tune researchers from Denmark published a research study in the Journal of Applied Biomechanics in February 2012 entitled Walking on high heels changes muscle activity and the dynamics of human walking significantly.


The researchers’ stated study aim was to investigate the distribution of net joint movements in the lower extremities while walking on high-heeled shoes, compared with barefoot walking at identical speeds. The results of the study showed that there were greater bone-on-bone forces in the knee joint during walking with high heels, compared to barefoot walking. They concluded that these findings may explain the observed higher incidence of osteoarthritis in the knee joint in women, compared to men.


So what’s the take-home message? 


Can we definitively say that wearing high-heeled shoes will cause arthritis in the knee? No. However, if we consider this as a possibility, especially in an environment of long walking commutes in many major cities, this information provides us with a valuable suggestion.


My suggestion (despite my less than infinite fashion sensibility) is to wear a good pair of walking sneakers during your commute, and then change into your wonderfully stylish high heels at the front door, or when you get to your desk. Think of it this way – if high heels really do cause arthritis, then by wearing sneakers during the periods of greatest demand on your feet, you may actually extend your high-heel wearing years overall.


Let’s start a new fashion trend – sneakers on the commute, and fashion-forward high heels in the office!


I will gladly accept any questions, constructive criticism, or fashion tips. Thank you!





 Walking on high heels changes muscle activity and the dynamics of human walking significantly. Simonsen EB, Svendsen MB, Nørreslet A, Baldvinsson HK, Heilskov-Hansen T, Larsen PK, Alkjær T, Henriksen M. J Appl Biomech. 2012 Feb;28(1):20-8.



Key Risk Factors for Shin Splints


Shin splints, more formally known as medial tibial stress syndrome or tibial periositis, are a common injury among athletes – especially those engaging in running. Shin splints account for approximately 13-17% of all running-related injuries.1 They are caused by repeated trauma to the connective tissue and tibialis anterior muscle on the front of the tibia or lower leg bone. Symptoms include pain or a dull ache present in the front portion of the lower part of the leg. If left untreated, shin splints could result in a stress fracture to the tibia bone.


Risk factors for shin splints:

  • One study showed that during running, the tibialis muscle increased in activity and fired above the fatigue threshold 85% of the time in those with shin splints.This increased muscle activity during running may account for the high number of injuries seen in runners.
  • Females are 1.5 to 3.5 times more likely to progress to stress fractures due to diminished bone density.3
  • Muscle imbalance, including weakened core muscles
  • Inflexibility or tightness of the calf musculature
  • Training errors such as increasing activity, intensity, and duration too quickly
  • Improper footwear causing excessive pronation at the foot
  • Performing high impact exercises on hard, non-compliant surfaces4


Treatment for shin splints often consists of rest, ice, non-steroidal anti-inflammatories or NSAIDs, and physical therapy. During a physical therapy evaluation, the therapist would perform a biomechanical evaluation to determine potential causes and muscle imbalances which could be contributing to shin splints. Advice regarding footwear, orthotics or training may also be provided. Prognosis is favorable for these individuals if compliant with advice. Surgery is a last resort if conservative treatment fails.


Shin splints can be a frustrating injury, but knowing the risk factors and trying to avoid them will hopefully allow one to perform pain free.



1 Clement D, Taunton J, Smart G. A survey of overuse running injuries. The Physician and Sports Medicine, 1981; 9, 47-58

2 Reber LJ et al. Muscular control of the ankle in running. AJSM. 1993; 21, 805-810.

3 Bennett JE,Reinking MF, Pluemer B, et al. Factors contributing to the development of medial tibial stress syndrome in high school runners. JOSPT. 2001; 31, 504-510

4 Yates, B, White, S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. AJSM. 2004, 32(3), 772-780

Physical Therapy Can Help Chronic Jaw Pain

Temporomandibular disorder (TMD) is a disruption of the normal movement of the jaw and includes a variety of conditions associated with pain and dysfunction of the temporomandibular joint (TMJ), more commonly know as the jaw and its muscles. Overuse, tension, decreased blood flow, and other complications in various joints and muscles in the head, neck, and oral cavity can cause pain in the TMJ.


TMD affects individuals of all ages. In fact, it is estimated that 20% of the population is affected, but only 10-20% of those affected seek treatment.1





TMD sufferers may experience headaches, tinnitus (ringing in ear), altered jaw movement, jaw popping or clicking, limited jaw opening, difficulty swallowing, toothache, dizziness, neck pain, and/or vertigo.2



Pain in the TMJ can be caused by a wide variety of factors related to overuse, tension, decreased blood flow, and other complications in various joints and muscles in the head, neck, and oral cavity.


The most common causes include:


Poor posture: Individuals with TMD present frequently display poor posture and a more forward head position than individuals without TMD. Increased tension in the muscles at the base of the head (suboccipiatals) caused by a forward posture can lead to muscle imbalance, pain, decreased jaw motion, and displacement which directly affects the TMJ.3


High stress levels: Stress can be defined as either conscious or subconscious stress. A conscious stress response may be due to a specific event and result in elevated heart rate, anxiety, and/or inability to sleep. A subconscious stressor is created over a period of time and can often present itself when sleeping and result in the grinding of teeth. Subconscious stressors usually stem from an internal struggle that is overlooked or suppressed. 13


Teeth grinding and/or clenching: Teeth grinding is primarily an involuntary nocturnal behavior. Clenching can occur during the day or at night. In severe cases, disc displacement of the jaw and arthritis may occur and may require further medical intervention.4


Micro- and macrotraumas: Microtraumas include repetitive insult to the jaw, as seen with karate, boxing, or wrestling injuries. Macrotraumas include more forceful and direct insults to the jaw and are often linked to jaw dislocations, most commonly seen in motor vehicle accidents.



Noninvasive, conservative treatments generally provide improvement or relief of symptoms and are recommended in the initial management of TMD. Physical therapists are frequently involved in the management of TMD, often in collaboration with dental professionals. A wide variety of PT techniques including specific joint movement and manual therapy to the jaw and neck, postural exercises to increase strength around the shoulder blade region, soft tissue massage, electrotherapy, biofeedback, relaxation techniques, and flexibility exercises for the jaw and neck can be effective in the management of this disorder. 5-12


Patients suffering from chronic jaw pain should consult a physical therapist to determine what type of treatment plan is right for them.



1 Pedroni CR, De Oliveira AS, Guaratini MI. Prevalence study of signs and symptoms of temporomandibular disorders in university students. J Oral Rehabil. 2003;30:283–289.

2 Dworkin SF, Huggins K, Wilson L et al. A randomized clinical trial using research diagnostic criteria for temporomandibular disorders: axis I to target clinic cases for a tailored self-care TMD program. J Orofac Pain. 2002;6:48–63.

3 Di Fabio RP. Physical therapy for patient with TMD: a descriptive study of treatment, disability, and health status. J Orofac Pain. 1998;12: 124 –135.

4 Sturdivant J, Friction JR. Physical therapy for temporomandibular disorders and  orofacial pain. Curr Opin Dent. 1991;4:4885–4896.

5 Feine JS, Lund JP. An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain. Pain. 1997;71:5–23.

6 Linde C, Isacsson G, Jonsson B. Outcome of 6-week treatment with transcutaneous electric nerve stimulation compared with splint on symptomatic TMJ disc displacement without reduction. Acta Odontal Scand. 1995;53:92–98.

7 Conti PCR. Low-level laser therapy in the treatment of temporo-mandibular disorders (TMD): a double blind pilot study. Cranio. 1997;15(2):144 –149.

8 Wright EF, Domenech MA, Fischer JR Jr. Usefulness of posture training for patients with temporomandibular disorders. J Am Dent Assoc. 2000;131:202–210.

9 Nicolakis P, Erdogmus CB, Kopf A, et al. Exercise therapy for craniomandibular disorders. Arch Phys Med Rehabil. 2000;81:1137–1142

10 Nicolakis P, Erdogmus CB, Kollmitzer J, et al. An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis. Cranio. 2001;19(1):26 –32.

11 Minagi S, Nozaki S, Sato T, Tsuru H. A manipulation technique for treatment of anterior disk displacement with reduction. J Prosthet Dent. 1991;65:686 – 691.

12 Michelotti A, Steenks MH, Farella M, et al. The additional value of a home physical therapy regimen versus patient education only for the short-term treatment of myofascial pain of the jaw muscles: short-term results of a randomized clinical trial. J Orofac Pain. 2004;18(2): 114 –125.

13 http://www.subconscious-mindpower.com/brain/the-effects-of-stress-on-the-brain



Choosing the Right Running Shoe for Your Foot Type

Did you know that there are three main types of running shoes that are built to support your unique foot? Many of us go out to buy running shoes because they look good, we like the colors, the style, and if we are lucky – they are comfortable. However, there is a significant amount of science and technology that goes into developing running shoes that best suit the three most common types of foot arches: a flat arch (or pronated foot), a normal arch (or neutral foot), and a high arch (or supinated foot).1


Running shoes are structured mostly around mid-sole technology, which is located on the bottom of the shoe from mid-heel to the arch of the foot.2 This area is most important because that is where the shock absorption occurs, as the foot and makes contact with the ground.2 If you have poor shock absorption excess energy will continue to travel up the leg to the ankle, knee, hip, and low back – which, in some cases, can cause injury or discomfort while running.3 Pronation is the rolling inward of your foot, is your body’s way of absorbing and controling that shock. Problems can occur when you either overpronate (flat feet) or underpronate (supinate/high arches), because it can affect the shock absorption process.3


The three main types of running shoes are motion control, stability, and cushion.



1. Motion control shoes are designed for people with a flat arch or pronated feet. This type of shoe is typically more rigid and has a wider sole to control the excessive motion occurring at the foot.4


2. Stability shoes are designed for people that have a normal arch or neutral foot. This type of shoe typically has some rigidity and some cushioning to help support the mechanics of this foot type, which has normal pronation and shock absorption during running.4


3. The last type is a cushion shoe, which is designed for people with a high arch or supinated foot. This type of shoe is typically more flexible and cushioned to promote more pronation and shock absorption.4


Using these three categories as a guideline when purchasing your next pair of running shoes may help with improving comfort, decreasing soreness after running, and preventing overuse injuries.


So how do you know which type of shoe to buy?


Determine your arch type. The quickest and easiest way to determine this in your home is called the wet feet test.5 Place a paper bag on the ground with a pan of water next to it. Step your feet into the water and then onto the paper bag, step off the bag and observe the footprint left behind.5


If you see the entire outline of your foot then you likely have a flat arch or pronated foot.




If you do not see the entire outline of your foot and there is a little space left where the arch is located, you likely have a normal arch or neutral foot.




If you have just a fine line connecting your heel area to the ball of your foot, then you likely have a high arch or supinated foot.5




Of course, this is a less than scientific approach to determining what type arch you have but it will give you a general idea.


If you would like a more precise evaluation of your arch and what type of shoe would be the best for you, stop in to the nearest Sports PT location and chat with a physical therapist. We can evaluate your feet in both a static position and dynamic position (such as running or walking) to help decide what would be the best type of shoe for you.


Overall, it is important to consider a multitude of factors when purchasing your next pair of running shoes. Arch type is just one of them. Your feet and body will thank you.


Happy and safe running!



1 Loda, R. 3 Types of Running shoes for 3 types of feet. Running Shoes Guru. http://www.runningshoesguru.com/2009/03/3-types-of-running-shoes-for-3-types-of-feet/.  Published 2009.

2 Loda, R. Anatomy of a Running Shoe. http://www.runningshoesguru.com/2009/03/anatomy-of-a-running-shoe/. Published 2009.

3 Loda, R. Running shoes 101: Pronation and shock absorption. http://www.runningshoesguru.com/2009/03/running-shoes-101-pronation-and-shock-absorption/. Published 2009.

4 RunningShoeTypes. Running Shoe Types.  http://www.runningshoetypes.com/. Published 2009. Updated 2012.

5 Loda, R. A simple test to determine your foot type. http://www.runningshoesguru.com/2009/03/a-simple-test-to-determine-your-foot-type-neutral-pronator-supinator/. Published 2009.



The Truth About Sit-Ups

If you want to get your abs back in shape consider avoiding sit-ups and try planks instead. While sit-ups do strengthen your abdominal muscles, they do not strengthen them in a functional way and can actually cause excessive stress on your lower back. Think about how your abs work during a normal day. They stabilize your trunk so your arms and legs can move freely. You rarely need to bring your chest toward your hips with daily activities.


Repetitive bending of the lower back (which is the action taken when doing a sit-up) can slowly damage your discs, and could lead to disc problems. A spinal disc problem, put simply, is when a disc between your spinal vertebrae tears/protrudes and causes low back pain. Rather than over-strengthening your abs in a non-functional manner with sit-ups, consider performing some core exercises to balance your back muscles, abdominal muscles, and buttock muscles.


There are many good exercises for balancing your core muscles and not overloading your lower back. Here are my top three recommendations:



Prone plank: When performing the prone plank, you should brace your abdominalmuscles (like someone is coming to punch you in the stomach) because bracing improves stability of your core muscles. Avoid “sucking in” or hollowing your abs because this actually reduces efficiency of your core muscles. A prone plank should initially be held for 5-10 seconds for a few repetitions and slowly build up to a 60-second hold.






Side-lying plank: Lie on your side with your knees bent and hand on your oppositeshoulder. Lift hips off the table and shift hips forward so your body is in a straight line, brace your stomach (see above for tips how to do this in prone plank exercise) and hold for 5-10 seconds initially. As you get stronger with this exercise, build up to a longer hold time (max 60 sec). 





Mini-squat : Stand with feet a shoulder-width apart, brace your abdominal region, bendyour knees, push buttocks back, and go down a few inches. Return to standing and repeat about 10-15 repetitions. This is a similar motion to sitting down and getting up from a chair.








At Sports PT, we can assist you with creating a functional and spine-sparing exercise routine to improve your core stability without doing a single sit-up.



McGill, Stuart Ph.D. Designing Back Exercise: from Rehabilitation to Enhancing Performance. http://backfitpro.com/pdf/selecting_back_exercises.pdf. Accessed March 9, 2012. McGill, S.M (2007) Low back disorders: Evidence based prevention and rehabilitation, Second Edition, Human Kinetics Publishers, Champaign IL, USA.

6 Tips for Better Running Form


Improper form can lead to serious running-related injuries. Here is a list of tips to help you avoid the most common running mistakes:

  1. Did you know that 60% of running forces are absorbed by the ankle and 40% of that is transmitted up to the knee? Initial contact should occur at the mid-foot landing just under the hip or slightly in front of the hip. This will help to decrease landing forces and allow for a quick leg turnover.
  2. You want a slight forward-lean during your stride and good arm swing to help propel you forward.
  3. Remember to keep your shoulders relaxed, and your hands should be at hip level for optimal efficiency.
  4. As you enter into the propulsion phase, it is crucial to have triple extension at the hip, knee, and ankle pushing your body up and forward.
  5. Your head should float slightly up and down while running (but do not bound to improve efficiency and preserve energy while running).
  6. To optimize energy and efficiency you should strive to have leg turnover of about 180 times in a minute and 12 breath cycles in a minute.

For more information on choosing the right running shoes and other injury prevention tips visit www.sptny.com/Patients/HealthTips.aspx.