Running with Knee and Back Pain

So, I’ve been running more lately. To anyone reading this that knows me, knows that comes as an enormous surprise. I used to be a huge runner (3-4 times/wk) but, running and I fell out of love when I started to get injured. My knees and my back were always bothering me. I was getting tired of showing up to work and feeling worse off than my patients. Instead of working on the flexibility and strength deficits that I had, I decided to just stop running. Not exactly what I would recommend to any of my patients but, effective at eliminating my pain nonetheless.

Well I’m back on the team! I credit my return to three things. 1. Like most other people who run, it’s easy to just get out of the house and run. It doesn’t require driving anywhere, or signing up with any gyms, etc to participate. 2. I can do it with my kids in a stroller. I get to spend more time with them, and it gives my wife a little break (double bonus). 3. I was intrigued when I saw that “Headspace” had a running packet. To those of you who don’t know, Headspace is a meditation app. I’ve been using it for a while now and the running specific pack piqued my interest. I was pleasantly surprised it actually made it really enjoyable to run. It didn’t feel like the mental struggle that I remember from the past.

Unfortunately, with my renewed love of running, my knee and back pain returned as well. It’s like when you get back together with an old girlfriend and realize part of the reason why you broke up was her annoying best friend. Well this time the friend isn’t going to break us up again. Instead of running from my problems (see what I did there), I’m going to address them and make sure that I can keep my feet on the road.

My main issue (as is the case with many runners) is that I have very tight hip flexors and IT bands. Those muscles run in the front of the hip and can restrict your hip extension and stride length.


The problem with the hip flexors, and the reason why I get back pain, is that they anchor at the lumbar spine. When they are tight, your spine will flex with every stride and put excess pressure on your spine causing pain. The IT Bands run all the way down to your knee. When they are tight they will pull your knee out of alignment. That misalignment with every step will eventually lead to pain. Hence, the reason why I get knee and back pain when I run.

The good news for me (and anyone reading this with similar problems) is that it’s really easy to fix. All I have to do is stretch those muscles regularly to keep my body aligned and moving properly. Here is my favorite hip flexor and IT band stretch. If you are stretching pre-run then perform 15 repetitions holding the stretch for just a couple of seconds. If you are stretching post-run then hold for 30 seconds to a minute and perform the stretch a couple of times.

I hope this helps you stay flexible and keeps your feet on the pavement. If you have any questions please contact me here at OrthoCore Physical Therapy. Otherwise, HAPPY RUNNING!

Foot Pain Due to Flat Feet

I know this comes as no surprise but I’ve been treating a lot of feet lately. Apparently when you open a second office with a Podiatrist that is bound to happen. A majority of feet problems that I see are due to flat feet. About 12% of the population have flat feet. That might not seem like a lot but when you consider the amount of people in the world, that’s a lot of fallen arches.

Most foot problems, that are due to flat feet, stem from weakness in the arches of the feet. There are a group of 9 small muscles in the foot that help to create and maintain the shape of the arch.


Just like any other muscle in the body, if you don’t use it you lose it. The hard part about people with flat feet is that the muscles are constantly on stretch. A muscles that is constantly stretched, is going to be weak. So you are really fighting an uphill battle. The other difficult part for most people is they don’t know how to strengthen their feet. What do you do? Put a tiny dumbbell around your toes and do curls? As much as I would love to see people try that, it wouldn’t be effective. Here is one of my favorite exercises to do to strengthen the intrinsic muscles of the foot (crazy socks not required, but recommended).

If you perform this exercise regularly it will help to strengthen the foot muscles and start to build up your arch. If you have a really flat foot, I also recommend wearing a foot orthotic to give a little extra support and bring the arch up to where it belongs.

I hope this helps to keep your piggies from aching and get you up and on those feet pain free. If you have any questions please contact us . Thanks for reading!


When it Comes to Swing Length Size Really Does Matter, and Shorter is Better

Something that always comes up when I’m working with my golfers is their backswing length. Many golfers, and teachers, think that it’s vital to get to the top of their backswing, and get the golf club parallel to the ground. While I don’t disagree that players need to get to a good position at the top of the backswing, I do think that everyone has a unique backswing point. That point is very dependent upon how much flexibility you have.

How Many Degrees Do You Need?

Most professional golfers have 60 degrees of rotation in their shoulders, and 60 degrees of rotation in their hips. If you add those up it’s 120 degrees of rotation that is available (I know, difficult math). Now, you don’t need 120 degrees of rotation to get to the top of a “normal” backswing (lets just use parallel to the ground as a point of reference). You only need about 90 degrees of rotation to get there. There are two problems that most amateur golfers are faced with though. 1: They don’t have even close to 90 degrees of rotation. 2: If they do, that still isn’t enough.

Some of you are probably saying “what the heck! You just said I only need 90 degrees to get to the top of my backswing.” Let’s look back at those numbers though. Pro’s have 120 degrees and you only need 90 degrees to get to the top. That gives us a 30 degree difference (I know, hard math again). The pro golfer will get to the top of their backswing and then start the swing with their hips without moving their shoulders. That gives a greater stretch through the trunk and shoulders, and requires those extra degrees of rotation to prevent the shoulders from coming along for the ride. This gives them power and consistency with their swing.

So What Does an Amateur Do?

If you don’t have 120 degrees of rotation all is not lost. You should certainly do some stretching to improve your rotation if you don’t. What I do with my golfers is find the spot in their swing where they can still move their hips in the downswing. From there we use the K-vest system for biofeedback to memorize where that point is and prevent their swing from getting too long. It also helps them to coordinate the start of the downswing with their hips vs. their arms like most do. Once they do the flexibility exercises and improve their rotation we can continue to lengthen the swing without affecting the power and consistency they have created.

If you don’t have a fancy K-vest system but still want to find the correct length of your backswing watch this video.

The biggest thing to look for is the ability to start your hips without your arms. I always err on the side of short. You will be surprised how short you can make your swing and still hit the ball a far distance.

I hope this helps to improve your power and consistency with your golf swing. If you have any questions please contact me. Visit OrthoCore and learn more or make an appointment. Enjoy your new shorter, more powerful, swing.

Balance with Pitching

Balance and posture were the first two mechanical flaws I was taught to look for when I became certified through the National Pitching Association (NPA). The NPA is a group that was founded by Tom House who is the throwing coach for the G.O.A.T. (Tom Brady for those who live outside of New England), Drew Brees, Randy Johnson, Nolan Ryan, and so many other top athletes that this blog post would be 18 pages in just names alone. Their mission is to focus on strength and conditioning techniques that enhance a players skills and reduce their risk of injuries. In short, they look at the body first and performance second. You can’t be a division 1 pitcher if you can’t stay on the mound. Balance and posture is so important to this group that they don’t even look at anything else until this mechanic is fixed.

When we talk about balance we aren’t talking about a pitchers ability to stand on their drive leg for a long period of time. Quite honestly that doesn’t even matter that much. What we’re looking for is the pitchers ability to keep their shoulders level, through their stride, and delivery of the baseball to home plate. Any deviation from this level position will lead to a compensation which can lead to arm injury and break down over time.

Here are a couple of examples of good posture through delivery.

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Here are some examples of bad posture through delivery. They most common coaching mistake we see is telling a player to “get on top” of the ball.

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Now some of you reading at this point might be thinking, “Hey Matt Harvey was a dominant pitcher and Okajima was an World Series winning All Star.” That is all true but how long were they dominant and, at what cost.

A players inability to maintain their balance and posture through the delivery can be caused by a multitude of reasons. Literally any restriction in anything from the ankle up to the trunk can cause a loss of posture in the players delivery. I always recommend that a player get screened by a qualified movement specialist to be sure you are attacking the correct strength and flexibility deficits that are causing the problem. That being said here are some of the most common causes of loss of posture that I see with my pitchers.


If a players hips and trunk are tight it will limit their ability to rotate which can lead to a loss of posture while throwing. Here are two simple stretches that you can do to help improve your hip and trunk mobility. If you try to do these exercises, and its really easy, then flexibility probably isn’t the reason behind why you are losing posture. It’s still a good idea to perform them regularly to maintain the flexibility that you have. Try doing 15 repetitions holding each repetition for about 3 seconds

Hip IR/ER with Twist:

Sit on the ground with a bat. Rotate one leg in and the other leg out keeping a 90deg bend in the knees. Once your legs are touching the ground rotate your arms towards the leg that is rotating in.


Open Book:

Lie on your side with both legs bent up to 90deg. Rotate your arms open like a book.

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Core Strength:

Your core muscles are what keep your trunk upright while you are twisting as you throw. They also help to transfer the energy from your legs up to your arm. That means that by doing this exercise not only will you be able to better maintain your posture, you will also be able to throw harder (and who doesn’t like that). Perform 15 repetitions on each side and hold this reach/kick position for 3 seconds.

Plank with Reach:

Get into a tall plank position focusing on squeezing your glutes and keeping your core tight. Stay stiff and alternate reaching with your hands out in front of you. It’s important to prevent your hips from twisting while you reach.


Plank with Kick:

Get into the same tall plank position. Alternate kicking a leg up in the air. Make sure that your hips don’t twist. Also make sure that your back doesn’t arch as you kick up.



Well it’s what we’ve been talking about the whole time. Didn’t you think I was going to give you an exercise to work on? Balance is important in your trail leg but also your landing leg so be sure to work on this on both legs. You may notice a difference between your legs which is completely normal. The more you work on it, the more your legs will equal out. Try to do 15-20 repetitions on each leg.

Single Leg RDL:

Stand on one leg. Keeping your back straight, balance on one leg and kick the other leg back. The goal is to get your body parallel to the ground without rounding you back. This is a really challenging exercise so don’t get frustrated if you have trouble with it. Just keep practicing and eventually you will master it.

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I hope this helps you improve your strength and flexibility to limit any loss of balance and posture that you might have in your delivery. If you haven any questions or problems please don’t hesitate to contact me on our website, , or via email,

Golfers Elbow vs. Nerve Traction Injury

Specializing in treating golfers allows me to treat a lot of elbows. “Golfers elbow” is one of the most common injuries in golf (I know, shocking). What I find most interesting though is that pain in your elbow with golf isn’t always a true “golfers elbow.” Sometimes that persistent pain in your elbow could actually be a nerve problem coming from your neck. Please allow me to drop some knowledge.

Golfers elbow (or medial epicondylitis as the medical folk like to call it) is an inflammation of the medial epicondyle. It is the bony prominence on the inside part of your elbow.


Golfers elbow usually happens because a golfer flips the club through the hitting zone. This over activity of the wrist flexor and pronator muscles pulls on the tendon attachment and causes pain and inflammation. The pain is usually localized to the elbow area and can be reproduced when you poke at it, or resist the wrist flexor and pronator muscle groups.

I have found on numerous occasions though that pain on the inside of the elbow for golfers is frequently NOT golfers elbow. Most golfers that I treat are not professional golfers (even though most think they are). By that I mean that most are working at a desk job during the week and maybe get out and play once to twice a week. That amount of volume is not usually enough to create a true golfers elbow.

Take a look at this road map for the median and ulnar nerves in the arm. The nerves run right around the medial epicondyle.


That is why a nerve traction injury, or cervical spine radiculopathy, can feel like a golfers elbow but it’s actually a neurological injury. The nerve usually gets irritated up at the nerve root in the cervical spine. Although that is where the injury occurs, the pain usually presents down in the elbow and forearm.

Now let’s talk about how that nerve root gets irritated. Like I said before, my usual patient is the golfer that works all week and then golfs on the weekend. Most people have a sedentary job and really crappy posture. Does this picture look familiar?


The common rounded forward position leads to a hyperextension at the cervical spine. That hyperextension leads to compression of the cervical spine and compression of the nerve roots. This postural problem arises when you take that posture and try to swing a golf club.

A normal golf swing requires a lot of rotation out of the cervical spine. Everyone always focuses on their shoulder turn and the poor neck gets passed over and neglected. When you keep your eyes focused on the golf ball and turn your shoulders your cervical spine is still moving. That extra rotation puts even more compressive force on the cervical spine and those nerve roots. That is where the problem arises from and leads to the pain down the arm and into the elbow.

Here are some simple tests and fixes to see if your elbow pain is coming from your neck. Take your normal set up posture like you are hitting a 5 iron. Now, try and turn your head like you are trying to look at your shoulder. If you can’t easily turn your head without feeling a restriction in your neck you have a cervical spine problem that is probably due to poor posture.


If you want to test if your nerves are involved, try this. Hold your arm up like you are holding a waiters tray. Now keep your wrist extended and stretch your arm out as you turn your head away from your hand. If this reproduces any elbow pain, guess what, you have a nerve problem not an elbow problem. If this is you then try this exercise to get your nerves moving better. This will hopefully calm the nerve pain down and minimize the pain you are feeling with your golf swing.

OrthoCore if here to help! For more information or to make an appointment at either our North Kingstown or Westerly location, call us 401-667-0131 or Contact Us

Single Leg Romanian Deadlift for Golfers

If you read my last post you know I’m all about exercises that involve multiple body parts. I believe this is the best way to train. It helps to train movements rather than single muscle groups. It also helps you get in a great workout in a shorter period of time. The unfortunate thing for some golfers is they don’t have access to a gym. Well if that is you, nothing to worry about, I didn’t forget about you. Here is an exercise that anyone can perform to help improve your body’s stability, to improve your golf swing.

The exercise is a Single Leg Romanian DeadLift. Why Romanian? No clue, but they seem to have the best exercises going, so thank you Romania. Your glutes and abdominals are the most important groups of muscles in your golf swing. As a unit they help to keep you stable in your swing. They also help to transfer all the power from your big leg muscles into your arms and eventually into the golf ball. When you perform the deadlift on a single leg you are working on balance which will also help you stay more stable during your golf swing.

The glutes and abdominals are also the muscle groups that help you stay in posture during your golf swing. Most amateur golfers struggle with staying in posture during the swing. It can happen during your backswing, downswing, or both. Loss of posture is a power robber, it will also make your ball flight really inconsistent. When you struggle with a loss of posture you always have to use your hands to find the golf ball. When your timing is on, you can have a great day. When your timing is off, forget about it. Its lost ball city, population, you. The single leg RDL will help to keep your posture consistent and your scores low. We demonstrated this on our Facebook page recently.

You can start by using a golf club to help you get in the right position during the exercise. When that gets easier take the golf club away. Try to keep everything locked in like the golf club was still there. When that gets easy you can start to add weight to the movement. You can hold a weight in either hand or just use a band for resistance. That way you can start to build the strength in your glutes and abdominals to make your golf swing more powerful.

If you have any questions or comments please contact me here at OrthoCore Physical Therapy. Our office phone is 401-667-0131 or use the contact form on our website. Hopefully this will be the start to your best season ever! 

Lunge and Rotate To A Better Golf Swing

I hope that by now, if you have been following me, you know two things about the golf swing. You have to have a stable lower body with a really mobile upper body. That is the simplest way to explain what your body needs when it comes to a powerful, consistent, golf swing. Now describing it and achieving it are two very different scenarios. When it comes to improving your bodies fitness for golf I have found there are two major roadblocks to overcome. Time and knowledge. I’m here to help you with both.

I find that most golfers have the best intentions when it comes to improving their golf game. The hard part is the time that it takes to get there. Professional golfers work for 8-10 hours a day on the golf swing and their fitness levels. It’s their job. If you asked a pro golfer to be a landscaper on the side they probably wouldn’t be very good at it. Sure they may be able to cut the grass and do some weeding here and there but to be a professional at something takes a lot of time. That doesn’t mean that all hope is lost for us amateurs out there trying to lower our handicap. You can get a really good workout in a short amount of time, you just have to be sure that you are doing the right exercises. That gets us to the second roadblock, knowledge.

Too many people are still stuck in the dark ages of training (also known as the Arnold ages). Now don’t get me wrong. If you want to gain a ton of muscle mass and look like a Mr/Mrs. Universe, go read Arnold’s book, and train for 2-3hrs a day 6 days a week. I think that is why people get overwhelmed and feel like they are never going to have enough time to train and improve. If you want to be a good golfer and hit the ball farther, there are better exercises you can be doing with your time. Most conventional training is based around isolation exercises, bicep curls, knee extensions, etc. That is great if you are looking to gain muscle mass. It’s not very useful for the golf swing though. The important thing to do is incorporate a lot of muscle groups into one exercise that trains a movement. Here is one of my favorite exercises for golfers. It works on a stable lower body with a rotational movement. 

Hopefully that exercise will help to get you motivated and in the gym more. If you have any questions or comments please contact me at OrthoCore Physical Therapy  or call  401-667-0131. Hopefully this will be the start to your best season ever!

The Pallof Press: Excellent Core Exercise for Golfers

The golf season is coming, and it’s coming fast. Some of you are probably already out, all bundled up, trying to achieve your goals of getting in 100 rounds this year. I’m sure there are some of you that have been working hard on your golf specific strength and conditioning this off season. Unfortunately, there are probably more of you that haven’t. Not to worry! I have some of my favorite golf specific core exercises to show you. They will help to improve your core strength which will help to keep your back healthy, and help you launch that little white ball as far down the fairway as you can.

One of the best and “simplest” core exercises you can do is a Pallof Press. Don’t ask me who Pallof is, I never met the guy. Whoever he is, he came up with a killer exercise. Here is why I like the Pallof press. It works on core stability without requiring movement. It is ideal for any player because it doesn’t require a lot of coordination, or mobility, to perform the exercise. That means you can get the results you are looking for, with minimal risk of injury. Yahtzee!

Here is the most basic way to perform the Pallof press. Start with your feet about hip width apart and a band in your hands with the other end of the band anchored to something (preferably something that doesn’t move, your sibling or spouse are bad options). Slowly press your hands away from your chest without allowing your body to rotate. You should feel your glutes and abdominal engaged trying to prevent the rotation of the band.

Now here is what I really like about the Pallof press! You can make it as hard or as easy as you want. There are so many different variations. The only limitation is your imagination, and your stability. Here are a couple of variations that I like to give my more experienced clients. The variations will require you to purchase some additional equipment but you can get a sense of where you can take the exercise. Happy pressing everyone. Thanks Pallof, whoever you are.

Need some more work before the golf season is in full-swing? Contact us at OrthoCore to book your appointment and get started 401-667-0131.

Golf Posture and Back Pain

Back pain is the number one injury that I see in the golfers that I treat. There are a number of swing faults that can lead to back pain associated with your golf swing. When I work with golfers who are in pain I always like to start at the beginning and work on posture. If you don’t begin your swing in the right position it can put a lot of pressure on your spine and lead to pain in your back.


The most common postural issue that I see in a golfers set up is C-posture. C-posture is when you are rounded forward and look like the Hunchback of Notre Dame. This puts a large stretch on your low back and compresses your lumbar discs. Over time this compression and rotating around this compression will lead to pain in your back.


The other common postural issue in golf is S-posture which is the polar opposite of C-posture. S-posture is when your low back is scooped and your belly drops towards the golf ball. This position puts extra compression on your lumbar facet joints. Just like the discs, over time this compression will lead to inflammation of the joints and pain when you play golf.


Not that we’ve gone over what bad posture is, let’s talk about what you should look like when you set up to the golf ball. If you look at your set up from a down the line view you should be able to draw a straight line from your hips to your ear and your spine should fall right on that line. This flat back position stabilizes your lumbar spine and allows you to rotate with your hips rather than your low back. Not only will this position keep your back pain free when you play but it will also give you a little extra pop in your swing. When your low back is flat it means your core and glutes are active. This will lead to an increase in your swing speed and more distance down the fairways.

Here is a good drill that you can do to make sure that you are getting in the right position before you take a swing. Work on this drill during the off season to make sure you are in the right setup position when the season starts. Enjoy playing golf next year with a pain free back.

Have more questions about preventing pain while golfing? OrthoCore can help! Call today!

Physical Therapy to Strengthen the Pelvic Floor

It isn’t uncommon for women to experience discomfort, pain or some incontinence during pregnancy. Most MD’s will advise you to ignore it because you are pregnant and that it will get better once you have your baby. Unfortunately, that is not what the research shows. For 80% of women, if pain or urinary incontinence hasn’t resolved after 3 months postpartum, it’s not going to. Some leaking is normal for 3-4 weeks following birth due to the pelvic floor being stretched. Other than that, overall leaking is not normal and can be addressed with treatment. 

Physical therapy can significantly help with with urinary incontinence by not only strengthening your pelvic floor muscles (kegels) but by also assessing how your diaphragm and abdominals are functioning.  If you are not breathing correctly and tend to hold your breath, this places pressure on the pelvic floor and can lead to leakage. The abdominals are also a key part of urinary incontinence as they are the roof of your pelvic floor.  If your abdominals are weak or even overactive in some cases, then this can also cause increased pressure in the pelvic floor.  Physical therapy can greatly address these dysfunctions and re-train these muscles to function correctly through exercises while ensuring you are breathing correctly.  

During pregnancy, the most common area of pain is in the pelvic girdle, low back, and hips. The most common reason for this is the laxity in the ligaments coupled with the increased load of the baby. This is only exacerbated by any muscle weakness or joint instability that was present pre-pregnancy. Once again, most women are advised it’s normal and that this pain will go away once they give birth. Women who are pregnant don’t have to be in pain for 9 months. There are plenty of treatment options that a Physical Therapist can utilize to make your pain more manageable as you go through the pregnancy process. Here is Ian demonstrating an exercise that works well to strengthen without putting pressure on the pelvic floor!

Unless there are serious complications during pregnancy there is no reason why a woman shouldn’t exercise. The American College of Obstetricians and Gynecologists recommend 30 minutes of moderate intensity exercise most days of the week throughout pregnancy. In fact, 30 minutes of exercise has been shown to significantly reduce the risk for complications during pregnancy, and the babies are usually healthier. Walking, using a stationary bike, and pre-natal yoga are great options!

If you interested in starting a program either before birth or after, Kristi here at OrthoCore is certified to work with expecting mothers and can build a personalized program for you. Call 401-667-0131 to make an appointment with Kristi.

Rear End Car Accidents And Personal Injury Law – What YOU Need To Know

Guest blogging this week is Mike Bottaro of Bottaro Law Firm. He takes a close look at rear-end car accidents and what you need to do to protect yourself. Welcome, Mike!

The Bottaro Law Firm Team

The Bottaro Law Firm Team

What are your legal rights after sustaining personal injury in a rear end car crash in Rhode Island and Massachusetts?  Our law firm handles personal injury legal cases stemming from car accidents everyday.

The first thing to understand is that there are about 2.5 million rear end collisions annually in this country.  Big insurance companies profit from taking in your premium dollar and by acting slow to deny, defend, or delay your valid legal damages after a crash.  The insurance company is looking out for their interests and you need a lawyer to look out for your interests!  Whether you hire our firm or another, if you are injured in a rear end crash, do not delay in hiring a law firm that has won awards in limiting its practice to plaintiff personal injury cases.

Proving Negligence - Causes of Rear-End Collisions

From a legal perspective, we will want to get to work right away on winning your case by first establishing that the other driver is “liable,” in other words, considered to be legally at fault. You would be surprised that how often, especially without a lawyer, the insurance company seeks to save money by blaming you a percentage of fault (“comparative negligence”) – even in a rear end collision. Sometimes they do not even tell you this, but simply reduce the money that is owed to you!  

Proving Legal Causation: Injuries Sustained From Rear-End Collisions

The next step our top rated personal injuries will work on is establishing the legal link between the collision and your injuries.  

This comes into play if you already had an underlying neck, back, or other condition affected the crash.  In this case, the insurance company will attempt to save money on your case by arguing that you were already injured before this crash.  Of course, such an argument may not be true, or may not account for the fact that your condition worsened as a result of this crash.  Lawyers fight insurers to establish legal causation on your case.

Proving Legal Damages: Medical Expenses, Pain and Suffering, Lost Wages, etc.

Rear-end auto accidents result not only in physical and emotional injuries, but also result in real money lost to you.  Insurance companies are quick to promise that you will receive compensation, but later act a little foggy on the details.  

I know how to properly calculate your true losses after a Rhode Island or Massachusetts car accident and that is important to you, because the law differs in each state.  

If you have questions after an injury form a car crash, our firm limits our practice to helping you.  We offer 24/7 free consultations via text, phone, or website: (401) 777-7777 ; . Mike Bottaro