Returning to Sports After Injury

Now that the weather is getting warmer, we are starting to see the benefits of living in Idaho.  People are getting outdoors to hike, bike, swim, and run.  Baseball, softball, and other summer sports are starting, and  so are the injuries that accompany them.  At the beginning of the spring season, orthopaedic centers and physical therapy clinics all over the Treasure Valley “spring” to life.  Whether you are a pitcher, swimmer, goalie, or runner, you run the risk of getting an overuse injury or a muscle strain without proper conditioning. 

The hardest part of being an athlete is suffering from an injury.  Do I tell the coach?  Should I sit out of practice?  Will I still have my spot when I get back?  As a physical therapist, deciding whether someone is capable of playing is probably the most difficult aspects of my job.  To start, I look at strength and range of motion of the individual.  Then, I assess the functional needs of the athlete in relation to the sport that he/she is participating.  When the athlete is able to actively go through full range of motion and has good strength, we usually begin functional training.  This may include lunges, squats, agility drills, or even a throwing or running progression.  Making sure the athlete is strong enough to return is a big concern which is why these functional progressions are so important. 

 When rehabilitation has concluded, I try to insert the athlete back into practice while keeping a close eye on him/her to ensure that the injury doesn’t flare up again.  I encourage my athletes start with a good warm-up:  1. Jog and stretch.  2. Gradual increase to full speed running.  3. Agility exercises with gradual increase in intensity.  4. Gradual increase in sport specific movements.  Following those steps, the athlete can partake in regular practice.  Even when practice concludes, the athlete is still not done.  A cool down routine is necessary.  Usually, I ask athletes to cool down with jogging then stretching.  I also instruct the athlete to ice the injury following all activity for 15-20 minutes.

A good rule of thumb for returning to sports after an injury is:  If your injury is sore and swollen the day after practice, you should take the next day off, then lighten your workload for the next practice.  Coming back from injury too soon may cause you to miss more time. 

Brett Walker
Sports Resident, St. Luke’s-Idaho Elks Rehabilitation Services

Misconceptions of “The Core”

Core strengthening, training, and stabilization have become popular terms in exercise discussion.  However, they are often misused or referred to incorrectly.  Core exercises are often thought of as exercises of abdominal muscles (crunches, etc), or back muscles (lat pulls, rows, roman chair, etc.).  Although these are great for strengthening certain muscles of the trunk, they are not true core exercises.  Core muscles are not the abdominals, back extensors, or “prime movers” of the spine.  They are much smaller and more specific “stabilizers” of the spine.  Their responsibility is to control the vertebral movement, not initiate it.  These muscles reduce the amount of shear force at each vertebral level and give the spine balance and control.  They consist of the transverse abdominus, multifidus, pelvic floor muscles, and many of the smaller muscles that link each vertebrae together.  Training these muscles is not only essential for spine rehabilitation, but for functional training and activities of daily living. 


To truly work the core stabilizers, one must first learn to fire them volitionally, and once that is mastered they must be trained in an unstable environment.  This can be accomplished through a great deal of therapeutic ball use and balance oriented training to stimulate these muscles to centrally control the spine.  The improved functioning of the core muscles will result in “prime mover” strength being enhanced, more efficient, and the spine becoming more protected.


Therefore, understanding the use of the term “Core” is very important in understanding how spine rehabilitation progresses.  SLIERS therapists understand the core and are committed to correctly training and rehabilitating spine patients for the rigors of working and activities of daily living.  



Ski & Snowboard Conditioning

To all you skiers and snowboarders out there!!   Are you ready to hit the hills or do you need some “tuning up” like your skis?  
We are offering a sking/snowboarding injury prevention and training course that will help you to find what your weaknesses are that may lead to an injury and how to strengthen/stretch them to assure a fun and safe ski season.  
The course is 4 consecutive Wednesdays starting Oct. 22nd from 6:30-8:00 at our East Boise clinic (by Apple St. and Boise Ave.).   The first week entails an assessment period where you will be put to the test by Physical therapist and staff in coordination with what level of skiier you feel you are, and that will find your deficits to work on throughout the rest of the course.   The following weeks will have lectures about common skiing injuries from Orthropedic Sports Medicine Physicians and Physical Therapist as well as an introduction and progression through an exercise program to work on all areas for safety during skiing and boarding. 
The course cost is $20 including all sessions and materials.   Please contact the East Boise clinic for more information or to sign up at 208-336-0312.

Hamstrings & Injury Prevention

If you are an athlete, you are at a higher risk of injuring a knee when the hamstring muscles are much weaker than the quadriceps.  This is why strength and flexibility are great for preventing injury to the hamstrings and/or the knees.


Athletes are also at risk for hamstring and knee injuries when the gluteal muscles are not functioning properly or strongly enough. Tight hip flexor muscles are usually accompanied by weak gluts, which are responsible for shock-absorption during activity, but when not utilized, can lead to overuse of the hamstrings. Unfortunately the hamstrings are not structured to handle this type of workload, which results in injury to the hamstrings and even the knees, such as the ACL. In sum, it is also beneficial to have well stretched hip flexors prior to engaging in sports.


Here is a brief list of stretches and exercises to do as injury prevention.


Bridges – good for the gluts. Lay on your back with your knees bent, feet flat on the ground. Raise your hips off the ground so your torso and thighs make a straight line. Repeat this exercise until your feel a good burn in your buttocks. Remember you can always further challenge yourself by bridging with one leg.


Hip flexors stretch – Lunge forward with one leg and position the foot beyond forward knee. Straighten your hip of the rear leg by pushing hips forward. Hold this stretch for 30-60 seconds. Repeat with opposite side.


Walking lunges – To increase the challenge, start by bending your knees further to the ground or add dumbbells. Repeat until there is a great burn in your buns, hamstrings, and thighs.


If you are more experienced, other great hamstring strengthening exercises include dead lifts, good mornings, physioball hamstring curls, and many others.


Tyler Williams, SPT

Kristi McMahan, DPT

Snapping Hip Syndrome

Your outfit should be snappy, not your hips.  Unfortunately with marathon season underway that is exactly what ends up happening in many recreational runners.  Robie Creek anyone?

            Many runners begin feeling a snapping, popping or sometimes a painful sensation in their hips whenever they run, squat or stand up.  This is because tendons of the hip begin to swell and become irritated.  They swell up and become painful because they are constantly rubbing against part of the leg bone (femur).  The swelling can eventually become permanent if left untreated.

            There are many reasons why this happens, but most of the time it is from too much running and/or poor running form.  Stretching, icing, resting and contacting a physical therapist for more information will help you get rid of that hitch in your giddyup and back on the trails.  Happy running.


Tyler Jepson, PT, DPT

Emergency Department Physical Therapist



Trampolines: Jump into summer and not the ER

Spring is in the air and so are little kids – when they jump on trampolines that is.  They may be fun, but they can also cause some major injuries.  To avoid injures you should NEVER let more than one person jump at a time.  If there is more than one person, the lighter of the two is usually injured.  This happens most often while playing the game “crack the egg.”  Safety equipment and adult supervision are also a must, but do not guarantee against injury.  Children should be instructed on safe jumping and understand the rules parents set for them.

Other ways to cut back on injuries include

·        Make your trampoline ground level by placing it in a hole

·        Have spotters while kids jump

·        Avoid putting the trampoline near trees or walls

·        Do not let animals on or near it while jumping

·        Set up the trampoline on soft grass (instead of hard packed ground)

·        Balance the trampoline so it is level

Spring time is a great time of year to begin enjoying the outdoors again, but always make sure you have the proper protective equipment and children have adult supervision – and enjoy the weather!


Tyler Jepson, PT, DPT

Emergency Department

Shin Splints

The term ‘shin splints’ is a catch-all phrase for lower leg pain that occurs below the knee, usually on the inner edge of the tibia (‘shin’ bone).  Medial tibial stress syndrome is the most common cause of shin pain.  This pain originates from an inflammation of the outer layer of the tibia and/or the connective tissues that attach your muscles to the bone.  Whether you are an experienced runner looking for a new challenge or a beginner looking to establish a healthy habit, you need to avoid the ‘too much, too soon’ philosophy that activates this inflammatory process.   Common mistakes include increasing your mileage too quickly, switching from running on flat surfaces to hills or abruptly changing your workout regimen. 

If you have shin splints, you will notice pain on the inner edge of the tibia and this area will be tender to touch.  Mild swelling is possible but less likely.  In the early stages, the pain begins immediately but often goes away when you are warmed up.  As the condition progresses, the pain lasts throughout your run and usually into the next day during normal activities. What can you do to treat shin splints?

  • Select the correct running shoe! – The folks at the Pulse can help you find the right shoe for your foot type. If excess pronation is a problem for you, shoe inserts or foot orthotics may be necessary to support your arch and maintain proper alignment of the foot/ankle. Running shoes should be replaced after 300-400 miles to ensure the ability to absorb the shock/stress created when the foot hits the ground.
  • ICE! Apply ice for up to 20 minutes on a regular basis (2-4x/day) to decrease pain and inflammation. Use a compression bandage with the ice to reduce any swelling and provide support for the soft tissues of the lower leg.
  • ‘Relative rest’ – Rest until there is no pain with normal daily activities. Increase days of rest between running days, maintaining cardiovascular fitness with stationary bike or pool running which have less impact on the legs. Stop hill training. Reduce speed and mileage to 50% of preinjury level, increasing gradually over 3-6 weeks.
  • Anti-inflammatory medications – Talk with your physician regarding the short-term use of over-the-counter meds like Motrin, Advil or Aleve to control pain and inflammation.
  • Stretching of calf (gastrocnemius & soleus) and anterior tibialis muscles
  • Strengthening of the anterior tibialis muscle
  • Run on a softer surface, such as grass, dirt or outdoor tracks
  • Strengthening of the gluteus medius, hip abductors and core muscles

Try these self-treatment techniques for 2-4 weeks.  If your symptoms continue, consult a physical therapist to determine if faulty skeletal alignment or muscle imbalances contribute to your condition.   Your therapist will recommend a re-evaluation by your physician if they suspect the pain is related to other pathologies, such as a stress fracture or compartment syndrome.

Dean Myers, PT