Author: Dr. Wade Rinehart

Do your feet hurt during your morning jog or evening walks around the neighborhood? Does your calf, knee or hip hurt every time you get a mile into your run?  As a runner or distance walker, choosing the right pair of shoes can be the difference in developing a running/walking injury versus having an enjoyable, injury-free trip. Many people assume that comfort when trying on shoes in the store is the best way to choose a shoe. While comfort level is part of the process in choosing the right shoe, there are many other factors one should consider before making the final decision.

The first thing to determine when choosing the right shoe is the level of support you need. Most reputable running shoe companies will provide many different styles of shoes with different levels of support to accommodate their customers. You will generally have 4 levels of support to choose from; minimalist, neutral, moderate support, and maximum support. The salesperson should be able to tell you what level of support each shoe provides. If they are unable to provide this information, you need to find a different salesperson or move on to the next store.  The best way to determine the level of support needed is by looking at your arches while standing with your feet separated about 6-8 inches. Those with flat feet, where the arch is diminished or non-existent, require a shoe with moderate to maximum support depending upon body weight and how far your arches have fallen. Those of you with normal to high arches do not need as much support because you already have plenty of support that comes from the natural cantilever provided by your arch. Thus, a neutral shoe is ideal for those of you with normal to high arches.

After determining the level of support that is best suited for your feet, determining the quality of the shoe structure and design is paramount. Making this determination is done in 3 steps. The first step is to make sure the sole of the shoe has the proper combination of stability and mobility to allow your foot to bend at the toes when pushing off as you propel your body forward. A properly designed shoe will allow the toes (especially the big toe) to extend back in the proper fashion while providing support to the remaining portion of the foot. To test this combination, hold the shoe at the heel with the toes pointed down to a flat surface. Gently press the shoe into the ground and see where the shoe breaks down. A properly designed shoe will stop breaking down at the point where the toes meet the body of the foot just in front of the arch. See Fig 1.

A poorly designed shoe will break down completely into the midportion or arch of the shoe (see Fig 2) causing excessive stress on the midfoot. 

The next test to perform on the shoe tests the medial and lateral support of the shoe which helps with your balance.  This test involves twisting the shoe in both directions while holding the sides of the toe box with one hand and the heel of the shoe without your other hand. A quality shoe will give just a bit but should resist the twisting motion in both directions. A poorly constructed shoe will rotate excessively in on or both directions See Fig 3 and 4.

If the shoe passes both of these tests, it’s time to check to see if the shoe has any more defects. Even good quality designed shoes can have defects. Some estimates say roughly 5% of shoes will come out of the factory with a defect of some sort despite inspections. The most common defect is in the sole of the shoe which can be uneven on the horizontal axis. To check for this defect, place the shoe on a level surface. Looking from the back of the shoe (looking from the heel forward) at eye level, place your index finger on the outside edge of the heel tab and gently press down. See Fig 5. 

Each shoe should move slightly or not a all but, most importantly, should be symmetrical. If any excessive wobbling or asymmetry is noted, the shoe is defective and could likely cause you to develop a running/walking injury. I have had several patients in my 22 years as a physical therapist that developed knee, hip, or ankle pain while running or walking that was a direct result of this type of defect.  

Now it’s time to try on the shoe. A few factors should be taken into consideration before making your final decision. Obviously, the main factor is comfort. You must note whether the shoe crowds your toes, midfoot, or heel. Does the shoe provide an adequate balance of cushion and support for your entire foot?   Also, determine whether or not the sole of the shoe provides full coverage of your entire foot. A common error I see clients make is purchasing shoes in which the sole does not provide full coverage of the midfoot, heel, and arch. If your foot is wider than the sole, the shoe will not perform the way it was designed and can lead to foot, knee, hip, or even back pain. If the shoe “checks all the boxes” then it is time to purchase the shoe. However, purchasing the shoe is not the final step in determining if this shoe is the one for you. I always encourage my patients to take the shoes home and wear them in the house or go walk somewhere indoors for a couple of hours and see how the feet respond. I encourage my runners to run 15-20 minutes on the treadmill to see how their feet, knees, and hips respond. Any unusual pain or soreness in these areas indicate the shoe may not be a good fit and should be returned. Mild soreness in the feet is not necessarily a sign of an improper fit and is sometimes simply because the shoes are new and your feet are not used to the support a new shoe provides. 

If you develop a running or walking injury or just need a consultation to determine if you have the proper footwear for your feet, come see our Doctor’s of Physical Therapy at First Choice Physical Therapy.

Call today, and let’s get your problem solved! 850-248-1600 – Dr. Brett Frank PT, DPT

Do you suffer from knee pain during an activity? Have you tried every brace, cream, footwear, and gimmick out there? Are you ready to get better by strategically attacking the cause instead of looking for a quick fix? See our Doctors of Physical therapy, let us perform a detailed assessment to identify your problem, and implement a treatment plan geared towards helping you get where you want to be.

Knee pain is common among all age groups and genders. The pain can be caused by a variety of biomechanical factors that are causing your dysfunction. In fact, knee pain tends to be a multifactorial problem commonly associated with strength deficits throughout the posterior chain (muscles in the back of your leg). These deficits can create an improper angle at the hip in relation to the knee or simply create muscle imbalances with increased shear forces on specific structures of the knee. Our bodies were made to move, and it will find ways to move even if the proper muscles are not being utilized, which creates compensatory movement strategies. If this occurs over a long period of time or through a repeated functional task such as walking, running, or climbing stairs, then these maladaptive movements are magnified, and you can end up with pain.

Another plausible cause to knee pain is the type of footwear and the support it offers in relation to your native anatomy, more specifically, the arch of the foot and position of the heel to the lower leg. Footwear can be a two-sided coin depending on whether the shoe offers too much or too little support. The position of the foot during weight acceptance, mid stance, and push-off are similar to how the angle of the hip affects the knee. It does so by the way the forces are transferred up the chain through the knee.

The big picture here is that many different factors can cause knee pain. Sure, you can have arthritis and tendonitis, but what is the cause of this? How do you know where to start? That’s where the experts at First Choice Physical Therapy come in. Let us analyze your problem so that we can help you get better.

Call today, and let’s get your problem solved! 850-248-1600 – Dr. John Gray PT, DPT

It’s Saturday afternoon and after working in the yard your lower back is sore and tight, what do you do? Do you lie on a heating pad or do you brave the cold and lie on an ice pack? We get asked on a daily basis, “Which is better? Ice or heat?” That is a loaded question. In my opinion, you can never go wrong with ice. Applying ice to the affected tissue will vasoconstrict the blood vessels which will decrease inflammation, numb sore tissues, acting as a local anesthetic, and slows down the pain messages being transmitted to the brain. Ice is also best utilized during the acute phase (0-48 hours after injury) while heat may be best used for chronic pain.

A good rule of thumb to go by is that you can never go wrong with ice. So after any physical activity, applying an ice pack to the affected area will be your best bet for avoiding increasing pain. If your pain persists or even gets worse, then you may want to come see us and let one of our Doctors of Physical Therapy perform an extensive examination of the injury.

Brannon Chester, DPT
Doctor of Physical Therapy

Traveling, give you headaches, interrupt your daily activities, or interfere with sleeping through the night? Your pain can be brought on by a few different sources but can often be alleviated by addressing one key factor. That key factor is posture, and it can alter the length of muscles and create changes in spinal curvature, affecting the biomechanics of the cervical spine. The classic case of postural deficits creates what is referred to as “upper cross syndrome.” The diagram used to depict this syndrome is an X drawn over the head, neck, and shoulders of an individual as you examine them from the side. Each axis indicates the muscles that are weak or lengthened and those that are tight or shortened. Commonly the muscles lengthened are the deep neck flexors underneath the chin and the scapular (shoulder blade) adductors or rhomboids and middle trapezius. In contrast, those that become tight are the pectorals (chest muscles) and the suboccipital group (small muscles at the base of your skull). These changes create that classic forward head and rounded shoulder appearance we see all too often. If you stretch the muscles that are tight and strengthening, those that are weak, you can alleviate your symptoms. However, repetitive activities or sustained postures likely create these postural abnormalities in the first place. Among the top of the list of activities to avoid is sitting at a desk for a long duration. Self-treatment strategies would include a doorway stretch targeting the pectorals and performing resisted rowing exercises targeting the scapula adductor group. In addition to focusing on those major muscle groups, chin tucks or head lifts would be ideal for helping address the deep intrinsic neck flexor tightnesses. We understand that this can be confusing, especially when you don’t know the anatomy-much less the physics involved.

Let our Doctors of Physical therapy help diagnose the source of your neck pain and develop an individualized treatment plan to get you back to living a pain-free life. Call today to get started! 850-248-1600 – Dr. John Gray PT, DPT

The new year brings a lot of new beginnings. The beginning of a new decade, the beginning of weight loss challenges among friends and family, and a chance to become a better “you.” However, if chronic pain is hindering you from living a healthy lifestyle, if the nagging back and knee pain is keeping you from exercising and losing the weight you desire, there is hope!

At First Choice Physical Therapy, we specialize in restoring pain-free joint mobility, increasing strength and stability as well as returning you to the high quality of life you want and deserve. If you are suffering from pain, struggling with not being able to exercise and move the way you desire, then give us a call and make an appointment to see one of our Doctors of Physical Therapy and start your journey to recovery today!

Brannon Chester, DPT
Doctor of Physical Therapy
First Choice Physical Therapy

Whether you are a pitcher, play volleyball, tennis, swim, or play quarterback, your shoulder pain may be more than just soreness. Many of you play on multiple teams/clubs or travel out of town for baseball and softball tournaments every weekend. Most of you are talented and perform at a high level, but when do you train your body? More importantly, how do you train your bodies for your specific sport? Pitchers want to throw hard, with all of their power moving from the mound to the plate. Which muscles have to control that motion and stop the arm and body from moving forward? Or as a volleyball player slamming aces down. Do you train your scapular muscle groups that allow you to load up, stabilize the shoulder, and deliver an unreturnable serve?

The research looked at the risk factors, as well as the diagnosis and treatment of shoulder injuries in the overhead athlete and have identified several characteristics that cause these injuries. Scapular malpositioning (Poor Shoulder blade position), deficits in shoulder internal rotation, and weakness of the rotator cuff musculature are a few characteristics researchers have found. If any of the aforementioned are present, the increased likelihood of future injury in overhead athletes increased.

Statistics show that damage can be prevented if the impairments are addressed. With the proper training of these critical muscle groups that perform these functional motions specific to the sport, a lot of trouble can be avoided. Whether you are having pain now or want to prevent future surgery, see our Doctors of Physical Therapy, and let us work together to develop a personalized treatment plan for you. We will find the source of your problem and help you safely return to your respective sports pain-free and better than before.

Give First Choice Physical Therapy a call today! 1-850-248-1600! We are here for you –Dr. John Gray PT, DPT