Are You Balanced?

Proprioception and Its Affect on You

To give you a little background proprioception, it is a sense of balance and knowing where your joints are in space without you observing them.

Poor balance can compromise our proprioception system.  This makes individuals more prone to injury resulting in falls, ACL tears, and sprained ankles.   Young females are more prone to knee injuries secondary to hormonal and puberty changes.  Proper training with core strengthening and balance activities individuals decrease their risk for injury.

Simple exercises like single leg stance with eyes open and then challenging yourself with eyes closed can help improve the proprioception system.  Then progressing to a wobble board or blue foam pad can also challenge the proprioception system.

Core stability training and exercises can be prescribed as warranted to help address your current deficits.  With proper core strength whether you are a current athlete or a have a job that involves sitting our core is our powerhouse, which can prevent back injuries and help our balance.

Overall appropriate proprioceptive training prescribed by your Physical Therapist can help you prevent future injury.  Please come into one of our three Intecore locations to be assessed properly by a Physical Therapist to prevent future injury.

By Layla Rabbani, PT, DPT



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Injury Q and A session with Dr. Chris Koutures.

Take a look at our new video, an in-depth Q and A session on youth baseball player elbow and shoulder injury, featuring Anaheim Hills, CA pediatric orthopaedic specialist, Dr. Chris Koutures, MD.



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A Pain In the Back

The Role of an MRI with Lumbar/Spine Pain

Low back pain is the most common cause of disability and lost work time in industrialized countries. Research suggests that 80% of those who experience back pain recover in 6-8 weeks and do not require extensive treatment. It is important to note that recurrences and flare-ups of low back pain are normal and do not represent a failure of treatment. This is the natural history of low back pain.

Lumbar/Spine (L/S) imaging is very effective in detecting fractures, cancer, and compression of the spinal cord/nerves. Fortunately, 99% of those with low back pain do not have these serious conditions. Research has shown that anatomic variations on MRI (Magnetic Resonance Imaging), including herniated discs and degenerative disc disease, are normal findings and are common even on those without low back pain. Therefore, one should be aware that bulging discs and degenerative discs do not necessarily indicate a serious condition. In fact, labeling low back pain in this manner often convinces the patient that they have a serious problem. Research has shown that those with non-specific low back pain tend to have worse outcomes when an MRI is performed versus when no MRI is performed.

In conclusion, most incidences of low back pain resolve in the short term followed by incidences of recurrence or flare-up. 99% of the time an MRI is not necessary and may actually act to worsen symptoms by labeling a problem and creating a negative emotional response. Because of this, national guidelines call for restricting the use of MRI in patients with non-specific low back pain.









By Adam Skrove, MPT, OCS

Intecore Physical Therapy

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Common Runner’s Injuries

injuryI have vast experience as a runner, and have been treating runners for almost 30 years. Runners can have a wide assortment of injuries; many of these can require physical therapy to recover from. I am going to review some of the more common injuries that runners can develop, how to recognize them, and what you should do to treat them.


The first and probably the most common runner’s injury would be Shin Splints. I have often felt this is a garbage can term for pain along the anterior shin. Shin Splints can be several different injuries, including Medial Tibial Stress Syndrome. It is characterized by pain on the inner edge of the tibia or anterior tibialis tendon. It can become inflamed from the pounding the lower half of the body takes with the act of running, running on hard surfaces or poor arch support and control. This is often treated with rest, icing, and putting an arch support in your shoes. I would recommend going to a knowledgeable running store and making sure your running shoes are appropriate for your foot type.


Another common running injury is Iliotibial Band Syndrome (ITBS). This can develop from increasing mileage too quickly, changing surfaces from a soft one to a hard one, and worn out shoes. ITBS is caused by the Iliotibial band (ITB) and friction where it crosses the knee. The ITB rubs on the lateral surface of the knee with running; it can become inflamed causing pain over your lateral knee. Typically it only hurts when you are running, and for a period of time after your run. Normal daily activities rarely cause pain. Recommended treatment would be ice, stretches to your ITB, massage and rest.running 2

Lastly Patellofemoral Stress Syndrome (PFSS) is yet another common issue runner’s deal with. This is caused by tight muscles (Hamstring, Quadriceps, ITB) causing the knee cap (Patella) to track laterally which causes inflammation of the cartilage under the patella. This injury typically hurts with running, sitting for long periods like a long car ride or going to the movies (called movie goers sign). When running it is typically a sharp pain, yet when sitting it can be more like a deep ache in the knee. Treatment for this is ice, stretching exercises to hamstrings, Quadriceps, ITB, and calves. And when pain and inflammation improve quadriceps strengthening exercises will help as well.


Now I have touched upon a few the many injuries that occur with runners. A good rule of thumb if you can’t run pain free in 7-10 days, it is time to get in to your Physical Therapist for treatment. We can get you back on the roads and pain free.


By Bradon Griffith PTA, ATC, CSCS







Bradon ran competitively in high school and NCAA Division 1 Cross Country and Track and Field at Northeastern University in Boston MA

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Bursitis-What a Pain in My Hip!

hip painHip Bursitis

In between the femur (hip bone) and the lateral thigh muscles lies a protective fluid filled sac called the bursa. Bursa sacs are found in different areas besides the hip like the shoulder and knee.   They act as a cushion to prevent excessive friction of the soft tissue like our hip muscles to slide over the bone.

When an individual overuses or participates in repetitive activities that involve excessive hip flexion, extension and external rotation hip bursitis may develop. There are other causes of hip bursitis like leg length discrepancy, sacroiliac joint dysfunction, motor vehicle accidents, falls, bone spurs and gait abnormalities.  As with any inflammatory disorder, precaution and action should come into play.



Here are some of the activities to avoid with hip bursitis:

  1. Excessive stair climbing
  2. Sleeping on the affected side
  3. Running uphill
  4. Avoid sitting cross legged
  5. Avoid excessive standing and sitting
  6. Biking







Once you are diagnosed with hip bursitis there are proper steps and proactive measures to follow:

  1. NSAIDs
  2. Possible cortisone injection to help reduce the inflammation
  3. Sleep with a pillow between your knees at night to prevent excessive hip movement while sleeping on the unaffected side.
  4. Rest from the sport or activity that may be causing the excessive pain.
  5. Ice to the affected hip
  6. Possible Therapeutic Ultrasound to the affected hip
  7. Lastly proper strengthening exercises and stretches that will be prescribed by a licensed Physical Therapist.

Blog by Layla Rabbani, PT, DPT

Intecore Physical Therapy

Aliso Viejo Office

Reference: Orthopaedic Physical Therapy Secrets by Jeffery D. Placzek, MD, PT and David A. Boyce, PT, EdD, OCS

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Take Five! …and stretch the TENsion from your workday.






During the work day do you ever feel stiffness and tension in your muscles? This is a very common complaint for those working behind a desk. Here are some helpful stretches you can do to relax while at your desk.

  1. Shoulder circles- make circles with your shoulders, you will be bringing your shoulders to your ears then pinch your shoulder blades together, last part is bringing the front of your shoulders forward thus completing the “circle”. (repeat sequence 10 times)
  2. Neck stretches- making sure that your shoulders are not rising up, bring your left ear to your left shoulder and hold for 30 seconds. Repeat on the other side alternating to finish 3 times on each side (left and right)
  3. Shoulder blade stretch- interlace your fingers and bring your arms outstretched in front of you (palms facing away from you), hold for 30 seconds and do it 3 times.
  4. Triceps stretch- bend your right elbow and raise it towards the ceiling while holding it with your opposite hand. You should feel this stretch on the backside of your arm. Hold for 30 seconds repeating 3 times on each side
  5. Low back stretch- while sitting in a stationary chair with no wheels hold onto the back of your upper leg behind your knee and gently pull towards your chest. Hold this stretch for 30 seconds and doing it 3 times on each side

neck stretxh

arm stretch

When stretching never go beyond your comfort zone. If you are stretching and start to feel pain and or tension stop immediately. Remember to breathe in slowly and deeply during stretches, never holding your breath.


~Heather Hunt, PTA

Intecore Physical Therapy

Aliso Viejo Office

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Should You Eat Like A Caveman?

cavemanThe paleo diet is a low carb diet which recommends consuming only the foods available more than 10,000 years ago, during the Paleolithic era. The assertion is simple: diseases like obesity, diabetes and heart disease are illnesses “of civilization” and so, to combat the ill effects of the modern diet, we should return to a pre-civilization, hunter-gatherer diet of meat, fish, fruits and vegetables. That means all gains from the agrarian revolution — grains, dairy, legumes, salt and sugars — are off the menu.

A study published in 2009 in the “European Journal of Clinical Nutrition” concluded that a Paleolithic-type diet improves blood pressure, glucose tolerance and lipid profiles — even without weight loss — and increases insulin sensitivity while decreasing insulin secretion. In 2010, “Nutrition & Metabolism” published a study stating that, per calorie, the Paleolithic diet is more satiating than the Mediterranean diet. A study published in 2009 in “Cardiovascular Diabetology” concluded that the Paleo diet improved glycemic control and cardiovascular risk factors in those with Type 2 diabetes.

So should you do it? Critics state that nutrients in legumes, whole grains, and dairy help to lower one’s risk of osteoporosis and cardiovascular disease, lower blood pressure, and maintain a healthy weight. Critics also state that the diets restrictive nature may result in initial weight loss followed by binge eating. I suggest utilizing the aspects of the paleo diet which work for you, eating colorful foods, eating foods which look like they did when they came from the earth, avoiding frequently eating high fat meats, and staying active all day, every day.


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Avoiding Common Injuries In Little League Baseball

bballYouth baseball throwing injuries are on the rise across the country. Increases in participation coupled with the popularity of year round travel teams and player showcases (play multiple games in a weekend without strict standards for pitch counts or numbers of innings pitched) has orthopedic specialists treating overuse injuries (typically seen in the professional ranks) at the youth league to high school levels.

Two main areas injured in throwers are the rotator cuff muscles in the shoulder and the ulnar collateral ligament found on the inside of the elbow (popularly known as it is the ligament repaired in the “Tommy John” procedure). The impact of youth injury is more substantial as not only muscles or ligaments may be injured but also the non-fused bone (growth plates) found both in the shoulder and inside of the elbow. Growth plate injuries can cause abnormal development of the elbow and shoulder possibly leading to future inability to throw and post-traumatic arthritis.


The number one statistical cause of youth arm injury in baseball is overuse and throwing with arm fatigue. Arm fatigue is caused by excessive throwing but can be compounded by sports training in general. Parents are investing hundreds of dollars per month with the hopes of making their 9-17 year-old stronger and faster than the competition. Sports training facilities are more popular now than ever before and are more than willing to take parents’ money without considering the long term impact of overtraining a young athlete. Training programs designed to improve performance may be overstressing young joints and contributing to muscle fatigue. Experts feel the unrealistic performance standards of parents, performance trainers and coaches put the child at risk and don’t consider their health first.

What to be aware of

●High velocity throwing: Pitchers enjoy the success of overpowering the competition. As velocity increases, stress on the shoulder and elbow joints also increases. The growing body may not be equipped to tolerate this stress so players with above average throwing velocity should be closely monitored for arm pain.

●Overtraining: Participating in similar activities requiring an overhead motion (baseball and swimming or tennis), year round participation or over training/practicing does not allow the young player’s muscles and tendons to recover properly. Young athletes need time-off from organized sports participation.

●Throwing too much too soon: in the early weeks of the season, young arms are adapting to the increase in training and stress from throwing. To minimize soreness and fatigue players should start throwing gradually and increase as the body acclimates.

●Restricted or painful joint movement: If your child complains of pain during or the days after throwing and have pain with movement or limited motion with comparison to the other arm, seek attention from a medical professional familiar with sports injury.

What parents can do:

●Parents are the youth players advocate.   Communicate and be proactive when it comes to your player’s league rules and with coaches in regard to training and pitch counts. Does the team use pitch counts even if the league doesn’t require it? What are the Coach’s expectations and limits?

●Keep track of how much your player is throwing in practice and at home. Rest is necessary for the young arm and body in general to recover from practice and games. Pitching practice in the backyard with mom or dad that the Coach may not know about contributes as much to arm fatigue as team practice and games.

●Don‘t let your child pitch with elbow or shoulder pain. If pain persists, seek medical attention.

●Avoid pitching/throwing on multiple teams and/or year round: The USA Medical and Safety Board Advisory Committee recommends at least 3-4 full months of complete rest from throwing every year.

●Communicate with your child about how their arm feels. Is there any pain when throwing? How about after?

What Coaches can do:

●Warm-up players up properly

  • Don’t pitch or use a player at catcher that complains of arm pain. Ask the parents if the player complains of arm pain at home.

●Report complaints of arm pain to parents and ask that they follow-up with a qualified medical professional.

●Emphasize proper throwing mechanics; if you aren’t familiar with proper mechanics seek outside education or assistance for your players.

●Avoid pitching a player on consecutive days.

●Avoid teaching breaking pitches until age 14. Master the fastball and change-up first.

●Adhere to pitch counts and required rest limits.

●Minimize throwing in practice for players who recently pitched; maximum effort throwing from the infield or catcher position is stressful to the throwing arm and the number of throws are not counted. Be aware that rest days mean just that, rest.


With youth baseball leagues utilizing varying standards (see tables below) for pitch count and rest periods the responsibility falls on parents and coaches to closely monitor players for overuse and complaints of arm pain. Beyond verbal complaints, watch for subtle signs of arm pain or injury such as: decreased arm strength (decreased pitch velocity), unwillingness to attend practice or games, a change in throwing mechanics (dropping the elbow and pushing the ball vs. throwing with the elbow up), decreased throwing accuracy, and pain that persists even after a period of rest from throwing.

The most important thing to remember as a parent or coach, listen to your player when they complain of arm pain. Only they can feel their pain and the “throw through the pain” mentality puts young players at risk for a serious injury that could have long term effects.

This information was composed and reviewed by:

Dr. Andrew Vertson, PT,DPT, ATC (owner of Intecore Physical Therapy in Orange, Aliso Viejo, and Foothill Ranch). and Eric Welker MA, ATC, PTA. For more information or a free 30 minute arm injury assessment of your youth baseball player, please call:

(844) 468-7800 or visit

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Healthy & Happy Feet

Avoid Injury, Proper Footwear Selectionfeet 8

Running and walking are two of the most pure forms of exercise around. But choosing the wrong athletic shoe can have you end up lying on the couch nursing an injury. While most sporting good stores have knowledgeable sales people to guide you, you’ll be a few steps ahead of the game if you’re armed with some basic knowledge about your feet and their specific needs.

Know your foot. Feet come in a variety of shapes, knowing the type of foot you have will help you to make the right shoe selection. A way to determine this is to do the “Wet Test”. Wet your foot and step on a piece of brown paper and trace your footprint. If your footprint shows the entire sole of your foot with little to no curve on the inside, you have low arches or flat feet and will tend to over pronate, feet rolling to far inward. You’ll want a shoe with a motion control feature and maximum support.

If the footprint shows only a portion of your forefoot and heel with a narrow or no connection between the two, you have high arches and will tend to underpronate or “supinate”, meaning your feet roll outward. Look for a shoe with a soft midsole. You have a neutral arch if your footprint has a distinct curve along the inside and your shoes wear out uniformly. Look for a stability shoe which has a good mix of cushioning and support.

Choosing the Right Shoe. You need to choose the right shoe for the kind of workout you’ll be doing. A shoe made for running is very different from a shoe made for basketball or tennis. Running shoes have no lateral stability, they are made to go straight. Court shoes are made for lateral movement which is a huge requirement of sports such as basketball and tennis. Even walking shoes are different than running shoes. Running has a heavier impact than walking, and walking shoes should be stiffer than running shoes. A cross trainer can work, which has some lateral support, but you perform a certain type of exercise (Court vs. Running) 3 times a week or more than you should choose a corresponding shoe designed for that sport.

Benefits of a Proper Shoe. Choosing the proper shoe can help to protect you against common injuries associated with your type of workout. Good shoes can lessen the impact of your step and cushion the foot from heavy landings. In addition, sport specific shoes can improve your performance, enabling for example, quick direction changes.

Improper workout footwear can cause a number of injuries. Besides the more obvious injuries, including ankle sprains, fractures, bunions, some lesser know injuries such as Metatarsalgia. This is a condition that presents as pain in the foot which can be worsened by poorly fitting footwear.

Replacing Your Shoes. Worn out athletic shoes do not provide your feet with adequate protection during your workout. Running shoes should be replaced every 350-500 miles. Look more at the midsole to determine the condition of your shoe vs. the bottoms. Midsoles wear out faster and provide most of the shock absorption; poor midsoles can cause injury and decrease performance. Remember new shoes can be much cheaper than a trip to the doctor.

feet 3

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The Summer Misadventures of “Bruiser.”

imagesCATYFNZFSummer is here, and the activities available to those of us in southern CA are endless! I for one, am a HUGE fan of summer and being outside and active. Whether it’s riding bikes on the boardwalk in Huntington Beach, hiking in Peter’s Canyon, or playing catch with my boys at the park, I’m a happy person when I’m outside in the sun and getting some exercise.

I recently attempted a couple new activities, as I am always hoping to find fun ways to get exercise and keep it exciting and different. So I decided to try mountain biking. Grabbed my helmet, padded shorts and gloves, and was off to try my new adventure. I did have a more experienced friend along for safety’s sake, and thankfully so. As I had a very nasty crash coming down a rocky hill. I suffered minor flesh wounds, but was able to snap the visor back onto my helmet and ride out tof the park. (I did get a lot of stares from fellow bikers and hikers as I departed…)owie

My next adventure in new summertime activities is one I have wanted to try my entire life, and yet have never had the opportunity or a skilled person to take me out….until now. I FINALLY got an invite to go surfing last weekend. The text came at 11:30pm on Friday night, from a friend I have hounded for more than 2 years. He simply said, “Okay. Surf in the morning. 0700 pick up time.” I was eccstatic! Couldn’t believe it was actually true. Had to text back several times to make sure he wasn’t just toying with me. But he was serious, so I began rumaging through recently packed boxes scattered around my kitchen (we are in the middle of a move) looking for my $5 score on a spring wetsuit. (I got it for stand up paddleboarding, but that too has proved to be elusive to me). I was up the minute my alarm went off at 6:45am and had coffee in hand. Which NEVER happens on a work day, mind you…

sunglasses? check.

wetsuit? check.

flipflops? check.

baseball cap for frizzy hair? check.

I was ready to go! We tried several beach loactions for a place that wasn’t completely crowded and yet still had a little bit of waves for me to try out. Found one in Huntington Beach and headed to the water. I had his “longboard” which even my ape-like arms barely reached around enough to hold. He had me try to do a few “pop-ups” and was satisfied that while I have never done burpees, I had mastered enough to hop up on a surfboard while it was floating on a wave of water. (I was less convinced, but went with the flow). So we headed out, and I was relieved to find out that despite the outdated wetsuit, I was surprisingly comfortable in the water. It was extremely warm for southern California beaches so early in the summer. Nice.

I reached about stomach sized water when the first decent wave hit me. Uhhhhh oh. What did he say to do when I get tumbled by a wave??? Oh yeah, “let the board go.” So I did this as I was being tumbled underwater like a dirty sock in the washing machine, trying to maintain some kind of self-respect and get to the surface before he had to come save me. Sheesh, how emabrrassing. Then I suddenly felt pain in my right arm. Bad. No worries, I am NOT saying one word to him. As it has taken two years to get me out here, I am not going to be a whiner and never get asked again. “I’m good.” I shouted as I came to the surface. He laughed.

This thrashing of my body, and my subsequent re-paddling out, “Paddle, paddle paddle!” went on for quite some time, and he finally got me paddled out far enough to not be getting beat up by the waves, and we floated. I breathed and tried to expel all the salt water from my lungs, then noted him staring at my face. I wiped at my nose, assuming there was snot dripping out along with the salt water, but saw red instead. He said he had seen that I had a bloody nose but didn’t want to freak me out. WHAAAT??? Don’t we all know that sharks are drawn to blood??? Good gravy! I was shark bait.

I never did actually get to stand up on the board, but I did get a couple of really fun tasters of being pulled into the shore belly on the board. That was enough to make me want to go back for another try, or ten until I can pop up and land my feet on the board for one successful ride. When we got to the sand, I revealed my injury, and have since acquired my new surfing nickname, “bruiser.”

bruiserLovely. For those who know me, this is not the first time I have been blessed with such a ladylike nickname. I recall “Crash,” “Klutz,” and “Clumsy” among others. I suppose it could be worse. At least I didn’t drown, suffer a shark attack, or have to be rescued by lifeguards…Okay, I wouldn’t really have minded the last one… I will live to surf (or at least try) again. And, I finally attempted something I have wanted to do for more than 30 years. So far my summer is going pretty alright. I hope all of you have a fantastic summer, and fill it with things you have always wanted to do. Blessings!







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