Stabbing pain in your heel could be a sign of plantar fasciitis . Read below to find out more.

Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting.

Plantar fasciitis is more common in runners. In addition, people who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis.


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Do you have elbow pain with gripping or lifting? You may be dealing with tennis elbow even if you do not play tennis!

Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.

Despite its name, athletes aren’t the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and butchers.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. Pain can also spread into your forearm and wrist.

Rest and over-the-counter pain relievers often help relieve tennis elbow. If conservative treatments don’t help or if symptoms are disabling, your doctor might suggest surgery.


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Do you experience a mild ache in the back of the leg or above the heel after running or other sports activity?



Achilles tendinitis is an overuse injury of the Achilles (uh-KILL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.

Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.

Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under your doctor’s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require surgical repair.

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Total Knee Replacements are more common than ever before. Click on the link to learn what happens over time to your knee and what goes into a knee replacement.


Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. The procedure involves cutting away damaged bone and cartilage from your thighbone, shinbone and kneecap and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics and polymers.

In determining whether a knee replacement is right for you, an orthopedic surgeon assesses your knee’s range of motion, stability and strength. X-rays help determine the extent of damage.

Your doctor can choose from a variety of knee replacement prostheses and surgical techniques, considering your age, weight, activity level, knee size and shape, and overall health.

Why it’s done

The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have knee pain at rest.


Knee replacement surgery, like any surgery, carries risks. They include:

  • Infection
  • Blood clots in the leg vein or lungs
  • Heart attack
  • Stroke
  • Nerve damage

Signs of infection

Notify your doctor immediately if you notice:

  • Fever greater than 100 F (37.8 C)
  • Shaking chills
  • Drainage from the surgical site
  • Increasing redness, tenderness, swelling and pain in the knee

An infected knee replacement usually requires surgery to remove the artificial parts and antibiotics to kill the bacteria. After the infection is cleared, another surgery is performed to install a new knee.

Artificial knees can wear out

Another risk of knee replacement surgery is failure of the artificial joint. Daily use wears on even the strongest metal and plastic parts. Joint failure risk is higher if you stress the joint with high-impact activities or excessive weight.

How you prepare

Food and medications

Your doctor or anesthesiologist might advise you to stop taking certain medications and dietary supplements before your surgery. You’ll likely be instructed not to eat anything after midnight the day of your surgery.

Prepare for your recovery

For several weeks after the procedure, you might need to use crutches or a walker, so arrange for them before your surgery. Make sure you have a ride home from the hospital and help with everyday tasks, such as cooking, bathing and doing laundry. If you live alone, your surgeon’s staff or hospital discharge planner can suggest a temporary caretaker.

To make your home safer and easier to navigate during recovery, consider doing the following:

  • Create a living space on one floor since climbing stairs can be difficult.
  • Install safety bars or a secure handrail in your shower or bath.
  • Secure stairway handrails.
  • Get a stable chair with a firm seat cushion and back, and a footstool to elevate your leg.
  • Arrange for a toilet-seat riser with arms if you have a low toilet.
  • Get a stable bench or chair for your shower.
  • Remove loose rugs and cords.

What you can expect

Before the procedure

Knee replacement surgery requires anesthesia. Your input and preference help the team decide whether to use general anesthesia, which makes you unconscious, or spinal anesthesia, which leaves you awake but unable to feel pain from your waist down.

You’ll be given an intravenous antibiotic before, during and after the procedure to help prevent post-surgical infection. You might also be given a nerve block around your knee to numb it. The numbness wears off gradually after the procedure.

During the procedure

Your knee will be in a bent position to expose all surfaces of the joint. After making an incision about 6 to 10 inches (15 to 25 centimeters) long, your surgeon moves aside your kneecap and cuts away the damaged joint surfaces.

After preparing the joint surfaces, the surgeon attaches the pieces of the artificial joint. Before closing the incision, he or she bends and rotates your knee, testing it to ensure proper function. The surgery lasts about two hours.

After the procedure

You’ll be taken to a recovery room for one to two hours. You’ll then be moved to your hospital room, where you’ll likely stay for a couple of days. Medications prescribed by your doctor should help control pain.

During the hospital stay, you’ll be encouraged to move your foot and ankle, which increases blood flow to your leg muscles and helps prevent swelling and blood clots. You’ll likely receive blood thinners and wear support hose or compression boots to further protect against swelling and clotting.

You’ll be asked to do frequent breathing exercises and gradually increase your activity level.

The day after surgery, a physical therapist will show you how to exercise your new knee. After you leave the hospital, you’ll continue physical therapy at home or at a center.

Do your exercises regularly, as instructed. For the best recovery, follow all of your care team’s instructions concerning wound care, diet and exercise.


For most people, knee replacement provides pain relief, improved mobility and a better quality of life. And most knee replacements can be expected to last more than 15 years.

Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car, if you have enough muscle control to operate the brakes and accelerator, and if you’re not still taking narcotic pain medications.

After recovery, you can engage in various low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations.

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Anterior Cruciate Ligament tears appear more common than every, especially in female population. Learn more about the ACL in the following link.


An ACL injury is the tearing of the anterior cruciate (KROO-she-ate) ligament (ACL) — one of the major ligaments in your knee. ACL injuries most commonly occur during sports that involve sudden stops, jumping or changes in direction — such as basketball, soccer, football, tennis, downhill skiing, volleyball and gymnastics.

Many people hear or feel a “pop” in the knee when an ACL injury occurs. Your knee may swell, feel unstable and become too painful to bear weight.

Depending on the severity of your ACL injury, treatment may include rest and rehabilitation exercises to help you regain strength and stability or surgery to replace the torn ligament followed by rehabilitation. A proper training program may help reduce the risk of an ACL injury.


Signs and symptoms of an ACL injury usually include:

  • A loud “pop” or a “popping” sensation in the knee
  • Severe pain and inability to continue activity
  • Swelling that begins within a few hours
  • Loss of range of motion
  • A feeling of instability or “giving way” with weight bearing

When to see a doctor

Seek immediate care if any injury to your knee causes signs or symptoms of an ACL injury. The knee joint is a complex structure of bones, ligaments, tendons and other tissues that work together. It’s important to get a prompt and accurate diagnosis to determine the severity of the injury and get proper treatment.


Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments that cross in the middle of the knee, connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint.

Most ACL injuries happen during sports and fitness activities that can put stress on the knee:

  • Suddenly slowing down and changing direction (cutting)
  • Pivoting with your foot firmly planted
  • Landing from a jump incorrectly
  • Stopping suddenly
  • Receiving a direct blow to the knee or collision, such as a football tackle

When the ligament is damaged, there is usually a partial or complete tear across the tissue. A mild injury may overextend the ligament but leave it intact.

Risk factors

Women are more likely to have an ACL injury than are men who participate in the same sports. Studies have suggested some reasons for these differences in risk.

In general, women athletes exhibit a strength imbalance in their thighs with the muscles at the front of the thigh (quadriceps) being stronger than the muscles at the back (hamstrings). The hamstrings help prevent the shinbone from moving too far forward — movement that can overextend the ACL.

Studies comparing jumping and landing techniques among men and women athletes have shown that women athletes are more likely to land from a jump in a way that increases stress on their knees.

Research suggests that training to strengthen muscles of the legs, hips and lower torso — as well as training to improve jumping and landing techniques — may reduce the higher ACL injury risk associated with women athletes.


People who experience an ACL injury are at higher risk of developing knee osteoarthritis, in which joint cartilage deteriorates and its smooth surface roughens. Arthritis may occur even if you have surgery to reconstruct the ligament.

Multiple factors likely influence the risk of arthritis, such as the severity of the original injury, the presence of related injuries in the knee joint or the level of activity after treatment.


Proper training and exercise can help reduce the risk of ACL injury. A physical therapist, athletic trainer or other specialist in sports medicine can provide assessment, instruction and feedback that can help you reduce risks. Programs to reduce ACL injury include:

  • Exercises that strengthen leg muscles, particularly hamstring exercises, to ensure an overall balance in leg muscle strength
  • Exercises to strengthen the core: hips, pelvis and lower abdomen
  • Training and exercise for proper techniques and knee position in jumping and landing
  • Training to improve techniques for pivoting and cutting


Wear footwear and padding that is appropriate for your sport to help prevent injury. If you downhill ski, make sure your ski bindings are adjusted correctly by a trained professional so that your skis will release appropriately when you fall.

Wearing a knee brace does not appear to prevent ACL injury or reduce the risk of recurring injury after surgery.

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Do you have shoulder pain, stiffness, and weakness? You maybe experiencing a rotator cuff tear. To learn more about this read below.

Rotator cuff tears are one of the most common injuries of the shoulder. The shoulder is a ball and socket joint with the arm bone (humerus) meeting the shallow socket called the glenoid fossa. This socket is part of the shoulder blade (scapula).

The term “rotator cuff” refers to four muscles of the shoulder that help to support the shoulder joint during rest and movement. These muscles, known as the supraspinatus, infraspinatus, teres minor, and subscapularis, attach the shoulder blade and upper arm bone, and keep the arm bone against the shoulder socket.

Rotator cuff muscles and tendons can be injured over time, or with a sudden injury such as a fall. In an overuse injury, the soft tissues may start to fray, often caused by repeated activities. A tear can be partial or complete, with the muscle being torn into two pieces.

Symptoms of a rotator cuff tear can include shoulder pain, stiffness, and weakness. You may have difficulty raising the arm overhead or lifting objects, especially above shoulder height. Getting dressed, washing your hair, or tucking in a shirt can be difficult. Sleeping can be limited because of shoulder pain.

While recovering from rotator cuff injuries, you may need to avoid activities that are repeated or painful, such as swimming or playing tennis. Therapy can help you learn how to keep the shoulder moving while protecting the healing tissues with activities for stretching, strengthening, and healthy posture.

Courtesy from Medbridge

ACL Protocol, Assessment, and Training at Excel Sports and PT

ACL, three little letters that are notorious in the sports world. In the United States alone there are over 400,00 ACL repair procedures each year. Once you tear the anterior cruciate ligament in the knee your world will change forever. You will feel angry, upset, and nervous about what the future holds for you. Why did this happen to me? Why now? Will I ever play again? Will I hurt my knee again? All reasonable questions to ask. Your head is spinning. But it doesn’t have to be that way or stay that way. Not if you have the right physical therapist to guide you through this long and arduous process.

At the Excel North O’Fallon location we feel it is the responsibility of the physical therapist to provide a thorough and complete program for the patient in order to put them in the best position to succeed. We do this by using a progressive and systematic rehabilitation program that allows for some flexibility with each athlete. Included in this program are advanced strengthening exercises, neuromuscular reeducation, plyometrics, agility training, core strengthening, functional training and sport specific training.
Once the athlete approaches a return to sport, they are put through a battery of tests to ensure that the involved knee is close to the level of the uninjured knee. Research suggests that the surgically repaired knee perform to at least 90% of the uninjured knee during testing before returning to sport. We also do a complete and full biomechanical assessment that includes evaluating the athletes running form, jumping and landing form, and cutting/pivoting form. Studies have shown that neuromuscular deficits and functional limitations are common in athletes either due to preexisting abnormalities or because of subsequent surgery. All of this is done under video analysis so that we can slow down and break down the movements at trunk, hip, knee and ankle.

Again, we put a lot of time and effort into researching and developing new ways to treat our athletes and to get them back to where they want to be. When you choose us for your post-surgical rehabilitation, know that you are dealing with a group of experts you can trust. Call Brian Manning at the North O’Fallon clinic: (636)978-5255

Do you want to be an Athletic Trainer?

Excel Sports and Physical Therapy and Lindenwood University Athletic Training Program is hosting a FREE CLINIC on November 14, 2015 at Lindenwood University. Please see attached flyer!

Contact Anna Rozanski, MS, ATC/LAT

2015 Flyer

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‘Fall’ Prevention

The seasons are once again changing. Many people I talk with tell me this is their favorite season. Even if it is not, the cool weather, spectacle of changing leaves, and all the smells that accompany autumn have to make you smile. As the leaves begin to fall, everyone needs to take special precaution not to do the same. According to the National Council on Aging, falls are the leading cause of fatal and non-fatal injuries for older Americans. The U.S. Centers for Disease Control and Prevention have found that one-third of Americans aged 65+ falls each year and that falls result in more than 2.5 million injuries treated in emergency departments annually, including over 734,000 hospitalizations and more than 21,700 deaths. provides a check list for preventing falls in the home. Some easy steps include:

  • Making sure stairs have handrails and that the handrails are securely fastened preferably on both sides of the steps.
  • Make sure floor boards are even and secure all rugs, including area rugs with tacks or double sided tape.
  • Install grab bars at the toilet, in the shower, and in the bath tub.
  • Use and secure non-slip bath mats.
  • If you have to use a step stool, make sure that it has a bar at the top to hold on to.
  • Place nightlights in hallways, bedrooms, bathrooms and stairways.
  • Install light switches at the top and bottom of stairs.
  • Repair holes and uneven joints on walkways outside the home.
  • Wear shoes in the home as socks present a slipping risk.

By taking simple steps the risk of falls can be reduced significantly. If you feel a loved one is at risk for falls, help them to take the necessary steps to make their home as safe as possible. The following is a list of additional resources to aid in fall prevention:

References and additional information:



The Difference Between Manual Therapy and Chiropractic

Many neck and back patients can benefit from manual therapy to their spine. A common question that arises is “What is the difference between manual therapy and chiropractic care?” While the patient may perceive many similarities, they are rooted in very different philosophies. Most manual therapy is based on Osteopathic theories which focus on proper movement of the joints. Traditional chiropractic training is based off “The Law of the Nerve” which believes that the key to proper healing is through ensuring proper nerve flow. Traditional chiropractors look at perceived alignment problems of the vertebrae and manipulate to correct these positional faults. Manual therapy, on the other hand, assesses movement of each joint in the spine to see if it moves too little or too much. A joint that moves too little needs to be mobilized or manipulated whereas a joint that moves too much requires a stabilization program to strengthen the muscles around it. Physical therapy joint manipulation uses “locking techniques” to isolate a segment that moves too little without manipulating the adjacent segments. The goal of a successful manipulation is not a “pop,” but rather improved movement at the manipulated segment. If a cavitation or “pop” is brought on it should be a single level if the technique is performed correctly.

A great deal of research exists to support the specificity of skilled manual therapy and its use with an exercise program to correct improper movement patterns. If a manipulation is not accompanied by a stretching program the results tend to be temporary and require repeat manipulation. Performing a home exercise program designed by a physical therapist can minimize the chance of recurrence.


Joe Schmersahl, PT, MTC