Running Injuries

Finding Root Cause

Staying healthy and injury free is a goal for all runners. Whether you are a competitive or a recreational runner, young or old, there are many variables involved in staying healthy and injury free. It is very much like a puzzle. We have been treating recreational to elite runners for over 30 years, and we have seen the science of running constantly evolve and frequently attend medical conferences to keep up with the latest knowledge. A key point in understanding running injuries is to look beyond the symptoms and pain, and truly understand the “Root Cause” of the condition in order to achieve true resolution of the issue. For example, plantar fasciitis is a medical diagnosis, but it is actually a symptom of over use and irritation of the plantar fascia of the bottom of the foot, which in some cases causes inflammation of the plantar fascia. To fully resolve this nagging recurrent problem one needs to understand ROOT CAUSE. Why is the plantar fasica being overused and/or irritated? Medications and orthotics manage the symptom (pain) and the source (the plantar fascia), but in many cases the problem persists because the root cause, that is, how the foot hits the ground is complicated. There is a lot going on there. The foot accepts weight from rear foot to forefoot, the ankle pronates to balance, then the toe pushes off, all in a second, automatically. If any part of that motion is off or misaligned a problem can develop.

The invisible force we know as gravity affects how the weight of your body and its center of gravity are transferred, through the foot, knee, hip, pelvis, and spine in a complicated kinetic chain. Ground Force Reaction (CFR) is always the root cause of all running injuries. Therefore several factors need to be evaluated including mechanical load, skeletal properties, and tissue injuries inclusive of bone and stress injury to fully assess a running injury. There are 5 major components to running form that impacts your exposure to injury while running. All should be assessed in a running analysis.

  • Stride length and shin position of landing position
  • Step rate
  • Step width
  • Foot position of foot strike
  • Bounce – vertical movement while running

In circling back to resolving plantar fasciitis, the source is the plantar fascia being over loaded, the root cause is figuring out why, which is what we do.

Structure, habit, reflexes are the invisible components to running, walking and function. Medications and orthotics are common approaches to addressing a nagging plantar fasciitis, but function and neuromuscular control answers the questions of root cause. This model approach is pertinent to all types of running injuries including hamstring strain, hip pain, IT band syndrome, meniscal tears, labral tear of the hip, and stress reaction fractures of the shin, hip or femur. As therapists, who specialize in treating runners, we are the experts to figure out “Root cause”, and teach you the patients treatment strategies to fully resolve the injury and to prevent future injuries.

Text Neck

Cindy was a young, healthy, 24 year old who was active, eating well, and sleeping eight hours a night. She came to our office for her neck pain after a few months into a new job that required her using her upgraded iPhone all day long. Cindy told us her neck and back were sore and tense. After seeing her doctor and receiving a medical workup that included an X-ray which revealed little — the conclusion was she might have some arthritis in her neck. Cindy was frustrated and concerned; she didn’t like the sound of arthritis in her early 20’s. She left the office anxious and not sure where to turn to next or what to do about her neck and upper back pain. What she didn’t know then, but does know now, is that hers is a common 21st century ailment: Text Neck.

Due to gravity, we have head righting reflexes that are invisible. Text Neck is the result of the interaction of our bodies to gravity with the use of ever-developing and ever-present technology in our world. Phones still require that we hold them somehow. As long as we need to hold our phones, our bodies will find ways to support the weight of our heads up while we use them. As long as our bodies are supporting our heads, they will compromise and overwork relative to gravity to hold our head up (head righting). It does so because of reflexes, which we are not aware of, enter: Text Neck.

The human head weighs about 10-12 pounds. For every inch forward the head sits in front of the body, there is a 3-fold increase in strain and demand on the muscles of your neck, shoulders, and upper back creating muscle overuse and fatigue. This muscle overuse and fatigue will lead to muscle substitution, strain, and over time inflammation, and can escalate to joint degeneration and arthritis. This ripple effect, which is invisible can cause increased strain and dysfunction all the way down the spine and to the hips.

Statistically, the average person spends about 170 minutes per day on their phone. Do the math: as a country we spend 43 days a year on our phones. Holding our phones, means we’re holding our heads several inches out of alignment causing strain on muscles all the way down our bodies. Think about holding a 10 pound weight in your hand for 43 days. Ouch! My arm hurts just thinking about that!

The strain on our muscles is hard to comprehend, especially because our bodies are so adept at functioning even when under immense stress. Human bodies find a way– until they just can’t anymore. That’s when the neck, shoulders, and jaw begin to interpret the strain as dangerous. The brain picks up this signal and alerts the conscious mind, and the body responds with action. The most common action is muscle spasm which serves to protect the surrounding area from moving more and potentially doing more damage to the tissues. Spasm impacts movement and causes pain. This is where a qualified PT who understands how to identify the root cause can help get your tissues moving better and develop a strengthening program to counteract the strain and breakdown of your tissues.

If you or someone you know are suffering from head, jaw, neck, upper back, shoulder, or lower back pain without a known cause — it may be the result of the cumulative microtrauma related to being on your phone for over a month every year. Most people don’t even vacation as often as they are on their phone!

We at NJPTA understand the head righting reflexes to gravity and the jaw relative to neck pain and arthritis. Give us a call to help you learn what you can do to help minimize the pain caused by our ever changing relationship with technology. There is so much we can do every day to avoid getting to this point of pain from texting and checking your e-mail.


We often see patients who bring a copy of their MRI results and say, “My doctor told me that I have a herniated disc in my back”. However, MRI results also need to be correlated with the clinical findings of the physical exam. Research studies have confirmed that 70% of us have disc herniations, but do not have symptoms. It is important to have a thorough physical exam to further assess if your pain is coming from the MRI findings. We have had many patients with disc herniation on MRI, but the disc herniation is not what was triggering their pain. An indication of this situation is if you had an epidural without relief. Root causes of pain are very complicated and often have multiple components. Studies have also shown that there are many people without herniated discs that are in severe pain in the neck or back with referred pain into their arms or legs.

An MRI is a picture that is taken in one position, usually supine, where the back is not having to work and things are relaxed. Just like you can take a picture with your camera and it can look different depending on the different types of lighting, the flash, the time of day, so too, the MRI can look different in different positions and different times of day. One position might show a disc herniation compressing a nerve, another may show only a bulge without pressure on a nerve. It is important to assess strength, sensation, reflexes, and how a person is moving, then compare these findings to the MRI results. Ideally the physical exam findings support and help strengthen the diagnosis. Pain is very complicated, involving multiple sub-types of pain within the body (mechanical, inflammatory, neuropathic, neurogenic, central sensitization, neurovascular, neuromuscular to name a few). Each sub-type has specific pain qualities, and sub-types can also co-exist. The MRI can be a useful tool in helping to diagnose but it should not be the only tool used. If you are having pain and have been told that your herniated disc is causing it, just make sure that someone has also performed a comprehensive physical exam testing: movement, sensation, strength, and reflexes. This will help to confirm or refute the MRI results and this way you can truly have a CLEARER picture of what is or isn’t causing your symptoms, and have an appropriate treatment plan to address all the components to your pain.

If you aren’t sure about the cause because your pain persists, give us a call at North Jersey Physical Therapy. We will happily help you get a clearer picture and identify the root cause.


Here at North Jersey Physical Therapy, we believe that one of the root causes of muscle, nerve, and fascial pain is directly related to posture. Gravity is constantly pushing down on us and stressing our bodies in ways we are not always aware of it doing. Therefore, we have to be proactive against gravity. We have to realize that when we sit or stand we should be active, not passive. This is where good posture comes in. We must focus on certain muscle groups to align our spine in order to achieve posture alignment with the least amount of effort.

Correcting posture is not only possible but simple. With a little effort it can be practiced throughout the day and yield dramatic results. In fact the more you practice correct posture the simpler it becomes.

Our belief in the critical nature of good posture is so great that one of our therapists, Polixeni Katsaros, PT, DPT wrote a book on it called, “Posture, Simply Posture, Correct Simply” where she outlines the importance of understanding how gravity affects our body and the importance of understanding how posture and proper body alignment can counteract the effects of gravity.

Your Brain – Smoke Dectector

Patient: “But it hurts when I sit or lay down… shouldn’t I feel better when I’m resting?!”
PT: Not exactly…

A common line of thinking among many PT patients is that rest will resolve pain. It’s counterintuitive to many individuals that discomfort and pain persist while resting. Let’s dive into this misconception and shed some light on the topic of rest as it relates to pain.

When it comes to pain that is musculoskeletal in nature, it’s common that the cause is overworking, stress, or strain on the muscles, tendons, ligaments, or bones. People often associate this with active movement: running, walking, or even something as simple as getting out of a chair. In reality, your body is working all the time. In fact, resting states (lying down or sitting in a chair) can be interpreted by your brain as potentially dangerous if you have overworked a muscle that is typically used for this activity. For this reason, many therapists focus on educating their clients to rest in anatomically safe postures. You might ask: what is an ideal posture? How can my resting posture be flawed? Therapists know that ideal posture is a position in which your body is working most efficiently and able to support itself with minimal effort.

In cases where an individual is experiencing pain while sitting or otherwise resting, it’s likely that the resting or seated posture causes stress on this area of the musculoskeletal system. The brain interprets this as a stressor and triggers a pain response in the physical body to alert the individual of the burden that area of the body is under. What most people don’t understand is that the body is sending them a message. Pain is a news bulletin from the brain that the position is not ideal and that a change is necessary to obtain comfort. If the individual ignores this signal, as many do, the pain will persist and the brain’s alarm system may become more sensitive. This becomes cyclical, causing a lower threshold for activity before pain comes on again. If a smoke alarm is going off in your house– do you take action to address it or let it ring and ring? More than likely, you look for a reason for the alarm. Sometimes the smoke alarm goes off when something is burning– this can be analogous to an active pain response. Other times, you are taking a shower and the steam sets it off– this is what can happen to our alarm systems they can become more sensitive to stimuli that are not dangerous– like resting postures that seem like they should be pain free.

Now that we have a clearer understanding of why rest isn’t always restful, let’s explore some solutions. A few things need to happen in order for a patient to improve tolerance for resting postures. The first is being aware of your brain’s alarm system and making adjustments to your position when pain occurs. The second is freeing up the tissue that has been overworking and experiencing strain. This is where the PT often utilizes a variety of techniques like myofascial release, instrument assisted soft tissue mobilization or cupping to name a few. The third is to support the tissue that has been overworking by re-educating inhibited muscles to turn back on and properly support the straining tissue. Finally, in some cases the fourth step is to provide the area straining with some support while the system is rebalancing. When these steps are taken with the assistance of a PT to properly assess the body and determine a treatment plan, most individuals experience a reduction in their resting pain. Like anything that is worthwhile doing this process takes time and commitment to the program outlined by your PT.

If you experience resting pain, it might be your body’s smoke detector going off. Give us a call! Our job is to evaluate you and to help devise a treatment plan to make sure your alarm system is running correctly. We look forward to working alongside you on a treatment plan that balances your body and support getting you back to the place where rest is restorative and enjoyable, not painful.

Disclosure: If you experience pain that wakes you up at night and you are unable to fall back asleep, this may be a sign of a more serious problem and is something that should be brought to the attention of your team of healthcare professionals.