How to Tackle the Aging Knee: What to Know about Arthritic Knee Pain

As we get older, our knees take a lot of wear and tear. One of the most common culprits behind knee pain is Knee osteoarthritis (knee OA) — a form of arthritis that affects the cartilage, bones, and other structures of the knee joint. In this post we’ll walk through what it is, why it happens more with age, who is most affected, and what you can do (with your physical therapist!) to feel better and stay active.

What is Arthritic Knee Pain?

Knee osteoarthritis happens when the protective cartilage in the knee gradually wears down. This leads to changes such as:

• Bones rubbing or bumping each other,

• The joint lining becoming inflamed,

• Possible bony outgrowths (osteophytes), and

• Stiffness, swelling and pain in and around the knee.

This doesn’t happen overnight — it’s a slow process, often over many years. It becomes more likely as we age, especially if we’ve had prior knee injury, are carrying extra weight, or have certain structural knee alignment issues.

Why Age Matters

Age is one of the biggest risk factors for knee OA. Here are some key statistics:

• Globally, the prevalence of knee OA in people aged 15 and over is about 16.0%, and for those aged 40 and over it rises to about 22.9%. PMC

• According to the World Health Organization, about 73% of people with osteoarthritis are older than 55 years, and around 60% are female. World Health Organization

• In the U.S., about 9.3% of the population is diagnosed with symptomatic knee OA by age 60. PMC

• Among adults aged 45-64 in the U.S., symptomatic knee OA affects roughly 7.8% of people; for those over age 65 it rises to about 15.6%. PMC

• The annual incidence (new cases) of knee OA is highest in the 55-64 age group. Osteoarthritis Action Alliance+1

In simple terms: as you cross into your 50s and beyond, the risk of developing knee osteoarthritis goes up significantly. The wear-and-tear over years, combined with factors like previous injuries, activity level, body weight, and genetics, all add up.

Who is Most Affected?

While knee OA can occur in younger adults — especially if they’ve had knee injuries or are obese — the “aging” population is more commonly impacted. Some patterns to note:

• Women are at higher risk than men in many studies. PMC+1

• People who are overweight or obese have a higher risk (because extra weight increases the load on knee joints). BioMed Central+1

• The average/median age of diagnosis of symptomatic knee OA in one U.S. study was about 55 years. PMC

• Although older age groups have higher percentage prevalence, because there are many people in the 45-64 age range, the number of people with knee OA in that age band is nearly as high as older groups. PMC

For a physical therapy practice, this means many patients in their 50s, 60s and older will likely start showing knee pain from arthritic changes — but they don’t have to just accept it.

What Does Knee Arthritis Feel Like?

In the clinic you may see patients describing:

• Gradual onset knee pain (often worse after activity or long periods of standing)

• Stiffness in the morning or after sitting for a while

• Difficulty going up or down stairs

• A “giving way” or instability feeling (due to weakened muscles or altered joint mechanics)

• Possible swelling, warmth, or a “grating” feeling inside the knee

Because the condition progresses slowly, patients may attribute the symptoms to “just getting older.” It’s important to recognize that — yes, age is a factor — but there are things we can do to slow progression and improve function.

How Physical Therapy Can Help

1. Strengthening & Muscle Support

Stronger muscles around the knee (quadriceps, hamstrings, glutes) take pressure off the joint and help improve alignment and movement patterns.

2. Improving Mobility & Joint Mechanics

Gentle motion, stretching, and activity modification help maintain joint mobility so the knee doesn’t lock up or worsen stiffness.

3. Activity Guidance

We’ll help patients stay active (which actually helps cartilage health) while avoiding movements that overload the knee. Low-impact aerobic work, proper footwear, and safe stair/step mechanics all matter.

4. Weight & Load Considerations

A study found that for every 5lbs of fat, the load on the knee joint increases by 4lbs. So by losing even just 10lbs, it takes roughly 40lbs of pressure off of the knee joint.

5. Education & Pain Management

Teaching patients about proper biomechanics, pain-relieving strategies, and strategies to avoid worsening the joint helps them stay in control.

Age Groups & What to Know:

Here’s a breakdown of age bands and what to watch for:

• 40-49 years: Some early arthritic changes may begin. Prior knee injuries, high impact sports, obesity matter. Early intervention is beneficial.

• 50-64 years: This is often the “sweet spot” for diagnosis of symptomatic knee OA. Pain may become more noticeable, especially with stairs, walking, prolonged standing.

• 65 years and older: Higher prevalence of knee OA; however, because of other comorbidities (balance issues, bone health, other joints), tailored rehabilitation is critical to maintain independence and mobility.

Key Take-Home Messages

• Arthritic knee pain is very common in older adults — age 55 and up is where we start to see the bulk of diagnoses.

• You’re not just “old and sore” — knee osteoarthritis is a real joint condition that responds to intervention.

• Physical therapy is not too late at any age — strengthening, mobility work, load management and activity guidance can improve quality of life.

• The earlier you engage (even if symptoms are mild), the better chance you have of slowing progression and maintaining an active lifestyle.

• Age matters as a risk factor, but individual risk also depends on weight, injury history, activity level, and muscle strength/conditioning.

And to the active adults who still want to train like they did when they were younger— the key is finding the right volume that works for you. I personally used to play soccer everyday. But as I have gotten older, and my own personal knee arthritis has started to set in, I found that two days a week of soccer was doable without flaring up my knees. I also strength train and stretch at least 2 days per week to ensure my joints are protected when I step on the field. Sometimes figuring out the “right”" amount of volume takes some trial and error, but it is definitely possible with smart choices and discipline. 

Maybe it’s as simple as running 3 miles instead of 4 because you notice at 3.5-4 miles your knees ache for days. And instead of running daily you can choose to run every other day and supplement biking for extra cardio. These are all decisions we can help you with so feel free to reach out with any questions! 

Average Return‑to‑Sport Times After ACL Surgery: What the Research Really Shows

When athletes injure their ACL (anterior cruciate ligament), one of the first questions is: "How long until I can play again?" The honest answer is: it depends – but we have excellent research to help guide expectations.

The ACL is one of the key stabilizing ligaments in the knee, helping control rotation and preventing the shin bone from sliding forward. It is most often torn during sudden cutting, pivoting, or landing movements — especially when the foot is planted and the knee twists inward. Non‑contact injuries (like a quick change of direction or awkward landing) make up the majority of ACL tears in field and court sports.

Below is a current look at what return-to-sport timelines look like today:

The "6‑Month" Myth vs. Reality

Years ago, many athletes were told that they could return as early as six months after ACL reconstruction. Today, we know that rushing back too soon significantly increases the risk of re‑injury.

Modern research shows that athletes who return before 9 months are up to 7 times more likely to tear their ACL again.

Differences by Sport:

Sports involving jumping, cutting, and pivoting — such as soccer, basketball, lacrosse, football, and tennis — typically require 9–12+ months before a safe return.

Linear sports like running or cycling may allow earlier return, often between 6–9 months, depending on symptoms and strength recovery.

Why "time alone" isn’t enough:

Return‑to‑sport decisions today are based on criteria, not just the calendar. Common clearance factors include:

• Quad and hamstring strength symmetry (90% or greater)

• Balance and landing mechanics

• Single‑leg hop testing

• Confidence and psychological readiness

• Movement quality in cutting/jumping

Psychological Readiness Matters Too

Research shows that fear of re‑injury is one of the most common reasons athletes delay returning to sport—even when physically cleared. Structured rehab that includes confidence‑building and sports‑specific progressions leads to better outcomes.

Key Takeaways:

• Most athletes safely return to sport between 9–12 months after ACL reconstruction.

• Returning before 9 months dramatically increases the risk of re‑injury.

• A full clearance is based on performance criteria, not just the date on the calendar.

• Strength, control, and confidence are just as important as ligament healing.

If you’re recovering from ACL surgery or working your way back to your sport, a physical therapist can guide every phase of your rehab and testing so you return not only faster — but safer.

Research Sources:

1. Grindem et al. "Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction." British Journal of Sports Medicine, 2016.

2. Beischer et al. "Young athletes who return to sport before 9 months after ACL reconstruction have a higher risk of reinjury." American Journal of Sports Medicine, 2020.

3. Ardern et al. "2018 International Olympic Committee (IOC) consensus statement on return to sport after injury." British Journal of Sports Medicine, 2018.

Understanding Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is a painful condition that limits motion in the shoulder joint. It occurs when the capsule of connective tissue surrounding the shoulder thickens and becomes tight. This reduces the smooth gliding movement of the joint and makes even simple daily activities difficult, such as reaching overhead or behind the back.

This condition affects an estimated two to five percent of the general population. It is more common in adults between the ages of forty and sixty and is seen more often in women than in men. People with diabetes are at a much higher risk. Research shows that as many as twenty percent of people with diabetes will develop frozen shoulder at some point.

Frozen shoulder usually develops in stages and may take many months to improve.

How Long Does Frozen Shoulder Last

Frozen shoulder is temporary. The process usually lasts from one to three years, though many people begin feeling better much sooner once motion improves and the irritation settles. With consistent therapy and proper pacing, the shoulder often regains strength and mobility far earlier than the complete timeline suggests.

Common symptoms include:

• Deep aching pain in the shoulder

• Stiffness and loss of motion

• Difficulty sleeping because of shoulder discomfort

• Weakness due to pain and guarding

The pain is often constant and can worsen at night. Over time, the joint becomes more restricted which limits normal movement during daily tasks. These symptoms are frustrating, but they are reversible and can respond well to guided care.

The Three Phases of Frozen Shoulder

Frozen shoulder develops in a predictable pattern. Understanding the stages helps patients stay encouraged during treatment.

Freezing Phase: Pain begins gradually and motion becomes limited. The shoulder feels stiff and irritated. This is when calming the joint is most important.

Frozen Phase: Pain often begins to lessen, while stiffness remains the main concern. Many people begin to feel small gains in comfort during this period.

Thawing Phase: Movement steadily improves and the shoulder becomes more flexible. This is the stage where patients often feel major progress and return to confident use of the arm.

Why Hyperirritability Matters in Physical Therapy:

Many patients with frozen shoulder experience what therapists call a hyperirritable shoulder. This means the tissues react strongly even to gentle stretching or light pressure. Because of this, pushing too hard can increase pain and slow progress.

A thoughtful approach to physical therapy is important. Treatment often focuses first on calming the irritated tissues through gentle movement, soft tissue work, and pain control strategies. Only after the irritation settles can more aggressive stretching be introduced. Physical therapy that accounts for tissue irritability of the shoulder responds better and recovery tends to move forward more smoothly.

It is very important to not just push through pain. If you are noticing that your shoulder pain and stiffness is worse that night or the next day following stretching/exercises, than you need to go lighter with your program. 

Non Surgical Treatment Options:

Most people improve with non surgical care. These treatments include

• Physical therapy to restore motion, strength, and joint mobility

• Targeted stretching taught in a gradual and safe manner

• Heat or cold for pain relief

• Joint mobilization performed gently by a licensed therapist

• Anti inflammatory medication when recommended by a medical provider

• Corticosteroid injections in some cases to calm inflammation

With committed participation many patients see significant improvement in function over time without the need for an operation.

Surgical Treatment Options:

If pain and stiffness remain severe and do not improve after several months of therapy, a physician may recommend a surgical option. The two most common procedures are

• Manipulation under anesthesia, where the doctor gently moves the shoulder to loosen the tight capsule

• Arthroscopic capsular release, where tight tissue is carefully trimmed to restore motion

Even after surgery, physical therapy remains an important part of recovery to maintain the gains in mobility and to retrain healthy shoulder movement.

The Outlook:

The outlook for frozen shoulder is encouraging. The body is built to heal this condition and the great majority of people regain comfortable function. With patience, proper pacing, and skilled therapy, daily activities become easier and confidence in the shoulder steadily returns. Progress sometimes feels slow early on, but it builds momentum as the shoulder moves from stiffness toward freedom of motion.

Why Ankle Sprains Are the Most Common Sports Injury — and How to Recover Stronger

Whether you’re playing basketball on the court, sprinting down a soccer field, or diving for a volleyball save — your ankles are doing a lot more work than you think. In fact, ankle sprains are the single most common injury in sports, accounting for up to 40% of all athletic injuries worldwide.

Recent studies show that athletes in court sports like basketball and volleyball face the highest risk — often more than 5 sprains for every 1,000 games or practices. Field sports such as soccer and football aren’t far behind, with frequent twists, tackles, and uneven turf contributing to steady injury rates year after year.

Once you sprain an ankle, your odds of doing it again increase. Research suggests that nearly 1 in 5 athletes will experience recurrent sprains or develop chronic ankle instability, leading to ongoing weakness, swelling, or “giving way.”

But here’s the good news: understanding which sports carry the highest risk helps athletes, coaches, and clinicians focus on prevention — from strength and balance training to proper taping/footwear.

What These Numbers Mean for You

The chart above isn’t just about numbers — it’s about how your sport stacks up in ankle risk and what that means for keeping you on your feet.

• Court sports (like basketball and volleyball) lead the pack for ankle sprains because of the constant jumping, cutting, and landing on other players’ feet. Quick direction changes and rebounds make these sports a perfect storm for rolled ankles.

• Field sports (like soccer, football, and rugby) cause more contact-related ankle injuries — think awkward tackles, slippery grass, and high-velocity collisions. These injuries often involve the syndesmosis (“high ankle”) and can sideline athletes longer.

• Repetition matters: The more you play, the higher your exposure risk. That’s why professionals and year-round athletes report higher rates than casual players.

• Prevention pays off: Studies consistently show that ankle braces, taping, and neuromuscular training can cut sprain rates by 40–50%.

• Rehab isn’t optional: Once you’ve sprained an ankle, skipping rehab doubles your chances of another injury — and long-term instability can linger for years.

Bottom line: No matter your sport, ankle strength and balance training aren’t just accessories — they’re your best defense against the most common injury in athletics.

Every ankle sprain tells a story — but at our clinic, we make sure it doesn’t become a recurring chapter. While most people think a sprain just needs rest and time, research shows that without proper rehab, up to 70% of athletes develop lingering weakness or instability. That’s where physical therapy makes the difference.

At our facility, recovery isn’t a one-size-fits-all process. We combine evidence-based rehab with sport-specific retraining to restore balance, strength, and movement confidence — so you can return not just to play, but to peak performance.

How We Address Ankle Sprains In Physical Therapy:

Early Phase: Calm the Injury, Set the Foundation

In the first stage, our priority is to reduce swelling, relieve pain, and restore gentle motion. We also strengthen the joints and muscles above the ankle — the hips, knees, and core — to keep your body balanced during recovery.
 We introduce light neuromuscular and proprioceptive training early to keep your ankle connected to your brain’s balance system.

Treatments that accelerate this phase include:

• MyACT Piezowave therapy (shockwave treatment) to boost circulation and healing.

• Targeted massage and voodoo band compression to reduce swelling and stiffness.

• Dry needling to relieve pain and improve muscle activation.

• 24/7 compression sleeve use to manage swelling and promote recovery.

Mid Phase: Rebuild Strength and Control

Once swelling subsides and motion returns, we shift focus toward building ankle strength, balance, and coordination.
 This stage bridges basic movement and athletic function — restoring your ankle’s ability to stabilize under everyday and athletic demands.

Our focus:

• Progress range of motion and resistance training.

• Introduce balance and proprioception drills on stable and unstable surfaces.

• Continue managing any residual swelling to ensure smooth progress.

End Stage: Return to Power and Performance

The final stage is where athletes regain their explosiveness, agility, and sport-specific readiness.
 We integrate plyometrics, cutting, and directional drills that mimic your sport’s real-world challenges — basketball jumps, soccer pivots, football sprints, and more.

The goal: Build a resilient ankle capable of handling rapid movements, unpredictable landings, and high-impact demands — without fear or instability.

Ready to Start Your Recovery?

Don’t let an ankle sprain keep you on the sidelines longer than it should. Whether you rolled your ankle last week or have been dealing with chronic instability for years, the right physical therapy approach can make all the difference.

Schedule your ankle recovery evaluation today and take the first step toward getting back to the sport you love — stronger than before.

Building Better Athletes: A Smarter Path Back to Sport

At J Sports Rehabilitation (JSR), we believe that every setback is an opportunity for growth. When an athlete is injured, it’s not just about recovery — it’s a chance to rebuild, re-establish proper movement patterns, and strengthen the body as a whole. Injury can be the beginning of a smarter, stronger return to sport.

When professional athletes get hurt, they’re supported by a full team — doctors, physical therapists, athletic trainers, and performance coaches — all working together to create the best possible outcome. At JSR, we believe this level of coordinated care shouldn’t be reserved for elite athletes.

Our mission is to bridge the gap between injury rehabilitation and full return to sport or daily activity. You don’t need to play professionally to deserve a team dedicated to your recovery — and your success.

Comprehensive Sports Rehabilitation for Every Athlete

We work with adults and young athletes recovering from knee, hip, foot/ankle, shoulder, and back surgeries. Our goal is to collaborate seamlessly with your medical providers and strength and conditioning coaches to ensure a smooth, safe, and effective recovery.

Whether you’re returning from an ACL reconstruction, rotator cuff repair, hip labral surgery, or a muscle strain, our team helps you progress confidently back to the sport or activity you love. Every plan is customized to your goals — from rebuilding strength and stability to restoring speed, power, and confidence in movement.

The Return to Sport Difference

Our Return to Sport Program was designed to give every athlete access to the same high-quality, team-based care used at the professional level.

In the early phases of recovery, your physical therapist leads the process, focusing on healing, mobility, and proper movement patterns. As you advance, we begin to integrate modified strength training with your coach to prepare you for full performance.

For example:

• If you’re recovering from an ACL injury, your strength coach can guide upper-body development during the early recovery phase.

• If you’re rehabbing a shoulder injury, your coach can focus on lower-body strength to maintain balance and progress.

This collaborative model ensures your entire body continues to improve — not just the injured area.

A Team Approach to Athletic Recovery

At JSR, our team communicates across disciplines — sharing updates, insights, and progress notes to make sure your rehabilitation, strength training, and performance goals align perfectly. The result is a seamless transition from rehab to training to competition.

The goal is simple: to help you return stronger, more balanced, and more resilient than before.

In partnership with SPECTRUM Performance and Competitor Performance Academy, we don’t just help you recover — we help you build a better athlete.

Understanding Headaches: Causes, Types, and Relief Strategies

Headaches are the most common pain disorder worldwide, affecting roughly 66% of the global population. The International Headache Society classifies headaches into several categories:

• Tension-type headaches

• Cervicogenic headaches

• Migraine and cluster headaches

• Secondary headaches resulting from underlying conditions (e.g., fever, infection, sinus issues, or tumors)

• Cranial neuralgias, facial pain, and other headache syndromes

Tension-Type Headaches

Tension-type headaches are the most common form of headache in adults, with studies suggesting that 30–80% of U.S. adults experience them. These headaches often result from stress, poor posture, fatigue, jaw or neck pain, or dysfunctional breathing patterns.

People often describe the pain as a dull ache or tight, band-like pressure around the head — particularly at the temples, forehead, or the back of the neck. The discomfort can last anywhere from 30 minutes to several days and usually affects both sides of the head, although it may occasionally occur on one side.

Anatomically, this pain occurs because the neck muscles attach to the cervical spine and skull. When these muscles tighten or spasm, they can “tug” on the skull and create tension that radiates into different regions of the head. Depending on which muscles are involved, pain may be felt at the base of the skull, across the forehead, or above the eyes.

Common Muscles That Contribute to Tension Headaches

• Upper Trapezius

• Sternocleidomastoid

• Levator Scapulae

• Suboccipitals

• Scalenes

These muscles, when tight or overused, can refer pain into the head and mimic classic headache symptoms.

Managing Tension Headaches

Over-the-counter medications such as Tylenol, Advil, Motrin, or Aleve can help relieve symptoms, but it’s important to consult your doctor before use. Always take the lowest effective dose, as overuse can sometimes lead to rebound headaches — a worsening cycle of pain triggered by frequent medication use.

Cervicogenic Headaches

Unlike tension headaches, cervicogenic headaches stem from dysfunction in the upper three cervical spine segments (facet or zygapophyseal joints). Nerves originating in the cervical spine provide sensory and motor information to the head and neck, and irritation of these nerves can produce referred pain that mimics a headache.

Common Identifiers of Cervicogenic Headaches:

• Pain primarily on one side of the head (though both sides can be affected)

• Restricted neck movement or stiffness

• Pain triggered by neck movement or awkward postures

• Pain reproduced by pressure at the base of the skull or upper cervical spine

• Accompanying same-sided neck, shoulder, or arm pain

Treatment and Outlook

Research shows that neck-specific exercises — particularly low-intensity endurance training — and spinal mobilization can be effective both in the short and long term for managing cervicogenic headaches.

It’s also important to note that not all headaches share the same cause. Some result from dehydration, lack of sleep, or underlying medical issues. Identifying the root cause is the first step toward effective relief — and many cases can be managed without heavy reliance on medication.

In some instances, a local anesthetic injection may be required for pain relief, but this is typically reserved for more severe or persistent cases. Physical therapists can play a crucial role in addressing both tension-type and cervicogenic headaches through posture correction, strengthening, and manual therapy. When in doubt, consult a neurologist or primary care physician to help determine the underlying source of your headache.

Treatment Strategies:

1. Posture Correction & Mobility Exercises

These target stiffness and poor alignment — common triggers for both tension-type and cervicogenic headaches.

Chin Tucks

• How: Sit or stand tall. Gently draw your chin straight back (as if making a double chin), keeping your eyes level.

• Hold: 5 seconds

• Reps: 10–15

• Goal: Strengthen deep neck flexors and counteract forward-head posture.

Upper Trapezius Stretch

• How: Sit tall. Gently tilt your head to one side (ear toward shoulder). Use your hand to lightly increase the stretch.

• Hold: 20–30 seconds each side

• Reps: 2–3 per side

• Goal: Reduce tightness in the upper trapezius muscles.

Levator Scapulae Stretch

• How: Sit tall. Turn your head 45° to one side, then look down toward your armpit. Use your hand to apply gentle pressure on the back of your head.

• Hold: 20–30 seconds each side

• Reps: 2–3 per side

• Goal: Decrease neck base and shoulder tension.

Thoracic Extension (on a Foam Roller)

• How: Lie with a foam roller under your upper back, knees bent. Support your head and gently arch backward over the roller.

• Hold: 2–3 seconds

• Reps: 10–12

• Goal: Improve upper-back mobility and reduce strain on the neck.

2. Neck Strengthening & Endurance Training

These build stability in deep neck muscles that often weaken due to poor posture or prolonged screen time.

Deep Neck Flexor Endurance (Nod Exercise)

• How: Lie on your back with knees bent. Gently nod your head (“yes” motion) without lifting it off the floor.

• Hold: 5–10 seconds

• Reps: 10–12

• Goal: Strengthen deep cervical flexors — crucial for posture and neck support.

Scapular Retraction (Shoulder Blade Squeeze)

• How: Sit or stand tall. Gently squeeze your shoulder blades together and down (avoid shrugging).

• Hold: 5 seconds

• Reps: 10–15

• Goal: Strengthen mid-back muscles that support the neck.

Isometric Neck Presses

• How: Press your head gently into your hand (forward, backward, side to side) without actual movement.

• Hold: 5 seconds each direction

• Reps: 5–10 each way

• Goal: Build neck stability and reduce muscular fatigue.

3. Breathing & Relaxation Techniques

Dysfunctional breathing and stress can amplify headache frequency and intensity.

Diaphragmatic Breathing

• How: Sit or lie comfortably. Place one hand on your belly and one on your chest. Inhale deeply through your nose so your belly rises, then exhale slowly through your mouth.

• Duration: 2–5 minutes

• Goal: Reduce muscle tension and activate relaxation responses.

4. Daily Habit Fixes

Simple lifestyle adjustments can make these exercises even more effective:

• Take movement breaks every 30–45 minutes during desk work.

• Keep your monitor at eye level to reduce neck strain.

• Stay hydrated and get adequate sleep.

• Consider gentle yoga or Pilates to maintain flexibility and posture control.

Understanding Hamstring Injuries in Sports: How Common Are They—and What You Can Do

Hamstring injuries are one of the most common complaints among athletes—especially in sports involving sprinting, kicking, or sudden stops and starts. If you’ve ever pulled up with a tight back thigh or heard the dreaded “pop,” you know just how disruptive these injuries can be. In this post, we’ll look at what the research says about how often hamstring injuries happen, who’s at risk, and what physical therapy can do to prevent and recover from them.

What Are Hamstring Injuries?

The hamstrings are a group of muscles and tendons at the back of the thigh. Injuries range from mild strains (small tears) to more serious ruptures or tendon injuries. Some are acute (sudden) while others develop over time or recur.

How Common Are They?

Here are some key statistics from recent studies:

• Incidence in field‑based team sports

• About 0.81 hamstring injuries per 1,000 exposure hours (training + matches) in sports like soccer, rugby, field hockey, Gaelic football, Australian football. PubMed

• Proportion of all sports injuriesHamstring injuries make up ~10% of all injuries in those same sports. PubMed

• Prevalence over a season (~9 months)Around 13% of athletes will suffer a hamstring injury during a typical 9‑month season in field‑based team sports. PubMed

• Change over time (professional male soccer) In one 21‑season study in European male professional soccer: hamstring injuries went from accounting for ~12% of all injuries in early seasons to 24% in more recent seasons. The number of days players miss from these injuries also doubled. PubMed+1

Risk Factors: Who’s More Likely to Get Them?

• During matches vs training: Hamstring injuries are much more likely during matches than training. In one review, match injury incidence was ~9.4‑fold higher than training. PubMed

• Age: Risk increases with age; older athletes have higher rates of hamstring injury. PubMed

• Surface type: Injuries are more common on natural grass vs artificial turf. PubMed

• Previous injury: Athletes who have had hamstring injuries before are at greater risk of recurrence. JOSPT+2JOSPT+2

Why Are Hamstring Injuries Getting More Common?

The studies suggest a few trends:

• Increasing match intensity and schedules (more games, less rest). PubMed+2JOSPT+2

• Greater demands during training sessions. PubMed+1

• Possibly more awareness/reporting and better diagnostic tools, which may increase recorded incidence.

• In professional soccer, the “burden” (how many days missed, how long players are out) of hamstring injuries has increased over time. PubMed+1

How Physical Therapy Helps: Prevention & Recovery

Here’s how a physical therapist can help reduce risk and get you back in the game.

1. Screening & Assessment

   • Assess strength, flexibility, muscle imbalances.

   • Examine movement patterns, running or sprint mechanics.

2. Targeted Strength Training

   • Eccentric training (lengthening under load) is especially effective for hamstrings.

   • Balance between hamstrings and quadriceps/groin muscles.

3. Flexibility & Mobility

   • Regular hamstring stretches and dynamic warm‑ups.

   • Also hip flexor and glute work to ensure pelvis positions are optimal.

4. Load Management

   • Gradually increasing training intensity.

   • Ensuring adequate rest between high‑intensity efforts.

5. Neuromuscular Control & Technique

   • Drills for proper technique in sprinting, cutting, stopping.

   • Core stability, pelvic control, coordination.

6. Return‑to‑Sport Planning

   • Gradual return with progressive demands.

   • Monitoring for signs of fatigue or tightness.

   • Ensuring full recovery before resuming sprinting or cutting loads.

Takeaway

Hamstring injuries are frequent, costly, and appear to be increasing in both number and severity—especially in sports with high demands like sprinting, football/soccer, rugby, etc. But they’re not inevitable. With careful prevention, good rehab, and smart training loads, many athletes can reduce their risk and recover fully if injury does happen.

Let us know if you have any questions. We are happy to help!

Shoulder Instability: Do you have Multidirectional Instability?

Do you commonly feel like your shoulder is unstable or “pops” in and out of place? If you do then you may have something called Multidirectional Instability (MDI). 

MDI is defined as laxity in the shoulder joint in multiple directions.

MDI is either caused by a traumatic or atraumatic mechanism. That means the individual either had:

             1. A traumatic incident like a fall, which leads to dislocation of the shoulder joint. This dislocation ultimately leads to residual laxity in the shoulder

            OR

             2. They are a generally hypermobile individual, perform repeated overhead movements (such as with volleyball, baseball, weight lifting, etc), and have a history of subluxations

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What is the Difference between a Subluxation and Dislocation?

A Dislocation is considered a displacement of the bone from its natural position in the joint. The humeral head completely comes out of place and may require medical intervention to return the bone back into place.

A Subluxation is a partial dislocation of the joint. Typically the shoulder will feel like it pops out of place but then will quickly pop back into place.

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Common MDI Presentation:

1. <35 years of age

2. Typically uses words like “double jointed” or “always been flexible” to describe themselves

3. Multiple episodes of subluxation

4. Pain or feeling of instability typically at the end range of motion 

5. History of participating in overhead sports (MDI may be related to repeated microtrauma)

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The good news is nonsurgical, conservative care is frequently recommended for MDI. The bad news is that these individuals will need to be diligent with a strengthening program to reduce the risk of subluxations in the future. 

I have seen many clients with MDI and the key is to strengthen the rotator cuff, scapulo-thoracic complex, core and hips. Addressing Range of Motion should NOT be the focus for these individuals. You do not want to create further instability by stretching the joint. Trigger point release is okay however to alleviate pain caused by overuse of the muscles associated with instability. 

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The exercises below are a great way to start addressing MDI. Let me know if you have further questions at rachel@jsportsrehab.com!

Band Resisted Shoulder External Rotation (Bilateral): 

Band Resisted Internal Rotation:

Band Resisted External Rotation:

Wall Walks:

Supine Arm Bar:

Anterior Hip Pain: Do you have Femoroacetabular Impingement (FAI)?

A recent case: A 19 year old female soccer player presented to therapy with pain into the front of her right hip and groin. She is a right footed soccer player and reported a pinch-like pain into the front of her hip as her leg traveled across her body when shooting. She also felt pain when hugging her knee to her chest and an aching pain into the hip after sitting for a few hours. She kept playing through the pain and reported the pain just seemed to get worse and worse. Clinical testing suggested she had hip impingement but Imaging from a physician officially diagnosed her with a pincer type of impingement. 

What is FAI?

An Overgrowth of either the femoral head or the acetabulum (hip socket). It is defined as motion or position related pain in the hip or groin with possible clicking, catching, locking, stiffness, giving way, and decreased range of motion.

2 Types of FAI:

1. CAM: Overgrowth of Bone at the Femoral Head

2. Pincer: Overgrowth of Bone at the Acetabulum

CAM Impingement is more commonly seen in males in their 20s vs Pincer impingement is more commonly seen in females in their 30s and 40s.

Both types of impingement can feel like a pinch. That is because there is an overgrowth of bone in the hip joint.  The head of the femur and the hip socket basically bump into each other during any motions where you bring your hip up to your chest.  This “bumping” or frictioning of bone on bone is not only painful, but can lead to damaging the labrum over time. The labrum is what cushions the femoral head within the socket. Damage to the labrum can potentially lead to longer recovery times or even surgery. 

Symptoms:

• Pain or aching (usually located at the inner hip, or groin area), usually after walking, or prolonged sitting

• A locking, clicking or catching sensation within the joint

• Pain bringing your hip up towards your chest and and across the body towards the opposite shoulder
  

How to Diagnose:

Clinical Testing: FADIR and FABER

Range of Motion: Limitations in hip Internal rotation and flexion

Imaging: X rays, Magnetic Resonance Athrography (MRA), or CT scan

Treatment:

Conservative Treatment: Physical Therapy/Activity Modification: Avoid activities that cause pinching/pain

– Activity Modification: Avoid activities that cause pinching/pain

– Rehab Focus: Address hip strength, hip stability, neuromuscular control, range of motion, and movement mechanics

Surgical Intervention: Hip arthroscopy or open surgery: recovery time 4-6 months

Sports you are more likely to see impingement in:

Soccer, martial arts, ballet, cycling, rowing, golf, tennis, football, hockey, baseball, lacrosse, rugby, and deep squatting activities such as powerlifting.

Interesting Fact:

CAM impingement is common in male soccer players, with 60-75% of adult male soccer players found to have this type of impingement.  This number is high especially when considering the prevalence of CAM in the general person is only roughly 17-20%. 

Exercise Ideas:

Hip Flexor Release: https://www.youtube.com/watch?v=f13QETYZQMg

Quadriceps Stretch:Couch Stretch: https://www.youtube.com/watch?v=tABeNRBDf30

Bridge: https://www.youtube.com/watch?v=gYVVdmARLuU

Clamshell: https://www.youtube.com/watch?v=2OhR279AWNY

Side Plank: https://www.youtube.com/watch?v=TPp92f8HlG0

Single Leg Bird Dog: https://www.youtube.com/watch?v=GlutdS3NdXQ

Thoracic Mobility: Important for Every Sport and Movement in Life!

Do you have low back pain, shoulder pain, or neck pain? Do you want to improve your golf swing, overhead serve in volleyball, hitting power in baseball and softball, or pitching velocity?

As a physical therapist, the thoracic spine is one of first areas I treat. Whenever you lift your arm overhead, throw a ball, swing a golf club, or even look up at a book on a high shelf, your thoracic spine is moving.

Try this: relax your upper back and shoulders and get really slouchy in your chair. Now try looking up at the ceiling. Then try lifting your arm overhead… Hard right? Now sit up nice and tall in your chair and perform the same two movements. Should be much easier, more comfortable, and you should be able to get more range of motion in your neck and shoulder. I know this is a very extreme example but imagine how much even a little bit of thoracic spine stiffness can affect how you get your arms overhead to spike a ball in volleyball or throw a baseball.

Common problems associated with poor thoracic mobility include shoulder impingement/pain, low back pain, and neck pain. There are other factors that can contribute to these same issues but, in this article, we are going to focus on the thoracic spine as the root of the problem. When the thoracic spine doesn’t move, your low back starts to pick up the slack. Instead of getting normal extension through your thoracic spine you end up hyperextending through your lumbar spine. This repetitive lumbar hyperextension leads to pinching posteriorly of the bones in your low back, thus resulting in pain. The same issues can happen at your neck.

When you lift your arm overhead and you cannot extend in the thoracic spine, what will typically happen is your humerus will jam up against the acromion (See picture below). Having this bone to bone contact overtime can lead to pain. This same issue can also lead to rotator cuff muscle microtears because the rotator cuff muscle sits right underneath the acromion, and the friction of the constant bone to bone contact can lead to fraying of the muscle underneath.

From a performance perspective in overhead athletes or overhead lifting (push press, push jerk, overhead squat), more force can be generated and more weight can be lifted when you have the range of motion to complete the movement. To properly engage your shoulder blade muscles and have your shoulder blade sit properly on the ribcage, you need full range of motion of the shoulder joint and thoracic spine. If not, like we mentioned before, your shoulder blades will sit forward on your ribcage (like with bad slouching posture) and your shoulder blade muscles won’t be able to engage properly. The better your shoulder blade muscle strength and stability are, the more power you can generate and the more weight you can lift overhead.

Imagine swinging a baseball bat if you can’t rotate your thoracic spine. With this limitation the force you can produce when you hit the ball will be considerably less as compared to being able to rotate your spine fully.

Here are some exercises you can do on your own to address this area of the body:

7 Common Reasons Why You Have Shoulder Pain

Shoulder pain is one of my favorite issues to treat. For me, shoulder pain is easy to treat. Why? Because there are a lot of commonalities among individuals that come to me with shoulder pain, no matter what type of shoulder pain it is. No, not everyone with shoulder pain will have the same exact 3 or 4 problems; which is why an extensive examination is necessary before I start treating someone. However, I still find that most of my shoulder pain patients have a few things in common. Listed below are the top 7 dysfunctions I see in my shoulder patients:

1. Restricted pectoralis minor/major flexibility

1. You will notice difficulty reaching behind your back

2. Restricted latissimus dorsi flexibility

1. You will notice difficulty raising your arm to your ear

3. Trigger points (muscle knots) that refer pain into the shoulder

1. If you apply deep pressure to certain muscles, you will feel tender points that refer pain elsewhere (especially common with the rotator cuff muscles that sit on top of your shoulder blade)

4. Forward head and shoulder posture

1. Most people have sitting jobs and tend to sit with slouchy posture

5. Overactivation of the upper trapezius muscles

1. You will notice you constantly shrug your shoulders up when lifting your arm overhead

6. Weak scapular retractors, core, and rotator cuff muscles
7. Poor motor control

1. You have the range of motion but your body doesn’t engage the right muscles at the right time appropriately to perform a specific movement

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Next I want to talk about some common diagnoses I hear when a patient walks into my facility.

• Pain in the biceps or the front of the shoulder: A lot of times people come in with pain in the front of the shoulder and have been told they have a biceps tendonitis/tendonapathy. If you hear this diagnosis it means your biceps tendon has taken on extra work because your rotator cuff muscles, your scapular stabilizers and your core are slacking on the job. Other common issues found with this diagnosis include: restricted thoracic mobility, and slouchy forward head and shoulder posture, tight pectoralis minor/major muscles, and potentially tight latissimus dorsi muscles.

• Pain that travels from the top of your shoulder down your arm an inch or two? This sensation is commonly due to what we call active trigger points (inflamed muscle knots). Your rotator cuff muscles, which sit on top of the shoulder blade, can develop trigger points that can refer pain into the shoulder and, at times, down the arm. Performing soft tissue massage using the lacrosse ball on tender or tight spots will help calm down the muscle and reduce the feeling of pain traveling into your shoulder.

• Pain at the top of the shoulder joint and pain with raising your arm to end range overhead: This type of pain is typically given the diagnosis of shoulder impingement/ bursitis. This occurs because the humerus (arm bone) basically jams into the top of the shoulder joint whenever you raise your shoulder overhead. These people typically have bad forward head and shoulder posture. This diagnosis is either due to excessive shoulder mobility, or it is due to tight shoulder musculature (pectoralis minor/major, lats, rotator cuff muscles), overuse of the upper trapezius muscles, restricted thoracic mobility, or the inability to use your back, shoulder blade and core muscles efficiently. The latter option I tend to see more often.

• Shoulder pain that is associated with weakness and, at times, the inability to lift your arm overhead: This injury can result from a traumatic fall or gradual wear and tear of the muscle with overhead activity. Common issues I see with this diagnosis include: forward head and shoulder posture, restricted thoracic mobility, tight shoulder musculature (pectoralis minor/major, latts, Rotator Cuff muscles), overuse of the upper trapezius muscles, and you are not using your back, shoulder blade and core muscles efficiently.

Notice a trend with some of the different diagnoses?.. It may seem like I am repeating myself a lot but most shoulder diagnoses stem from the same problems (excluding traumatic shoulder injuries of course). If you have shoulder pain and are reading this article then attacking the 7 problems I have listed above is a good place to start.

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Patellar Tendinopathy (Jumpers Knee):

What Is It and How Do You Treat It?

Have you ever had pain in the front of the knee with jumping, cutting, running, or kicking?  I personally have and it stinks. I played soccer growing up so the feeling of a sharp jolt to the front of the knee is not something foreign to me. To those of you experiencing the same sharp pain to the front of the knee, you will know that  it feels as if you are running or jumping on eggshells. You want to be explosive but you feel like if you bend your knees too much to really generate power or to absorb a landing, the sharp jolt is just waiting for you not far behind. I experienced this pain as a soccer player but it affects many other sports such as basketball, volleyball, tennis, track and field, football and the recreational runner.  Athletes between the ages of 15 to 30 are primarily affected, with men more commonly affected than women.     

By definition, patellar tendinopathy (Jumper’s knee) is an overuse injury thought to be caused by excessive or repetitive forces applied to the patellar tendon.     

Signs and Symptoms of Patellar Tendinopathy:

• Anterior knee pain over the patella tendon

• Tenderness at the inferior pole of the patellar tendon

• Pain made worse with jumping, landing, cutting/pivoting, or running activities

• Pain with stairs, squatting, and at times prolonged sitting

• Onset of pain is usually gradual and commonly related to an increase in sport activity

• The feeling of stiffness in the patellar tendon in the morning

• Increased thickness of the patellar tendon compared to the opposite side

What is the Function of the Patellar Tendon?

The patellar tendon attaches directly from the tibial tuberosity to the inferior tip of the patella (knee cap). The quadriceps muscle attaches into the superior tip of the patella, thus transmits forces through the patellar tendon based on the common attachment into the patella. Therefore, any tightness or weakness in the quadriceps pulls on the patellar tendon. The patellar tendon also functions in the storage and release of energy when you jump, run, cut or pivot. This means there is a lot of load that has to transfer through the patellar tendon so overtraining, insufficient rest, faulty movement patterns, mobility impairments, and hip, core and foot weakness can contribute to the development of patellar tendinopathy.

Common Impairments Found in Individuals with Patellar Tendinopathy:

• Hip Abductor and Hip External Rotator Weakness

• Altered Hip and Knee Movement Patterns upon Landing (Poor Movement Quality)

• Excessive or Restricted Hip and Ankle Mobility

  • Look for reduced dorsiflexion, quadriceps or hamstring tightness, hip Internal rotation mobility, increased varus foot alignment, etc.

• Quadriceps Weakness

• Excessive Foot Pronation: foot collapses inward upon landing which causes knee valgus (knee collapse inward) as well as the femur to then internally rotate excessively

Rehabilitation Focus:

• Eccentric Quadriceps Strengthening

• Quadriceps and Hamstring Flexibility

• Hip Abduction and External Rotation Strengthening 

• Movement Competency–May require Cueing from a Rehab Professional or Qualified Strength Coach to address running, cutting, and jumping mechanics

• Foot and Ankle Strengthening

• Ankle Dorsiflexion Range of Motion

Exercise Ideas:

Here are some exercise ideas to get you started but it is always helpful to seek help from a medical professional.

Quadriceps Flexibility:

1. Couch Stretch: https://www.youtube.com/watch?v=tABeNRBDf30

Hip External Rotation Strengthening:

1. Clamshell: https://www.youtube.com/watch?v=2OhR279AWNY

2. Fire Hydrant (can add band around knees to increase difficulty): https://www.youtube.com/watch?v=0Vk6BrtikL8

3. Side Plank with Clamshell: https://www.youtube.com/watch?v=82tKGsLrADY

Hip Abduction Strengthening:

1. Sidelying Hip Abduction: https://www.youtube.com/watch?v=Ku6QkDJqdwY

2. Side Plank: https://www.youtube.com/watch?v=TPp92f8HlG0

Ankle Dorsiflexion:

1. Mobilization with Movement: Long Sitting Position with Mobility Band: https://www.youtube.com/watch?v=sBCMIaIkP8c

2. Wall Stretch: https://www.youtube.com/watch?v=9QRVlaw9QWM

References:

Malliaras, P., Cook, J., Purdam, C. and Rio, E. (2015). Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp.887-898.

Mendonça, Luciana D., et al. “Association of Hip and Foot Factors With Patellar Tendinopathy (Jumper’s Knee) in Athletes.” Journal of Orthopaedic & Sports Physical Therapy, vol. 48, no. 9, 2018, pp. 676–684., doi:10.2519/jospt.2018.7426.

Baseball Specific Screening

The OnBase University screening stems from the belief that there is not only one technically correct way to play baseball or softball. There are an infinite number of ways to play the game. The best baseball players in history don’t all hit or pitch the same way, but they do have some commonalities in their styles that have allowed them to be the best.  The aim of a good coach or trainer is to find the one efficient style that works for that player, and that is based on what the player can physically do. If we can match an athlete’s physical ability to his/her technical skills, it will help the player play at his/her highest level possible.

Coach and Player Goals: To be Efficient and Powerful

What makes a hitting or pitching style Efficient?

• It is Reproducible

• The player has command over their pitching/hitting style

• The player is able to maximize his/her power with the least amount of effort

What makes a hitting or pitching style Powerful?

• Proper Kinematic Sequencing: how energy is transferred from the ground through the body to the ball or bat

It’s up to the coaches to guide the player into what kind of hitting or pitching style the athlete uses. Our goal is to assist the coach and player by determining how the athlete’s physical abilities relate to their technical skills.  Pitching and hitting requires involvement from the whole body, from the feet all the way through to the neck, shoulders, elbow and hand. If there is a breakdown anywhere in this chain, it could lead to poor power, poor contact on the ball for hitters, inconsistency, and pain or injury.  

How is your body limiting your performance and where exactly are the breakdowns? That’s what we want to find out.

How do we determine where the breakdowns are?

Through Movement Screening: Functional Movement Screening (FMS), Y balance testing, OnBase University pitching and hitting screening, the Selective Functional Movement Assessment (SFMA), and through joint by joint assessment.

We will provide these findings to you, your pitching or hitting coach, and your fitness coach to develop a team approach in order to help you become a better athlete.

Let us help you and your coaches. Call us at 407-718-0437 or email us at rachel@jsportsrehab.com..

Reference: http://www.onbaseu.com