My Knees Crack… Should I Be Worried?

Katelyn Thies, SPT



Besides pain, joint noises (cracking, clicking, popping) are one of the most common concerns people have about their knees. Many people wonder if these sounds mean there is something wrong. To answer this, it is important to ask yourself if these noises cause pain.


Answer 1: No, these noises are not painful


Explanation—knee sounds themselves do not indicate injury or joint disease. In fact, it’s completely normal for everyone’s joints to make sounds at times, especially with movement after sitting, standing, or lying still for a long time. Inside the knee joint is a substance called synovial fluid—this lubricates the joints and allows joint surfaces to glide smoothly. Synovial fluid is made up of gases and other substances; with movement, changes in pressure cause tiny gas bubbles to form. These bubbles can burst and be released into the knee joint, leading to cracking or popping sounds. This is one of the most common explanations for painless knee sounds and should not be a cause for concern.





Answer 2: Yes, these noises are painful


Explanation—painful popping, snapping, or clicking in the knee may (but not always) be a result of tissue injury or irritation—but there is no need to worry! If you are experiencing frequent knee pain, it may be time to see a physical therapist. PTs can perform a full evaluation on your knees and create a therapy program that fits your specific needs. They specialize in treating this type of pain by using hands-on techniques, teaching stretches for structures that may be preventing normal motion, and prescribing exercises for muscles that can help take stress off the knees.



Bottom line: There is no need to stress about knee sounds! Most of the time, this is a normal process that leads to no future issues. Even if injured or irritated tissues are involved that are causing pain, many people are very successful at managing their symptoms after attending physical therapy and learning about what movements work best for their body.



How Hard Should Your Workouts Really Be?

By Julian Bermingham PT, DPT, CSCS



If you are a hard-charging weekend warrior, the answer to this question might surprise you!  On the other hand, if you have just recently joined the gym and are unsure how to appropriately execute a fitness plan, then read on, as the information below will be tremendously valuable to you.


But first, a quick vocab lesson. Quantitative data refers to the hard, measurable numbers in a workout: the number of sets, repetitions, and the amount of weight being lifted. Most people have a good grasp of this portion of their workout plan. Qualitative data, on the other hand, refers to data that can’t be measured, but must be observed/experienced. 


In 1982 the Swedish researcher Dr. Gunnar Borg published his Rating of Perceived Exertion (RPE) scale, which was effectively the first widely used qualitative rating system that was applied to physical activity. The Borg Scale ranges from 6 (no exertion at all) to 20 (very, very hard).  Why these seemingly arbitrary numbers?  If the researchers added an additional zero to the chosen exertion number, they would get an accurate estimation of heart rate for a given activity (for instance 6 on the BORG = 60 heart beats per minute). 


In recent years, members of the strength and conditioning community have come to adopt a modified and more user-friendly version of Dr. Borg’s RPE scale. Following a given exercise or task, the participant can use a 0-10 scale of difficulty, with 0 being no exertion at all, and 10 being “I could not have continued”, or “I could not have performed 1 more repetition.” In this way, trainees are assigning a qualitative measure to their training.  Why is this important?  Well let’s take this hypothetical example:


On week 1, a trainee performs 1 repetition of a 100 pound bench press and labels it as a 10/10 difficulty.

On week 2 that same individual performs 1 repetition of a 100 pound bench press and labels it as a 7/10 difficulty. 


Although the number of sets, reps, and weight lifted are the exact same, we can conclude that from week 1 to week 2, the trainee has become stronger, as the same task is now performed at a lower relative exertion rating.



So why is any of this important to the average gym goer? For every training session there exists some relative risk to performing the exercise, as well as some potential reward for performing the exercise. As intelligent trainees, we want to minimize risk as well as maximize reward. One could easily imagine that if an entire workout was performed at a 10/10 intensity, the risk of injury would be much higher than if all exercises were performed at a 1/10. But if the intensity of the exercise was only a 1/10, very little benefit would be attained by that session.


So here are my recommendations based off of clinical and personal experience. If performance is the goal: most training sessions should be performed between a 7-9 relative intensity on a 0-10 scale. True 10/10 efforts should be reserved for when they matter the most: a competition, a meet, or the big game. In this way we can maximize our benefits of training and minimize the risk of injury. 


One final note: in the rehabilitation setting all the above recommendations still apply, but as we attempt to retrain movement patterns, and decrease the perception of threat/harm, exercise intensity can be decreased to a 5-7 RPE, at least until the patient has been successfully rehabilitated.

Plantar Fasciitis Awareness: What’s Causing Your Heel Pain?

By Nick Puleo, SPT



What is plantar fasciitis?



Your heel pain may be associated with plantar fasciitis, as it is the most prevalent condition of the foot and most common cause of heel pain! Plantar fasciitis is characterized as inflammation of the plantar fascia, a thick band of connective tissue that travels along the bottom of the foot from the heel bone to the toes and serves to support the arch of the foot. Plantar fasciitis is typically an overuse injury that is self limiting. Inflammation associated with plantar fasciitis can cause a stabbing, sharp pain that is relatively localized to the bottom of the foot on the heel bone. People suffering from plantar fasciitis often explain that their symptoms are worse with walking their first steps in the morning, or walking after any prolonged period of inactivity. Pain associated with plantar fasciitis usually subsides with activity. 




Factors that increase the likelihood of developing plantar fasciitis



Age: most commonly affects individuals between the ages of 40-60.


Improper footwear: walking barefoot or wearing shoes that do not support the arch of your foot increase the chance of developing plantar fasciitis. Footwear that does not support the arch of the foot increases the amount of stress placed on the plantar fascia.


Foot biomechanics: flat feet result in a foot that has a stretched plantar fascia, which is not optimal for foot function. High arched feet create a shortened or tight plantar fascia, which results in a decreased ability to accept loads placed on the tissue. 


Running: plantar fasciitis is the most common injury for runners.


Obesity: increased BMI places excessive loads on the plantar fascia, making it more susceptible to becoming irritated.


Jobs that require long periods of standing on your feet: The weight of your body in standing flattens the arch of the foot, increasing the amount of tension placed on the plantar fascia. Increased tension to this tissue can increase the likelihood of plantar fasciitis.


Multiple corticosteroid injections: corticosteroid injections are a common non-conservative treatment method for plantar fasciitis because they offer fast relief of pain. However, chronic corticosteroid injections decrease the extensibility and integrity of the plantar fascia, increasing the likelihood of a tear or rupture.




What should I do if I have plantar fasciitis?



See your PT!! 


Physical therapists are trained to treat impairments associated with plantar fasciitis. Physical therapy for plantar fasciitis focuses on stretching of calf musculature, strengthening of the intrinsic foot muscles that support the arch of the foot, and improve joint mobility in the foot. PTs will use different manual techniques to address soft tissue and joint mobility restrictions to improve mobility of the foot. PT’s can also prescribe specific exercises that promote muscle strengthening and normalization of gait. Consult with your PT about trying orthotics. Orthotics can provide artificial support to the arch of the foot. In many cases, correcting the position of the foot will reduce symptoms associated with plantar fasciitis. Don’t neglect rest from activity! Although it may be difficult to heal (especially for runners), plantar fasciitis will often resolve with rest from intense activity. Plantar fasciitis is self limiting; rest will allow the inflammation of the plantar fascia to subside. Avoiding aggravating activities will speed up the recovery process.

How Can a Physical Therapist Help With Turf Toe?

By Sports PT Blog Team





Immediately following a turf toe injury, the RICE protocol is recommended: Rest, Ice, Compression, and Elevation. The goal of the RICE protocol is to decrease pain and swelling and protect the joint from further injury until it can be more thoroughly assessed. Most turf toe injuries do not require surgery and are treated with physical therapy. The treatment depends on the severity of the injury.


  • Grade 1. To treat a Grade 1 injury, your physical therapist may use narrow athletic tape to immobilize your big toe with your second toe to restrict painful motion. Your physical therapist may also place a firm insert in your shoe to limit motion and promote healing. In many cases, an athlete may be able to return to sport soon after a Grade 1 injury.
  • Grade 2. Treating Grade 2 injuries may require immobilizing the foot in a brace or walking boot and allowing several weeks of rest.
  • Grade 3. Treatment of Grade 3 injuries is dependent on the severity of the damage to the structures of the foot. Surgery may be required if there is a fracture of a bone, damage to the cartilage (the tissue that lines the bones of the joints), a complete tearing of the tendon, or excessive movement of the joint that causes repetitive instability (subluxation or dislocation).


In each case, your physical therapist will work with you to design an individualized treatment program specific to the exact nature of your condition and your goals. Treatment may include:



Range of Motion Exercises. It is important to regain a full range of motion of your big toe. Your motion may be limited after a turf toe injury, particularly one that requires immobilization in a brace or boot. Your physical therapist will teach you gentle stretching exercises to help regain motion.


Muscle Strengthening. It is common to lose strength in the muscles of your leg, particularly around your foot and ankle after a turf toe injury due to the limited weight-bearing and activity that is required to allow the injury to heal. Your physical therapist will determine which muscles are weak and teach you specific exercises to treat them, such as strengthening with resistance bands, balance activities, and functional activities, like stair climbing.


Manual Therapy. Many physical therapists use manual (hands-on) therapy to gently move and manipulate muscles and joints to improve their motion and strength. These techniques can target areas that are difficult to treat on your own. Manual therapy can be especially effective for joints that become stiff following immobilization; with turf toe injury, your physical therapist will use different techniques to mobilize your big toe as well as the other joints of your foot and ankle that may have become stiff during your recovery.


Patient Education. Your physical therapist will educate you on the do’s and don’ts following turf toe injury to ensure that your recovery is a smooth one. Your physical therapist will work with you to develop an individualized rehabilitation program, including expected timelines and goals to give you a roadmap for your return to full activity.


Hydration for Young Athletes

Improving performance while reducing the risk of injury and serious illness

By Chad LaChance, PT, DPT, ATC, CSCS



It’s hot out there in most areas of the country right now and many of us aren’t taking the proper measures to make sure we can hold up against the heat. This is especially important for our young athletes participating in outdoor sports. Maintaining proper hydration doesn’t only reduce the risk of serious injury or death, but it can help boost performance while reducing the risk of an orthopedic injury.



Why is Hydration Important?



Internally, our bodies consist of 65% water! Our blood relies on proper amounts of water to remain at optimal consistency for pumping blood and regulating our blood pressure. Our muscles rely on water to allow them to use energy efficiently and deliver oxygen and nutrients to working muscles. Without this, we wouldn’t be able to meet the increasing demands of physical activity and sport. Our brain is 85% water. An athlete’s ability to concentrate and be alert during sport rely on adequate amounts of water in the brain. When some or all of these are affected, the risk of injury increases substantially.



Numbers to Remember:


50% : Approximately 50% of all athletes (youth through professional) report to sport inadequately hydrated; this can lead to muscle cramping, muscle fatigue decreased alertness and ultimately injury.


2% : A 2% loss in body weight through sweating causes the body to experience increased fatigue, reduced endurance, declining motivation and beginnings of heat-related illnesses. It’s recommended that you limit weight loss to <2% through adequate hydration before, during and after activity.


16 oz : Athletes should replace every pound of body weight lost after activity with at least 16 ounces of water for proper re-hydration.



Signs of dehydration

  • Dark colored urine
  • Decreased frequency of urination
  • >2% loss in body weight pre vs post exercise
  • Dry mouth, extreme thirst
  • Dizziness, light headedness
  • Lethargy




Preparing for Activity in the Heat


Before a workout or competition, properly hydrate by drinking 1 to 2 cups of fluid an hour before starting, one cup about 15 to 30 minutes prior and then 5 to 10 ounces of fluid every 15 to 20 minutes of activity. These amounts can be adjusted based upon heat index and the amount the individual sweats (ie: sweat rate)



How to Monitor Hydration


Monitor urine color: Well-hydrated persons will have clear to light yellow urine; dark colored urine indicates hypohydration.


Calculate Sweat Rate: There’s no cookie-cutter approach to hydration. Each athlete should consider their individual sweat rate to assist in preparation and rehydration. Sweat rate is the amount of fluids lost during a workout. To calculate sweat rate:


Body Weight (before exercise)Body Weight (after exercise) + any fluids consumed during workout = Sweat loss


Sweat Loss / Exercise time = Sweat Rate (mL/min or mL/hour)


Online Sweat Rate calculator



Know the signs of dehydration and measures to help prevent it! Keep our young athletes healthy and in the game!



For more information please visit:





McDermott, Brendon P., et al. (2017) National Athletic Trainers’ Association position statement: fluid replacement for the physically active. Journal of Athletic Training 52.9: 877-895.

Casa, Douglas J., Priscilla M. Clarkson, and William O. Roberts (2005). American College of Sports Medicine roundtable on hydration and physical activity: consensus statements. Current sports medicine reports 4.3 115-127.

Judelson, D. A., Maresh, C. M., Anderson, J. M., Armstrong, L. E., Casa, D. J., Kraemer, W. J., & Volek, J. S. (2007). Hydration and muscular performance. Sports medicine37(10), 907-921.


Early Single Sport Specialization Statistics

Chad LaChance, PT, DPT, ATC, CSCS



  • Less than 1% of young athletes age 6-17 years old achieve elite status in basketball, soccer, softball, baseball or soccer
  • Highly specialized youth athletes are at 2.5x greater risk of serious injury as opposed to their non-specialized peers
  • In one study, those who trained more than 28 hours per week in their varsity sport before high school were more likely to report multiple injuries (90.0 vs. 56.7%).
  • “Specialization” is classified as a young athlete that participates in year-round training > 8 months of the year, chooses a single main sport and quits all other sports to focus on single sport.
  • In a study of 519 junior tennis players, 70% of them claimed to begin single-sport specialization by age 10.
  • 20% of children ages 8 to 12 and 45% of those ages 13 to 14 will have arm pain during a single youth baseball season.
  • The American Medical Society for Sports Medicine (AMSSM) published results of a 2012 survey that found 88% of college athletes surveyed participated in more than one sport as a child.






  1. DiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry GL, Luke A. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. Clin J Sports Med. 2014;24(1):3-20.
  2. American Orthopaedic Society for Sports Medicine. (2019, March 16). Early sports specialization tied to increased injury rates in college athletes. ScienceDaily. Retrieved July 16, 2019 from
  3. Abbott, A., Collins, D., Sowerby, K. & Martindale, R. (2007). Developing the Potential of Young People in Sport: A report for sportscotland by The University of Edinburgh, sportscotland: Edinburgh.
  4. Fransen, J., Pion, J., Vandendriessche, J., Vandorpe, B., Vaeyens, R., Lenoir, M., & Philippaerts, RM. (2012). Differences in physical fitness and gross motor coordination in boys aged 6‐12 years specializing in one versus sampling more than one sport. Journal of Sport Sciences, 30, 379‐
  5. Jayanthi, N., Pinkham, C., & Luke, A. (2011). The Risks of Sports Specialization and Rapid Growth in Young Athletes. 2011 Annual Meeting of the American Medical Society for Sports Medicine. April 30th-May4th, Salt Lake City, Utah.

3 Reasons Why Water is So Important

By Sports PT Blog Team




“Baby, it’s hot outside!” Just a few months ago we were complaining about the cold in Upstate NY, but now that summer has officially arrived, heat and all, it’s important to remember to stay hydrated!


So what’s all the fuss about water, anyway? Here are three reasons why it’s so important to our bodies:


  1. Water boosts energy.
  2. Water delivers important nutrients to all our cells, especially muscle cells, postponing muscle fatigue.
  3. Water acts as a lubricant and cushion for your joints.


Water does many other helpful things, too, like regulate body temperature, flush body waste, and help maintain blood pressure; all of which helps keep us healthy and moving! So, grab a glass and take a sip! Your body will thank you!

The Many Benefits of Yoga

By Amy Barbasch, DPT




Have you been looking to try Yoga? Here are just a few of the many health benefits that Yoga may provide. 



Improves Flexibility and Balance-  Yoga commonly incorporates poses and movements that work on muscle flexibility and balance training. Studies have shown that yoga not only improves flexibility and balance but can therefore improve athletic performance. 



increased muscle strength and endurance- Yoga is commonly known to improve flexibility, however the practice can also help to increase strength and improve endurance. A number of yoga poses are used to build muscle tone and endurance with prolonged holds and repetition. 



Improves posture-  A number of yoga poses work to combat the modern day posture that can be easy to achieve through desk and computer work. A number of poses encourage spine extension combating the seated ‘flexed’ spine, as well as work on strength and endurance of the upper back and postural musculature helping to improve overall postural endurance. 



Helps train proper breathing- Yoga incorporates movement with breath. It can help to train the use of the diaphragm to not only improve the function of breath, but reduce the use of accessory muscles. This can help to improve breathing and lung function. 



Improves bone health- Weight-bearing exercises done against gravity have been shown to improve bone density and overall bone health. Yoga incorporates weight bearing through many joints of both the upper and lower body helping overall bone health and fighting osteoporosis. 



May help to improve sleep- Yoga has been found to increase the secretion of Melatonin, the hormone that is responsible for regulating sleep. Studies have also shown that yoga can reduce the need for medications to help one sleep. 



Decrease Stress- Many studies have shown that yoga can help with relaxation and decrease stress by decreasing the secretion of cortisol the primary stress hormone. 



May help to reduce depression- This may be because yoga is able to decrease levels of cortisol, a stress hormone that influences levels of serotonin, the neurotransmitter often associated with depression.



May help decrease Inflammation- Inflammation is a normal and needed immune response, however chronic inflammation can be a leading cause of pro inflammatory disease and pain. Some studies have shown that yoga may reduce inflammatory markers in the body and help prevent pro-inflammatory diseases and chronic inflammation. 



May help to reduce Chronic pain-  Although further research is needed on this, studies have shown that Yoga can help to reduce chronic pain in patients and improve overall physical function.



May help combat Migraines- 1 in 7 Americans deal with migraines each year; characterized as severe recurring headaches. Commonly migraines are treated with medications. Studies have shown that yoga may stimulate the vagus nerve helping to reduce migraine intensity and frequency. 




Whether you are an avid Yogi or looking to try a new form of exercise, Yoga has been found to be a safe and great form of activity. Roll out your mat and enjoy a Yoga class for International Yoga day! 





13 benefits of yoga supported by science:

38 Health Benefits of Yoga:



Men’s Health and How it Relates to Injury

By Teresa Lindell, DPT, OSC


Everyone gets hurt whether they are male or female.  Did you know though that men are more susceptible to certain types of injuries than women?



  • Achilles tears: Men are three times more likely to tear this powerful tendon in the back of the leg. This is usually a result of playing sports and is most common in men in their 30s and 40s.  This is often repaired surgically and takes several months to return to sports.
  • Finger and Hand fractures: Men are also more likely to sustain fractures of the hand and fingers, usually due to a fight with yard or work equipment, or commonly in a fight with another person or wall when angry. The best way to prevent these types of injuries is to obviously avoid the cause of the situation.
  • Muscle tears: While women tend to have more problems with bone injury, men’s muscles and tendons tend to tear more under stress. This typically has to do with sport and recreation activities as well
  • Pelvic health: While men and women both have problems with pelvic pain at times, it can occur specifically in men after treatment for prostate cancer. Many men don’t realize that a physical therapist who specializes in pelvic floor rehab can make a really positive change for this population.



Physical therapy can help to prevent and treat many of these conditions and return men to their full participation in work, life, and sports.

June: Alzheimer’s and Brain Awareness Month!

By: Melissa Patnella, SPT



What is Alzheimer’s Disease?


Alzheimer’s Disease is a form of dementia that occurs due to degenerative neurological changes in the brain and primarily affects those who are over the age of 65. The most prominent effects caused by Alzheimer’s are loss of memory, confusion, difficulty problem solving, trouble speaking and writing, and withdrawing from social activity.





How do I know if I have Alzheimer’s Disease?



Only 16% of adults over the age of 65 are receiving cognitive assessments during their annual check-ups. If you believe you are experiencing the early signs of Alzheimer’s Disease, tell your primary care physician. You may see exams on the internet that claim to test for Alzheimer’s but speaking to your doctor is the best way to receive an accurate diagnosis.




What do I do if I have Alzheimer’s Disease?



  • Be Open and Direct: Receiving an Alzheimer’s diagnosis can be an emotional experience. Create open conversation about your condition with your loved ones. Advocation for yourself and your feelings are important to open communication and mental well-being.


  • Seek Support: 8 million Americans are living with Alzheimer’s, so you are not alone. Find local or online groups for emotional support and social activity with others with Alzheimer’s. In addition, push yourself to avoid withdrawal from your family and friends.


  • Use Your Voice: The number of people affected by Alzheimer’s is increasing. Your voice is important and powerful in educating those around you about your condition. Education can lead us closer to a cure.




What do I do if I have a loved one with Alzheimer’s Disease?



  • Create a Support System: If you are a care taker, remember that care taker burnout is a very real thing. Take advantage of online and local resources to ensure that you are adequately supported. You are taking care of someone in need; there is no shame in needing some support through your journey.


  • Stay connected: Maintaining family and friend relationships is important for caretaker mental and emotional health. Make time to socialize and stay active in the things that you love.


  • Use technology: MedicAlert+Alzheimer’s Safe Return is a technological device for your loved one with Alzheimer’s to wear. This allows their location to be tracked at all times and if they are lost they (or a person who finds them) can press the button and it will send an alert to you, as well as emergency services.




Resources for those who have Alzheimer’s:


  • 1-800-272-3900: Free confidential 24/7 helpline for those with Alzheimer’s Disease to refer to local programs and provide education, crisis assistance, and emotional support.


  • Free online community for those affected by Alzheimer’s.




Resources for caretakers of those with Alzheimer’s:



  • 1-800-272-3900: This is a free, confidential 24/7 helpline for caretakers of those with Alzheimer’s disease to refer them to local support groups and provide education and emotional support.