What is Trochanteric Bursitis?

The trochanteric bursa is a small fluid filled sack that lies between the greater trochanter (the bony knob on the side of your hip) and the iliotibial band (a band of connective tissue that runs along the side of the thigh).  Trochanteric bursitis occurs when this fluid filled sack becomes inflamed and painful. The pain from trochanteric bursitis is usually felt along the side of the hip.

What causes Trochanteric Bursitis?

Trochanteric bursitis is most often caused by a mechanical fault at the pelvis and hip. The mechanical fault involves the inability to control the femur (thigh bone) during weight bearing activities such as walking, hiking, running and going up and down stairs. The lack of control of the femur during these activities causes increased friction between the greater trochanter and the iliotibial band resulting in irritation of the bursa.

How Is Trochanteric Bursitis Treated?

Many treatments such as ultrasound, ice, anti-inflamatories and steroid injections can provide short term benefit.  However, in order to provide long term relief and prevention one must treat the mechanical cause.  The muscles that control the femur must be strengthened in order to eliminate the excessive friction on the bursa.  The muscles that help control the femur during weight bearing activities include the gluteus medius and the deep lateral rotators of the hip (the rotator cuff of the hip).  Excessive pronation (flattening) of the foot during weight bearing activities may also cause excessive friction on the trochanteric bursa.   This excessive pronation of the foot can be reduced by wearing proper footwear or using orthotics.

Here is a video demonstrating some of the hip strengthening exercises we recommend for the treatment of trochanteric bursitis:

If you live near Lakewood, CO and need help finding the cause of your hip pain for successful treatment we are here to help.  Contact Belmar Physical Therapy at (303) 274-2404.

What is Adhesive capsulitis?

Adhesive capsulitis, also known as frozen Shoulder, is a disorder of the shoulder in which the capsule surrounding the joint becomes inflamed and stiff.  As the condition worsens range of motion of the shoulder is severely reduced.  The exact cause of frozen shoulder is unknown.  However, there are a number of risk factors for this problem including diabetes, stroke, trauma, lung disease, connective tissue disorders and heart disease.  Frozen shoulder usually occurs in 3 phases:

People with Frozen Shouler typically lift the entire shoulder girdle when attempting to lift the shoulder.

1. The Freezing Phase: This is the most painful stage.  Pain occurs with any movement and there is a gradual reduction in range of motion.
2. The Frozen Stage: During this stage the pain in the shoulder gradually decreases.  However, the shoulder is extremely stiff during this stage.
3. The Thawing Stage: During this stage range of motion of the shoulder gradually returns to normal.

Each stage can last months and full resolution can take over a year.

What is The Best Treatment For Adhesive Capsulitis?

Physical therapy can be very effective in decreasing the duration of frozen shoulder as well as improving function during this period.  However, it is important that the physical therapist use effective treatment techniques.  A recent study in the Physical Therapy Journal examined the records of 2,370 patients (That’s alot of patients!) with adhesive capsulitis to see which treatments were effective in decreasing pain and improving function and which treatments were not effective.

The treatments that increased the likelihood of pain reduction and improved function were:

1. Joint mobilization performed by a licensed physical therapist.
2. Exercise

The treatments that decreased the likelihood of pain reduction and improved function were:

1. Ultrasound
2. Massage
3. Iontophoresis (Delivery of steroid with electrical stimulation)
4. Phonophoresis (Delivery of steroid with ultrasound)

You can view a synopsis of the article here.

If you think you may have adhesive capsulitis (frozen shoulder) we would be glad to help you. Please contact Belmar Physical Therapy at (303) 274-2404.

What is Plantar Fasciitis?

The Plantar Fascia is a thick band of connective tissue that supports the arch of the foot.  This band of connective tissue runs along the bottom of the foot from the heel to the toes.  The plantar fascia is an important energy storing structure acting like a spring to assist pushing off of the foot during walking and running.  Plantar fasciitis occurs when this band of tissue is overloaded and becomes inflamed or irritated.

What Are The Symptoms of Plantar Fasciitis?

1. Pain on the bottom of the foot towards the heal.
2. The pain is usually worse with the first few steps in the morning or after sitting for a long time.
3. Increased pain after weight bearing exercise.

What Are The Possible Causes Plantar Fasciitis?

The possible causes are:

1. Abnormal foot mechanics such as excessive pronation (flattening)
2. Abnormal hip and knee mechanics placing increased stress on the foot.
3. Tight calf muscles placing increased stress on the foot.
4. Wearing shoes that lack arch support.
5. A sudden increase in weight bearing activities such as running.
6. Weight gain placing more pressure on the feet.
7. Pregnancy due to added weight and softening of the plantar fascia due to hormonal changes.

How is Plantar Fasciitis Treated?

We have found the EdUReP (Education, Unload, Reload, Prevention) model to be very effective for treating Plantar Fasciitis.

1. Education: The patient is educated regarding predisposing factors and mechanical faults that may be contributing to overload of the plantar fascia.
2. Unload: A period of rest is recommended and the plantar fascia is unloaded by improving hip and knee mechanics as well as stretching the calf muscles.  Calf stretches must be altered to isolate the stretch to the calf without stretching the plantar fascia (see our self management hand out).  We do not recommend stretching the plantar fascia because we feel that excessive elongation of this tissue is the cause of the pain in the first place.  Orthotics may also be necessary to help unload the plantar fascia.  The pain can often be managed with ice and self massage.
3. Reload: Once the pain is diminished wight bearing exercise is slowly reinstituted into the patients program.
4. Prevention: The patient is further educated regarding ways to prevent recurrence.  This includes instituting recovery weeks into their training program and exercises to maintain proper mechanics of the lower extremity.

We’ve made a self-management handout for treating plantar fasciitis. Click on the link to download.

If Pain Persists and You’re In the Denver Metro Area

Schedule an appointment with our staff of licensed Physical Therapists. We’ll do a thorough exam and evaluation and suggest a course of treatment. If you’re not local to Belmar Physical Therapy then please contact a local, licensed therapist in your area.

What Are Shin Splints?

Shin splints, or medial tibial stress syndrome, is an overuse injury that causes lower leg pain. This problem is the cause in 18% of running injuries and is 2-3 more prevalent in women than men. Shin splints are primarily caused by a mismatch between overload and recovery during weight bearing exercise. High-stress impact loading during running or walking places an increased stress on the lower leg bone (tibia). When this stress increases gradually the bone strengthens in order to handle the load. Shin splints occur when the body’s ability to strengthen the bone is not able to keep up with the stress being placed on the bone. This imbalance of bone strengthening and stress causes small cracks in the bone and inflammation of the surrounding tissue.  The pain from shin splints can be classified into 4 stages in order of severity:

1. Light pain or stiffness after working out.
2. Pain at the beginning of a work-out which dissapears during the warm-up.
3. Pain during the work-out, but also after the workout and during the night. The pain subsides after long rest and inactivity.
4. Constant pain. The pain does not dissapear after rest.

What Mechanical Factors Contribute to Shin Splints?

1. Excessive flattening (pronation) of the feet when walking or running.
2. Tight calf muscles.
3. Weak ankle stabilizer muscles (soleus, flexor digitorum longus, posterior tibialis).
4. Walking or running on hard surfaces.
5. Walking or running in old shoes.

What is the Preferred Treatment for Shin Splints?

1. Ice


Superfeet are an inexpensive orthotics option.

2. Rest (The amount of rest depends on the stage above).
3. Anti-inflamatory medication (prescribed by a medical doctor).
4. Orthotics to support the arch of your foot and decrease the flattening of your feet.
5. Make sure you shoes are not too old (running shoes should be replaced every 300-600 miles).
6. Run or walk on softer surfaces such as dirt.
7. Increase the endurance of your ankle muscles with these exercises.
8. Stretch your calf muscles.
9. Cross-train to give your body a break from high-stress impact loading (cycling and swimming are great choices for maintaining aerobic fitness while resting the injury).
10. When you are ready to resume training, gradually increase your duration and intensity so that the bones can keep up.
11. Prevent recurrence by instituting rest weeks into your training (We recommend an active rest week of 1/2 your usual training duration and intensity every 4th week).

If you live in the Denver or Lakewood, CO area and would like help treating or preventing shin splints give us a call at (303) 274-2404.  If you do not live in our area and have more questions about this or any other orthopedic problem please contact us and we would be glad to help.