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Dear friends,

I was humbled last year when I got injured and my dreams of running a marathon came to a crashing halt.

For 15 weeks I was faithful to a running program that was showing some real promise. I was getting faster and feeling confident I was on my way. One day, after a workout I came back to the clinic and I noticed I could barely walk. Now this was not your standard post -running pain, it was pain that limited my ability to bend my knee and put weight on my leg.

I immediately sought out skilled physical therapy. The course of treatment of was initially focused on inflammation control with ice, range of motion and a technique that was new to me; dry needling. Dry needling is similar to acupuncture and it did wonders for the acute pain. The therapist I work with, Dr. Angelo Pompeo did a great job of identifying and needling my problem area. I was able to walk pain free immediately. I also attempted Kiensio tape which did wonders for the swelling that had occurred, thanks to our student athletic trainer Daniel Fox.

Once I could bend and straighten by knee again I had learn to walk correctly again. I was surprised how quickly my leg weakened over 2 weeks. I did a variety of leg strength exercises, plyometrics and core strength work.

One week before the race I still had some hamstring tension which had not completely resolved from the initial injury. The final missing piece was some quality deep tissue which was done by a physical therapist friend of mine Michael Moore. He used a small stainless-steel instrument that really targeted the hamstring and allowed me to run pain-free.

I thought I had the perfect the plan of attack to run the marathon but my body thought different. However, I received some great physical therapy that allowed my to complete the half marathon. Looking back it was a great experience as it allowed me to relate to my patient’s and appreciate what physical therapy can do. Do not suffer in silence, if you are a runner with knee pain please seek physical therapy we are happy to see you.

Felipe J. Mares, PT, DPT, ATC/L, CAFS


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Dear runners,

As I look at the calendar and look outside I can see the weather is ready and primed for running. I know you have circled a number of events on your calendar and I wish you the best. At some point you may have some aches and pains that may arise with your running program. Many of you will face the dreaded “runners knee.” This article has some great evidence based suggestions to get you back to your training program and on your way to your running goals. Best of luck with you future events.

What is runners knee?

Runners knee is a painful condition that most athletes experience in their careers; especially avid runners. Athletes with runners knee have pain in the anterior knee that is exacerbated with running and stairs (especially going down stairs). Additional symptoms maybe be pain in the knee after sitting for a prolonged period of time (also called theatre sign).

Myth #1

Runners knee is often thought to be irritation to the cartilage on the undersurface of the knee cap. Recent evidence has shown that the cartilage behind the knee cap, while noisy is not the MAIN pain generator. The fat pad above the knee and the remaining collateral support (joint capsule) have more pain producing capability than the cartilage.

Myth #2

In the past taping and bracing was the primary means of treating this painful condition. The assumption was the knee cap was tracking poorly on the femur(thigh bone). While there is some truth to this, taping has not been an evidence supported intervention. This theory assumes the train (the patella) is the problem and not the track (the femur or thigh bone). Recent evidence suggest a focus on your thigh is of greater benefit than passive taping. See the suggestions below.

Myth #3

Other interventions have supported a rest period then a return to activity at graded intervals, i.e. Stop running for 2 weeks then gradually add your mileage back. While this seems correct in theory, the runners knee often returns after a few training sessions. The answer to this myth may surprise you. Continuing to run with a decrease in intensity may actually be of more benefit than rest alone. However, this is a good time to get a mechanical analysis of your movement to correct the train or track theory.

Evidence Based Treatment Strategies:

Work the lateral hip. Exercises that strengthen the lateral hip are critical to keeping a level pelvis and thus maintaining a level train track for the patella to move. See the picture below as a simple suggestion
Make sure to run on soft ground when possible. While your event may be on a firm surface, a softer surface reduces wear and tear on the knee.
Graduate your running distance. Jumping ahead is critical training error for both experienced and inexperienced runners. Allow ample time to train for the distance you desire to run.
Follow the ABC’s: Agility, balance and coordination. While our bodies were perfectly designed to run, we should do activities that support the basic tenants of proper running. Agility, balance and coordination are all elements of good running form. Below are a few suggestions of activities that can be added to your non-running day program.
Body inventory: This was a critical mistake I made training last year. Take some time after each run to see how you feel. I have found the best way to do this is to do a general leg stretch, hips to calves and see how I feel. Stretching is controversial but SAFE to do. clam

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Dear throwers,

The spring is one my favorite times of the year because baseball season has finally arrived. With all levels of baseball in full go the crack of the bat is music to my ears. In addition to the joy of what’s happening on the field comes the agony of shoulder pain off the field.

For many high school athletes shoulder injuries will be the primary factor that interrupts their season. The incidence of shoulder is on the rise and there are many factors that contribute to this increase. While there is no lack of training protocols, pitch counts, and throwing techniques there is still an increasing number of athletes that need to be shut down for a game or even worse a season, due to shoulder injuries.

From a physical therapy point of view the overhead throwing motion is a “natural” motion of the shoulder, but it is also a stressful motion. This physiologic stress is likely why overhead throwing is often incorrectly dubbed an “unnatural motion.” With that being said, there is a great deal of stress generated in the shoulder/elbow with every throw.

The first antidote to reduce shoulder pain is having the proper “functional strength.” The term “functional” has become a catch-all term that has lost its true meaning. With respect to baseball players, if they spent the weeks leading up to the season doing 3 sets of 10 on the bench press, you should not expect an arm that can throw 90 effective pitches. Consider doing light weight higher repletion exercises for your arm to build the proper endurance.

Next, pitchers should be distance runners first. I say that tongue-in-cheek, but a pitchers main engine to throw longer and harder is in their legs. Running is a great way to build endurance in the legs to power you through those long innings.

While most throwers know and do the “Throwers 10” exercises to prepare to throw, there is little fanfare on recovery after throwing. To ice or not to ice! There are some schools of thought that ice adversely impacts the healing process after throwing. There is no scientific evidence to support this, so you should ice your shoulder. Also, it is a good idea to do some light stretching no later than 1 day after your throwing session. The ideal time is after your start but this often not practical. Also, soft tissue work is a big key in reducing any inflammatory chemicals stills present in the muscles.

Building back up to next start with light throwing days in between is a great way to reduce soreness and build strength. Throwing a football is great way before you throw is a great way to get the protective muscles of the shoulder to ramp back up.

In closing, throwing is a natural stressful activity with respect to the shoulder. Making sure you are fit to throw and recovering properly will allow you to manage your next outings. Best of luck to all teams this year!

In health,

Felipe J. Mares, PT, DPT, ATC/L, CAFS

shoulder stretchesPre/post throwing stretching

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I want to congratulate all the participants of this years high school basketball season. Your hard work on and off the court will serve you well in your future endeavors. The lessons you learned and the friends you made will last forever. Many of you may have directly transitioned from competitive basketball to a baseball or track season. Some of you may be continuing with a club basketball team or other organized basketball group.

The post-season is the ideal time to recover from many months of wear and tear on the body and mind. How does one recover when they jump into another sport or continue in the same sport? Well, the answer is not so simple but the post-season is a season and should be treated as such when possible. Professional athletes have the luxury of a scheduled rehabilitation at this time; this may not be true for the amateur high school player.

Here are a few suggestions to get you through the grid of your current transition.

The best predictor of an injury is a previous injury. If your old injury is still bothering you and LIMITING your participation in your sport it is time to STOP and get treatment.
You need to spend more time on flexibility than any significant weight lifting. You should reduce your running and jumping outside of your sport for then next few weeks. Now is a good time to review your metrics and work on the things you did not do so well during the season (free throws, jump shots from 25 feet etc.)
If you are participating in a non related sport (i.e. baseball or track) make sure you graduate both your running and throwing programs. Seek guidance and listen to your body. Going 100% with these activities will likely set you up for injury.
For those athletes not playing a sport this is an ideal time to recover both physically and mentally. This is an ideal time to begin making a plan for your next sport and start your individual goal planning. If you are injured seek care. If you are not injured back off on the weights to complete higher reps. Reduce your running and jumping and spend some additional time working on flexibility and balance.
For those athletes preparing to got to college you may want to invest in some professional training to get your body ready for the next level.
I wish all of you the best as you transition between seasons.

In health,

Felipe J. Mares, PT, DPT, ATC, CAFS