Solutions for Pain from Pedaling

By Theresa Delvo, Physical Therapist
Director of Therapy, Midwest Rehab at OCI

MWR PhotoThe snow has melted, the temperatures are rising and many of us are ready to get on our bikes and go for a long ride. Whether you’re an experienced cyclist, or just going out for a leisurely ride, below are a few hints in preventing injuries while riding.

Bike Fit

  • Keep a controlled but relaxed grip of the handlebars.
  • Change your hand position on the handlebars frequently for upper body comfort.
  • When pedaling, your knee should be slightly bent at the bottom of the pedal stroke.
  • Avoid rocking your hips while pedaling

Patellofemoral pain syndrome (PFPS)
One of the most common types of injuries particularly among athletes, active teenagers, and older adults is Patellofemoral pain syndrome (PFPS), which refers to pain at the front of the knee, in and around the kneecap or patella. It often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion– running, stair climbing, squatting, and cycling.

Patellofemoral pain affects more women than men and accounts for 20%-25% of all reported knee pain. Current research indicates the PFPS is an “overuse syndrome,” which means that it may result from repetitive or excessive use of the knee. Other contributing causes may include weakness, tightness, or stiffness in the muscles around the knee and/or an abnormality in the way the lower leg lines up with the hip, knee, and foot.

These conditions can interfere with the ability of the patella to glide smoothly on the femur (the bone that connects the knee to the hip) during movement. The friction between the under-surface of the patella and the femur causes the pain and irritation commonly seen in PFPS. Usually, patellofemoral pain is worse when you walk up or down hills or stairs and on uneven surfaces. This pain tends to increase with activity and improve with rest.

Common Problems
Anterior (Front) Knee Pain: Possible causes are having a seat or saddle that is too low, pedaling at a low cadence (speed), using your quadriceps muscles too much in pedaling, misaligned bicycle cleat for those who use clipless pedals, and muscle imbalance in your legs (strong quadriceps and weak hamstrings).

  • Neck Pain: Possible causes include poor handlebar or saddle position. A poorly placed handlebar might be too low, at too great a reach, or at too short a reach. A saddle with excessive downward tilt can be a source of neck pain.
  • Lower Back Pain: Possible causes include inflexible hamstrings, low cadence, using your quadriceps muscles too much in pedaling, poor back strength, and too-long or too-low handlebars.
  • Hamstring Tendinitis: Possible causes are inflexible hamstrings, high saddle, misaligned bicycle cleat, and poor hamstring strength.
  • Hand Numbness or Pain: Possible causes are short-reach handlebars, poorly placed brake levers, and a downward tilt of the saddle.
  • Foot Numbness or Pain: Possible causes are using quadriceps muscles too much in pedaling, low cadence, faulty foot mechanics, and misaligned bicycle cleat.
  • Iliotibial Band Syndrome (ITBS): Possible causes are too-high saddle, leg length difference, and misaligned bicycle cleat for those who use clipless pedals.

How a Physical Therapist Can Help
Your physical therapist will perform a series of tests to evaluate the knee, check flexibility of the muscles in your leg, observe the alignment of your feet, analyze your walking patterns and test the strength of your hip, thigh and core muscles to find out if there is a weakness or imbalance that might be contributing to your pain. After performing a series of tests to evaluate the knee, your PT will analyze, and prescribe an exercise program just for you.

Your individual program may include:

  • Strengthening exercises targeted at the hip (specifically, the abductor and rotator muscles of the buttock and thigh), the knee (specifically, the quadriceps femoris muscle, which is located on the front of your thigh and straightens your knee), the ankle and core.
  • Stretching exercises for the muscles of the hip, knee, and ankle.
  • Taping of the patella to reduce pain and retrain muscles to work efficiently.
  • Exercises for improving your performance of activities that have become difficult for you.
  • If the alignment and position of your foot and arch appear to be contributing to your knee pain, they may suggest a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by excessive rotation or impact during walking and running.
  • Recommend that you apply ice or heat for relief

Your physical therapist will work with you to help you stay active and maintain your fitness level. You may need to modify your activity level or change your training activities until you recover; your therapist will show you how to do activities and exercises that will not increase your pain. Most importantly, your therapist can make recommendations to help prevent PFPS from returning.

If you have any questions about the information in this article or would like to talk with a therapist about your exercise routine, we can help. Call Midwest Rehab today to set up a consultation: (217) 547-9108.

Underwater Marathon Benefiting Girls on the Run


Rounded photo web registerJoin the Orthopedic Center of Illinois Foundation to support Girls on the Run of Central Illinois with a fun twist on the traditional relay race!

Underwater Marathon benefiting Girls on the Run of Central Illinois
Saturday, March 7, 2015 • 8am-3pm
Midwest Rehab at the Orthopedic Center of Illinois


Twenty-six athletes of all ages and skill levels will complete one mile each on the underwater treadmill in the therapy pool at Midwest Rehab. Each athlete is encouraged to ask friends and family to pledge to support their mile so the runner can donate a minimum of $100. Runners must be at least 5’1″ to participate.

Sign up today to start your own fundraising page to share via email and social media. Runners will be able to choose their optimal run time through the reservation link on a first-come, first-serve basis. Prizes will be awarded, including Garmin race watches, for fastest time and highest fundraiser.

Midwest Rehab is located inside the Orthopedic Center of Illinois at 1301 S. Koke Mill Road (the corner of Koke Mill and Old Jacksonville Roads) in Springfield. Locker rooms are available for your convenience, but please bring a towel and bag for wet items.

All donations from the event will directly benefit Girls on the Run of Central Illinois.

Questions? Call (217) 547-9100.

Give the gift of relaxation and good health!

giftPicking out just the right gift for everyone on your holiday list can become tedious and stressful. Let Midwest Rehab help ease the stress with the gift of massage or fitness!

Throughout the holidays, purchase a gift certificate for three 60-minute massages for $150 and save $30! Half-hour massages are also available for $40 and one-hour massages for only $60.

Midwest Rehab is now offering individual and group fitness sessions with an exercise specialist. Book three or more sessions by January 15th and save 10%!

Call Midwest Rehab at OCI or stop in today to complete your holiday shopping.

1301 S. Koke Mill Road, Springfield
(217) 547-9108

Enjoy the Great Outdoors Pain Free

By Joe Williams, Physical Therapist, Midwest Rehab at OCI

As the days begin to shorten and the air begins to cool,
Raking Exercisethe fall season also brings to mind the beauty of the changing leaves.  But, the leaves that are so pretty on the trees are not so beautiful on the ground.  Getting them off your lawn and out of your landscaping is a seasonal challenge that can be a challenge to your body as well.  We want you to protect your body.

Before heading out to work in the cool air, we have some suggestions to help protect you from injury.  It is always a good idea to do some type of warm up before jumping to a task in the yard.  The body needs some time to get going, the blood to start pumping, and the joints to loosen.  A 5-10 minute walk can be just the activity that can help get you going.

Now that the body is going, it is important to choose the right equipment.  Many hardware stores will sell you broad rakes that pick up a lot of leaves with one pass.  While this might seem desirable at first, the larger the rake, the larger the load you are lifting.  Consider how much force it might take you to lift those leaves to bag them.  Wet leaves will be heavier than dry ones, which will also increase the load you lift.  Rake heads may vary from 8″ to 30″ or more.

As you start to use the rake you have chosen, it is very important to watch your posture.  Raking is by nature an activity in which we flex the spine often.  This can create quite a strain on the back.  Try to keep the back upright and use your legs to step forward and back with the raking motion.  After 15 minutes of raking, it is also a good idea to stop and stretch.  After repeated flexing, it is good to extend the spine arching the back in the opposite direction.

Most of us prefer raking leaves on one side or the other.  But, that can produce uneven stresses on the back and other structures.  You would be wise to switch your grip on the handle often, switching the lead hand as you rake.

Many people live where they must bag their leaves.  Be sure to lift with your legs, keeping the back straight, when you are picking up the leaves.  Your legs can do the lifting when you keep the chest up.  Tightening the abdominals as you lift can help support the spine as well.  This can be a good time to practice good body mechanics, so it will be good habit with any other lifting you may do around your home or work.

Above all, be safe as you prepare your house and yard for the winter ahead.  Autumn is a great season, and we want you to enjoy it.  If you have questions about information in this article or would like to discuss how to prevent injuries with a physical therapist, we can help. Call Midwest Rehab today to set up a consultation: (217) 547-9108.

Jow Williams 4x6Joe received his bachelor’s degree from St. Louis University. He practiced in a wide range of settings before focusing on orthopedics. He is especially interested in treating lower back and lower extremity pain and other orthopedic conditions.

This article was published in the October-December 2014 edition of ”FYI from OCI”, a quarterly publication created by the Orthopedic Center of Illinois. To see the full publication, click HERE.



Improve Your Core Knowledge to Prevent Injury and Improve Balance

By Duane Meyer, Physical Therapist
Midwest Rehab at OCI

From elite athletes to seniors, core exercises are acknowledged as an important part of any exercise program. They not only help athletes of all calibers perform at their best, but they are an important element in helping to reduce falls and injuries for seniors.absfinal

What exactly are the core muscles? Different experts include different muscles, but they all agree that they consist of the muscles of the abdominal region, the hips, and the back, including the deep muscles of the abdomen and back. The following are the most commonly included muscles:

  • rectus abdominus, front of the abdomen
  • internal & external obliques, abdominal front and side
  • transverse abdominus, deepest muscle of the abdominal wall located under the obliques and wrapping around the waist
  • erector spinae, running from the neck to lower back
  • multifidus, under the erector spinae and along the vertebral column to extend and rotate your spine
  • hip flexors, front of the pelvis and upper thigh
  • gluteus muscles, buttocks, outer thigh, hipadductors, the medial thigh

Benefits of core strength
Strong core muscles can help reduce back pain and improve balance, posture and athletic performance. While the abdominal muscles get most of the credit for protecting the back, it is the combination of the abdominals, the hips, and the back muscles that provide the foundation for maintaining normal posture and reducing the strain on the lower back.

Athletic performance is also improved by strong core muscles. The transfer of power to the arms and legs is provided by the stabilization of the spine. Powerful movement is accomplished from the center out, not from the extremities alone. We often hear of baseball pitchers working on leg, back, and abdominal strength to get more velocity on their pitches. The same is true for tennis players and their serve.

A strong core also improves balance and posture. Muscle imbalances and weakness can lead to poor posture which can lead to pain and injury. Muscle weakness and poor posture can also lead to poor balance, especially in seniors. In a 2013 article in Sports Medicine, studies showed that core strengthening can increase strength by 30% and balance and functional performance by 23% among seniors. Core strength training had an adherence rate of 92% based on a German study of 32 older adults, published in Gerontology in 2013.

Core strengthening is most effective when the exercises cross multiple joints and work together to stabilize the spine. A study published in March of 2013 in the Journal of Strength and Conditioning Research showed that exercises that move muscles farther away from the torso, such as buttocks and deltoids (shoulder muscles) elicited greater core activation than isolated exercises. A 2012 study showed that seated dumbbell exercises had an 81% lower rectus abdominus activation rate than standing dumbbell presses. Therefore, seniors should try to perform standing exercises when possible and safe.

There are many exercises that can strengthen the core. Many of them can be performed at home with little or no equipment. Abdominal bracing is a key element of core strengthening. To correctly brace, you should attempt to pull your navel back to your spine. This primarily recruits the transverse abdominus. You should avoid holding your breath when performing abdominal bracing and strengthening exercises. A core strengthening program should contain elements of spinal flexion, rotation, extension, and stability.

Pictures and instructions abound on the internet for core strengthening programs. However, you should check with your physician or physical therapist before beginning a new exercise program. Not all exercises are appropriate for every individual and every condition. Seniors with osteoporosis need to be especially careful with flexion and rotation exercises. Our staff is available to work with you on developing a program specific to your abilities and needs—call our office today to schedule a consultation: (217) 547-9108.

Duane received his physical therapy degree from the University of Iowa. Duane has worked in hospital and private practice settings for more than 30 years. His clinical interests are primarily in orthopedics and neuromuscular disorders.



This article was published in the July-September 2014 edition of ”FYI from OCI”, a quarterly publication created by the Orthopedic Center of Illinois. To see the full publication, click HERE.

Put Some Spring in Your Step for Better Health!

By Theresa Delvo, Physical Therapist
Director of Rehabilitation, Midwest Rehab

Walking to Improve Running460The weather has changed and now you’re ready to get out of the house. Walking is currently the most commonly reported form of physical activity among U.S. adults and is one of the simplest ways to exercise. It only requires a good pair of shoes, comfortable clothing and desire! Just a few extra steps each day is an easy way to maintain a healthier life.  The American Heart Association recommends at least 30  minutes of moderate intensity aerobic activity at least five days per week, at least 25 minutes of vigorous aerobic activity at least three days per week, or a combination of the two.

Start off your exercise or walking program slow and easy. For many, this means head out the door, walk for 10 minutes, and walk back. After a week, you’ll be ready to add five minutes to your daily walks. Continue to add five minutes until you are walking 30 minutes per day. When you have walked 30 minutes, you can increase your intensity by increasing your speed.

Checking your heart rate enables you to gauge the difficulty of your walk. You can check your heart rate by manually checking your pulse, or using a heart rate monitor. Most recommendations suggest beginning at 70-75% of your maximum heart rate (See Table 1). Keep in mind the standards of the traditional heart rate formulas do not fit everyone. You can also use the “talk test” to gauge your walking intensity. Talking pace means you have elevated breathing, but you can still carry a conversation. If you have been inactive for a long period of time or have any medical conditions, please consult with your physician before starting a new exercise program.


Remember to watch your posture. Walk tall, hold your head up, tighten your abdominal muscles and buttocks and swing your arms. To help prevent injury, warm up first, walking slowly the first five minutes and end your walk with stretching.  When you begin a fitness program, some muscle soreness the day after you exercise or walk is typical. Soreness is expected to go away with regular exercise, although if you experience pain or swelling, contact your doctor or physical therapist.

When picking out shoes, there are specific recommendations depending on the individual’s foot type, though general recommendations are to make sure the shoes fit properly and are comfortable. They should be wide enough for the toes to move freely, the heel should not slip and about a thumb width between your toes and the end of your shoe. Another suggestion is to go shoe shopping at the end of the day or after your walk when your feet might be slightly swollen. Replacing your shoes every 6-9 months or about every 250 miles is recommended to prevent pain or injury.

Staying motivated and developing a habit are the keys to a successful fitness or exercise program. Having a walking partner will help with accountability, and tracking your time and distance can also be beneficial. This can be as simple as using a journal to or as advanced as using one of the new technology products. Fitness apps for smart devices have become very popular and can track your progress, provide walking routes, track your distance and calories burned.

Start your spring off on the right foot and remember if you have questions on beginning a walking or exercise program, the Physical Therapists at Midwest Rehab at OCI can assess your movement, strength and flexibility and develop an exercise program to help you meet your fitness goals. Give us a call at 217.547.9108

DelvoTTheresa received her bachelor’s degree in Physical Therapy from Washington University in St. Louis. She has more than 25 years of therapy experience, primarily in the outpatient setting. Her professional interests focus on orthopedics, education and training to industry, workplace injury reduction and industrial rehabilitation.


This article was published in the April-June 2014 edition of ”FYI from OCI”, a quarterly publication created by the Orthopedic Center of Illinois. To see the full publication, click HERE.

Staying Balanced: What Keeps You on Your Feet

By Amy Blanford, PT, DPT
Midwest Rehab at OCI

balanceWhat are YOU afraid of? For those with balance problems, fear of falling is a very real and scary problem. Emergency rooms nationwide treat a patient every 15 seconds for a fall related injury (most of whom are in the 65+ age range). These falls frequently result in injuries that can have a lifelong impact. For those who fracture a hip, 20% end in death within the next year.

Balance is a very complex series of constant adjustments that help us stay upright. There are three systems that work together to maintain balance. Vision, sensory input from the legs and feet and the vestibular system of the inner ear all function in tandem to allow adaptation for changes.

The eyes help us stay oriented to the horizon ahead. When vision is impaired or if we have to function in the dark, the brain has decreased input to process for balance. As an example, if a person stands with their eyes open, it is usually easy to maintain quiet stance with no wobbling. If the same person closes their eyes and tries to stand quietly for 20-30 seconds, they will sense their body swaying slightly to try to adjust balance without visual input.

Sensory information from the legs and feet is critical for adjusting to changes in surface. Walking on a firm, flat concrete driveway is fairly simple. Crossing the yard requires constant alterations in balance to accommodate the bumps, slopes and holes that are common. If the sensation from the feet is impaired, the brain does not get clear messages about the surface under the feet. Sensation from the feet can decrease due to problems such as peripheral neuropathy, back problems and diabetes. Weakness in the lower extremities can also slow or decrease the balance reactions. Strengthening and proprioceptive training in physical therapy can help improve awareness and reaction time for the legs.

The vestibular system is located in the inner ear. Its primary job is to send information to the brain about where our head is positioned in relation to both the body and the ground. As we move our head, the vestibular system provides information about current position. During transitions from lying down to sitting, the inner ear is responsible for sensing when the body is erect. This prevents tipping over from sitting or overshooting the desired upright position. Conditions in which this system does not function correctly can cause dizziness with positional changes or head movements.

The staff at Midwest Rehab are trained to work with patients who have balance and dizziness problems for a variety of reasons. Often times treatment techniques include strengthening and stretching for the lower extremities. Balance and proprioceptive exercises help improve awareness of sensation from the feet and improved reactions to correct missteps and changes in the surface under the feet. Vestibular exercises and treatment can decrease dizziness with changes of position and head movements. Physical therapy can help to address balance and dizziness issues. So, don’t get scared, get STEADY with help from Midwest Rehab’s physical therapy staff.

Learn more about Midwest Rehab at or call (217) 547-9108 today to schedule an appointment with a therapist.

This article was published in the January-March 2014 edition of ”FYI from OCI”, a quarterly publication created by the Orthopedic Center of Illinois. To see the full publication, click HERE.

Give your Valentine the gift of relaxation from Midwest Rehab

Heart with MWR logoStill looking for just the right present for that special person in your life? Treat your Valentine to the gift of relaxation.  Midwest Rehab at OCI is offering a Valentine’s massage package with a licensed massage therapist. Stop by our office and pick up a gift certificate today!

Three 60-minute massages  • Only $150! •

• Also Available •
One hour massage: $60
Half hour massage: $40

Midwest Rehab is located in the Orthopedic Center of Illinois
1301 S. Koke Mill Road, Springfield
At the corner of Old Jacksonville and Koke Mill Roads
(217) 547-9108

Santa Claus at Midwest Rehab

By Joe Williams, Physical Therapist

‘Twas late in September, no snow on the ground,
And baseball season was just winding down
When what to my wondering eyes should appear,
But an old man in red, and he sobbed through his tears,

“I’ve injured my back,” said the white bearded man.
“I slipped off my sleigh, and I fell on my can.”
“Why, you’re Santa!” I said with my voice full of cheer
“SHH!” St. Nick scolded. “You cannot tell I’m here.”

“I’ve been all around. I’ve looked at the rest.
But, I’m coming to you, ‘cause I hear you’re the best”
We went right to work. We knew just what to do.
Exercise is a must, and we’ll start in the pool.

He got into the pool, a bit nervous at first,
But he liked that his head needn’t be submersed.
Soon his pain was diminished, just as we’d planned.
We said, “The water is nice, but you live on the land”

So, we moved to the gym, and continued to strive
Weight machines and Free weights to help the old man revive.
We instructed Old Santa in the best way to lift
So his back would not hurt as he delivered his gifts.

As the days moved on, and the nights grew longer,
Old Santa was growing thinner and stronger.
No more was the old chap covered in lard
His thighs were now firm. His pecs were now hard.

Halloween and Thanksgiving soon passed by
And we knew St. Nick would be saying “Good-bye”
He was now without pain for the holiday season
And was sporting the form of an athlete mid-season

As he left, he gave the staff quite a thrill
We watched as he drove off, north on Koke Mill
Glancing back as he drove, in a manner most cool,
He exclaimed, “One and all, have a Fantastic Yule!”

Call today to set up an appointment with a Midwest Rehab therapist: (217) 547-9108.