This weekend I competed in a pickleball tournament. I passed the ball to my opponent and he took a lunge forward. A terrible look suddenly crossed his face and he froze in horror. He reported that he felt a pop in the back of his leg and felt like someone had hit him with a bat in the back of his leg. My opponent had torn his achilles tendon. Achilles tendon injuries, including tears and tendinitis, can be incredibly painful and debilitating. Whether you’re a seasoned athlete, a weekend warrior, or just an active individual, these injuries can disrupt your daily life and athletic pursuits. In this article, we will delve into the causes of Achilles tendon injuries, explore effective prevention strategies, and discuss the crucial role of physical therapy in rehabilitating these injuries.

Understanding Achilles Tears and Tendinitis

Before we dive into prevention and rehabilitation, it’s essential to understand the two primary Achilles tendon injuries: tears and tendinitis.

1. Achilles Tears:
   • Achilles tendon tears can range from partial to complete ruptures of the tendon. These injuries often result from sudden and forceful movements, such as jumping or sprinting. They can be extremely painful and may even require surgical intervention.
   • Common causes of Achilles tears include:
     • Overexertion during physical activities and sports
     • Poor conditioning before exercise
     • Aging, as the tendon naturally weakens with time, making it more susceptible to injury
     • Body Mass Index (BMI) >  30 kg/m²  (Alegre et at 2021)
     • Sex. A recent study found that 83% of those with Achilles ruptures are men (Alegre et at 2021)
     • Previous tendon injuries, which increase the risk of future tears
     • Prolonged use of corticosteroids, fluoroquinolone antibiotics, and oral bisphosphonates (Shamrock et al 2023)
   • Symptoms of an Achilles tear may include sudden pain, swelling, and difficulty pointing your toes or pushing off your foot.
2. Achilles Tendinitis:
   • Achilles tendonitis is an inflammation of the Achilles tendon, often resulting from overuse, repetitive stress, or improper training techniques. Unlike tears, tendinitis doesn’t involve a complete rupture but can still be incredibly painful and limit your activity.
   • Common causes of Achilles tendinitis include:
     • Excessive running, walking, or jumping
     • Sudden increases in activity levels or training intensity
     • Prior history of lower limb tendinopathy or fracture
     • Use of fluroquinolone antibiotics
     • Moderate alcohol use
     • Training in cold weather
     • Decreased isokinetic plantar flexor strength (Malliaras 2022)
   • Symptoms of Achilles tendinitis include pain and stiffness in the tendon, particularly during the first few steps in the morning or after prolonged periods of inactivity.

Preventing Achilles Tears and Tendinitis

Preventing Achilles tendon injuries is far more desirable than having to deal with the pain and recovery process. Here are some essential tips to reduce your risk of these injuries:

1. Proper Footwear:
   • Invest in well-fitting athletic shoes that provide adequate arch support and cushioning. The right shoes can make a significant difference in reducing the strain on your Achilles tendon.
2. Gradual Progression:
   • Whether you’re starting a new exercise program or increasing your training intensity, gradual progression is key. Avoid sudden and significant changes in your activity level to give your body time to adapt and strengthen.
3. Warm-Up and Stretching:
   • Before any physical activity, ensure you warm up properly. Dynamic stretching and gentle range-of-motion exercises can prepare your muscles and tendons for more intense movement.
4. Strengthening Exercises:
   • Incorporate exercises that specifically target the calf muscles and Achilles tendon. Strengthening these areas can help reduce the risk of injury. Exercises like calf raises and eccentric heel drops are particularly effective.
   • Posterior kinetic chain strengthening beyond the gastrocnemius-soleus complex. This includes strengthening the hamstrings and gluteal muscles (Von Rickenbach et al 2021).
5. Cross-Training:
   • Vary your physical activities to prevent overuse of the Achilles tendon. Alternating between different sports or exercise routines can help reduce the repetitive strain on the tendon.
6. Balance Training:
   • Increases your body’s awareness of where you are in space.
7. Listen to Your Body:
   • Pay attention to any signs of discomfort or pain in your Achilles tendon. If you experience persistent discomfort, it’s essential to rest and seek medical attention if necessary.

The Role of Physical Therapy in Rehabilitation

Achilles tendon injuries can be challenging to recover from, but physical therapy plays a crucial role in the rehabilitation process. Here’s how physical therapy can help:

1. Pain Management:
   • Achilles injuries can be extremely painful. Physical therapists use various techniques, such as ultrasound and manual therapy, to manage pain and reduce inflammation.
2. Restoring Range of Motion:
   • After an Achilles injury, your range of motion may be limited. Physical therapists work on gentle stretching and mobility exercises to gradually restore the natural movement of your ankle and calf.
3. Strengthening Exercises:
   • Strengthening exercises are a fundamental component of Achilles tendon rehabilitation. Physical therapists design specific exercises to target the calf muscles and Achilles tendon. Eccentric exercises, where the muscle lengthens under tension, are particularly beneficial in rebuilding strength.
4. Gait Analysis:
   • Walking and running mechanics play a significant role in Achilles tendon health. Physical therapists can analyze your gait and make necessary corrections to reduce stress on the tendon.
5. Biomechanical Assessment:
   • If your Achilles injury resulted from poor foot biomechanics, physical therapists can assess your feet and recommend appropriate orthotics or shoe modifications to prevent future problems.
6. Neuromuscular Re-Education:
   • Learning how to move efficiently and distribute forces evenly can be crucial in preventing reinjury. Physical therapists help you retrain your body to move safely and avoid putting excessive strain on the Achilles tendon.
7. Home Exercise Programs:
   • Physical therapists provide you with a personalized home exercise program that complements your in-clinic sessions. Consistent, at-home exercises are essential for long-term recovery.
8. Gradual Return to Activity:
   • Your physical therapist will guide you through a carefully structured return to your desired physical activities, ensuring you don’t rush back to full intensity, which could increase the risk of reinjury.
9. Education:
   • Understanding your injury, the rehabilitation process, and preventive measures is crucial. Physical therapists educate you about your condition and how to care for your Achilles tendon in the long term.

Conclusion

Achilles tears and tendinitis injuries can be painful and frustrating, but with proper prevention and rehabilitation strategies, you can regain your mobility and return to your active lifestyle. Taking care of your Achilles tendon through appropriate footwear, gradual progression, and proper technique can significantly reduce your risk of injury. In case of an injury, working with a skilled physical therapist is invaluable in your journey to recovery. With their guidance, you can rebuild strength, restore mobility, and develop strategies to protect your Achilles tendon in the future. Remember, prevention is the best medicine, but when injuries do occur, there’s hope for a full recovery with the right care and dedication.

Citations

Alegre B, Seijas R, Alvarez P, Pérez A. The Achilles Tendon Rupture in Basketball: Systematic Review of the Present Literature. Surg J (N Y). 2021;07(03):e265-e270. doi:10.1055/s-0041-1733988.

Malliaras P. Physiotherapy management of Achilles tendinopathy. J Physiother. 2022;68(4):221-237. ISSN 1836-9553. doi:10.1016/j.jphys.2022.09.010.

Shamrock AG, Dreyer MA, Varacallo M. Achilles Tendon Rupture. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430844/

Von Rickenbach, Kristian J. MD, MS^1,2; Borgstrom, Haylee MD^1,2,3; Tenforde, Adam MD^1,2; Borg-Stein, Joanne MD^1,2; McInnis, Kelly C. DO^1,2,3. Achilles Tendinopathy: Evaluation, Rehabilitation, and Prevention. Current Sports Medicine Reports 20(6):p 327-334, June 2021. | DOI: 10.1249/JSR.0000000000000855

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Being an athlete in sports that require overhead movements demands a unique set of skills and physical capabilities. These sports demand strength, power, agility, and a strong overhead motion. To excel in these activities and reduce the risk of injuries, athletes must focus on targeted exercises that enhance their performance and protect their bodies. In this blog, we will explore some essential exercises that every overhead throwing, racquet sport, and volleyball athlete should incorporate into their training routine.

Check out our Instagram Reel for videos of these exercises.

1. Rotator Cuff Strengthening Exercises

   The rotator cuff plays a crucial role in stabilizing the shoulder joint during overhead movements. Perform exercises like external and internal rotations with resistance bands, dumbbells, or cables to strengthen the rotator cuff muscles. These exercises improve shoulder stability, reduce the risk of injury, and enhance throwing and hitting power.

   1. Prone External Rotation Strengthening Exercise: Lie face down on a flat surface, such as a workout bench or the edge of a bed, with your affected arm hanging off the side. Hold a light dumbbell or a small weighted object in your hand with your palm facing down. Start with your arm hanging straight down, then slowly lift your arm away from your body while keeping your elbow bent at a 90-degree angle. Focus on squeezing your shoulder blade as you lift the weight. Pause for a moment at the top of the movement and then slowly lower your arm back to the starting position. Perform 2-3 sets of 10-15 repetitions, gradually increasing the weight as you get stronger.
   2. Sidelying External Rotation Strengthening: Lie on your unaffected side with your affected arm positioned comfortably in front of you, resting on your abdomen. Hold a light dumbbell or a small weighted object in your hand with your palm facing up. Keep your elbow bent at a 90-degree angle and close to your side throughout the exercise. Slowly rotate your forearm away from your body while keeping your elbow and upper arm stationary. Pause for a moment when your forearm is parallel to the ground, then slowly lower it back down. Perform 2-3 sets of 10-15 repetitions, gradually increasing the weight as you progress.
   3. Banded Internal Rotation Strengthening: Attach a resistance band to a sturdy anchor point, such as a door handle or a post, at waist height. Stand sideways to the anchor point with your affected arm closest to the band. Hold the band with your affected hand, keeping your elbow bent at a 90-degree angle and your forearm parallel to the ground. Step away from the anchor point until you feel tension in the band, ensuring there is some resistance. Slowly rotate your forearm inward across your body while maintaining the 90-degree angle at your elbow. Pause for a moment when you reach the end of the movement, then slowly return to the starting position. Perform 2-3 sets of 10-15 repetitions, gradually increasing the resistance of the band as your strength improves.

2. Core Strength and Scapular Stability:

A strong and stable core is essential for generating power and maintaining proper posture during overhead motions. Exercises like planks, Russian twists, medicine ball rotations, and cable woodchops help strengthen the core muscles. Focus on exercises that engage both the abdominal and lower back muscles to maintain balance and prevent imbalances in the body. Here are a few of my favorites:

3. Scapular Stability Exercises:

Proper scapular stability is crucial for optimal shoulder function and injury prevention. Include exercises like scapular retractions, wall slides, and prone T/Y/I exercises to enhance scapular stability and improve posture. These exercises promote proper shoulder mechanics and minimize the risk of impingement or rotator cuff issues.

1. Single-Leg Deadlifts: Stand tall with your feet hip-width apart and your arms relaxed by your sides. Shift your weight onto your left foot and slightly lift your right foot off the ground, maintaining a slight bend in your left knee. Engage your core muscles to stabilize your body. Slowly hinge forward at your hips, extending your right leg straight behind you and lowering your torso towards the ground. Keep your back straight and your hips square to the floor. As you hinge forward, allow your arms to extend towards the ground, maintaining a straight line from your head to your right heel. Pause for a moment when your torso is parallel to the ground or when you feel a stretch in your hamstring. Engage your left glute and hamstring muscles to raise your torso back to the starting position, keeping your right foot off the ground throughout the movement. Repeat the exercise for the desired number of repetitions and then switch to the other leg. Aim for 2-3 sets of 10-12 repetitions per leg, gradually increasing the difficulty as you progress.
2. Squat Jumps: Start by standing with your feet shoulder-width apart and your toes slightly pointed outward. Lower your body into a squat position by bending your knees, pushing your hips back, and keeping your chest up and your spine neutral. Once you reach the bottom of the squat position, explosively jump straight up into the air, extending your hips, knees, and ankles. As you jump, swing your arms forward for momentum and balance. Land softly on the balls of your feet, rolling back into the squat position to absorb the impact. Immediately go into the next squat jump by repeating the motion. Aim for 2-3 sets of 10-15 repetitions, focusing on explosive power and maintaining good form throughout.

Conclusion: To excel in overhead throwing, racquet sports, or volleyball, athletes must prioritize a well-rounded training program that incorporates exercises targeting specific areas of strength, stability, mobility, and power. The exercises mentioned in this blog provide a solid foundation for athletes in these sports, helping them enhance their performance, reduce the risk of injuries, and reach their full athletic potential. Consult a qualified physical therapist or trainer to tailor these exercises to your specific needs and always prioritize proper form and technique during training. With consistent dedication and smart training, athletes can take their game to new heights.

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Pregnancy is a beautiful and transformative journey, but it can also bring about various physical challenges. As the body adapts to accommodate a growing baby, many people experience discomfort and pain in the pelvic region. Pelvic instability encompasses a broad range of conditions that cause pain and discomfort in the pelvic region during pregnancy. It can involve a combination of SI joint dysfunction, Symphysis Pubic Diastasis (SPD), and generalized ligamentous laxity. Pelvic instability often leads to difficulties with mobility and impacts daily activities. Pelvic instability is usually caused by hormonal changes which increase ligamentous laxity in the pelvis. The laxity accompanied by the growing baby’s weight can contribute to pain in the pubic region, difficulty walking, and discomfort during certain movements. The ligamentous laxity in the pelvis is helpful during labor and delivery, but can cause a lot of discomfort in the preceding months.

Pelvic instability during pregnancy can lead to additional complications, such as sciatica and nerve irritation. The pelvic region houses a network of nerves, including the sciatic nerve, which extends from the lower back down the legs. When the pelvis becomes unstable, it can put pressure on the nerves, leading to symptoms such as shooting pain, tingling, or numbness along the sciatic nerve pathway. This condition is commonly referred to as sciatica.

It is crucial to seek professional guidance from a physical therapist or healthcare provider if you experience symptoms of sciatica or nerve irritation during pregnancy. They can assess your condition, provide appropriate interventions, and guide you through exercises and stretches that will help alleviate nerve-related discomfort.

Remember, everyone’s experience during pregnancy is unique, and the severity of symptoms may vary. The key is to address pelvic instability and associated nerve issues promptly and with the guidance of healthcare professionals to ensure a comfortable and healthy pregnancy journey.

Symphysis Pubic Diastasis (SPD)

Symphysis Pubic Diastasis (SPD) is a condition characterized by the separation or widening of the pubic symphysis, the joint located at the front of the pelvis where the pubic bones meet. Sometimes this condition is called, “lightening crotch” because it can cause sharp groin pain with positional changes. During pregnancy, hormonal changes, particularly the hormone relaxin, cause the ligaments in the pelvic region to loosen. This is a natural process that allows the pelvis to accommodate the growing baby and facilitates childbirth. However, in some cases, the pubic symphysis can become excessively lax, leading to SPD.

Symptoms of SPD: Women with SPD may experience a range of symptoms, including:

1. Pubic pain: Pain in the pubic area is the primary symptom of SPD. It can vary from mild discomfort to severe pain that radiates to the groin, lower abdomen, hips, or lower back. The pain may worsen with activities such as walking, rolling over in bed, climbing stairs, or spreading the legs.
2. Difficulty with weight-bearing activities: Women with SPD may find it challenging to perform weight-bearing activities like standing, walking, or getting in and out of a car due to the instability and pain in the pelvis.
3. Clicking or popping sensation: Some women may experience a clicking or popping sensation in the pubic area during certain movements or transitions.
4. Difficulty with certain positions: Activities such as getting in and out of a car or getting up from a chair may be uncomfortable or painful.

Management and Physical Therapy Interventions for SPD

Physical therapy plays a crucial role in managing SPD during pregnancy. A physical therapist specializing in pelvic health can provide tailored interventions based on the individual’s specific needs. Here are some common strategies used in physical therapy for SPD:

1. Manual therapy: Therapists may use gentle manual techniques to help realign and stabilize the pubic symphysis. These techniques can include gentle mobilizations, soft tissue massage, and myofascial release to reduce pain and improve joint function.
2. Pelvic floor muscle exercises: Strengthening the pelvic floor muscles can provide additional stability to the pelvis. Physical therapists provide guidance in performing appropriate exercises that engage the pelvic floor muscles, such as Kegels.
3. Stabilization exercises: Targeted exercises are prescribed to strengthen the muscles surrounding the pelvis, including the hip abductors, glutes, and core muscles. These exercises help improve overall pelvic stability and reduce strain on the pubic symphysis.
4. Pain management techniques: Therapists may utilize various pain management modalities, such as heat or cold therapy, or TENS (Transcutaneous Electrical Nerve Stimulation), to alleviate discomfort and promote healing.
5. Education and activity modification: Physical therapists educate women about proper body mechanics, postural alignment, and strategies to modify daily activities to minimize stress on the pubic symphysis. They may recommend techniques such as using a pillow between the legs while sleeping, avoiding activities that exacerbate symptoms, and providing guidance on safe movement patterns during pregnancy.
6. Stability belt recommendations: Stability belts, also known as maternity support belts or belly bands or Serola Belts, are external devices designed to provide additional support to the abdominal and pelvic region during pregnancy. These belts can help alleviate pressure on the SI joints, reduce pubic symphysis separation, and provide support to the growing belly.

It is important to note that the severity of SPD can vary among individuals, and treatment plans should be tailored accordingly. In some cases, the use of assistive devices, such as crutches or a pelvic support belt, may be recommended to reduce stress on the pubic symphysis and provide additional support.

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SI joint Anatomy

The sacroiliac joint is a complex joint that connects the sacrum (the triangular bone at the base of the spine) to the ilium (part of the pelvis). It plays a crucial role in transferring forces between the spine and the lower extremities during various movements.

Research and biomechanical studies have provided insights into the movement patterns and range of motion at the SI joint. While the exact degree of movement varies among individuals, the following evidence-based information can guide our understanding:

1. Nutation and Counternutation: The primary movement at the SI joint is nutation and counternutation. Nutation refers to the forward and downward rotation of the sacrum, while counternutation refers to the backward and upward rotation. These movements occur in response to weight-bearing, walking, and dynamic activities.
2. Limited Range of Motion: The range of motion at the SI joint is relatively small compared to other major joints in the body. Research suggests that the average range of nutation and counternutation is approximately 2-4 degrees in each direction.
3. Force Closure and Ligamentous Support: Stability at the SI joint is maintained through a combination of bony architecture, ligamentous support, and muscular control. Ligaments such as the anterior sacroiliac, interosseous sacroiliac, and posterior sacroiliac ligaments play a significant role in providing stability and limiting excessive movement.
4. Influence of Pelvic Muscles: The muscles surrounding the SI joint, including the gluteal muscles, deep core muscles, and hip rotators, contribute to its stability and control. Proper activation and coordination of these muscles are essential for maintaining optimal biomechanics and preventing excessive stress on the joint.
5. Altered Movement Patterns in Dysfunction: Sacroiliac dysfunction or pathology can lead to altered movement patterns at the joint. Research suggests that conditions such as sacroiliac joint hypermobility or hypomobility may affect the joint’s ability to properly distribute forces during movement, potentially leading to pain and dysfunction.

It is important to note that individual variations in SI joint movement and mechanics exist. Factors such as gender, age, and previous injury history may influence the range of motion and functional capacity of the joint. Pregnancy-related hormonal changes can also affect ligamentous laxity, which in turn affects motion at the joint.

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Spondylosis, also known as spinal osteoarthritis, is a degenerative condition that affects the spine. It is a natural and gradual wear-and-tear process that occurs as we age and can affect any region of the spine, including the cervical (neck), thoracic (mid-back), and lumbar (lower back) regions.

In spondylosis, the cartilage between the vertebrae, the small joints in the back of the spine called facet joints, and the intervertebral discs start to break down and wear away. As a result, the bones in the spine begin to rub against each other, causing pain, stiffness, and a loss of flexibility.

Spondylosis can also cause bone spurs or osteophytes to develop, which are small bony growths that can cause further irritation and pressure on the nerves in the spine. In some cases, these bone spurs can even compress the spinal cord or nerve roots, leading to more severe symptoms such as weakness, numbness, or tingling in the arms or legs.

While spondylosis is most commonly associated with aging, it can also be caused by other factors such as injury, repetitive strain, or a genetic predisposition. Obesity, smoking, and a sedentary lifestyle can also increase the risk of developing spondylosis.

How do you treat Spondylosis?

Treatment for spondylosis typically focuses on relieving pain, reducing inflammation, and improving mobility. This may include physical therapy and anti-inflammatory medication.

Physical therapy is an important part of managing spondylosis. A physical therapist can design an exercise program that is tailored to the patient’s specific needs and limitations. Exercise can help to improve range of motion, strengthen the muscles that support the spine, and improve posture, all of which can help reduce pain and improve overall function.

Regular exercise can help to improve flexibility, strength, and posture, which can all help alleviate the symptoms of spondylosis.

One of the main benefits of exercise for spondylosis is improved flexibility. As spinal spondylosis can cause the space between the facet joints of the spine to narrow, it can result in reduced flexibility and mobility. Engaging in regular stretching and flexibility exercises can help to increase the range of motion in your spine, reduce stiffness, and alleviate pain.

Core strengthening is essential for managing spondylosis. Strengthening the muscles that support your spine can help to reduce pressure on the vertebrae. This can help to alleviate pain and improve overall function.

Another great option for treating spondylosis is AlterG antigravity treadmill training, which allows patients to walk or run with reduced impact on their joints. This can be especially helpful for those who struggle with traditional exercise due to pain or mobility issues.

It’s important to work with a physical therapist to develop an exercise plan that is tailored to your specific needs and limitations. A physical therapist can help you to develop a safe and effective exercise plan that takes into account your individual condition, limitations, and goals.

So if you’re struggling with lumbar spondylosis, don’t suffer in silence! Talk to your doctor about physical therapy options and start feeling better today.  In the meantime, here are some beginner exercises you can try to help your pain.

1. Pelvic Tilt:
   1. Lie on your back with your knees bent and feet flat on the floor.
   2. Gently contract your abdominal muscles to flatten your lower back against the floor.
   3. Hold this position for 5-10 seconds and then relax.
   4. Repeat for 10-15 repetitions Perform 2-3 sets.
2. Supine Marching:
   1. Lie on your back with your knees bent and feet flat on the floor, hip-width apart.
   2. Engage your core muscles by drawing your belly button toward your spine.
   3. Slowly lift one foot off the floor, keeping your knee bent at a 90-degree angle.
   4. Lower the foot back down and repeat the movement with the opposite leg.
   5. Continue alternating legs for 10-12 repetitions on each side. Perform 2-3 sets
3.  Side Plank:
   1. Start by lying on your side, propping yourself up on your forearm with your elbow directly beneath your shoulder.
   2. Stack your legs on top of each other and lift your hips off the ground, creating a straight line from head to heels.
   3. Engage your core muscles by drawing your belly button toward your spine.
   4. Hold this position for 20-30 seconds on each side, gradually increasing the duration as your strength improves.
   5. Repeat for 3-5 sets.

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Common Pickleball Injuries

While pickleball is generally a safe sport, there are still some common injuries that can occur. Some of the most common injuries include:

1. Ankle Sprains: Ankle sprains are a common injury in many sports, and pickleball is no exception. The sudden changes in direction and quick movements can cause players to roll their ankles, leading to sprains.
2. Tennis Elbow: Tennis elbow is a common injury in racket sports, and pickleball is no different. This injury is caused by overuse and can result in pain and inflammation in the elbow.
3. Shoulder Injuries: Shoulder injuries are common in many racket sports, and pickleball is no exception. The repetitive overhead motion of slamming and hitting can lead to shoulder impingement, rotator cuff strains, and other injuries.
4. Knee Injuries: Knee injuries can occur in pickleball due to the sudden changes in direction and quick movements. These can result in strains, sprains, and even tears.

It’s important to warm up properly before playing. Here are some of the best stretches to warm up with:

1. Leg Swings: Leg swings are a great way to warm up your hips and legs. Stand with one hand on a wall for support and swing one leg back and forth, keeping it straight. Do this 10-15 times on each leg.
2. Arm Circles: Arm circles are a great way to warm up your shoulders. Stand with your arms out to your sides and make small circles with your arms, gradually increasing the size of the circles. Do this 10-15 times in each direction.
3. Wrist Stretches: Wrist stretches are important for warming up your wrists and forearms. Hold one arm out in front of you with your palm facing down. Use your other hand to gently pull your fingers back towards your wrist. Hold for 15-30 seconds and then switch arms.
4. Quad Stretches: Quad stretches are important for warming up your legs. Stand with one hand on a wall for support and bend one leg behind you, grabbing your ankle with your other hand. Hold for 15-30 seconds and then switch legs.
5. Reaching Hamstring Stretch: Stand with your feet shoulder-width apart and your knees slightly bent. Extend your right leg out in front of you, keeping your toes pointed up towards the ceiling. Reach forward with your left hand and try to touch your right toes, while keeping your back straight. Hold the stretch for 1-2 seconds and then return to the starting position. Repeat the stretch on the other side, extending your left leg out in front of you and reaching towards your left toes with your right hand. When performing this stretch, make sure to keep your knees slightly bent and your back straight. Avoid rounding your spine or hunching over as you reach forward. You should feel a gentle stretch in the back of your thigh as you reach towards your toes.
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The Proper Shoes to Wear

When it comes to playing tennis or pickleball, your shoes can make a big difference in your performance and your safety. The right shoes can provide support, stability, and comfort, while the wrong shoes can lead to slips, falls, and injuries. Here’s what to look for when picking out shoes for tennis or pickleball:

1. Traction: One of the most important factors in tennis or pickleball shoes is traction. You want shoes that will grip the court and prevent you from slipping or sliding. Look for shoes with non-slip soles or outsoles made from rubber or other high-friction materials. Some shoes may also have special tread patterns or grooves that provide extra grip.
2. Support: The constant stopping, starting, and lateral movements involved in tennis and pickleball can be tough on your feet and ankles. That’s why it’s important to look for shoes that provide good support. Shoes with sturdy uppers, padded collars, and reinforced heels can help stabilize your feet and prevent injuries.
3. Cushioning: The impact of running and jumping on a hard court can take a toll on your joints, especially your knees and ankles. Look for shoes with good cushioning in the midsole or heel area. Some shoes may also have additional padding or gel inserts for extra comfort. You can also add your own orthotic made of a memory foam material for more cushioning.
4. Breathability: Tennis and pickleball can be hot and sweaty sports, so you want shoes that allow your feet to breathe. Look for shoes with mesh or other breathable materials that will help keep your feet cool and dry. Some shoes may also have moisture-wicking liners or ventilation holes to reduce sweat buildup.
5. Durability: Finally, you want shoes that are built to last. Tennis and pickleball shoes can take a beating, so look for shoes with durable materials and reinforced stitching. Some shoes may also have additional features like toe guards or scuff-resistant uppers to protect against wear and tear.

When you’re shopping for tennis or pickleball shoes, make sure to try them on and walk around in them before making a purchase. Look for shoes that feel comfortable and provide a snug, secure fit. And don’t forget to consider your own playing style and needs – for example, if you have a history of ankle injuries, you may want to prioritize support and stability over other factors.

In summary, when picking out shoes for tennis or pickleball, look for shoes with good traction, support, cushioning, breathability, and durability. By choosing the right shoes, you can improve your performance and reduce your risk of injuries. So step up your game and step into some great shoes!

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This large, complex, and highly flexible joint also carries a great risk of injury, especially when pushed to anatomical extremes. A hip injury can be a source of nagging pain and discomfort that can be difficult to diagnose, given the complexity of the hip. One of the possible sources of hip pain is femoroacetabular impingement, or FAI, which is common in high-level athletes and active individuals. This common diagnosis is complicated by its relatively unknown cause.

In this article, we’ll cover the anatomy of femoroacetabular impingement, what causes it, the symptoms associated with it, and possible treatment options.

Anatomy of the hip and implications of FAI

The hip joint (ball and socket) consists of the femoral head (ball), which is the top end of the long bone of the thigh, and the acetabulum (socket), which is attached to the pelvis. The acetabulum is covered with articular cartilage, which allows for smooth movement in the joint, as well as a labrum, which is a strong, fibrous cartilage that lines the outer rim of the socket. The labrum helps to deepen the hip socket and allows for greater range of motion in the joint.

In patients with femoroacetabular impingement (FAI), the contact between the femoral head and the acetabulum is abnormal during movement, causing pinching of soft tissue (labrum or cartilage) and excess friction within the joint. FAI can result in damage to these soft tissue structures, subsequent pain, and the possible development of hip arthritis at an early age.

What causes FAI and who is affected?

The abnormal contact in the hip joint associated with FAI can be due to one of two forms of FAI, known as Cam and Pincer. Often these two forms of FAI exist together.

In the Cam form, the femoral head and neck are not perfectly spherical, causing abnormal contact between the femur and the acetabulum during movement. In the Pincer form of FAI, the acetabulum over-covers the femoral head, usually occurring along the front-top rim of the socket. With Pincer FAI, the socket can also be angled backwards more than it should be (retroverted) or could be deeper than normal, leading to abnormal over coverage of the femoral head.

This abnormal anatomy and malalignment during movement can damage the cartilage and labrum of the hip, possibly leading to arthritic changes in the hip at an early age. The Cam form of FAI often affects young male athletes, while the Pincer form is more common in middle-aged female athletes. FAI affects athletes across many different sports, including martial arts, ballet, football, baseball, soccer, and cycling.

The cause of femoroacetabular impingement continues to be under investigation. Some proposed theories include participation in high-impact sports during adolescence, genetic predisposition, and history of pediatric hip disease.

Symptoms of FAI

Most people with FAI experience pain in the front of the hip that can be felt in the groin. Sometimes the pain can radiate down the front of the thigh. Oftentimes, patients will cup the outside of their hip with their hand in a “C” position to describe the deep pain location associated with FAI. This is known as a “C” sign. Patients with FAI may also experience low back pain, buttock pain, or pain at the side of the hip.

Prolonged sitting, such as while driving, or deep squatting can increase pain in a patient with FAI. This is because hip flexion (bringing the thigh up to a 90-degree angle with the trunk) can cause anterior impingement or abnormal contact at the front of the hip joint that can pinch the cartilage and labrum. Other daily activities that involve hip flexion include putting on socks and shoes and walking up a hill, and these may also be a source of pain in patients with FAI.

If damage to the cartilage or labrum has already occurred, the patient may experience a “clicking” or “catching” sensation in the hip during movement.

In addition to discussing your pain pattern, a physical therapist will assess your hip strength, hip range of motion, and observe your gait, or walking pattern. Oftentimes, hip flexion and hip internal rotation (turning the toes inwards when the leg is straight) are restricted in patients with FAI.

Treatment options for FAI

Conservative Care

If your physical therapist suspects FAI based on your clinical examination, they will refer you to your primary care physician for X-rays. If the X-ray suggests abnormal bony anatomy, your physician may order an MRI to assess the soft tissue damage.

Although physical therapy will not change the bony anatomy of your hip, it can be beneficial in addressing the symptoms associated with FAI and is almost always recommended as the initial treatment. A physical therapist can help you to improve your hip strength, increase your flexibility, and retrain movement patterns which may have been contributing to your pain. They can also offer strategies for conservative pain management and lifestyle modifications, such as activity avoidance.

Here are five easy exercises that you can do to help manage FAI:

1. Hip flexor stretch: Kneel on your left knee and place your right foot in front of you, with your knee bent at a 90-degree angle. Lean forward into your right hip until you feel a stretch in the front of your left hip. Hold for 30 seconds and repeat on the other side.
2. Clamshells: Lie on your left side with your knees bent and your feet together. Keeping your feet together, lift your right knee as high as you can without moving your pelvis. Lower your knee and repeat for 10-15 repetitions. Repeat on the other side.
3. Hip bridges: Lie on your back with your knees bent and your feet flat on the ground. Lift your hips up towards the ceiling, squeezing your glutes at the top of the movement. Lower your hips back down and repeat for 10-15 repetitions.
4. Side-lying leg lift: Lie on your left side with your legs straight. Lift your right leg as high as you can without tilting your pelvis. Lower your leg and repeat for 10-15 repetitions. Repeat on the other side.
5. Quadruped hip extension: Get down on all fours with your hands under your shoulders and your knees under your hips. Lift your right leg behind you as high as you can without arching your back. Lower your leg and repeat for 10-15 repetitions. Repeat on the other side.

Remember to start slowly and gradually increase the intensity and duration of the exercises as you become more comfortable with them. It’s always a good idea to consult with your physical therapist before starting any exercise program.

Surgical Options

There are minimally invasive and open surgical options for treating FAI. Be sure to discuss both of these options with your surgeon to determine the right course of treatment for you. Both surgical options aim to correct bony abnormalities and repair cartilage or labral damage. The ultimate goal of FAI surgery is to halt degenerative changes within the hip and prevent hip osteoarthritis. The success of surgery is often dependent on the amount of joint damage prior to surgery, making early detection and care crucial in patients with FAI.

The minimally invasive procedure uses an arthroscope to repair the soft tissue damage, stimulate new cartilage growth (through microdamage), and remove bone (decompression). The arthroscopic procedure is typically done at an outpatient center and the patient returns home the same day. One recent study found that arthroscopic surgery for FAI yielded significant reductions in pain and functional improvements within one to two years after surgery [3]. However, the minimally invasive procedure is not right for everyone and is more likely to fail in patients with advanced hip arthritis.

The open surgical option involves a hip dislocation and the patient must remain in the hospital for a few days after surgery. You can expect to be on crutches after your surgery, with a total recovery time of 4-6 months for both procedures. After a full recovery, you may be cleared to return to unrestricted physical activity, however, this is dependent on the type of surgery you underwent and the condition of your hip joint prior to surgery.

Takeaways

Femoroacetabular impingement (FAI) is a common cause of hip pain in adolescents and adults and is often seen in high-level athletes. FAI is due to abnormal bone structure of the hip and resulting impingement of the hip cartilage and labrum, which produces pain during certain positions or activities. One of the biggest concerns with FAI is its acceleration of degenerative changes in the hip, which can lead to hip osteoarthritis. Early identification and treatment of FAI is key for optimal recovery. Physical therapy is typically the first line of treatment for FAI to conservatively manage symptoms. Minimally invasive and open surgical options exist and can correct the bony anatomy and soft tissue damage. Research has shown significant pain reduction and functional improvement after minimally invasive procedures in patients with minimal joint damage.

Sources

https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/femoroacetabular-impingement.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280287/pdf/nihms631203.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684675/pdf/12178_2019_Article_9567.pdf

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