4 Steps to Eliminate Shoulder Pain

Sh Workshop Close up

Time was made to present on the topic of 4 ways to eliminate shoulder pain this past February 23rd, 2016 with Kirsten Heath PT, DPT by the newest member of our staff,  Eric Chaconas PT, PhD, FAAOMPT.  In addition to his part time work with Vighetti & Associates Sports Physical Therapy, he is also the Assistant Program Director and a Professor at the University of St. Augustine.

Eric is particularly passionate about shoulder pathology and rehab as evident by his PhD work in the area.  During the workshop he discussed the basic anatomy of the shoulder, several more commonly known diagnoses such as rotator cuff injury/tear, frozen shoulder and shoulder laxity, and as the workshop was titled, the 4 steps to eliminate shoulder pain.

1st STEP was addressing thoracic mobility or upper back mobility during which Kirsten Heath discussed two exercises that can be used to maintain and/or increase mobility.

2nd STEP was shoulder blade strength with an emphasis on performing 2x more pulling exercises than pushing.

3rd STEP was to address rotator cuff strength with increasing in difficulty exercises demonstrated from by your side to in front of your head.

4th/Final STEP was emphasized as many people don’t progress far enough and get to this point.  It consisted of progressive closed chain (or when your hand is in contact with a surface, floor/wall etc) and overhead activity.  It is important as we utilize numerous muscles around our shoulder when performing closed chain exercises that will help keep our shoulders strong, and to be strong overhead for the shoulder is essential for everyday activities and especially when weight lifting.

Much more detail is included in the video below of what was previously mentioned so please check it out if you want some exercises to help you with the various steps or are curious about different shoulder conditions.

Also, during the workshop we practiced many of the exercises that were discussed, so below is some of the instruction on the thoracic mobility exercises and several of the shoulder exercises.

As always, If you have any comments, questions or concerns feel free to comment below, contact your local area physical therapist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.  Otherwise, we hope you learned something from the videos about how to best maintain shoulder health!

Running Related Injuries

running 2 legs

The good news is…we have been BUSY!  Bad news…this blog post with the videos from our Running Related Injuries workshop on February 1st, 2016 has taken a while to be edited and uploaded.  But, it is ready now!

In this workshop we planned to discuss 5 common running related injuries that we often see in the clinic, which included Plantar Fasciitis, ITB Syndrome, Hamstring Strain, Achilles Pain and Dead Butt Syndrome.  Due to audience interest, we also discussed the different types of Shin Splints as well as a little added bonus.  In addition, we took the time to separate each injury’s information so that you are able to pick and choose which video is pertinent to your current needs, so hopefully you will find the information convenient and useful.

As always, If you have any comments, questions or concerns feel free to comment below, contact your local area physical therapist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.  Otherwise, enjoy the videos below for each running related injury and a short video with generalized advice for our injured runners.

Plantar Fasciitis

ITB Syndrome

Hamstring Strain

Achilles Pain

Dead Butt Syndrome

Shin Splints

General Advice for our Injured Runners




Essential Exercises and Stretches for Runners

Running pic

It’s about time…We are finally done with editing the videos from our New Year’s Resolutions Workshop that took place at 1st Place Sports in St Augustine regarding the essential stretches and exercises.

We began by discussing the idea of Run to be fit, or Fit to Run and the reasoning why we need to be strong to be efficient and healthy runners.  See below.

For those that were not at this latest informational session, we started off with assessing mobility, stability and strength to help illustrate to those in attendance what will be beneficial to them with the following exercises and stretches.

We recorded one of the assessments at home, to help show those on the worldwide web, but many of the others require some assistance by a physical therapist to determine the results and therefore were not included.  But check out the one below on ankle mobility!

After we determined the group’s strengths and weaknesses, we provided some strength exercises that are often beneficial to runners.

Clamshells below were included in the talk, but the video was better previously and therefore is below.

We ended the session discussing the bare essential stretches for runners to perform once the run has been completed.

Calf stretches were also mentioned and follow.

Our next workshop is this upcoming Monday February 1st, A NEW DAY: MONDAY!  We will be discussing various topics depending on audience preference with the possibilities of plantar fasciitis, hamstring strain, ITB syndrome, dead butt syndrome and Achilles tendinitis.

If you have any comments, questions or concerns feel free to comment below, contact your local area physical therapist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.

Foot & Ankle Strength Training

First off thank you to all those who made it out to our Foot & Ankle Strengthening workshop at 1st Place Sports in St. Augustine, we truly appreciate your enthusiasm and involvement.

The first video we have is of Steve discussing several different points important to mention when thinking of the foot and ankle.  He touches on plantar fasciitis, the reasoning and thinking behind barefoot running and what to consider when looking at various types of shoes styles.  Watch below to find out more.

Next, as we often do we start at the “core”, if you will, of the foot.  There are very small muscles in your foot only known globally as the intrinsics, and this first exercise focuses on addressing them….although slightly mentally challenging!

Heel raises, may seem common but many people do not perform them correctly or know that it is important to perform them sitting and standing to address different muscles…They can also be advanced by going from two legs to one, and even off a step!  Click below to find out more!

Many people also tend to have tight calves in our seated world, so below we include stretches to address both muscles of the calf.

We have yet to come up with a good name for this next exercise…beyond the fact that it works the tibialis posterior (or posterior tibialis, whichever you prefer) muscle.  However it is very important for many people who suffer from foot, shin and/calf pain.

Last but not least, balance exercises!  To be honest, we could have discussed these at any point during our work-shop series as balance does not just come from the foot and ankle but from your whole lower leg and core.  So walk through these balance exercises/tests with Kirsten, and see just how good (or poor) your balance really is!

If you If any comments, questions or concerns feel free to comment below, contact your local area physical therapist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.

Knee Strength Training

knee pain

Knee pain is a common injury with many runners.  From experience, we have often found this to be because runners like to run…and they don’t always like to strength train to make sure they are strong enough TO run.  But those who have suffered from pain while running and/or who have come to see us have learned that lack of strength training is often the reason why runners and others are experiencing these pains.  So before you get to the point where you have to come see us or seek out another medical professional, check out some of the exercises below to make sure the muscles around your knee stay nice and strong and are able to help protect your knees.

But first, to explain further the importance of knee strength training…

One of our favorite exercises is the squat.  Good form is the key here, as without it the exercise may even be contributing to your knee pain.  Also, you can increase the difficulty of a squat by adding weight or even by making it a single leg squat!

Lunges are next.  While these exercises may seem basic…they are.  But the unfortunate truth is so many perform them incorrectly or think they are beyond these exercises and move to exercises they are not yet ready for.  So the following videos take you through our lunges progression, going from the easier step back lunge to the progressively more challenging step forward lunge and lastly the lateral lunges which are vital for many runners to help strengthen appropriate muscles!

Step Back Lunge

Step Forward Lunge

Lateral Lunges

There are most definitely runners out there suffering from hamstring injuries as well.  So these next two videos are how to initially help strengthen those all important hamstrings starting with the hamstring walk outs followed by the hamstring bridges.

Hamstring Bridge Walk Outs

Hamstring Walk Outs

Lastly for those who made it out to our last work-shop at the wonderful 1st Place Sports here in St. Augustine, you will recall that we presented on the Romanian single leg deadlift.  Unfortunately due to technical difficulties, we are unable to include a video to show you know.  But they are a great exercise for what we call, the “posterior chain”.  This means that they are able to work all the muscles on the backside of the leg you are standing on including your gluts, hamstrings and calf muscles.  Hopefully we will have a video up in the near future, but feel free to check out our deadlifts video in the core and hip workshop or google in the meantime.

We ended this most recent workshop for questions and answers and officially ended the Vighetti & Associates Sports Physical Therapy knee workshop at 1st Place Sports.  Stay tuned for our next blog post, which will be outlining our ankle and foot strengthening exercises!

If any comments, questions or concerns regarding these exercises please feel free to comment below, contact your local area physical therapist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.


Hip and Core Strength Training

People have been reaching out to us to educate individuals regarding the importance of strength training among runners.  1st Place Sports and Vighetti & Associates Sports Physical Therapy teamed up to present to all those interested in a complimentary work-shop regarding core and hip strengthening by Steve Vighetti, MPT, MTC, FAAOMPT, CSCS and Kirsten Heath, PT, DPT.  We wanted to record the session so that we could share it with those that were unable to make it to the live event.  Unfortunately, there was some technical difficulty with the core strengthening portion of the work-shop but we were able to record all other exercises and included them below.

Why is strength training of the core and hip so important, well watch below to find out!

Below, is an earlier recording of Transversus Abdominis bracing that goes into even more detail than during the actual work-shop.

A quick review of some core strengthening, to progress to after initial mastering of transversus abdominis, in addition to diaphragmatic breathing and kegels is included below.

For the hip, we divided the work-shop into 2 parts in which we addressed strengthening the gluteus medius which is a muscle located on the side of your hip and then strengthening the gluteus maximus the largest muscle on your backside that are both vital to be strong for runners.

The first 3 strength exercises that we discussed were to address the gluteus medius and we tried to give you all an easy, medium and hard exercise.  By no means is it a perfect progression as there are many other exercises we might utilize between, but just to give you all an introduction!

Clamshells (Clams)

Side Plank with Clams

Side Plank with Leg Lifts

Next is the final series in the core and hip strengthening workshop in which we addressed the gluteus maximus.  It is similar to the gluteus medius series with a relative easy, medium and hard strength exercise with many potential exercises in between.

Bridges (with single knee to chest)




After this point, we broke for questions and answers and officially ended the first Vighetti & Associates Sports Physical Therapy workshops at 1st Place Sports.  Stay tuned for our next blog post, which will be outlining our knee strengthening exercises!

If any comments, questions or concerns regarding these exercises please feel free to comment below, contact your local area physical therapist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.

Real Women Lift (and Men too!)

Strength Training.  Who does it?  How do you do it?

Almost two months ago now, the clinic seemed to be receiving several patients that were affiliated with Real Women Lift.  The patients all had the highest regard for this local personal trainer and I wanted to meet her and see what she did.  I looked up her website online, http://realwomenlift.com/, and spoke with the owner, Cindy Treaster (see her beautiful picture below) who allowed me to come in and observe her training sessions.  A significant portion of her business is treating in small groups, 4-6 people for an hour with varying types of training methods attacking the entire body.  My interpretation is that this allows her to personalize her sessions and monitor the clients thereby providing great service, but allowing a more reasonable price for her clients.  I was so intrigued that I signed up for a month this past July for the 4 week session she hosts in the summer.

Cindy Treaster

I quickly learned that each session, she asks her clients if they have any aches/pain or tender spots and then alters the training session accordingly, which is wonderful.   In general I do think personal training is great, it gets people doing different routines and challenging their bodies.  For me personally, after designing treatment and exercise programs all day long, it is nice to just have someone else tell me what to do!  Also in particular to Real Women Lift, with my substantial schools loans from my wonderful doctoral education the small group price is a wonderful value!

Of course, the more individualized training and/or attention an individual receives the more personalized it can be for the client.  Hence, why I believe in my model of physical therapy with the 1-on-1 personalized attention for an hour where it allows you to address the patient holistically.  But with healthy individuals, who are looking to have someone assist you in your strengthening needs, I think Real Women Lift is a great option!  Especially for many of those runners we see who only run, and keep coming back to us and we say…”Do you strength train?” and you say what again?? (you know who you are…)  Whatever way you choose to strength train on your own, Real Women Lift, at a gym/fitness center, with a personal trainer, in your own home, WHATEVER, remember that your body wants you strong no matter if you are a desk job individual, recreational runner or elite athlete and it will scream at you when its weak spots start showing!

Often too people like to strengthen the “showy” muscles: 6 pack abs (rectus abdominis), biceps, triceps, upper traps, chest, lats etc…But don’t forget to strengthen those smaller and deeper muscles that keep you strong and stable like your rotator cuff muscles, deep ab muscle called transversus abdominis, the intrinsic muscles in your feet, etc.

If you have any comments, questions or concerns regarding strength training or physical therapy feel free to comment below, contact your local area physical therapist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.  If you are interested in learning more about Real Women Lift and live in the St. Augustine area as well, feel free to contact Cindy Treaster at RealWomenLift@aol.com.


Annual Check-ups with a “Peace” of Nutrition

As a physical therapy practitioner, my goal is always to treat patients holistically.  If an individual comes in for knee pain, I am not just going to look at the knee but also the hip, ankle/foot maybe even the back depending on what they tell me initially.  In addition, I don’t just ask about the pain, but I ask about what is limited functionally, about their past medical history, their goals from physical therapy and what not.  But, there is not enough time, in my opinion, to assess what is wrong functionally or is painful as well as look and screen 100% of the other areas and I want to be able to provide that information for my patients.

So, Steve and I spoke about this matter and we decided to start offering Annual Check-ups to provide that overall assessment of individuals.  We are able to look and screen hearing, mental health, nutrition, social behaviors, emotional health as well as cardiorespiratory health, sensation, vision, risk for disease etc.  That is all in addition to the more physical therapy aspects as well of aerobic capacity, balance, speed, core and functional strength, flexibility, posture and quality of certain movements.  It took us some time to develop these Annual Check-ups to ensure an individual’s overall wellness, but we feel confident that we not only have the screens put in place to help to identify an individual’s strengths and weaknesses but also the resources set to address things that are outside our scope of practice such as social and emotional well-being in addition to nutrition.

Speaking of nutrition…I recently met with Amanda Perrin a wonderful Registered Dietician Nutritionist and owner of Peace of Nutrition, LLC out off of SR 16 to discuss our nutrition screening aspects.  I was happy to hear how we were quickly screening nutrition was up to her standards and appeared to be appropriate for what we were doing.

Amanda Perrin Photo

After we got the business out of the way and speaking with her further, I learned that Amanda and I had numerous similarities including our desire to help mothers during pregnancy and afterwards with addressing wellness of the whole body.  She even offers a service called Mommy and Baby Grow that is specially designed for mothers, in addition to her being a certified lactation specialist!  We discussed potentially pairing up in the future with our Bounce Back to Baby program so that she can answer the nutrition aspect that new mothers often ask us when participating as it is a vital part of pre and post birth.

So who knows what the future holds?   But she definitely agreed if we have patients that require a nutrition consult through the annual check-ups, she would be willing to be a resource for them, so we are very happy in making this relationship.

Just as a little plug too, Amanda offers one-on-one nutrition counseling, personalized weight loss programs, medical nutrition therapy for disease management and prevention, diet analysis with personalized nutrient preferences, group talks, grocery tours, home visits and much much more!  In addition, she specializes in digestive issues and diabetes and also shared with me her passion for addressing childhood obesity.  Feel free to check out her website at www.peaceofnutrition.com or contact her directly at 904-377-6190 or aqpnutrition@gmail.com.

If any comments, questions or concerns for myself feel free to comment below, contact your local area physical therapist and/or nutritionist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.

Abdominal Bracing for Back Pain

If I only have time to give my patients with back pain one exercise, it would more than likely be abdominal bracing.  Abdominal bracing is working the muscle transversus abdominis which goes from the ribs to the pelvis and wraps from the front all the way around to the back.  It is often referred to as the natural back brace and hence why I find it so important with many patients because it helps support your spine.  In the beginning, I have patients starting with just laying on their back and gradually I progress with adding movement of the arms and/or legs, and then performing the bracing in sitting, standing, and finally with all functional movements such as squats, lunges, etc as the quality and endurance improves.  Check out the video above for details on how to initially perform abdominal bracing.

abdominal bracing

If any comments, questions or concerns feel free to comment below, contact your local area physical therapist or if you are in the St. Augustine, FL area contact us at info@vighettipt.com or 904-516-8121.


How to Decrease Neck Pain with a “Simple” Chin Tuck

Neck pain?  Who hasn’t had neck pain?  Whether it was from looking down at the computer too much, sleeping in an awkward position or after an ab work-out, we have all had some sort of neck pain.  Often in the beginning, people just have temporary neck pain, with the pain being for the most part gone within a day or three.  But when people get more concerned is often when it is lasting for a week, month, 6 months etc.  When they should be most concerned though is the beginning of the pain, because at that point in time who knows how long it is going to last.  Often when you have that first experience of the pain, it goes away fairly quickly and then you notice it happening again 6 months later…and again 2 months later. The neck pain begins happening more frequently and perhaps taking more time to let it go…and other things might start to bother you like headaches or shoulder pain because you start compensating due to the pain in your neck without even knowing.

Good news though…you can help your neck for the long haul.  With the below exercise, effects will most likely be more immediate for those who have been experiencing pain the least amount of time, the longer you have been dealing with the problem the more time it may take to take effect.  With that being said, it is helpful and necessary for nearly all individuals with neck pain…

I call this exercise a chin tuck.  The reason for the doing this is you have a muscle that tends to work too much, called in short SCOM, and you have muscles that become too weak that rest on the front of the vertebrae in your neck, longus colli and longus capitis which are behind your trachea and esophagus.  We want to help those smaller weak muscles work better so that they are able to stabilize your neck.

To do so…the most important aspect when starting out is to lie on your back!  In this position gravity will help you, and your neck muscles will not be fighting to hold your head up.  Now there is a muscle that runs from just behind and below your ear to your breastbone and collarbone (this is the muscle I mentioned, called the SCOM), you should be able to feel for its edges as it feels like a big twizzler, maybe ¾” in diameter.  If you are having difficulty finding it, try turning your head to the left and feel for the muscle on the right side of your neck.  After finding this, simply rest your finger lightly on top of it.  (If you start feeling lightheaded, dizzy, double vision, sweating, nauseous, anything similar in nature, simply remove your hand from the muscle, and stay laying on your back until it subsides within a couple of minutes, usually less.  I have never had a patient experience these symptoms, but there are some sensitive structures in the area you will be resting your finger, so just in case!)

Next, I want you to nod your head like you are saying yes.  You should NOT feel the muscle that you have your fingers resting on, SCOM plump up/get bigger/contract.  If so, try to nod a little less.  Once you are able to perform without the SCOM plumping up, hold for 10 sec and repeat 10x (if able to without the muscle plumping).  Stop the repetition if the muscle plumps as you are no longer using the correct muscles, longus colli and capitis, but you are using the SCOM.  Try again and hold as long as you can, within the 10 seconds, before SCOM plumps.  If you are only able to hold less than 3 seconds before SCOM plumps, discontinue the chin tucks and try again later in the day.

The key is to get those muscles I mentioned, longus colli and capitus, to have more ENDURANCE not necessarily strength, so don’t try contracting harder but if 10sec holds 10 times are a breeze, trying holding for longer.  These muscles will be vital in making sure that your neck pain goes away and doesn’t return later down the line.  So check out the video to give you perhaps a better idea than just my words, and if there are any questions or concerns feel free to comment below or if you are in the St. Augustine area feel free to email me at kirsten@vighettipt.com and if not please contact your local physical therapist.


Sports Physical Therapy