Patient Question Friday. Knee Pain



I am going to start a regular patient question answer thing here on Fridays. I will take any questions if you have them, just post in the comments or email them in. Or I will take questions from people I see here in the clinic.

Jen from Edwards asked me ” I have knee pain when hiking, especially down hill, and riding my mountain bike uphill. What should I do?”

When I asked Jen a bit more about her pain, she described it as pain under her knee cap. In addition to hiking downhill and biking up hill, she notices it with squats and kneeling too.

This type of pain is often called anterior knee pain, or sometimes patellofemoral pain. There are different reasons we get it. But generally the surface of the patella or the femur where they contact each other becomes sensitized. All the things Jen describes her pain with increase load in this area.


To help the pain we need to figure out ways to decrease loads on this joint, at least for a while. Then we need to build up loads gradually to allow return to the activities that are an issue.

The first way is to look at activity management. Sometimes the issue is we ramp up activities to fast. We don’t do something much for a while then we jump in and do too much too fast. This gets things irritated and then we keep them irritated by trying to push our way through. Or we are sensitive enough that things like walking and stairs keep it going. The solution in these cases is to back down on the offending activities, as you feel better then gradually build them up. In Jen’s case we talked about hikes with less vertical descent and mountain bike rides with less steep climbs. As she is able to do this easily she can build up.

The second way to reduce load is to look at how your knee is loading biomechanically. The knee is caught between the hip and the ankle. Sometimes things happening above and below the knee can increase loads on the knee. By altering things you can make changes. A few examples are:

  • A stiff ankle may increase load on the knee. Improving ankle flexibility may help your knee.
  • Poor hip strength or endurance may cause increased rotation at the knee with downhill activities. Working on strength and endurance in our hips can alter these mechanics.
  • Poor balance can add stress at the knee every time we are in single leg stance. Improving dynamic balance can reduce these loads.

There are others also, but you can see there are different issues which load the knee. Changing these loads combined with progressive loading of the knee will work very well in reducing pain.

If you have tried dealing with your knee pain and are stuck, getting a physical therapist to look at your management plan and mechanics can be helpful getting you on the right track. If you have any questions about your knee or anything else, post it in the comments call me at 970-949-9966 or

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Concepts of Pain 3

conceptsof pain

The last couple of weeks I have been talking about pain and. This graphic above lists some things about pain that many people don’t know or understand. Knowledge of these concepts may help you make sense of your pain a bit more which can help in moving forward in your healing and life.

Today’s concept is pain does not equal the amount of tissue damage. You may assume that the more pain you experience the worse your injury is, or the worse the damage is.

Now sometimes this is true. Big injuries can cause a lot of pain for sure. But not always. The guy in the video below had a severe fractured leg. You can see that the other players and the fans watching had a much bigger reaction than he did. If you are squeamish maybe don’t watch.


You may have stubbed your toe and had severe pain and was sure it was broken, but a while later it was fine. Or think of a paper cut, how much it can hurt for a comparatively small injury.

These are a couple examples of how pain and tissue damage are related but not the same. This is important to know. As, when we are recovering from an injury and have pain, we tend to think if our pain is worse, we must be getting worse or have created new damage.   Many times our system is sensitized after an injury. When things that alter sensitivity occur like increased activity or physical load, poor sleep, stress, or worry, then our system may feel stuff more. Knowing this can allow us to better evaluate what is happening in our body or to our injury.

If you have any questions about your pain drop a comment, give us a call at 970-949-9966 or go to ascent-pt.

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Healthy Habits



Found this graphic thanks to Ben Cormack today.  Most healthy habits are behaviors are not one magic bullet, but persistent, sustainable changes. Taking small steps consistently in the right direction is what makes us healthier.

Unfortunately, the things that sell are the “best diet”, “the easy way to weight loss” or “the trick”. As humans, this is easy to understand. Sustainable change is difficult to make. It all goes great until it doesn’t, and its easy to slip back into old ways and habits.

This graphic is about diet and weight loss. It could also pertain to exercise, building a training program, recovering from surgery, or pain management. The quick fixes and magic bullets are what we focus on. The “right” exercise to get me better. The “best” exercise to get me going. Its probably more important that you find things that you can do and sustain. Things that you enjoy and bring meaning to your life. If you can do that you are more likely to be persistent and get things done.

If you have any questions give us a call at 970-949-9966 or

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Concepts of Pain Part 2

conceptsof pain

Last week I posted this graphic about some core concepts of pain that many people do not understand. You may ask “what does this have to do with me?” Understanding pain can be helpful in getting it better. Many people’s misconceptions lead to fear and anxiety, which can lead to more pain. It can also lead to poor decision making in what to do, especially with more persistent pain.
The first concept to understand is that pain is produced by our nervous system and brain. The first thing to understand about that concept is that this does not mean pain is “all in your head”.
Many people, in fact science, until somewhat recently though of pain as an input from our body to our brain. In other words, you get some damage to a tissue lie a cut, sprain, or broken bone, and your body sends a pain signal to your brain to make it aware so it can take action. Our body does send signal to our brain. But they are danger or potential danger signals. Your body has nerves throughout which are always sensing what’s happening. They can sense temperature, chemical stress, and mechanical stress. If something out of the ordinary is going on they send this information onto the spinal cord and the brain. The nervous system then analyzes this along with lots of other information to decide if this sensation is worth worrying about and then makes a decision what to do. The other information includes what else you are feeling, seeing, or hearing, previous experiences, memories, thoughts and beliefs, and emotions, among other things.


Once all this gets processed, the nervous system makes a decision. Is this a threat? If it is, what to do? It could decide that the pinch on your nose is you baby grabbing it and that’s not a threat so you feel a little pressure and not much else. It could decide that the same pinch is a stranger on the subway and go into threat mode. It may hurt. You may get nervous and tense up and protect yourself. This process is called nociception and is happening constantly, all day through our lives. Most of the information we process is normal and we don’t feel too much and what we do feel is normal. But we may get a chill and grab a coat. We might get hungry and get some food. Me might feel pressure on our back after sitting too long and move around. Sometimes when it is threatening enough we feel pain.

As you can see pain is a process from the body and tissues and the nervous system and brain together. This system is meant to protect us. If we step on a sharp rock and cut our foot or twist our ankle we need to be aware. This allows us to take care of things. Clean out the cut. Rest the ankle. Get things checked out.
In acute pain this is necessary and helps keep us healthy and alive. Sometimes our system can get sensitized or over protective and this can lead to more persistent pain. In some of the future concepts we will talk about this and what it means.
If you have any questions about pain, post in the comments or give us a call at 970-949-9966 or


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5 Exercises for Acute Lower Back Pain


Earlier this week I posted about some myths and lower back pain. Here is a link.

Acute back pain is recent pain. Pain that is less than a couple months old. A takeaways I like people to understand about acute lower back pain are: it is very common and usually will go away fairly quickly, the amount of pain you have doesn’t always correlate to the severity of the injury, feeling some pain after an injury is quite normal and doesn’t mean you are harming it further, and moving and staying as normal as possible is generally the best course of action.

That is where exercise and activity come in to play. Many people are understandably fearful or worry about hurting themselves more. And, the message we commonly hear is if you lift wrong you will damage yourself, bad posture will wreck your back, be careful you will hurt yourself, or don’t do too much. In truth staying as normal as possible and moving is helpful. This doesn’t mean you should ignore your pain and do everything full on. But it does mean you can continue to do some things even if there is some manageable pain or discomfort.

Many people will find movement is more comfortable than being sedentary. They will find sitting or first thing in the morning is worse and walking and changing posture is better. With acute pain the goal is to get your spine moving all the directions it needs to move without aggravating things. Sometimes specific movements will reduce symptoms. If this is the case then focus on doing that movement frequently through your day. Sometimes a specific movement will aggravate things. If that happens, wait to do it a bit longer and reduce activities in your day that are similar. Sometimes just general movement will help. All of these motions are safe. So try them. If they help keep doing them. If something doesn’t feel right back off or wait a bit on that exercise.

Press ups: These exercises extend your spine or back bend. Many people find these can reduce pain, especially if you find sitting or bending over forward is painful or difficult. If they do reduce pain try to do them 10 times every hour or 2.


Prayer: This stretch flexes or fully bends your spine. It does it in a position with less weight on your back and can also provide a bit of traction. prayer-stretch-02

Open Book: This stretch rotates your spine. It focuses on your mid back, but can be a good early comfortable way to begin some easy twisting.


Cat and Camel: This exercise works flexing and extending your spine in an easy position. It also allows you to begin active control work with your pelvis, hips, and core with not too much load on your back.


Walking: If you are comfortable walking, it is a great activity to help your recovery. It gives you overall body movement, can get you outdoors, and get your cardiovascular system going. Sometimes you can only tolerate short distances. Its Ok. Do what you can and build it up.


These are exercises for new back pain or injury, although many people can use them at any stage of recovery. They won’t cure you, but they can keep your spine moving, and in some cases give people some relief. Ultimately, pain resolves as we heal and our nervous system feels we are safe. Moving can help this happen. I will do some future posts on other exercises for other stages of back pain.

As always post questions or comments here. Give us a call at 970-949-9966 if you have questions or






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5 Myths About Back Pain


Last week I put up a poll in the Eagle County Mountain Sports Injury Group about things people wanted to know about.  Here’s a link to the group if you are interested.

The most answered topic was back pain, and a couple of people asked about exercise for back pain. That can be a tricky question, because there are lots of different reasons for back pain, and they can call for different strategies.  I will answer that in an upcoming post. But, today I wanted to talk about some of the myths and misconceptions about back pain. Back pain is very common. And there is a lot of fear and uncertainty for people about. When you see some of these misconceptions it may help you understand why exercise might be so variable. So here are 5 common myths about back pain.

  1. Your back needs special protection in regards to posture and specific exercises or it can get damaged because it is so weak and fragile: This is the biggest myth I see in people’s understanding of their back and the messages they get from culture and the medical system. Yes low back pain is common, and it can be serious and very limiting when it happens. But, your spine is actually very strong and resilient and is designed to tolerate all kinds of heavy loads and various postures. Do we need to be careful and limit things when we have an injury? Yes. Does sitting “wrong” or lifting “wrong” cause us severe problems? Probably not. If we are lifting high loads we should be aware of good posture. If we are sitting or sedentary a lot moving can help. But good general exercise has been shown to be as effective as any specific kinds to help your back pain.
  2. If you have back pain you need x-rays or an MRI for safe treatment or return to activity: Yes there are sometimes serious injuries or situations called “red flags” that require these tests. Examples are trauma that might cause a fracture, significant or progressive neurological changes, and severe intractable pain. But, most low back pain is not these things. Conservative management does not generally require these for safe effective treatment.
  3. If you have a disk issue you will have problems for ever and need to change how you live: This relates to the above issue. Many people get tests done with back pain. Those tests frequently show bulging, herniated, or degenerative disks. What people don’t understand is many people without pain would also have those findings too. Changes in our spine are quite normal as we age, and they aren’t always the sole cause of our pain. You can treat things conservatively, feel better, and the tests would not change.
  4. When you have back pain you need to stop doing everything until the pain stops: Pain is disconcerting. When we have it we are understandably concerned that we are hurting ourselves when we feel it. But, many times our system has become sensitized, and you are not causing harm, your body is just saying be aware or careful. Feeling some pain with activity is OK. Keeping active and as normal as possible, within reason, has been shown to be helpful in recovering from back pain. Try to keep up as many activities as you can and modify what you need to.
  5. Back pain is only about the damage to tissues and physical things I do to my back: Of course tissue injury and physical loads we place on our back affect back pain. But pain is seldom single cause, although that’s what we are all looking for, a cause to fix. Pain can have contributions from our biology, which includes tissue and structure but also things like stress biology, psychology, and sociology. So if you have persisting back pain it can help to also evaluate things like sleep, stress, nutrition, worry, and fear. Also understanding how the pain is affecting your life. Things like how it affects your job, family life and recreational activities. Many people get focused on what part they can fix, and miss other important contributing things.

As you can see, there can be a lot to back pain. Many people get it, and it may just be a normal part of our lives that we have to deal with time to time. If you have any questions about back pain, post a comment, call us at 970-949-9966 or go to

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Patient Question Friday: Does _______ Work?


This isn’t one question I get from any particular person. Its a form of a question I get from almost every person. Does something work for my problem? The something can be a wide variety of options medications, surgery, creams or rubs, braces, straps, ice, heat, massage, acupuncture, taping, and others.

There are a couple of layers to this question. The first is what does the person mean by works? Do you mean fix my problem? Or more along the lines of will it help my pain to some extent? What I think some people mean is am I going to be spending my time and money wisely to try this.

The truth is the answer to the first question is frequently, no its not going to fix your problem. The body will fix most problems by healing. We can help that along with proper management of the injury. Rest when needed. Protect what needs protecting. Restoring movement, strength, and function at an appropriate level. Time is a factor. Now some of those techniques and products may help in that situation. Taping or bracing may protect something for example.

The answer to the second question, will it help my pain to some extent?, is usually maybe, or it might, or it could. But, everyone is different and we never know for sure. So, does that mean you should try these things?

I like to ask a few questions when assessing whether a technique or product could be useful.

  1. Is it scientifically plausible?
  2. Can it be harmful?
  3. Is it affordable for you?

The 1st question is probably the most important. There are many things out there that just make no sense from a scientific perspective. But, some people swear by them. Why is that? Its also sometimes difficult as a consumer to ferret out the evidence. Testimonials in ads are powerful and we don’t really have time or access to do research. The first thing to know is many products “work” in the sense of reducing pain. The issue is sometimes the scientific reasoning is backfilled in after someone discovers something helps pain. They design a new product or technique. They want to market it. They know it needs an explanation to convince people. So they come up with a seemingly plausible reason that it might work, it puts you back in alignment, it changes blood flow, it releases energy. They usually don’t have much science behind it.

There are some reasons that many things “work” in many people. And there is science behind it. Pain from tissues is driven by your nervous system as a protective response. You have an injury and nerve endings send signals detecting mechanical stress, temperature, or inflammation up to the brain. The brain processes these signals and determines what to do. This can be pain. Many of the things I listed above alter the signals the nerve endings send up to your brain. Heat and ice affect temperature. Manual therapies and taping affect mechanical stresses. If we get a different input from the nerve endings, we can get a different out put from the brain. We may experience less pain. We aren’t really changing the tissues, we are influencing the nervous system.

Two other plausible reasons things “work” from a scientific reason are treatment alliance and placebo/treatment effect. Treatment alliance has to do with your relationship to the person giving you advice or helping you. We know that if you have confidence and trust in the person you are getting advice from or working with you will have an improved response. Placebo and treatment effect also play a part. Knowing we are doing something has a powerful effect on our nervous system. Even if the treatment isn’t doing a lot biologically, it can affect pain perception and biological systems.

So if we determine that there frequently is at least some plausibility, what should we do? I then assess the nest 2 questions safety and cost. If we know something is really safe and very affordable. There is no reason not to give it a go. Most conservative things are pretty safe. Many are free to try at home or minimal cost. Go for it. It may give you relief, it may not. But no harm done. Things like surgeries or other major procedures are where the questions come in. Their is a lot more risk when we get involved with these. That’s when we really need to focus on why someone is having pain, and if these procedures really will “work”.

If you have questions about something, post in the comments or call us at 970-949-9966 or


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Concepts of Pain

conceptsof pain

Last time I talked a bit about “pain science” Here is a graphic that talks about some of the core concepts of pain. Some of these concepts are becoming more well known in the medical world and to the average person. But, when I talk to people, many don’t really understand them, or in the medical world treatment and language don’t reflect that. Many people still think and believe that pain always means damage. The amount of pain reflects the amount of damage. Persisting pain means increasing severity of your physical or structural condition. And, pain must be reduced or eradicated before you can continue to move forward with your life. These beliefs are well-ingrained not only into our culture, but also our medical system. People will continue to search for a “fix” and there are plenty of people willing to offer them “the fix”.

Now, of course, sometimes damage and pain correlate quite well. You break your leg, cut yourself, or sprain your ankle and their is structural damage to bones, skin, ligaments, muscles, or tendons. In a normal situation they are painful at first, as they should be. Then as time goes by you heal and the pain steadily resolves and you feel better. You assume you healed so your  pain went away. This is acute pain. But, sometimes normal healing times pass and the pain is still there. Sometimes even worse than it was when it was new. This is persistent or chronic pain. You assume you have pain because something is not right in your structure. Something hasn’t healed right or is out of place or is not working right. And sometimes that is true, but sometimes something else my be going on. You might be having a pain problem.

Over the next couple weeks I will go in detail about the 6 core concepts of pain mentioned above. There are lots of other important things. But, these concepts are a good place to start. So keep an eye out.

If you have pain issues, and aren’t sure what to do give us a ring at 970-949-9966 or our website at

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What Is Pain Science?


On or facebook group last week I was asking what people might be interested in for content. Someone responded more about pain science. Here is a link to the group if you are interested in checking it out.  Eagle County Sports Injury Group

The person asking was a physical therapist. So, to the average person the term pain science may not mean a lot. So over the next few weeks I will intersperse some posts about pain and “pain science” here. Today I will try to define it, although it may mean different things to different people. I will say what it means to me.

Most simply pain science is the science of pain. You might think how much science is there about pain? You damage something or injure it and it hurts. When it heals or I get straightened out then the pain goes away.

Well it turns out there is more to it than that. The International Association for the Study of Pain defines it this way. “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

A couple of things to note. One is that pain can occur with actual or potential damage. So it is not as straight forward as damage equals pain. The other thing to notice is that pain is an unpleasant sensory and emotional experience. That brings in a lot. It means we are dealing with biological, psychological, and social processes. That means we have lots of areas of science that are contributing to pain science.

When I think of trying to understand pain science it takes understanding in things like biology, structure and mechanics, neuroscience, psychology, kinesiology, sociology and communicating with people. Lots of stuff. Pain science isn’t a thing you do to fix people. It is a way to understand pain and to help people understand how to move forward with their pain.

So to me pain science involves:

  • Knowing when to push something and when to rest
  • Understanding all the complex factors that affect your pain other than an injury
  • Understanding how pain can change a person’s life
  • How to communicate with people so they are heard and can work toward their goals
  • Knowing how getting back to life despite pain can sometimes be helpful
  • Helping people understand what they can do to manage their own pain
  • Understanding the pros and cons of various orthopedic procedures in relation to pain
  • And knowing that as much as we think we know about pain, its just the tip of the iceberg.

When we think about pain science, what we are really talking about his how we work as humans. We are dealing with every part of our system. Our muscles, bones, ligaments, tendons and joints, yes. But also our nervous system, brain, and identity. We are trying to understand how humanity works in a nutshell.

I hope this helps, and over the next few weeks we will talk a bit more about how pain works as far as we know now. It will keep changing. Its always interesting and exciting, at least to me.

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Natural Medicine.


When people are recovering from pain or an injury, most people want to know what to do to make things move a bit faster. I like to touch on all aspects of the biopsychosocial aspects of health when we talk about this. Of course things like the right amount of rest, doing your exercises, not doing things to soon, using ice etc.. are all helpful.  But, people don’t often consider the other things, their mental health and social life. When people are in pain or injured, lots of things change. You might be in bed or sitting around the house a lot recovering. Maybe you are off work. You can’t get outside and do your favorite activity here in the mountains. Social hour with your friends doesn’t happen. You aren’t being you. All these things are healthy activities that we use to cope with the difficulties and stresses of life and renew and refresh ourselves mentally and physically.

In relation to this, here is a link to an article about doctors in the UK prescribing nature to help with various health issues. We are more and more recognizing how needed activity and being out in the world are important to health, just as world puts us indoors with more difficult access. So weather you are healthy now, or recovering from an injury or in pain, finds ways to add some nature to your life, even if its different than normal.

Nature prescriptions

If you have any questions about exercise and health, give us a call at 970-949-9966, or drop by our website

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How Bad Is Not Exercising?


sylvan.jpgAn interesting article about research into exercise. We know that exercise helps us mentally and physically in all kinds of ways. This research shows how harmful not exercising regularly can be on your heart. Long term issues at higher rates than smoking and diabetes among others. So keep on being active.

Here is the link to the article.

If you are having difficulty beginning or maintaining your exercise program because of pain or injury, a physical therapist can help. Call us at 970-949-9966 or go to our website.


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