Module Two:  Neck and upper Back

Common Neck injury











Module Three:  Shoulder and Elbow

Rotator Cuff Conditions








Module 4:  Hand and Wrist

There are three types of arthritis that may affect your foot and ankle.






Module Five: Lower Back and Hip 















Module six: Knee and lower extremity 









Module Seven:  Foot & Ankle

There are three types of arthritis that may affect your foot and ankle.





Depending on the type, location, and severity of the arthritis, there are many types of treatment available.


Nonsurgical treatment options include:


  • Pain relievers and anti-inflammatory herbal medications to reduce swelling

  • Shoe inserts (orthotics), such as pads or arch supports

  • Custom-made shoe, such as a stiff-soled shoe with a rocker bottom

  • An ankle-foot orthosis (AFO)

  • A brace or a cane

  • Physical therapy and exercises

  • Weight control or nutritional supplements

The joints most commonly affected by arthritis in the lower extremity include:

The ankle (tibiotalar joint). The ankle is where the shinbone (tibia) rests on the uppermost bone of the foot (the talus).
The three joints of the hindfoot. These three joints include:

  • The subtalar or talocalcaneal joint, where the bottom of the talus connects to the heel bone (calcaneus);

  • The talonavicular joint, where the talus connects to the inner midfoot bone (navicular); and

  • The calcaneocuboid joint, where the heel bone connects to the outer midfoot bone (cuboid).

The midfoot (metatarsocuneiform joint). This is where one of the forefoot bones (metatarsals) connects to the smaller midfoot bones (cuneiforms).
The great toe (first metatarsophalangeal joint). This is where the first metatarsal connects to the great toe bone (phalange).This is also the area where bunions usually develop.

Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain in runners, eventually affecting 10 percent of the running community. 

While running, the plantar fascia works with the Achilles tendon to store and return energy. Because of its powerful attachment to the base of the toe, the plantar fascia stabilizes the inner forefoot as forces peak during push off. Unlike bone spurs and stress fractures of the heel, plantar fasciitis tends to produce pain during the push off phase while running, not during initial contact.

A simple way to tell if you have plantar fasciitis versus a heel spur/stress fracture is to walk on your toes: heel spurs and heel stress fractures feel better while you walk on your toes, while plantar fasciitis typically produces more discomfort when you shift your weight onto your toes.

Module One:  Spinal Column 

There are many potential causes for spinal stenosis, including:

  • Aging: With age, the body's ligaments (tough connective tissues between the bones in the spine) can thicken. Spurs (small growths) may develop on the bones and into the spinal canal. The cushioning disks between the vertebrae may begin to deteriorate. The facet joints (flat surfaces on each vertebra that form the spinal column) also may begin to break down. All of these factors can cause the spaces in the spine to narrow.

  • Arthritis: Two forms of arthritis that may affect the spine are osteoarthritis and rheumatoid arthritis.

  • Heredity: If the spinal canal is too small at birth, symptoms of spinal stenosis may show up in a relatively young person. Structural deformities of the involved vertebrae can cause narrowing of the spinal canal.

  • Instability of the spine, or spondylolisthesis: When one vertebra slips forward on another, that can narrow the spinal canal.

  • Tumors of the spine: Abnormal growths of soft tissue may affect the spinal canal directly by causing inflammation or by growth of tissue into the canal. Tissue growth may lead to bone resorption (bone loss due to overactivity of certain bone cells) or displacement of bone and the eventual collapse of the supporting framework of the spinal column.

  • Trauma: Accidents and injuries may either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal.

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  • An injury to the ligaments or muscles in the neck, such as a sprain or strain. When neck pain is caused by muscle strain, you may have aches and stiffness that spread to your upper arm, shoulder, or upper back. Shooting pain that spreads down the arm into the hand and fingers can be a symptom of a pinched nerve (nerve root compression). Shooting pain is more serious if it occurs in both arms or both hands rather than just one arm or one hand.

  • A fracture or dislocation of the spine. This can cause a spinal cord injury that may lead to permanent paralysis. It is important to use correct first aid to immobilize and transport the injured person correctly to reduce the risk of permanent paralysis.

  • A torn or ruptured disc. If the tear is large enough, the jellylike material inside the disc may leak out (herniate ) and press against a nerve or the spinal cord (central disc herniation). You may have a headache, feel dizzy or sick to your stomach or have pain in your shoulder or down your arm.

  • Rotator cuff tear: An injury tears a rotator cuff tendon that’s been weakened by age or wear and tear. Weakness in the arm (and usually pain) are the symptoms.

  • Rotator cuff tendinitis (tendonitis): Repetitive overhead use of the arms (such as painting or throwing) causes a painful strain injury. 

  • Rotator cuff impingement: The tendons of the rotator cuff are squeezed between the humerus and a nearby bone called the acromion. Symptoms and treatment of impingement are similar to tendinitis.

  • Frozen shoulder (adhesive capsulitis): The humerus adheres to the shoulder blade, causing shoulder pain and stiffness. Symptoms usually resolve with time, acupuncture, herbal therapy and exercise.

  • Subacromial bursitis: Inflammation of the small sac of fluid (bursa) that cushions the rotator cuff tendons from a nearby bone (the acromion).

  • Arthritis of the Wrist

  • Carpal Tunnel Syndrome

  • deQuervain's Tendinitis

  • Trigger Finger

  • Ulnar Tunnel Syndrome of the Wrist

Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.


Overload (or training errors): Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, piriformis syndrome is not only found in athletes. In fact, a large proportion of reported cases occur in people who lead a sedentary lifestyle. Other overload causes include:

  • Exercising on hard surfaces, like concrete;

  • Exercising on uneven ground;

  • Beginning an exercise program after a long lay-off period;

  • Increasing exercise intensity or duration too quickly;

  • Exercising in worn out or ill fitting shoes; and

  • Sitting for long periods of time.

Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to piriformis syndrome are faulty foot and body mechanics, gait disturbances and poor posture or sitting habits. Other causes can include spinal problems like herniated discs and spinal stenosis. Other biomechanical causes include:

  • Poor running or walking mechanics;

  • Tight, stiff muscles in the lower back, hips and buttocks;

  • Running or walking with your toes pointed out.

  • ACL, PCL and Knee Injury

  • IIitibial Band Syndrome

  • Bursitis 

  • Meniscus


Osteoarthritis, also known as degenerative or "wear and tear" arthritis, is a common problem for many people after they reach middle age. Over the years, the smooth, gliding surface covering the ends of bones (cartilage) becomes worn and frayed. This results in inflammation, swelling, and pain in the joint.

Osteoarthritis progresses slowly and the pain and stiffness it causes worsens over time.

Rheumatoid Arthritis

Unlike osteoarthritis which follows a predictable pattern in certain joints, rheumatoid arthritis is a system-wide disease. It is an inflammatory disease where the patient's own immune system attacks and destroys cartilage.

Post-Traumatic Arthritis

Post-traumatic arthritis can develop after an injury to the foot or ankle. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, severe sprain, or ligament injury.