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Why Lateral Hip Pain Keeps Coming Back and What to Do About It

Santo Riva — Mon, 31 Aug 2026 09:30:37 +0000

You catch the outside of your hip getting out of the car. Then it wakes you when you roll onto that side at night.

That pattern is usually gluteal tendinopathy, a load-related change in the tendons anchoring your glute muscles to the greater trochanter, the bony bump on the outside of your hip. It is a common hip complaint we see at Victory Performance and Physical Therapy in Mar Vista, and it responds well to the right exercises in the right order, plus what you do with that hip the rest of the day.

Below is a phased loading program of the type the cited trials tested, with real sets and reps and the tests that tell you when to progress.

What Should You Rule Out First?

Get this checked before you do anything

Most lateral hip pain is a tendon problem, and much of it responds to graded self-management once you screen out the exceptions. See a clinician first if you have a fever, unexplained weight loss, or a history of cancer; the same goes for night pain that does not change however you shift, a leg that gives way, or sudden inability to weight-bear.

Two more: pain in your groin rather than the side of your hip, and a hip that feels weak rather than sore, since weakness can mean a larger tear needing imaging and a different plan. A self-guided program is also the wrong tool after a hip replacement. More generally, hip pain past two weeks, getting worse, or disturbing your sleep is worth an assessment.

Two other conditions change the plan. Hip arthritis hurts in your groin and stiffens with deep bending. In a runner who recently added mileage or hills, a femoral neck stress fracture usually brings worsening groin or thigh pain, though presentation varies; that one means stop running and get seen. Our hip pain page covers how they are told apart.

Gluteal tendinopathy sits over the greater trochanter, is tender to press, and rarely travels below your knee. One test carries real weight. In 65 people with lateral hip pain checked against MRI, pain within 30 seconds of standing on the sore leg alone moved the odds from a coin flip to roughly 98 percent, by the authors' figures. No tenderness over that bony bump largely ruled it out (Grimaldi et al., 2017, Br J Sports Med. View on PubMed).

The authors' cautions matter: the study was small, possibly underpowered, and 20 of the 65 had gluteal tendinopathy on MRI yet tested negative. A positive result is meaningful; a negative one does not close the case. This belongs in an examination rather than self-diagnosis.

How irritable the tendon is right now

Irritability, meaning how easily your hip flares and how long it takes to settle, is what decides where a program starts. Our Doctors of Physical Therapy work that out at your first visit. A common grading:

High. Night pain most nights, pain within 30 seconds of standing on that leg, and walking tolerance under 10 minutes. Programs of this type typically start you at phase 1, lying down.
Moderate. Stairs, hills and standing after sitting all hurt, but you sleep most nights. A common approach is phase 1, bringing the standing and light work in early.
Low. Pain only at the end of a long run, or a long day on your feet. Phase 1 often gets skipped, with the standing hold kept as a daily check.

What Should You Change Before the First Exercise?

For your first week, changing these positions is the treatment. One trial makes the point uncomfortably well. In 132 postmenopausal women with greater trochanteric pain syndrome, every group was taught to avoid compressing the tendon; on top of that education, targeted exercise did not outperform sham exercise at 12 or 52 weeks, and all groups improved (McMillan et al., 2022, Am J Sports Med. View on PubMed). One trial, one population, so exercise is not pointless. But de-loading does more of the work than most exercise lists admit.

The education arms of both trials taught every participant to avoid compressing the tendon. In everyday terms:

Pause the stretches that pull your hip across your body. Figure-four, pigeon and knee-across-chest all drive the thigh toward the midline, called adduction, which squeezes the tendon. (Hip-flexor stretching for knee pain is a different situation.)
Leg-crossing, and standing with your weight parked on one hip, are the habits to break.
Change your sleeping position. A full-length pillow between your knees and ankles keeps the top leg level. A folded towel at the knee lets your ankle drop into adduction for hours, and that applies on the good side too.
Foam rolling the sore spot is out. It compresses an already-compressed tendon.
Deep squats, low soft chairs and the adductor machine are dropped for now.
Hills, stairs and cambered roads (side-sloped streets) come out temporarily; flat walking is fine.

Not sure where to start? Our team can assess the hip and help you find the right starting point.

Call today: 424-543-4336

What Does the Program Look Like?

The doses throughout are representative of published tendon-loading programs, and we adjust them to the individual. Get individual clearance first if you are pregnant, post-surgical, or have osteoporosis or balance concerns. Those programs commonly use a pain-monitoring rule rather than demanding pain-free exercise. Here is a widely used version:

During an exercise, discomfort up to about 3/10 is acceptable; what matters is that it does not climb rep to rep.
Immediately after, pain stays within 1 point of where it started.
The next morning, it is back at baseline. Is it not? Then the dose was too much.

A mild increase that clears within the day means holding the dose rather than progressing. Pain that persists into the next day is the point to stop and have it looked at.

Phase 1, weeks 1–2: settle it down

Everything here is isometric, meaning a held position with nothing moving. How often? Usually daily, or every other day if your tendon is highly irritable.

Isometric abduction press, on your back. Knees bent, feet flat, with a band or belt around your thighs above the knees. Press your knees outward into it and hold. 5 holds of 30–45 seconds at about 70 percent of a hard push, 45 seconds rest.
Standing level-pelvis hold. Weight on your painful leg, other foot resting lightly on the floor, hip bones level and neither hitched nor dropped. 5 holds of 20–30 seconds each side.
Banded double-leg bridge. Band above your knees, feet flat. Press your knees out against it as your hips lift, hold, then lower slowly. 3 sets of 10, 3-second hold, 3-second lower.
Sit-to-stand. From a chair at about knee height, feet hip-width. 3 sets of 8, 3-second lower.

Phase 2, weeks 3–4: load through range

Progression is usually gated on both being true:

A 30-second standing level-pelvis hold at 3/10 or less.
Morning pain at baseline five days in a row.

This phase is usually trained three times a week on non-consecutive days. Daily loading of an unadapted tendon is a common self-treatment error.

Side-lying work is both the most-recommended exercise here and a compressive position. Which is it for you? Screen it first. Lie three minutes on your good side. If the painful hip complains, swap side-lying for standing band abduction, 3 sets of 12.

Offset bridge, building to single-leg bridge. Feet staggered with the painful side's foot closer to your hips so it takes more load. 3 sets of 10, 3-second hold, 3-second lower, typically progressed by lifting the other foot off.
Side-lying abduction over a pillow. On your good side with a folded pillow under the top thigh, so that leg never drops below level with your body. (Without lateral hip pain, as in our knee-pain posts, it needs no modification; with a tender greater trochanter it needs the pillow and the screen.) 3 sets of 10–12, 2 seconds up, 3 seconds down.
Step-up onto a 4–6 inch step. Lead with your painful leg, pelvis level; if your opposite hip drops, the step is too high. 3 sets of 8 each side, 2 up, 3 down.
Half-depth split squat. One foot forward, one back, on parallel tracks rather than a tightrope. 3 sets of 8 each side, 3-second lower.

Phase 3, weeks 5–8 and beyond: build capacity

Typical criteria for moving on, and you want all three:

3 sets of 12 single-leg bridges with the pelvis staying level.
3 sets of 10 step-ups onto an 8-inch step.
A 30-minute walk including stairs, no flare outlasting the next morning.

This phase is usually two heavy sessions a week; the load is the point.

Loaded single-leg deadlift or hip hinge. Weight in the opposite hand, hinge from the hip. 3 sets of 8, 3-second lower.
Weighted step-up onto an 8-inch box. Dumbbells at your sides. 3 sets of 8 each side.
Heavy slow abduction on a cable, machine or band, standing tall. 3 sets of 8, 3 seconds out and 3 back.
Side plank, from the knees first, then the feet. 3 sets of 20–40 seconds.

A common loading rule: start with a weight you can manage for about 12 reps, then progress toward one leaving 8 hard but clean reps. If you get 15, it is too light. Under-loading is this phase's failure mode, and where supervised personal training pays off.

Symptoms can fluctuate when loading changes, and an early week often coincides with two things moving at once: training volume rises, and because the hip feels better, the old sitting positions creep back. Judge the plan on the trend rather than any single day. If next-morning pain stays raised or the trend is worsening, reduce the dose and get it reassessed.

Is Exercise Better Than an Injection?

The largest trial randomized 204 people aged 35 to 70 with MRI-confirmed gluteal tendinopathy. At 8 weeks, load-management education plus exercise beat both corticosteroid injection and wait-and-see on self-rated improvement and pain intensity. At 52 weeks it kept its edge over injection on overall improvement, though the pain gap had closed (Mellor et al., 2018, BMJ. View on PubMed). The authors call that support rather than proof.

A 2024 review pooled three trials covering 383 people, and its headline is the caveat: certainty graded low to very low. Within that limit, exercise beat minimal intervention for function, and no significant difference was found between exercise and injection for pain (Patricio Cordeiro et al., 2024, Sci Rep. View on PubMed). No significant difference is not proof of none; the ranges were wide. Hold it loosely.

Where shockwave fits. If your hip plateaus after months of consistent loading, shockwave therapy (EPAT) sits alongside the program rather than in place of it.

How Do You Get Back to Hills, Stairs and Running?

Before running is reintroduced, the usual markers apply: no pain on stairs, no discomfort after sitting a while, no limping or guarding. A five-minute easy jog with no pain during it or in the 24 hours after is a meaningful green light. If symptoms rise even mildly, it is not ready yet.

Get a Program With Numbers On It

The difference is rarely the exercise list. It is irritability, your daily positions, the dose, and the progression criteria. The trials run 8 to 12 weeks to their main result, so set your expectations in months rather than weeks. That is what an appointment at Victory Performance and Physical Therapy in Mar Vista is for. Our programs are always tailored to you. Our physical therapy page explains how we work, and a free initial consult pins down your starting point.

Book your evaluation today.

📅 Book Your Appointment

📞 Call: 424-543-4336

Why Knee Pain From Cycling Keeps Coming Back and What to Do About It

Santo Riva — Fri, 28 Aug 2026 09:30:06 +0000

You have moved the saddle three times this month. The knee still aches at minute forty, in the same spot. So you move it again.

This is a common frustration we hear from riders at Victory Performance and Physical Therapy in Mar Vista. Usually it is one of two things: either the bike asks your knee for a position it does not tolerate, or your riding has outgrown what the knee can handle. From the saddle those feel identical, and need opposite fixes.

A bike fit and a clinical knee assessment answer different questions. Fit changes what the bike asks of you; testing looks at whether the knee can meet that demand. Riders often work the fit checklist twice over without anyone asking the second.

What Is Cycling Knee Pain?

"Cycling knee pain" is not a diagnosis. It tells you when your symptom shows up, not what is producing it; at least six different tissue problems hide under that phrase, and each one wants a different fix from you.

So what makes cycling different? Repetition. At 90 rpm, your one-hour ride is roughly 5,400 pedal strokes per leg through a narrow, fixed arc. Low impact only means the absence of jarring; it does not mean low load on your knee.

Among professional road cyclists asked about the previous twelve months, 36% reported anterior knee pain, meaning pain at the front of the knee, and knee injuries were the ones most likely to cost a rider training time (Clarsen et al., 2010, Am J Sports Med. View on PubMed). That was a professional peloton, so the 36% does not transfer to your Saturday group ride. The pattern does: in a sport with no impact, the knee is still what stops people riding.

When to Stop Adjusting and Get It Looked At

If the knee swells, locks, catches, or gives way, or if it hurts at rest and at night, stop adjusting and get it assessed. Those are joint symptoms, not loading symptoms. Saddle height does not change them.

Past those, here is when we would rather see you than have you keep experimenting:

You changed the bike and nothing changed. Three adjustments, no response; you are working the wrong variable.

The pain shows up off the bike. Stairs, squatting, getting out of the car. Millimeters will not fix it.

The same knee has done this before. A recurrence means your first episode never fully closed out.

It started when you came back from time off. The knee that handled hundred-mile weeks in May is a different knee in September.

It has lasted more than two weeks, or is getting worse. That is a general threshold for any pain worth having looked at.

Nothing below is a diagnosis, the pain map included; it sorts riders so the first thing you try is the likeliest.

What a Physical Therapist Looks For

Where does the pain sit?

Where your pain sits narrows the field, though it will not identify the tissue on its own.

Front, around or under your kneecap. Most often patellofemoral pain, meaning irritation of the joint between kneecap and thigh bone; sometimes patellar tendinopathy, the tendon just below it.

Outside. Usually the iliotibial band, the connective tissue running down the outside of your thigh. Stretching does not meaningfully lengthen it; hip-focused strengthening is where the evidence sits.

Inside. Either the inner side of your kneecap joint, or the pes anserine tendons just below the knee.

Behind. Often over-extension, where your leg straightens too far at the bottom of the stroke; usually a saddle that is too high or too far back.

Those two front-of-knee possibilities behave differently, which is how they are told apart. Tendon pain warms up: sore for ten minutes, quieter mid-ride, worst next morning, tender on the bottom tip of your kneecap. Patellofemoral pain builds as the ride goes on, and sustained bending makes it worse, so long drives aggravate it too.

Is it the bike or the training?

This is the most useful question to answer, and you can usually bring a good guess to your appointment.

The bike is the leading suspect if the pain appeared within one to three rides of a change to your saddle, shoes, cleats, fit, bike, or trainer, if it feels the same on easy rides as hard ones, and if it leaves you alone off the bike.

Your training is the leading suspect if it followed a jump in volume or intensity with no equipment change, is worse on climbing days, and turns up on stairs, squatting, or getting out of low chairs.

The short version: if your knee already hurts on the stairs before you get on the bike, the problem is unlikely to be solved by saddle position alone. That points toward capacity. The tissue is not currently handling what is being asked of it, and capacity gets built rather than adjusted.

How much does saddle height matter?

More than any other single adjustment. A 2011 review reported that a 5% change in height altered knee mechanics by about 35% and knee moments by about 16%, and that pressure behind your kneecap appears to rise as the saddle drops. On what they called conflicting evidence, the authors recommended setting height by knee flexion angle, at 25° to 30° of bend with the pedal at the bottom (Bini et al., 2011, Sports Med. View on PubMed).

Treat that as a starting point rather than a proven injury-prevention number; the authors call the evidence limited. Bike fitters commonly change height no more than 5mm at a time and ride it a week before judging. Give cleat changes a week too; cleats sit behind a disproportionate share of inside and outside knee complaints.

Cadence and Gear Selection

In twelve competitive cyclists riding at a hard sustained effort, a joint-force model estimated that 90 rpm produced a 29% smaller peak force pressing the kneecap against the thigh bone than 70 rpm did. Force through the main hinge of the knee was not much affected by cadence or workload (Bini & Hume, 2013, Sports Biomech. View on PubMed).

That 29% is a modeled estimate in trained riders. It is a direction, not a dose, and it is not evidence that a high cadence prevents injury. Even so, if you are grinding a big gear at low cadence, a modest increase is worth trying. Are you a masher? Then cadence is the one change that costs you nothing to try.

Can your leg actually do the work?

Cycling hides a weak side better than almost any sport, because the pedals hold both legs on a fixed path whether or not both contribute. If your knee tracks cleanly for ten minutes and falls inward at thirty, that is usually endurance rather than alignment. Our knee pain clinic page describes how we use the VALD force plates, because riders can rarely feel the difference.

Not sure whether it is your bike or your training? That is what our evaluation sorts out first, before building a loading plan you can run alongside your riding. Book a free initial consult.

Call today: 424-543-4336

What Does an Eight-Week Strength Program Look Like?

Bike changes alter what your knee is asked to do; strength work changes what it can absorb. This is the half riders skip. What follows is one example of how a program like this is structured. Each phase is best dosed after strength testing rather than taken off a page, and our programs are always tailored to you.

Get individual clearance first if you are pregnant, post-surgical, or have osteoporosis or balance concerns. Programs of this type usually run on pain rules borrowed from tendon and patellofemoral loading research:

Discomfort up to about 3/10 during a movement is generally acceptable if it settles within 30 minutes.
A mild stiffness that clears within the day means holding at the previous dose rather than progressing. Knee pain that persists into the next day is the point to stop and check in with a clinician.
Progression usually requires both: every set within that threshold, and the next morning no worse. Riders who stall tend to meet the first and ignore the second.
Visible swelling is a stop sign.

Weeks 1 and 2, settle it down and keep it loaded. Isometrics are holds with no movement, and they are usually what an irritated kneecap joint accepts first.

Wall sit at about 60° of knee bend. Commonly 5 holds of 30 to 45 seconds with 60 seconds rest, most days. Back flat, shins vertical.
Side-lying hip abduction. Often 3 sets of 12 each side, three days a week, 2 seconds up and 3 down. A 2 to 5 lb ankle weight gets added once every set stays inside the pain rules.

Weeks 3 and 4, slow and heavy. Typically three non-consecutive days a week, mostly single-leg work, because two-legged exercises hide a weak side exactly the way your pedals do. The three-second lowering is the exercise.

Split squat. Commonly 3 sets of 8 each leg, 3 seconds down, a 1-second pause at the bottom, 90 seconds rest.
Step-down from a 6-inch step. 3 sets of 8 each leg, 3 seconds lowering, heel tapping without dropping. Programs typically move to 8 inches once the knee stays over the mid-foot for every set.
Romanian deadlift. 3 sets of 8, 3 seconds lowering, 90 seconds rest. Knees softly bent, hips back until the hamstrings load, back flat.
Standing band abduction. 3 sets of 12 each side with a band around the ankles, taking the leg out sideways without leaning.

Weeks 5 to 8, build capacity. Usually twice a week and heavier.

Loaded step-up to an 8 to 12 inch box. Commonly 3 sets of 6 each leg with full 2-minute rests, dumbbells in hand.
Single-leg squat to a box. 4 sets of 6 each leg, 3 seconds lowering, sitting down under control rather than dropping.

Load or height typically advances only when both pain rules are met; if you are unsure, hold the week rather than adding.

What about everything else? The 2018 international consensus statement on patellofemoral pain recommends exercise therapy combining hip and knee work, plus combined interventions and foot orthoses. It does not recommend joint mobilization on its own, or electrophysical agents. It puts patellar taping, bracing, dry needling, manual soft tissue work, blood flow restriction training, and gait retraining on an explicit uncertain list (Collins et al., 2018, Br J Sports Med. View on PubMed). That statement covers patellofemoral pain generally rather than cycling, and research on gait retraining and manual therapy combined with exercise has moved on since 2018.

Can You Keep Riding While It Settles Down?

Usually yes. Complete rest is a common misstep: four weeks off hands back the same knee with less capacity than it started with.

For the first two weeks, a common approach is to cut weekly volume by about a third, hold cadence around 85 to 95 rpm, and drop climbs, standing efforts and sprints, where pedal force spikes. On a trainer, watch ERG mode: it holds power while your cadence sags, the exact combination to avoid.

Hard riding comes back one element per week: climbing, then intensity, then standing efforts, so each week shows which your knee objects to. Common criteria before moving up: two straight weeks with no ride pain above 3/10 and no extra stiffness after your longest ride.

Tired of guessing? Victory Performance and Physical Therapy works with riders across Mar Vista, Culver City and the Westside, building the strength work that supports a knee. At our Mar Vista clinic, our Doctors of Physical Therapy provide one-on-one care, and our programs are always tailored to you. Book your evaluation today.

📅 Book Your Appointment

📞 Call: 424-543-4336

Why Your Headache Might Be Coming From Your Neck and What to Do About It

Santo Riva — Mon, 24 Aug 2026 12:52:47 +0000

Your headache always sits on the same side. It starts as an ache at the base of your skull, then creeps up behind your eye. And it turns up on the days you spent four hours in a chair.

If that is your pattern, take it seriously; exercise does help this one. But it is worth screening first. Most routines you find online skip that step and hand you four movements for a neck nobody has examined.

What Is a Cervicogenic Headache?

It is head pain that starts in your neck. When the top neck joints, or the small muscles under the base of your skull, get irritated, your brain reads the signal as pain in your head; that is why your neck can be the source and barely hurt at all.

This makes it a secondary headache, meaning a symptom of something else. Migraine is primary: there, the headache is the condition itself.

When Should You Get a Medical Opinion First?

This article is general education, not a substitute for a medical evaluation. A new headache, a sudden or severe one, or a familiar headache that has changed character should be assessed before you try any exercise. The same goes for a headache arriving with dizziness, vision changes, difficulty speaking or swallowing, weakness, numbness, fever, or a neck too stiff to bend forward, and for any headache following a head or neck injury.

Not sure whether yours is appropriate for self-management? Get it looked at first; our team is happy to talk it through before you book. Our general guidance also applies: neck pain or headaches lasting more than two weeks, getting worse, or disturbing your sleep are worth an assessment.

How Do You Know If It Is Your Neck?

No single finding settles this. Several features pointing the same way is what makes a headache worth examining as neck-driven, and that same cluster is a reasonable prompt to get looked at.

The Pattern That Points to the Neck

So how does it behave? Cervicogenic headache is one-sided and it stays there: same side, every episode, for months. If yours swaps sides between attacks, that points toward migraine.

It usually starts at the base of your skull and travels forward to your temple or eye, a steady ache rather than a throb, with nausea and light sensitivity absent or mild. Migraine throbs, worsens on stairs, and brings both. Note which side yours sits on; an examiner will ask.

Now the trap. Neck pain is extremely common in migraine, and it often arrives hours before the headache does. A sore neck during a headache is not evidence your neck caused it. That confusion is what keeps people being treated for the wrong disorder for months.

The Two Tests That Matter

The first is a provocation test used in the clinic, and one you can try cautiously at home once you have cleared the red-flag list. Sit tall and turn your head toward the painful side, only to the first resistance and never into a stretch. Hold 20 to 30 seconds, then back off a few degrees and press two fingers firmly into the soft hollow just below your skull.

Tenderness there is not the finding, because nearly everyone is tender. What matters is whether that pressure reproduces your familiar headache in its familiar place. Bring that to an examination; it is not a diagnosis to act on alone.

The second one belongs in the clinic. In the cervical flexion-rotation test, we bend your neck fully forward, then rotate it to isolate the C1–C2 joint. Pooling four studies and 182 participants, it separated cervicogenic headache from migraine, mixed headache and no symptoms, with sensitivity 83% (95% CI 70–92) and specificity 83% (71–91), at moderate certainty (Demont et al., 2022, Musculoskelet Sci Pract. View on PubMed). A positive result "probably has a small to moderate effect on the probability of a patient having a CGH," and "the diagnostic value of detailed history and clinical findings remains unclear." It moves the answer without delivering it. Please do not try this one on yourself.

A larger review compared migraine, cervicogenic headache and no headache on examination. Two findings stood out in cervicogenic headache: flexion-rotation range about 18° smaller, and lower neck flexion strength. These findings "could support the differential diagnosis of CGH from migraine," though the authors note the overlap "makes differential diagnosis challenging" and that "additional high-quality studies are required to corroborate these findings" (Anarte-Lazo et al., 2021, BMC Musculoskelet Disord. View on PubMed).

Have you been treating a headache for months without anyone examining your neck? That is the missing step. If this pattern fits, it is worth having your history, neck motion, strength, and symptom reproduction assessed before a plan is chosen.

Call today: 424-543-4336

Can Exercise Actually Change This?

It can reduce how often your headaches come and how hard they hit. The trials below measured change over weeks to months; they did not test exercise as an in-the-moment treatment for a headache already underway.

The reference trial randomized 200 people with cervicogenic headache to manipulative therapy, a low-load craniocervical exercise program (precise training for the deep neck flexors, the small muscles that steady your head), both, or control. At 12 months, both had significantly reduced headache frequency, intensity and neck pain, with effects the authors call at least moderate and clinically relevant. Combining them was not significantly superior to either alone; about 10% more patients improved, reported descriptively (Jull et al., 2002, Spine. View on PubMed).

A second trial asks which kind of exercise. In 180 female office workers with chronic neck pain, randomized to strength, endurance or stretching alone and followed 12 months, headache fell 69% with strength, 58% with endurance and 37% with stretching alone (Ylinen et al., 2010, J Rehabil Med. View on PubMed).

Two caveats. These women had chronic neck pain rather than diagnosed cervicogenic headache, so 69% is not a cervicogenic-headache figure. What it gives you is the ranking, plus the authors' verdict on stretching: "which is often recommended for patients, was less effective alone than when combined with muscle endurance and strength training." Their second caveat: "Care must be taken in recommending the type of training to be undertaken by patients with severe cervicogenic headache."

Hands-on work has a real place alongside the loading. In Jull's trial, manipulative therapy and low-load exercise each helped as stand-alone treatments, with the combination not significantly better than either alone. If any treatment feels great for two hours and the headache is back by evening, that is worth raising at your next visit.

Get individual clearance first if you are pregnant, post-surgical, or have osteoporosis or balance concerns. Rules while you train. Programs of this type come with pain-monitoring rules. A common version allows your symptoms to reach about 3 out of 10 during a session if they settle afterwards. Then there is the next-day check. A mild, one-off increase that is gone within 24 hours generally means holding the dose steady rather than progressing. A headache that persists into the next day is different: that is the point to stop the exercise and check in with a clinician rather than working around it. The reference trial's treatment phase ran six weeks (Jull et al., 2002), so six weeks is a reasonable point to expect some change and to be reassessed if there is none. Rebuilding strength and control takes longer than that. It is also where a headache that was never cervicogenic gets caught.

What Does the Six-Week Program Look Like?

Eight exercises across three phases. Phase 1 runs two full weeks minimum. Jull's trial built its exercise arm on low-load, high-repetition training of these muscles, and that quality is what your first phase protects.

Phase 1: Weeks 1–2

Supine craniocervical flexion, the real chin tuck. On your back, knees bent, with a rolled towel under your neck, nod gently, like saying yes to someone across the room. The movement is about half an inch and your head stays on the towel. This is the core exercise of Jull's 2002 program, not the "glide your head backwards" version you see online.

A typical starting dose is 10-second holds, 10 reps, 1–2 sets, once or twice daily; begin at whatever hold stays clean, even 3 seconds, and add a second every few days. Watch the front of your throat: if those muscles stand out, the wrong ones took over, so shorten the hold rather than pushing harder.

Upper-cervical rotation, unloaded. Sit tall, chin gently tucked, rotating to the first point of resistance and never into a stretch. Typically 3–5 second holds, 8 reps each side, twice daily, adding 2 reps per side weekly up to 12. Keep your hands off; pulling your own head further loads a neck nobody has examined.

Thoracic extension over a chair back. Hands behind your head, extend your mid-back over the top edge of a firm backrest. Commonly dosed at 8–10 reps with 2–3 second holds, daily. Your low back stays quiet; if it arches, sit taller so the chair edge catches you higher.

Phase 2: Weeks 3–4

Progression here is gated on performance rather than the calendar: ten clean 10-second nods, no throat muscles standing out, and no worse headache the next morning. Can you do that yet? If not, repeat week two.

Craniocervical flexion with head lift. Same setup. Nod, hold the nod, then lift your head an inch off the towel while keeping it. A typical dose is 5-second holds, lowering over 3 seconds, 8–10 reps, 2 sets, 4–5 days a week. The set ends the moment your chin pokes forward, whatever the rep count says.

Prone Y raise. Face down, arms overhead in a Y at 45°, thumbs up: lift, hold 3 seconds, lower over 3. Commonly prescribed as 2 sets of 10, three days a week, adding a third set once all 20 reps are clean and then 1–2 lb per hand once all three are. Shoulders stay down. A shrug means the upper trapezius took over.

Cervical extensor holds. On all fours, chin lightly tucked, head in line with your spine, not hanging. A typical dose: 10-second holds, 8 reps, 2 sets, three days a week, progressing to 15-second holds and then a third set. Stop when the head drifts down, not when the number is reached.

Phase 3: Weeks 5–6 and Beyond

Loaded upper-back work. Single-arm or seated rows, plus farmer carries, which means walking with a heavy dumbbell in each hand, shoulders down, ribs over hips. A typical loading scheme: rows at 3 sets of 8, twice weekly, last two reps genuinely hard, a 3-second lower every rep, plus carries for 2 rounds of about 40 yards. Add weight only when all three sets are clean and the next-morning headache is unchanged or better. Loads like these are best set after testing, which is what our Doctors of Physical Therapy do at your evaluation.

If your shoulder complains first, see our page on shoulder pain; if you'd rather someone set the loads, that's what physical therapy is for.

Fewer Headaches, Without Guessing at the Cause

The problem is rarely discipline; it is the diagnosis, the dose, or both. A plan of care starts with screening the headache, then puts real numbers on the loading and reviews them as you go. If the pattern is not cervicogenic, we will explain why and recommend the right next step. At our Mar Vista clinic, our Doctors of Physical Therapy provide one-on-one care. Unsure what you're dealing with? Start with a free initial consult.

Book your evaluation today.

📅 Book Your Appointment

📞 Call: 424-543-4336

Can Physical Therapy Help You Become a Faster Runner

Santo Riva — Mon, 29 Jun 2026 09:30:07 +0000

Most runners think of physical therapy as something you do when you are hurt. You roll your ankle, strain your calf, or develop knee pain that will not go away, and then you make an appointment. The goal is to get out of pain and get back to training.

That is a legitimate use of physical therapy. But it is a narrow one.

At Victory Performance and Physical Therapy in Mar Vista, we work with a significant number of runners who are not injured. They come in because they want to run faster, handle more training without breaking down, and understand what is holding their performance back. The answer, almost always, involves physical structure, movement mechanics, and strength, which are exactly what physical therapy addresses.

Physical therapy can help you become a better runner even when nothing hurts.

What Limits Running Performance Beyond Fitness?

Training fitness, the aerobic and muscular capacity built through consistent running, is obviously central to performance. But many runners hit a ceiling despite consistent training because fitness is being limited by structural inefficiencies they are not aware of.

The most common performance limiters we identify in non-injured runners include:

Hip and glute weakness. The glutes are the primary power generator in running. When they are not firing effectively, the calves and lower back compensate, which increases injury risk and reduces the force available for propulsion with each stride.

Poor running economy. Running economy describes how much oxygen you use to maintain a given pace. Two runners with identical VO2 max scores can have very different performances if one has significantly better running economy. Economy is partly genetic, but it is also trainable.

Mobility restrictions. Limited ankle dorsiflexion (the ability to flex the foot toward the shin), tight hip flexors, or reduced thoracic rotation all alter running mechanics in ways that waste energy and increase tissue stress. When a joint cannot move through its full range, nearby joints compensate, and compensation costs efficiency.

Asymmetries. Small left-to-right differences in strength, mobility, or movement pattern become magnified over thousands of strides. An asymmetry that is barely noticeable in a 5K becomes a significant energy drain and injury risk factor in a half or full marathon.

What Does the Research Say About Strength Training and Running Speed?

The evidence connecting strength training to running performance is substantial.

A comprehensive review published in Sports Medicine found that strength training improved running economy, the single most important physiological predictor of performance in distance runners, across multiple studies. Improvements were seen in time trial performance and in the oxygen cost of running at submaximal paces. (Saunders et al., 2004, Sports Med. View on PubMed)

A second systematic review published in Sports Medicine examined strength training interventions in endurance athletes across multiple studies and found that concurrent strength and endurance training consistently improved performance markers including running economy, lactate threshold velocity, and time to exhaustion. (Beattie et al., 2014, Sports Med. View on PubMed)

And a more recent systematic review published in the same journal looked specifically at the effects of strength training on the physiological determinants of middle and long-distance running, finding significant improvements in running economy and maximal sprint speed in trained runners who added structured resistance work to their programs. (Blagrove et al., 2018, Sports Med. View on PubMed)

The mechanism behind these improvements includes increased tendon stiffness, improved neuromuscular coordination, and better force production per stride, all of which reduce the energy cost of running at any given pace.

How Physical Therapy Improves Running Performance

Here is what a performance-focused PT approach actually involves.

Movement Assessment

A physical therapist evaluates how you move in ways a coach or trainer typically cannot. We look at hip strength and activation, ankle mobility, thoracic rotation, single-leg stability, and how asymmetries in those factors show up in your running mechanics. This gives us a specific, measurable baseline to work from.

Targeted Strength Programming

Not all strength training is created equal for runners. General gym workouts often emphasize bilateral movements, like squats and leg press, while running is entirely single-leg. A PT-informed strength program for runners emphasizes:

Single-leg loading (Bulgarian split squats, single-leg deadlifts, step-downs)
Hip abductor and external rotator strength
Calf and Achilles loading, including eccentric and heavy-slow resistance work
Core stability under dynamic conditions, not just planks

The progression is structured to build the specific capacities your running mechanics require. The exercises are not random. They connect directly to identified weaknesses and the demands of your event.

Running Mechanics Refinement

Gait analysis at Victory allows us to identify mechanical inefficiencies and introduce targeted corrections. Small changes, applied progressively, can improve running economy measurably. Common adjustments include:

Increasing step rate to reduce overstriding and lower knee joint loading
Improving trunk position and arm carriage
Correcting foot strike relative to the center of mass
Addressing hip drop and pelvic instability mid-stride

These changes require supervised practice and gradual integration. The goal is not to overhaul your form overnight but to make specific, evidence-supported adjustments that reduce energy waste and tissue stress.

Mobility and Tissue Quality Work

Restricted mobility at the ankle or hip forces the body to compensate elsewhere. Improving range of motion in the joints that running demands most creates a mechanical environment where better force production is possible. This includes manual therapy, joint mobilization, and targeted flexibility work tailored to your specific restrictions.

Ready to understand what is actually limiting your running performance? Our team in Mar Vista can give you a clear picture through movement assessment and gait analysis.

Call today: 424-543-4336

Performance Gains Are Not Reserved for Elite Runners

A common misconception is that biomechanical refinement and structured strength work are for elite athletes who have already optimized everything else. In reality, recreational runners often have the most to gain.

Elite athletes are already moving close to mechanically efficient patterns because years of high-volume training have sorted out many inefficiencies. Recreational runners frequently carry significant strength deficits and movement pattern errors that, if addressed, produce noticeable and sometimes dramatic improvements in both pace and durability.

Running 35 miles a week with a significant hip abductor weakness, for example, means every mile is being run with a compromised glute, a compensating lower back, and more stress on the knee than necessary. Fixing that weakness does not just reduce injury risk. It also frees up muscular output that was previously spent on stabilization and channels it into propulsion.

The Role of Injury Prevention in Performance

There is a performance argument for staying healthy that does not get enough attention: consistent training time is the single greatest predictor of improvement in distance runners.

Every week of injury is a week of fitness lost. More significantly, it is a week of the specific adaptations, tendon stiffening, capillary density, neuromuscular efficiency, that only running produces. These adaptations accumulate slowly and erode more quickly than cardiovascular fitness.

A runner who logs 40 weeks of uninterrupted training will almost always outperform a runner who logs 52 weeks with two injury interruptions, even if the interrupted runner had a higher total mileage.

Keeping you running, consistently and without breakdown, is the most direct performance intervention physical therapy provides.

What Nina Found When She Started Training Smarter

Nina came to Victory Performance while training for her first half marathon. She had never worked with a physical therapist specifically for performance.

"I've been working with CJ to improve my mobility and strength while training for my first half marathon, and he's been amazing. Super knowledgeable, encouraging, and genuinely invested in my progress. I've gained so much confidence thanks to his support and expertise."

Her goal was not to recover from injury. It was to arrive at the start line having trained as well as possible and feeling confident in her body's readiness. That is exactly what PT-informed training can do.

Jessica O. took a similar path and saw measurable results. She came in running 35 miles a week with knee pain that was forcing her to cut back.

"Within just a few sessions my knee stopped hurting entirely and I was able to get my mileage back up to now 50 this week. I have been running for 5 weeks now without any pain."

Going from 35 to 50 miles per week, pain-free, is a performance outcome.

Running Performance in the Context of Westside Training

The Westside offers a training environment that supports intelligent performance development when approached with structure.

The Ballona Creek bike path provides an ideal surface for tempo work and long runs where you can focus on mechanics and pace without navigating traffic.

Baldwin Hills and Kenneth Hahn offer natural hill training that builds glute and hip strength in a way flat running never will. For runners focused on performance, structured hill work on these routes, not just recreational climbing, builds specific running-related strength.

San Vicente Boulevard is a staple for LA runners for good reason. The distance markings and consistent surface make it excellent for tracking pace progression over weeks and months of training.

A physical therapist can help you structure how you use these different surfaces and intensities to build performance without accumulating injury risk.

Physical Therapy and Performance Are Not Separate Things

The distinction between rehabilitation and performance optimization is smaller than most runners think. Both require understanding how your body moves, what is strong and what is not, and how to build capacity systematically without overdoing it.

At Victory Performance and Physical Therapy, we think about performance from the first session. Whether a runner comes in injured or not, the goal is the same: help them run better, handle more training, and stay healthy doing it.

Start Running Better in Mar Vista

If you are a runner who has been training consistently and wondering why progress has stalled, or if you want to build toward a goal race with every advantage available, physical therapy can offer something your training plan alone cannot: a clear picture of how your body is moving and a specific plan for making it move better.

Victory Performance and Physical Therapy works with runners across Mar Vista, Culver City and the Westside at every level, from first-time half-marathoners to experienced athletes chasing PRs. If you want to understand your body more deeply and train with more intention, we are here.

Book your evaluation today.

📅 Book Your Appointment

📞 Call: 424-543-4336

Achilles Tendinopathy in Runners: What It Is and How Physical Therapy Helps

Santo Riva — Mon, 22 Jun 2026 09:30:23 +0000

Achilles pain is one of the most common reasons runners end up sidelined, and it is also one of the most mismanaged. Rest helps for a few days. You head back out. The stiffness returns on the first mile. The cycle frustrates most runners into either pushing through pain or stopping altogether. Neither approach actually works.

At Victory Performance and Physical Therapy in Mar Vista, we see Achilles tendinopathy often in local runners, and the treatment approach that actually gets lasting results looks very different from simply resting and stretching.

What Is Achilles Tendinopathy?

The Achilles tendon connects your calf muscles to your heel bone. It is the thickest and strongest tendon in your body, and it handles enormous loads during running. Every time your foot strikes the ground, your Achilles absorbs and releases energy at a rate that can reach several times your body weight.

Achilles tendinopathy (ten-din-OP-uh-thee) is a condition involving pain, stiffness, and reduced function in the tendon. It is not the same as a rupture. In tendinopathy, the tendon structure has become disorganized at a cellular level due to repeated overload without adequate recovery. The fibers that normally run in parallel start to break down, collagen quality drops, and the tendon loses some of its capacity to handle load.

There are two primary locations where Achilles tendinopathy shows up in runners:

Mid-portion tendinopathy appears two to six centimeters above the heel bone. This is the most common form in runners and responds very well to physical therapy.
Insertional tendinopathy occurs where the tendon attaches to the heel bone. This type is more complex and requires a slightly different treatment approach.

Why Achilles Tendinopathy Is Not Just a Tightness Problem

Most runners assume Achilles pain means the calf is too tight. They stretch it. They massage it. They apply ice and rest. These strategies can manage symptoms temporarily, but they often make the underlying problem worse over time, particularly passive stretching, which can irritate an already compromised tendon insertion.

The research tells a different story. The Achilles tendon does not respond to passive treatment. It responds to load. Gradual, progressive loading is what drives tendon remodeling, rebuilds collagen quality, and restores the tendon's capacity to handle the demands of running.

A foundational study by Alfredson and colleagues published in the American Journal of Sports Medicine demonstrated that a structured program of heavy-load eccentric calf training produced significant improvements in chronic Achilles tendinopathy in runners who had been symptomatic for an average of over a year. (Alfredson et al., 1998, Am J Sports Med. View on PubMed)

This study helped shift how the entire physical therapy and sports medicine field approaches tendon rehabilitation.

What Makes Achilles Tendinopathy Worse

Knowing what aggravates the tendon helps you manage load smarter during recovery. Common irritants include:

Rapid increases in training volume or intensity. The Achilles adapts more slowly than your cardiovascular system. Your lungs might be ready for more mileage before your tendon is.
Too much hill work. Uphill running increases Achilles loading significantly. Downhill running, while easier on the calf, changes the tendon mechanics in ways that can also cause irritation.
Changing footwear suddenly. Moving from a cushioned shoe with heel drop to a minimal shoe dramatically increases Achilles demand. That transition needs to be gradual.
Running on hard surfaces without adequate variation. Concrete and asphalt are unforgiving on tendons. Mixing in softer surfaces like the grass sections of Kenneth Hahn State Recreation Area can reduce cumulative loading during recovery.
Too much passive stretching. For insertional tendinopathy especially, aggressive calf stretching into dorsiflexion (pulling the toe up) compresses the tendon at its attachment point and can worsen symptoms.

How Physical Therapy Treats Achilles Tendinopathy

Physical therapy for Achilles tendinopathy is built around progressive tendon loading. The goal is to guide the tendon through a rehabilitation process that systematically increases its capacity to absorb and generate force.

Phase 1: Isometric Loading

Isometric exercises involve holding a contraction without movement. These are used early in rehabilitation because they can reduce tendon pain quickly while maintaining some load through the tissue. A common example is a sustained calf raise hold on a step.

This phase does not build much tendon capacity, but it reduces sensitivity and helps you stay active during the early weeks.

Phase 2: Isotonic Loading (Eccentric and Heavy Slow Resistance)

This is the core of Achilles rehab. Eccentric loading, particularly slow heel drops off a step, has decades of research supporting its effectiveness.

A randomized controlled trial published in the American Journal of Sports Medicine compared eccentric training to heavy slow resistance training for Achilles tendinopathy and found both approaches produced significant and comparable improvements in pain and function. (Beyer et al., 2015, Am J Sports Med. View on PubMed)

The key with both approaches is that the load must be heavy enough to stimulate tendon adaptation. Lightweight, high-rep calf raises do not generate enough stress to drive meaningful change. Your physical therapist will help you calibrate the right resistance.

Phase 3: Energy Storage and Return

Tendons are like springs. They store energy and release it. Running demands this capacity. Phase three introduces plyometric loading, double-leg hopping, then single-leg work, and finally running-specific drills that challenge the tendon's ability to function under dynamic load.

This phase is where most runners become tempted to rush. The tendon may feel good, but it takes time to rebuild the structural quality that supports sustained running. Returning to full training too quickly is the most common reason Achilles tendinopathy recurs.

Shockwave Therapy as an Additional Option

For cases that have been present for several months or are not progressing at the expected rate, Victory offers shockwave therapy, a non-invasive treatment that delivers acoustic energy to the tendon to stimulate healing and break up disorganized tissue. Shockwave can be a useful adjunct to loading-based rehabilitation for chronic tendinopathy.

Dealing with Achilles stiffness or pain that is limiting your training? Our Mar Vista team can assess your tendon health and build a structured loading program around your specific situation.

Call today: 424-543-4336

Understanding the Tendon Continuum

Researcher Jill Cook published a model in the British Journal of Sports Medicine that explains tendinopathy as a continuum, ranging from reactive tendinopathy (an acute overload response) to tendon disrepair (structural breakdown) to degenerative tendinopathy (significant tissue loss). (Cook and Purdam, 2009, Br J Sports Med. View on PubMed)

This model matters because treatment needs to match the stage. A runner in the early reactive phase needs load management and relative rest. A runner with degenerative changes needs progressive loading to stimulate what remodeling is still possible.

Guessing where you are on that continuum without an evaluation leads to the wrong approach at the wrong time, which is why so many runners end up in the frustrating rest-return-hurt cycle.

What to Expect With Recovery

Achilles tendinopathy does not resolve in a few weeks. The tendon heals and adapts more slowly than muscle. A reasonable recovery timeline for mid-portion tendinopathy with consistent physical therapy is three to six months of progressive work before returning to full unrestricted running.

That sounds long, but the alternative is repeated cycles of partial recovery and re-injury that can extend into years.

Progress is typically measured by:

Reduced morning stiffness (one of the most consistent early markers of improvement)
Ability to complete loading exercises without increased pain or latent symptoms
Gradual return to running with appropriate load monitoring

The goal is not just to get you to the start line of your next race. It is to build a tendon that holds up through months of training and beyond.

A Runner Who Made It to Race Day

Will M. came to Victory Performance with a lingering calf and tendon injury while training for a marathon. He was not sure he would make it to the start line.

"CJ created a plan that not only addressed my pain but focused on long-term strength and mobility to improve my performance overall. The combination of expert manual therapy, thoughtful progressions, and genuine care made a huge difference in my recovery."

Will made it to race day strong and ready to run. That is what a systematic, load-based approach to tendon rehabilitation can produce.

Ready to Tackle Your Achilles Problem for Good

If Achilles pain keeps interrupting your training, the solution is a structured loading program, not more rest. Victory Performance and Physical Therapy in Mar Vista works with runners at every stage of tendon rehabilitation, from early reactive cases to chronic tendinopathy that has been hanging around for months.

If you are in Mar Vista, Culver City, or anywhere on the Westside of Los Angeles, schedule an evaluation and get a clear picture of where your tendon is and what it needs.

Book your evaluation today.

📅 Book Your Appointment

📞 Call: 424-543-4336

What a Physical Therapist Looks for During a Running Gait Analysis

Santo Riva — Mon, 15 Jun 2026 09:30:18 +0000

If you have ever had knee pain flare up at mile four of every run, or felt one hip tighten at a specific pace, or noticed that your right shoe wears out faster than your left, your body is sending a message. A running gait analysis is how a physical therapist translates that message into something actionable.

At Victory Performance and Physical Therapy in Mar Vista, gait analysis is not a gadget demonstration. It is a clinical assessment that connects how you move to why you hurt, and it is one of the most valuable tools we use to help runners improve both their durability and their performance.

What Is a Running Gait Analysis?

A running gait analysis is a structured observation of how you run, typically captured on video and reviewed in slow motion from multiple angles. A physical therapist looks at the mechanics of your stride from the ground up, examining how your foot contacts the surface, how your hips and pelvis move, what your trunk does, and how your arms contribute to the overall pattern.

The goal is not to turn you into a textbook runner. Running mechanics vary significantly between individuals, and not every deviation from an ideal pattern causes injury. The goal is to identify the specific movement faults that are loading your tissues beyond what they can handle, or limiting the efficiency of your stride.

At Victory, gait analysis is always integrated into a broader evaluation. We also assess hip strength, ankle mobility, single-leg stability, and training history, because the way you run is shaped by all of those factors.

What Does a Physical Therapist Actually Look For?

Here is what we examine during a running gait assessment and why each factor matters.

Cadence and Step Rate

Cadence is the number of steps you take per minute. Most recreational runners land somewhere between 150 and 165 steps per minute. Research shows that simply increasing step rate can meaningfully reduce the forces acting on the knee and hip.

A landmark study published in Medicine and Science in Sports and Exercise found that increasing step rate by ten percent reduced knee joint loading and hip internal rotation, two of the primary mechanical contributors to overuse injuries. (Heiderscheit et al., 2011, Med Sci Sports Exerc. View on PubMed)

Many runners with knee pain are actually running with a step rate that is too low, meaning each stride is too long and the foot lands too far in front of the body. This single adjustment, gradually applied, often produces noticeable improvement.

Foot Strike Pattern

Where your foot contacts the ground matters, but not in the all-or-nothing way it is often presented online. A heel strike is not automatically bad. A forefoot strike is not automatically good. The position of your foot relative to your center of mass is what actually determines loading.

We look at how far in front of your hips your foot is landing with each step. Overstriding, which is landing the foot well ahead of the body, creates a braking force with every stride. It increases impact and loads the knee and shin more than necessary.

Hip Drop and Pelvic Control

One of the most clinically significant things we look at is what happens at your pelvis when you are on one leg. Ideally, the pelvis stays relatively level through each stride. When the hip abductors and glutes are weak, the pelvis drops on the opposite side as the foot hits the ground.

This pelvic drop, called a Trendelenburg pattern, increases the demand on the IT band, shifts force toward the inner knee, and can contribute to a cascade of issues including runner's knee, IT band syndrome, and low back pain.

A systematic review and meta-analysis published in Gait and Posture found that runners with patellofemoral pain demonstrated significant differences in hip biomechanics compared to healthy runners, and that targeted interventions addressing those mechanics produced meaningful improvements in both pain and function. (Neal et al., 2016, Gait Posture. View on PubMed)

Trunk Position and Forward Lean

Runners sometimes neglect the role of the upper body in injury development. Excessive forward trunk lean, lateral trunk sway, or arms crossing the midline of the body all affect how force is distributed through the lower extremity.

A slightly forward trunk lean is efficient and can reduce impact. Too much forward lean compresses the lumbar spine. Too little, or a backward trunk lean, increases braking forces. We look at trunk position in relation to foot strike and hip extension.

Arm Swing

The arms balance the legs. When arm swing is asymmetrical, or when the arms cross the body's midline, the lower body compensates with rotation that increases torsional stress on the hips and knees. For runners dealing with hip flexor pain or lateral knee pain, arm swing correction is often part of the solution.

Who Should Get a Running Gait Analysis?

Gait analysis is useful for runners in several situations:

Recurring injury. If the same injury keeps returning despite treatment, the movement pattern driving it has not been addressed. Gait analysis finds it.

New pain during training. Pain that develops as you increase mileage often signals that your mechanics are not efficient enough to handle the added load. Identifying and correcting the problem early prevents it from becoming a serious injury.

Performance plateau. Inefficient mechanics waste energy. If your pace has stalled despite consistent training, improving your gait economy can help you run faster with the same effort.

Returning from injury. Before ramping mileage back up after an injury, knowing whether you have developed compensatory patterns during the recovery period can prevent re-injury.

Running your first long race. Runners training for their first half marathon or marathon are putting more cumulative load on their bodies than they have before. A gait assessment before that build begins is one of the smartest investments you can make.

Are you training around Mar Vista or Culver City and want to know how your mechanics are affecting your running? Our Doctors of Physical Therapy can assess your gait and connect what you see on video to what you feel on the road.

Call today: 424-543-4336

Can You Actually Change How You Run?

Yes. Running mechanics are trainable. Research published in Clinical Biomechanics showed that mirror gait retraining, where runners receive real-time visual feedback on their form, produced significant improvements in hip mechanics and reduced knee joint loading. Those improvements were maintained at a six-month follow-up. (Willy et al., 2012, Clin Biomech. View on PubMed)

The key is gradual implementation. Changing mechanics suddenly and dramatically can cause new problems as different tissues experience unfamiliar load. At Victory, gait cues are introduced one at a time and practiced first at low speeds, then progressively integrated into normal training.

Common cues we use include:

Running taller (reduces forward lean and improves hip extension)
Shortening stride length and increasing step rate
Landing with the foot closer to under the hips
Focusing on a soft, quiet landing
Keeping arms at ninety degrees and driving the elbows back

Gait Analysis and the Local Running Environment

The Westside running landscape puts specific demands on mechanics.

The Culver City Stairs and Baldwin Hills climbs. Uphill running strengthens the glutes and calves but also demands strong hip drive and ankle stiffness. Downhill sections require hip control and eccentric loading capacity. If your mechanics have not been assessed, downhill running on these routes can be particularly hard on the IT band and knee.

The Ballona Creek bike path. This is one of the best long-run surfaces in the area, relatively flat and consistent. It is excellent for practicing gait changes at comfortable paces before applying them to more varied terrain.

San Vicente Boulevard. The tree-lined median of San Vicente is a Los Angeles running staple. The surface is softer than asphalt, which reduces impact loading, but the slight cambered edges can cause issues for runners with hip weakness or asymmetrical mechanics over many miles.

What Nina Found Out About Her Running

Nina came to Victory Performance while training for her first half marathon and worked with CJ on improving her mobility and strength.

Understanding how she was moving helped her train with more intention and reach the starting line feeling genuinely ready.

Is a Gait Analysis Just for Injured Runners?

This is one of the most common misconceptions we hear. Many runners assume physical therapy is only for people who are already hurt.

Gait analysis is, in many ways, most valuable before an injury develops. Identifying the mechanical fault before it accumulates into tissue damage means you never have to deal with the injury at all. For runners building toward a goal race, being proactive about mechanics is one of the most effective injury prevention strategies available.

Even runners with years of experience and no current pain often find that a gait assessment reveals subtle inefficiencies they were not aware of. Those inefficiencies might not have caused pain yet, but they were slowly limiting performance.

See What Your Running Actually Looks Like

Understanding your mechanics is one of the highest-value things you can do as a runner, whether you are chasing a PR, training for your first race, or trying to figure out why the same injury keeps coming back.

If you are a runner in Mar Vista, Culver City, or anywhere on the Westside of Los Angeles, Victory Performance and Physical Therapy can give you a clear, evidence-based picture of how you move and what to do about it.

Book your evaluation today.

📅 Book Your Appointment

📞 Call: 424-543-4336

Why IT Band Syndrome Keeps Coming Back in Runners and What to Do About It

Sean Hubbard — Mon, 08 Jun 2026 12:29:04 +0000

If you have dealt with sharp, burning pain on the outside of your knee while running, you already know how frustrating IT band syndrome can be. You rest it. The pain fades. You start running again. It comes right back. This cycle is one of the most common complaints we hear from runners at Victory Performance and Physical Therapy in Culver City, and it almost always points to the same root problem: the IT band is not the actual issue.

Understanding why this injury keeps recurring is the first step toward breaking the pattern for good.

What Is the IT Band and Why Does It Hurt?

The iliotibial band (IT band) is a thick strip of connective tissue that runs along the outside of your thigh, from your hip down to just below your knee. It is not a muscle you can directly stretch or strengthen. It is a tendon-like structure that transfers force between muscles above and below it.

When runners experience IT band syndrome (ITBS), the pain typically appears on the outer knee, usually after a consistent distance into a run. Going downhill often makes it worse. In severe cases, even walking becomes uncomfortable.

The problem is that most runners treat the IT band itself. They foam roll it relentlessly. They stretch the side of their leg. They rest until the pain goes away. None of these approaches target the actual cause, which is why the injury keeps returning.

Why Does IT Band Syndrome Keep Coming Back?

The short answer is that IT band pain is almost always caused by weakness and poor movement control higher up or lower down in the chain, particularly in the hips and glutes, or foot and ankle.

A landmark study published in the Clinical Journal of Sport Medicine found that distance runners with IT band syndrome had significantly weaker hip abductors (the muscles that control how your leg moves outward and stabilize your pelvis) compared to healthy runners. (Fredericson et al., 2000, Clin J Sport Med.View on PubMed)

When those muscles cannot do their job, your pelvis drops on the opposite side with every stride. Your thigh rotates inward slightly. Your knee tracks off its ideal path. That small movement error, repeated thousands of times per run, creates excessive friction and compression where the IT band crosses the outside of the knee.

Foam rolling relieves some local tightness temporarily, but it never addresses the hip weakness or the movement pattern driving the problem. That is why the pain comes back.

A biomechanical research study published in Clinical Biomechanics confirmed this connection, finding that runners with ITBS demonstrated notable differences in hip adduction mechanics during running compared to runners without pain. (Noehren et al., 2007, Clin Biomech.View on PubMed)

What Does Physical Therapy Do Differently?

At Victory Performance and Physical Therapy, we do not just treat where it hurts. We assess why it hurts. For IT band syndrome, that means a thorough look at:

Hip abductor and external rotator strength. How well can your hip stabilize your pelvis while you are on one leg?
Glute activation. Are your glutes firing effectively when they need to, or are smaller muscles compensating?
Running mechanics. Are you overstriding, crossing your midline, or showing signs of hip drop with each step?
Training load. Did the injury coincide with a spike in mileage, new terrain like hills, or a change in footwear?

Once we understand the pattern, we build a plan around it.

Step 1: Calm the Irritation

In the acute phase, treatment focuses on reducing the load on the IT band while keeping you moving as much as possible. This often includes manual therapy, soft tissue work around the hip and lateral thigh, and temporary modifications to your training volume or intensity.

We try to keep runners running whenever possible. Complete rest often delays recovery without improving the underlying cause.

Step 2: Rebuild Hip and Glute Strength

The core of IT band recovery is targeted hip strengthening. A study published in the Journal of Orthopaedic and Sports Physical Therapy demonstrated that a hip-strengthening program significantly improved running mechanics and reduced lower extremity loading in runners. (Willy and Davis, 2011, JOSPT.View on PubMed)

This is not about doing generic side-lying clamshells forever. The exercises progress from basic activation work to single-leg loading and eventually to sport-specific movement patterns that replicate running demands.

Step 3: Correct Running Mechanics

Once your strength foundation improves, we look at how you actually run. Small adjustments to cadence (your step rate), foot strike, and trunk position can significantly reduce IT band stress. These changes are introduced gradually and practiced with intention so they become automatic over time.

What About Foam Rolling and Stretching?

Foam rolling the IT band can provide temporary relief. It should not be your primary treatment strategy.

Because the IT band is connective tissue rather than muscle, it does not respond to stretching the way a muscle does. You cannot elongate it meaningfully. What foam rolling does is stimulate blood flow and reduce localized sensitivity, which can feel helpful in the short term.

Think of it like loosening a tight rope by massaging the middle of it. The tension is still coming from both ends. Until you address the hip weakness and movement patterns creating the tension, the band will stay irritated.

We teach patients to use foam rolling as a warm-up tool or for temporary symptom management, not as the solution.

Local Running in Culver City and IT Band Risk

Certain training environments can increase IT band irritation, and Culver City runners have a few to be aware of.

Hills. The Baldwin Hills Scenic Overlook stairs and the climb into Kenneth Hahn State Recreation Area are popular training spots, but downhill sections are particularly hard on the IT band. The knee flexion angle during downhill running places more compression on the lateral knee. If you are returning from an IT band flare, save the hills until your hip strength is solid.

Cambered roads. Running on roads with a lateral tilt (common on many Culver City streets) means one leg is constantly running slightly lower than the other. Over many miles, that asymmetry accumulates. Rotating your running direction, or choosing flatter paths like the Ballona Creek bike path, can help during recovery.

Rapid mileage increases. Many runners we see were training for the LA Marathon and significantly increased their weekly distance in a short window. The tissue adapts more slowly than your aerobic fitness improves, and the IT band is often the first to show that stress.

A Culver City Runner's Experience

Jessica O. came to Victory after her left knee pain had forced her to cut her weekly mileage significantly. She had been running 35 miles a week and wanted to build from there.

"Within just a few sessions my knee stopped hurting entirely and I was able to get my mileage back up to now 50 miles this week. I have been running for 5 weeks now without any pain."

She left with better hip strength, improved movement patterns, and a sustainable training plan. That is the outcome we work toward with every runner we see.

Dealing with lateral knee pain that keeps coming back? Our Doctors of Physical Therapy in Culver City can assess your hip strength and movement patterns and build a plan around the root cause.

Call today: 424-543-4336

How Long Does It Take to Recover From IT Band Syndrome?

Recovery timelines vary depending on how long the issue has been present, how significant the strength deficits are, and whether training load is managed appropriately during rehab.

Mild cases with early intervention often respond in four to six weeks. Runners who have dealt with recurring ITBS for months may take longer because compensatory movement patterns need to be retrained alongside strength deficits.

The good news is that most runners do not need to stop running entirely. With the right guidance on load management, most can continue training at a modified level throughout the recovery process.

Ready to Run Without Lateral Knee Pain

IT band syndrome does not have to be a permanent part of your running life. With the right evaluation and a targeted approach to hip strength and movement patterns, most runners can get back to full training and stay there.

If you are in Culver City or the greater Los Angeles area and dealing with recurring IT band pain, reach out to the team at Victory Performance and Physical Therapy. We work with runners at every level, from first-time 5K participants to experienced marathoners, and we focus on understanding your body and your goals before building a plan.

Book your evaluation today.

📅Book Your Appointment

📞 Call: 424-543-4336

Why Golfer's Elbow Keeps Coming Back and What to Do About It

Sean Hubbard — Mon, 01 Jun 2026 12:24:38 +0000

Pain on the inside of your elbow that flares when you grip, pull, or flex your wrist. It might throb after a lifting session or ache through a workday at a keyboard. A lot of people do not immediately recognize this as an injury with a name. They assume it is general elbow soreness, push through it, and then spend months wondering why it never fully clears.

At Victory Performance and Physical Therapy in Culver City, we see medial epicondylitis, what most people call golfer's elbow, in athletes and active adults who have been managing this pain far longer than they should have. The injury tends to linger because it is frequently underestimated, often mistaken for something else, and treated in ways that address the symptoms without touching the underlying tissue problem.

This post covers what is actually happening, who gets it beyond the golf course, and how we approach it at Victory with physical therapy and shockwave therapy when appropriate.

✅ Key Takeaways

Golfer's elbow affects the inside of the elbow and is far more common in climbers, CrossFitters, and desk workers than in golfers
It is frequently confused with tennis elbow, which affects the outside of the elbow, and the two require different treatment approaches
Like tennis elbow, the chronic form involves tendon degeneration that does not resolve with rest alone
At Victory PT, our Doctors of Physical Therapy use a thorough assessment, targeted loading, and shockwave therapy to address the root cause
No referral needed under California's Direct Access law

What Is Golfer's Elbow?

Medial epicondylitis is the clinical name. It involves the flexor and pronator tendons of the forearm where they attach to the medial epicondyle, the bony bump on the inside of your elbow. These tendons control wrist flexion and forearm rotation, movements that show up constantly in gripping, pulling, and throwing activities.

When those tendons are repeatedly loaded without adequate recovery, the same process that drives tennis elbow begins on the medial side. Micro-tears accumulate. The tissue shifts from acute inflammation to a chronic degenerative state, losing its normal organized structure and becoming painful under load.

The result is an injury that calms down with rest, seems manageable for a while, and then flares the moment training volume climbs back up.

How Is Golfer's Elbow Different From Tennis Elbow?

This is one of the most common questions we field at Victory, and it is worth a clear answer because the two conditions are easy to confuse.

Tennis elbow (lateral epicondylitis) affects the outside of the elbow. The extensor tendons are involved and pain is typically provoked by gripping, wrist extension, and activities like pulling, typing, or swinging a racket.

Golfer's elbow (medial epicondylitis) affects the inside of the elbow. The flexor and pronator tendons are involved and pain is typically provoked by wrist flexion, forearm rotation, and activities involving pulling, gripping, or throwing.

The two conditions share the same underlying tissue mechanism — tendon degeneration at an attachment site — but they involve different tendons, different sides of the elbow, and different movement patterns. Treatment for one is not interchangeable with treatment for the other. This is one of the reasons a proper assessment matters before starting a rehabilitation program.

A simple way to identify which you might have: if the pain is on the outside of your elbow and worsens when you extend your wrist against resistance, it is more likely tennis elbow. If the pain is on the inside and worsens when you flex your wrist or rotate your forearm, golfer's elbow is a more likely candidate. A Doctor of Physical Therapy can confirm this through clinical testing.

Who Actually Gets Golfer's Elbow

The name creates a misleading impression. The majority of patients we see with medial epicondylitis at Victory have never set foot on a golf course. The condition is common across a wide range of active adults in Culver City and the surrounding LA area:

Rock climbers putting sustained load through their finger flexors and forearm in grip-intensive movement
CrossFit athletes doing high volumes of deadlifts, rows, kipping pull-ups, and barbell work
Baseball and softball players whose throwing mechanics create significant medial elbow stress
Golfers, particularly through poor swing mechanics that overload the lead wrist and forearm at impact
Office workers and remote professionals with repetitive keyboard and mouse use
Weightlifters performing heavy rows, curls, and pulling movements with compromised forearm mechanics
Gym-goers who have recently increased volume on pulling exercises without a proportional increase in recovery

There is also a meaningful overlap between golfer's elbow and other medial elbow conditions, including ulnar nerve irritation. One of the reasons chronic medial elbow pain can be so stubborn is that when the diagnosis is not precise, the treatment tends to miss. Our DPTs at Victory are experienced in distinguishing between these presentations and building programs around what is actually going on.

Why Does It Take So Long to Resolve?

This is the question behind most of the frustration patients bring to us. The short answer is that the medial elbow is involved in a staggering number of daily movements, and achieving the kind of relative rest that allows early healing is genuinely difficult.

Every time you grip something, open a door, carry a bag, type at a keyboard, or perform any pulling movement in the gym, the flexor and pronator tendons are working. The cumulative load through these tendons over a day of normal activity is high, which makes it difficult for early-stage treatment to gain traction.

Layered on top of this is the same tissue biology that drives tennis elbow. Once medial epicondylitis has moved into a chronic, degenerative state, the tendon tissue is not going to recover through passive rest. The collagen structure has broken down. What the tissue needs is not less load but the right kind of load, applied progressively in a way that stimulates remodeling.

This is why the rest-and-return cycle repeats so reliably. The pain settles, activity resumes, and the degenerated tendon gets loaded again before it has structurally improved.

How We Treat Golfer's Elbow at Victory Performance PT

Our approach starts with precision. Getting the diagnosis right and understanding the individual factors driving the injury is what allows treatment to work rather than simply manage.

The Assessment

At Victory, our Doctors of Physical Therapy evaluate every medial elbow presentation thoroughly before any treatment begins. For golfer's elbow, that means looking at:

Reproducing and localizing the pain precisely to confirm medial epicondylitis vs. other medial elbow pathology
Assessing wrist flexor and pronator strength and flexibility
Evaluating shoulder and scapular mechanics that may be contributing to forearm overload
Reviewing the activities and training patterns that provoked the injury
Identifying any neural component, such as ulnar nerve involvement, that requires a modified approach

This is the root cause process that defines how we work. Two patients with the same diagnosis can have completely different contributing factors, and the program we build for each one reflects that.

The Loading Program

Progressive loading is the foundation of tendinopathy rehabilitation at Victory. For medial epicondylitis, this means a structured eccentric and isometric program targeting the wrist flexors and pronators, designed to apply the right mechanical stimulus at the right progression for your tendon.

The specifics matter. Load level, tempo, range of motion, and progression timing all affect outcomes. Getting them wrong can prolong recovery. Our DPTs monitor your response throughout and adjust as the tendon remodels.

We also address any contributing factors identified in the assessment. If shoulder mechanics are offloading grip stress onto the forearm, we address that. If training technique is part of the picture, we work through it together. The tendon loading program is the core, and the surrounding work is what prevents recurrence.

Peter K. came to Victory after five years of working through a complex injury history and trying multiple practitioners.

"His knowledge, expediency and accuracy with which he diagnosed my current issues is a testament to his experience as a healer and coach. Both Santo and his team built a progressive program that kept me challenged and on the path to painlessness. The only thing Victory PT can't do for you is the work itself."

That combination of precise diagnosis and a well-structured progressive plan is what we bring to every presentation, including the ones that have already confused other providers.

Where Shockwave Therapy Fits In

For patients with chronic golfer's elbow that has not responded adequately to loading and manual therapy, shockwave therapy gives us a direct way to target the degenerated tissue at the medial epicondyle.

Extracorporeal shockwave therapy (ESWT) delivers focused acoustic pulses to the tendon attachment site. The energy triggers mechanotransduction, a biological process where the mechanical signal stimulates cellular repair, promotes collagen remodeling, and encourages blood vessel formation in chronically degenerated tissue. The goal is to restart a healing process that has stalled.

A meta-analysis published in BMC Sports Science, Medicine and Rehabilitation analyzing 45 clinical studies across multiple tendinopathies found statistically significant pain reductions from shockwave therapy. (Majidi et al., 2024) A 2024 systematic review and meta-analysis covering upper limb tendinopathies including epicondylitis found support for ESWT as an evidence-based intervention in this population. (Xiong et al., 2024, Frontiers in Medicine)

It is worth being straightforward here. The research base for medial epicondylitis specifically is smaller than for lateral epicondylitis, where the evidence is more extensive. What is well established is the underlying tissue mechanism — tendinopathy at an attachment site — and ESWT has strong support for that mechanism across tendinopathies broadly. At Victory, when we recommend shockwave for golfer's elbow, it is as part of a comprehensive DPT-supervised plan, not as a standalone treatment, because the combination of loading and ESWT consistently produces better results than either approach alone.

We typically consider shockwave therapy when:

Symptoms have persisted beyond 8 weeks of appropriate conservative care
Activity modification and loading alone have not produced adequate improvement
The patient has a specific performance goal or timeline that makes accelerating recovery a priority
The clinical presentation is consistent with chronic tendon degeneration rather than acute inflammation

Dealing with inner elbow pain that has been hanging around for weeks or months? Our Doctors of Physical Therapy at Victory Performance and Physical Therapy in Culver City can assess exactly what is going on and build a plan that addresses it properly.

📞 Call or text: 424-543-4336 📅 Book online at victoryperformancept.com

No referral required. California's Direct Access law means you can come straight to us.

What Shockwave Sessions Look Like at Victory

Sessions are straightforward and typically run 10 to 15 minutes. Your DPT locates the site of greatest tenderness at the medial epicondyle and delivers the acoustic pulses to that area. Most patients describe the sensation as a firm tapping or pulsing that can be moderately uncomfortable over the most sensitive point but is manageable throughout.

A temporary increase in soreness in the 24 to 48 hours after each session is a normal part of the tissue response. It typically settles within a day or two. Most patients complete 5 to 10 sessions spaced approximately one week apart as part of their broader rehabilitation plan. Your DPT reassesses throughout and adjusts the overall program based on how your tendon responds.

Common Questions About Golfer's Elbow

Can I keep training while I treat golfer's elbow?

In most cases yes, with thoughtful modification. Our DPTs at Victory will identify which activities are aggravating the medial tendon and help you adjust load, volume, or technique to stay active while recovery progresses. Pulling movements, gripping intensity, and barbell load are common areas we address during this phase.

How long does golfer's elbow take to fully resolve?

Presentations caught early and treated appropriately often improve within 8 to 12 weeks. Chronic cases, particularly those involving a long history of pushing through pain or repeated cycles of rest and return, typically require 12 to 20 weeks of consistent work to resolve durably. Shockwave therapy can shorten this timeline for appropriate presentations. And if you want to fix the root cause (strength, mobility, how you move), lasting results can take 6+ months.

Can golfer's elbow affect people who do not play golf?

Absolutely, and the majority of patients we treat with this condition are not golfers. Rock climbers, CrossFit athletes, desk workers, and anyone doing high volumes of pulling or gripping work are just as susceptible. The name is historical, not diagnostic.

Do I need a referral to come to Victory?

No. Under California's Direct Access law, you can come directly to Victory Performance and Physical Therapy without a physician referral. Book online or call us and we will schedule your evaluation.

Stop Working Around It and Start Treating It

Golfer's elbow tends to become a background problem that active adults adapt to rather than resolve. At Victory Performance and Physical Therapy in Culver City, our experience is that this injury responds very well when it is properly assessed and treated with the right combination of targeted loading, hands-on care, and shockwave therapy when the tissue needs it.

Becca Powell came to Victory after years of lower back pain that had kept her out of the gym. Her experience captures what thorough, individualized care at Victory looks like in practice.

"From the first phone call, I knew I'd found a PT that was knowledgeable, empathetic, and willing to work with me not just throw exercises at me. I have had low back pain for years that prevented me from all kinds of activities. I'm now back at the gym even doing RDLs."

The same approach applies to every injury we treat, including the inner elbow pain that has been limiting your training longer than it should have.

📅 Book your appointment at victoryperformancept.com/contact

📞 Call or text: 424-543-4336

Victory Performance and Physical Therapy | Culver City, CA | Serving active adults and athletes since 2015

How to Return to Running After Injury Without Getting Hurt Again

Sean Hubbard — Mon, 25 May 2026 12:14:29 +0000

Getting hurt is frustrating. But for most runners, the part that is actually worse is coming back. You rest. You feel better. You test the waters with a short run and everything feels fine. You build back up, cautiously at first. Then at three weeks, or six weeks, the familiar pain returns and you are back to square one.

This cycle is so common that runners start to believe their body simply cannot handle consistent training. The problem is almost never the body. It is the return-to-run process.

At Victory Performance and Physical Therapy in Culver City, the transition from injury back to full training is one of the most important phases of care we provide. Done correctly, it gets you back to the miles that matter without putting you right back on the injury list.

Why Do Runners Get Reinjured So Often?

The answer comes down to a mismatch between how the body feels and how the body is actually prepared.

Pain is a poor indicator of tissue readiness. When an injury is healing, symptoms often resolve before the tissue has fully regained its structural integrity, strength, and load tolerance. A runner feels good, increases training too quickly, and the tissue fails again because it never fully recovered.

Research on running injuries consistently shows that training load errors are among the most common contributors to overuse injury. A systematic review published in the International Journal of Sports Physical Therapy found that rapid increases in training volume and intensity were significant risk factors for running-related injuries, including recurrence of previous injuries. (Nielsen et al., 2012, Int J Sports Phys Ther.View on PubMed)

The tissue heals at a rate that does not always match how confident you feel. Bridging that gap is what a structured return-to-run program does.

What Needs to Be in Place Before You Return to Running?

Physical therapy is not just about eliminating pain. Before we clear a runner to increase their training, we are looking for specific markers that indicate the tissue and surrounding structures are ready for running load.

Pain-Free Daily Function

This means no pain walking up stairs, no discomfort after sitting for extended periods, and no limping or guarding during normal movement. If there is still pain with basic activity, running is premature.

Strength Benchmarks

Running places asymmetric demands on the body. Before returning to running after lower extremity injury, we want to see hip, glute, and calf strength within approximately ten percent of the uninjured side. We measure this with specific tests, not guesswork.

Single-leg balance, single-leg calf raises, and single-leg squat quality are among the most informative markers we use. If the injured leg is significantly weaker or less stable than the other, running will expose that deficit immediately.

No Increase in Symptoms With Impact

A simple walking program, then a walk-run progression, shows us whether the tissue responds to loading without an increase in symptoms. If a five-minute easy jog produces no pain during or in the 24 hours after, that is a meaningful green light. If symptoms increase even mildly, the tissue is telling us it needs more time.

Movement Pattern Quality

Compensation patterns that developed during the injury period need to be addressed before full training resumes. Runners often develop subtle asymmetries in stride length, hip drive, or landing mechanics while protecting a painful area. If those patterns are not corrected, they become the next injury.

What a Return-to-Run Protocol Actually Looks Like

There is no universal timeline because injuries, fitness levels, and training history all vary. But a well-structured protocol follows predictable phases regardless of the specific injury.

Phase 1: Walk-Run Progression

This begins with intervals that are weighted heavily toward walking and gradually shift toward running. A common starting point might be one minute of easy jogging alternating with two minutes of walking, for a total of twenty minutes. Frequency is typically three sessions per week with rest days between.

Progression happens only when the current level is completed without increased pain during, immediately after, or in the 24 hours following.

The pace during this phase does not matter. Effort level should be low. The goal is to reintroduce running load to the tissue, not to train fitness.

Phase 2: Continuous Easy Running

Once you can run for 20 to 30 minutes continuously without symptom increase, you have established a base to build from. This phase extends the duration and introduces a second run per week.

Volume increases follow the ten percent guideline as a general rule, though that guideline is a starting point, not an absolute. The actual rate of progression depends on how your body is responding.

Phase 3: Load Variation

Once continuous easy running is established, the program can introduce variation in terrain, pace, and distance. Longer long runs, modest fartlek work, and route variety are added incrementally. Strength training remains a consistent part of the plan throughout.

Phase 4: Return to Full Training

This means race-pace work, tempo runs, and full long run distances for your event. This phase is reached when easy running is fully established, strength markers are symmetrical, and there has been no symptom recurrence over the previous four to six weeks of progressive training.

Working through a running injury and wondering if you are ready to start building back? Our Doctors of Physical Therapy in Culver City can assess where you are and build a return-to-run plan that fits your goal race or training timeline.

Call today: 424-543-4336

The Role of Training Load in Preventing Reinjury

One of the most important concepts in return-to-run care is the relationship between acute and chronic training load.

Your acute load is roughly what you have done in the past week. Your chronic load is the average of what you have done over the past several weeks. Research by sports scientist Tim Gabbett, published in the British Journal of Sports Medicine, showed that athletes whose acute load significantly exceeded their chronic load were at substantially higher injury risk. The tissue simply was not prepared for the sudden increase in demand. (Gabbett, 2016, Br J Sports Med.View on PubMed)

This is why returning to running does not mean picking up where you left off before the injury. Even if you were doing 40 miles a week before, returning at 40 miles a week is a massive spike over the near-zero load of the recovery period. The base needs to be rebuilt.

Understanding this ratio, and being patient with it, is one of the most protective things a runner can do.

Strength Training Through the Return Phase

A return-to-run program that does not include strength work is incomplete. Running is a single-leg activity that demands significant hip, glute, and calf strength. If those structures are not trained, the return to running will continue to expose weaknesses that accumulate into injury.

A systematic review published in the British Journal of Sports Medicine found that runners who included strength training in their programs had a more than fifty percent reduction in overuse injuries compared to runners who only ran. (Lauersen et al., 2014, Br J Sports Med.View on PubMed)

The key is that strength work needs to be progressive and structured. Random gym exercises with no progression do not provide the same benefit as a targeted program that builds the specific capacities your running demands.

What Taylor Learned About Coming Back Smart

Taylor P. Miller injured his ankle two weeks before he was scheduled to run the LA Marathon. He needed a fast, structured return to running.

"I can honestly say I would not have been able to cross the finish line or even the starting line without Victory Performance. They worked with me not only in the studio, but they also gave me daily exercises that I could do at home to help get me back in the right shape."

And Will M., who came to Victory with a calf injury before the same race:

"CJ created a plan that not only addressed my pain but focused on long-term strength and mobility to improve my performance overall. I'm grateful to say I'll be making it to race day feeling strong."

Both athletes needed a return-to-run process that was carefully managed. Both made it to the start line.

Local Considerations for Culver City Runners

Culver City's terrain offers useful options for a phased return to running.

Flat surfaces first. The Ballona Creek bike path is an excellent early return-to-run environment. The surface is consistent, flat, and forgiving. It allows you to accumulate time on feet without the additional demand of hills.

Reserve the stairs. The Culver City Stairs and Baldwin Hills climbs should be among the last things reintroduced. Stair training is demanding on the knees, Achilles, and calves, and it belongs in the later phases of a return-to-run program.

Vary your surfaces gradually. Soft grass sections in Kenneth Hahn Park are a gentle way to introduce some surface variety as your tolerance improves. Hard asphalt and cement can be added back progressively once easy flat running is well established.

Return to Running Is a Process, Not a Date

The goal of rehabilitation is not just getting you back to running. It is getting you back to running with the capacity to stay there. That requires patience with the process and clear-eyed assessment at every step.

If you are a runner in Culver City or the Los Angeles area working through an injury and wondering when and how to start building back, the team at Victory Performance and Physical Therapy can help you navigate that transition thoughtfully.

Book your evaluation today.

📅Book Your Appointment

📞 Call: 424-543-4336

Why Shin Splints Keep Derailing Your Training and What to Do About It

Sean Hubbard — Mon, 18 May 2026 12:10:26 +0000

You know how it starts. A dull ache along the inside of your shin midway through a run. You back off, take a few days, go back out, and it returns within the first mile. If this has happened to you more than once, you have probably also had the thought that every runner with persistent shin pain eventually has: is this something more serious than shin splints?

At Victory Performance and Physical Therapy in Culver City, we see medial tibial stress syndrome regularly in runners, CrossFit athletes, and anyone who has recently pushed their lower body training harder than their tissue could absorb. The injury is common, the training disruption it causes is real, and the question about stress fractures is one our Doctors of Physical Therapy take seriously every single time. Getting the right answer to that question is where treatment begins.

Here is what shin splints actually are, how they differ from a stress fracture, why they keep recurring, and where shockwave therapy fits into recovery when physical therapy alone is not enough.

✅ Key Takeaways

Shin splints, clinically known as medial tibial stress syndrome (MTSS), affect 13 to 17% of all running-related injuries and are among the most common training disruptions in active adults
The difference between shin splints and a tibial stress fracture matters enormously for treatment, and ruling out a fracture is the essential first step before any intervention including shockwave therapy
A systematic review of ESWT for MTSS found that shockwave therapy reduced pain and time to recovery with no reported adverse effects across included studies
At Victory PT, our Doctors of Physical Therapy assess the whole picture before building a treatment plan, including load history, biomechanics, and whether imaging is needed
No referral needed under California's Direct Access law

What Are Shin Splints?

Medial tibial stress syndrome (MTSS) is the clinical term for what most people call shin splints. It refers to pain along the posteromedial border of the tibia, the inner edge of the shin bone, that develops in response to repetitive loading. The pain typically spans a broader section of the tibia rather than concentrating in one precise point, and it tends to come on during activity and ease with rest.

What is actually happening in the tissue involves the periosteum, which is the thin layer of connective tissue that wraps around the bone, along with the muscles that attach to the tibial border. When training load exceeds the tissue's capacity to absorb and adapt, localized stress accumulates in this area. The bone and surrounding tissue begin to remodel under load, but when that remodeling cannot keep pace with the demands being placed on it, the result is inflammation, structural stress in the tibial cortex, and pain.

MTSS sits on a spectrum. At the milder end, it is a periosteal stress reaction. At the more serious end, without adequate management, it can progress toward a tibial stress fracture. This is the progression that every athlete with shin pain needs to understand, and the reason the first priority at Victory when someone comes in with lower leg pain is always to determine where on that spectrum they currently sit.

Is This a Stress Fracture or Shin Splints?

This is the question underneath most shin pain presentations, and it deserves a direct answer.

The two conditions can feel similar enough that distinguishing them is not always straightforward without clinical assessment and sometimes imaging. There are practical differences worth knowing:

Shin splints typically produce pain that is spread over a broader area of the medial tibial border, often several centimeters of the inner shin. The pain tends to warm up or reduce during a run and may feel more diffuse than sharp. It usually settles within a day or two of rest.

Tibial stress fracture tends to produce more focal, localized pain at one specific point along the tibia. Pain is often worse with weight-bearing and persists more consistently after activity. In some cases, there is point tenderness that can be reproduced by palpating a single spot on the bone.

At Victory, our DPTs use clinical testing including hop tests, tuning fork testing, and palpation patterns alongside a thorough history to determine whether imaging is warranted before any treatment begins. This matters not just for diagnosis but for safety. Shockwave therapy is contraindicated if a stress fracture is present. Applying acoustic energy to a fractured bone is not appropriate and could worsen the injury. This is a clinical gate we apply without exception.

If there is any clinical suspicion of a stress fracture, we will guide you toward appropriate imaging before any treatment protocol begins. Most presentations we assess are MTSS rather than fracture, but taking that differential seriously is non-negotiable.

Who Gets Shin Splints and Why

MTSS is not exclusive to high-mileage runners. At Victory, we see it in a range of active adults across Culver City and the surrounding LA area:

Runners who have increased their weekly mileage too quickly, particularly those building toward a marathon or ramping up after time off
New runners whose bones and soft tissue have not yet adapted to the demands of impact training
CrossFit or Hyrox athletes who have introduced box jumps, double-unders, or running into a previously gym-based program
Military-style fitness participants and boot camp athletes doing high volumes of running and plyometric work
Athletes returning from time away who resume at their previous training load without a gradual rebuild
Recreational athletes who train on hard surfaces like asphalt without adequate footwear or lower limb preparation

Research shows that prevalence of MTSS in active individuals ranges from 4 to 35%, with the highest rates in military populations and runners who have recently increased training intensity. The common factor across all groups is a mismatch between training load and the tissue's current capacity.

Several other factors can increase susceptibility, including hip abductor weakness that affects lower limb alignment during impact, limited ankle range of motion, and running mechanics that place excess stress on the medial tibial border. These contributing factors are exactly what our DPTs at Victory assess as part of a comprehensive evaluation.

Why Does It Keep Coming Back?

The pattern with shin splints is remarkably consistent. Pain develops, training is reduced, it settles, training resumes at a similar load, and the pain returns within a few weeks. This cycle can repeat through multiple training seasons if the underlying contributors are never addressed.

Rest reduces the provocative load, which is why symptoms ease. But rest alone does not strengthen the tissue. It does not improve hip mechanics, correct running gait, or build the bone density needed to tolerate higher training volumes. When activity resumes, the same tissue is faced with the same demands, and the stress accumulates again.

Breaking this cycle requires a different approach. The tissue needs progressive load to adapt and strengthen, the contributing factors need to be identified and addressed, and training needs to be managed in a way that allows the bone to remodel without being overwhelmed.

This is the approach our team takes at Victory, and it is the foundation on which shockwave therapy adds value when the situation calls for it.

How We Treat Shin Splints at Victory Performance PT

The Assessment

Before any treatment begins at Victory, your Doctor of Physical Therapy conducts a thorough evaluation that includes:

Ruling out tibial stress fracture through clinical testing and history, with imaging referral when clinically indicated
Identifying the location, extent, and severity of the tibial stress reaction
Assessing hip and glute strength, particularly hip abductor function, and how it influences lower limb alignment
Evaluating ankle and calf mobility and how they affect load distribution during impact
Reviewing your training history, recent load increases, and surface and footwear factors
Assessing running mechanics where relevant

This picture tells us not just what to treat, but why the injury developed, which is what determines whether it resolves and stays resolved.

Load Management and Progressive Bone Loading

The cornerstone of MTSS management is intelligent load management. This does not mean stopping all activity. It means identifying the load threshold your tibia can currently tolerate and building systematically from there.

At Victory, our DPTs work with you to restructure your training in a way that keeps you as active as possible while giving the bone the controlled stimulus it needs to adapt. Complete rest is rarely the right answer for shin splints, and it is not typically our first recommendation.

Alongside load management, we address the contributing factors identified in your assessment. Hip and glute strengthening to improve lower limb mechanics, calf and ankle work to optimize load distribution, and running gait modifications where needed are all part of the program.

Will Murphy came to Victory with a calf and lower limb issue while training for a marathon, unsure whether he would make the start line.

Will made it to race day. Building that kind of outcome requires more than just treating the painful area. It requires understanding the athlete and building a plan around what they are trying to get back to.

Where Shockwave Therapy Fits In for Shin Splints

For athletes with persistent MTSS that has not responded adequately to load management and rehabilitation alone, shockwave therapy offers a targeted intervention with growing clinical support.

Extracorporeal shockwave therapy (ESWT) delivers focused acoustic pulses along the medial tibial border. In addition to the mechanotransduction effects we see in tendon conditions, shockwave therapy for MTSS is thought to act on the periosteum and tibial cortex directly. Research suggests that acoustic energy stimulates osteoblast activity, the cells responsible for building new bone, promoting bone remodeling in tissue that has been caught in a cycle of stress and incomplete repair. It also targets the periosteal and soft tissue component of the injury.

A systematic review of ESWT specifically for MTSS found that shockwave therapy reduced pain and shortened time to recovery across included studies, with no adverse effects reported in any study. (As reviewed in: The diagnosis and management of medial tibial stress syndrome: an evidence update) A broader systematic review in the British Journal of Sports Medicine examining ESWT across common lower limb conditions found positive results for patient-rated pain reduction in MTSS among other conditions. (Korakakis et al., 2021, British Journal of Sports Medicine) The first systematic review in the British Journal of Sports Medicine focused specifically on athletes and physically active individuals also identified MTSS as a condition where ESWT may be considered. (Rhim, Tenforde et al., 2023)

Being straightforward about where the evidence stands for MTSS: the evidence base is smaller and less developed than for plantar fasciitis or Achilles tendinopathy, where shockwave therapy has been studied more extensively. The studies available are promising and consistently report benefit, but the number of high-quality randomized controlled trials is more limited. At Victory, when we recommend shockwave therapy for shin splints, it is as part of a comprehensive assessment-led plan, not as a quick fix or a replacement for addressing the load and mechanics factors that drove the injury.

We consider shockwave therapy for MTSS when:

A stress fracture has been confidently ruled out through clinical assessment and imaging if indicated
Symptoms have persisted beyond 6 to 8 weeks of appropriate load management and rehabilitation
The injury has become chronic and is interrupting repeated training cycles
There is a specific event or training deadline that makes accelerating recovery a meaningful priority

If you are dealing with shin pain that keeps interrupting your training no matter how much you rest it, our Doctors of Physical Therapy at Victory Performance and Physical Therapy in Culver City can assess what is actually going on and build a plan that addresses it properly.

📞 Call or text: 424-543-4336 📅Book online at victoryperformancept.com

No referral required. California's Direct Access law means you can come straight to us.

What Shockwave Sessions Look Like at Victory for Shin Splints

Sessions for MTSS differ slightly from tendon-focused shockwave in that the acoustic pulses are delivered along the length of the affected tibial border rather than concentrated at a single attachment point. Your DPT identifies the zone of maximum tenderness through palpation and covers that area systematically during the session.

Sessions typically run 10 to 15 minutes. The sensation is a firm pulsing along the inner shin that most patients describe as moderately uncomfortable over the most reactive areas. Temporary soreness in the 24 to 48 hours following a session is a normal response and typically settles quickly. Most protocols involve 3 to 5 sessions spaced approximately one week apart alongside your ongoing rehabilitation program.

Running volume is typically reduced during the treatment period, particularly high-impact and speed work, to allow the bone to respond to treatment without being continuously overloaded. Your DPT will advise on exactly what modified training looks like for your specific situation.

Common Questions About Shin Splints

How do I know if I have shin splints or a stress fracture?

Shin splints typically produce a broader, more diffuse ache along the inner shin that comes on with activity and settles with rest. A stress fracture tends to cause more focal, point-specific pain that persists more consistently and often hurts with everyday weight-bearing. That said, distinguishing the two reliably requires a clinical assessment. Our DPTs at Victory assess this at every lower leg pain presentation and will recommend imaging when there is any uncertainty.

Can I keep running while treating shin splints?

In most cases, modified activity is possible and preferable to complete rest. Your DPT will work with you to identify a training load your tibia can currently tolerate and structure your program around that. High-impact work and speed training are typically reduced, but staying active and building progressively is part of the plan.

How long does it take for shin splints to resolve?

Acute presentations managed early often improve within 4 to 8 weeks of appropriate load management and rehabilitation. Chronic cases with a long history of recurring symptoms typically require 10 to 16 weeks of consistent work, including addressing the contributing mechanical factors. Shockwave therapy, when appropriate, can support recovery in persistent presentations.

Is shockwave therapy safe for shin splints?

Yes, when a stress fracture has been properly ruled out. This is the critical safety gate that must be applied before ESWT for any lower leg bone stress presentation. Our DPTs at Victory assess this thoroughly before recommending shockwave for any shin pain presentation.

Do I need a referral?

No. California's Direct Access law means you can come directly to Victory Performance and Physical Therapy without a physician referral. Call us, book online, and we will get you in for a proper assessment.

Stop the Recurring Cycle With Victory PT

Shin splints have a way of becoming a background fixture in a runner's life rather than something that gets properly resolved. At Victory Performance and Physical Therapy in Culver City, our approach is to assess thoroughly, address the full picture including load, mechanics, and tissue health, and use shockwave therapy as part of that plan when the evidence and your clinical presentation support it.

Taylor P. Miller came to Victory after an ankle injury with only two weeks until the LA Marathon.

"I would not have been able to cross the finish line or even the starting line without Victory Performance. They worked with me not only in the studio, but they also gave me daily exercises that I could do at home to help get me back in the right shape."

The goal at Victory is always to get you back to what you love doing, with the tools to keep you there.

📅Book your appointment at victoryperformancept.com/contact

📞 Call or text: 424-543-4336

Victory Performance and Physical Therapy | Culver City, CA | Serving active adults and athletes since 2015

Why Tennis Elbow Keeps Coming Back and What to Do About It

Sean Hubbard — Mon, 11 May 2026 12:00:43 +0000

You have probably been here before. The pain on the outside of your elbow flares up, you back off, it settles down, and a few weeks later it is right back. Maybe you have tried rest, ice, a brace, or even a cortisone shot. Things calm down for a while and then the cycle starts again.

This is one of the most common stories we hear at Victory Performance and Physical Therapy in Culver City. Tennis elbow has a reputation as something you just manage around, and for a lot of people it becomes exactly that, a recurring problem they have learned to work with rather than resolve. The reason it keeps coming back is not bad luck. It is biology. And once you understand what is actually happening in the tendon, the path forward becomes a lot clearer.

✅ Key Takeaways

Tennis elbow keeps returning because most treatments address pain without fixing the underlying tendon degeneration
The problem is structural, not just inflammatory, which is why rest and cortisone often provide only temporary relief
A 2024 meta-analysis found shockwave therapy outperforms cortisone injection for pain and grip strength at 3 months and beyond
At Victory PT, our Doctors of Physical Therapy combine a comprehensive assessment, targeted tendon loading, and shockwave therapy to break the cycle for good
No referral needed under California's Direct Access law

Why Does Tennis Elbow Keep Coming Back?

This is the question worth answering first, because it explains why so many common treatments fall short.

Lateral epicondylitis is the clinical name for tennis elbow. It involves the extensor tendons of the forearm, specifically where the extensor carpi radialis brevis (the primary wrist extensor and gripping muscle) attaches to the bony prominence on the outside of the elbow. When that attachment site is repeatedly loaded without adequate recovery, micro-tears develop in the tendon tissue.

In the early stages, there is genuine inflammation, and anti-inflammatory approaches like ice or cortisone can genuinely help. But over time, in chronic cases, the tissue goes through a degenerative process and chronic inflammation - tendon degeneration and pain from structural breakdown of the collagen fibers themselves. The tendon becomes disorganized, thickened, and loses its normal mechanical properties.

Here is the critical part. Degenerated tendon tissue does not recover with rest. The pain decreases when load is removed, which feels like progress. But the structural quality of the tendon has not actually improved. The moment you return to the activities that provoked it, gripping, lifting, swinging, typing, the same compromised tissue gets loaded again and the pain returns.

This is why the cycle repeats. It is not that your elbow is uniquely stubborn. It is that the treatment has been targeting the pain rather than the tissue.

Who Gets Tennis Elbow in Culver City

Despite the name, most of our patients with lateral epicondylitis at Victory have never picked up a tennis racket. The condition affects 1 to 3% of adults annually and shows up across a wide range of activities:

CrossFit athletes doing high-volume pull-ups, bar muscle-ups, and rope climbs
Rock climbers putting sustained load through their forearm extensors
Office and remote workers spending hours at a keyboard and mouse
Tradespeople using tools that require repetitive gripping and wrist extension
Golfers, particularly through the lead arm and wrist extension on the backswing
Weightlifters performing rows, deadlifts, and curls with poor forearm mechanics
Musicians with repetitive forearm and wrist demands

The common factor is repetitive strain on the extensor tendon origin at the elbow, loaded faster than the tissue can adapt. Age, activity volume, and grip strength all play a role in who develops it and why.

Why Common Treatments Do Not Break the Cycle

Understanding why rest and cortisone often fail to produce lasting results is important before deciding on a treatment path.

Rest removes the provocative load, which reduces symptoms. But it does not stimulate the tendon to remodel or restore normal collagen structure. When activity resumes, the degenerated tissue is still there and the cycle restarts.

Cortisone injections can be genuinely useful for managing acute pain, but can cause more issues than it’s worth (as the cortisone itself can degrade both injured and healthy tissue). And then, there is another problem - the evidence on long-term positive outcomes is poor. A 2024 systematic review and meta-analysis published in Orthopaedic Surgery compared shockwave therapy directly against cortisone injection across six randomized controlled trials. At one month, cortisone was superior for pain relief. At three months and at final follow-up, the results reversed. Shockwave therapy showed significantly better outcomes for pain, grip strength, and functional scores. (Zhang et al., 2024, Orthopaedic Surgery)

This does not mean cortisone has no role. But for chronic lateral epicondylitis, the pattern is consistent: cortisone provides faster short-term relief and shockwave therapy produces more durable long-term results without the negative side-effects associated with using steriods. That is a meaningful distinction when you have already been through the rest-and-return cycle more than once.

The treatment that actually breaks the cycle needs to do two things: give the tendon the mechanical stimulus it needs to remodel structurally, and address why it was getting overloaded in the first place.

How We Approach Tennis Elbow at Victory Performance PT

Our Doctors of Physical Therapy do not treat tennis elbow as a simple fix. They treat it as a tissue problem with contributing factors that need to be identified and addressed.

The Assessment

Every patient at Victory starts with a thorough evaluation. For tennis elbow, that means looking at:

Where exactly the pain reproduces and which movements provoke it
Strength deficits in the wrist extensors, forearm, and shoulder
Whether shoulder mechanics or grip patterns are contributing to excess load at the elbow
Your activity history and how the injury has progressed
Ruling out other diagnoses such as radial tunnel syndrome, which can present similarly but requires a different approach

This matters because two people with the same elbow pain can have completely different contributing factors driving it. A CrossFit athlete who developed tennis elbow from high-volume pull work is not going to have the same plan as a software developer whose symptoms developed from poor desk ergonomics. We build programs around what we actually find.

The Tendon Loading Program

The foundation of evidence-based lateral epicondylitis rehabilitation is a structured eccentric and isometric loading program for the wrist extensor tendons. This is where lasting structural change happens.

At Victory, our DPTs prescribe and supervise these protocols with close attention to load, tempo, range of motion, and progression. The details matter. A loading program that is advanced too quickly or prescribed without a proper assessment can prolong recovery rather than accelerate it. We monitor how your tendon responds and adjust at every stage.

Most patients remain active throughout rehabilitation. Complete rest from all activity is rarely necessary and often counterproductive.

Nick Cuda came to Victory after trying other clinics and not finding the results he was looking for.

"Every aspect of care felt intentional. From stretching and cupping to stability and mobility exercises, I always left a session feeling better than when I arrived. It doesn't hurt that everyone in there is personable and has a great sense of humor."

How Shockwave Therapy Addresses the Root Problem

For chronic tennis elbow that has not responded to loading and manual therapy alone, shockwave therapy gives us a way to directly target the degenerated tissue that is perpetuating the cycle.

Extracorporeal shockwave therapy (ESWT) delivers focused acoustic pulses to the lateral epicondyle. Through a process called mechanotransduction, the acoustic energy stimulates cellular repair mechanisms, promotes collagen remodeling, and encourages new blood vessel formation in tissue that has lost its normal healing capacity. It is not a pain blocker. It is a biological stimulus for structural repair in tissue that has stopped repairing itself.

A large meta-analysis analyzing 45 clinical studies across multiple tendinopathies found statistically significant pain reductions from shockwave therapy, including for lateral epicondylitis. (Majidi et al., 2024, BMC Sports Science, Medicine and Rehabilitation) The first systematic review in the British Journal of Sports Medicine focused specifically on athletes and physically active individuals concluded that ESWT may be considered an initial treatment option for lateral epicondylitis in active populations. (Rhim, Tenforde et al., 2023)

At Victory, shockwave therapy is always integrated into a complete treatment plan. The combination of ESWT and a supervised loading program consistently outperforms either approach on its own.

We typically consider shockwave therapy when:

Symptoms have persisted beyond 6 to 8 weeks of appropriate rehabilitation
Cortisone relief was present but did not hold
The tendon is chronically degenerated rather than acutely inflamed
A faster return to activity is a meaningful priority

If your tennis elbow keeps coming back no matter what you try, the problem is likely in the tissue, not your effort. Our Doctors of Physical Therapy at Victory Performance and Physical Therapy in Culver City can identify exactly what is driving it and build a plan that addresses it properly.

📞 Call or text: 424-543-4336 📅Book online at victoryperformancept.com

No referral required. California's Direct Access law means you can come straight to us.

What Shockwave Treatment Looks Like at Victory

Sessions are straightforward and typically 10 to 15 minutes. Your DPT locates the site of greatest tenderness at the lateral epicondyle and delivers the acoustic pulses directly to that area. Most patients describe the sensation as a firm tapping or pulsing that is slightly uncomfortable at the most sensitive point but consistently manageable throughout.

A temporary increase in soreness for 24 to 48 hours after a session is normal and expected. It reflects the tissue response and is not a sign that something has gone wrong.

Most patients complete 5-10 shockwave sessions spaced approximately one week apart, alongside their ongoing loading program. Your DPT will reassess throughout and adjust based on how your tendon is responding.

Common Questions About Tennis Elbow

How long does tennis elbow take to fully resolve?

Acute presentations caught early often improve within 6 to 10 weeks of consistent rehabilitation. Chronic cases, particularly those with a long history of rest-and-return cycles or multiple cortisone injections, typically take 12 to 16 weeks of committed work. Shockwave therapy can accelerate this timeline in chronic presentations. And if you want to fix the root cause (strength, mobility, how you move), lasting results can take 6+ months.

Can I keep training while I treat my tennis elbow?

Usually yes, with modification. Your DPT at Victory will identify which activities are aggravating the tendon and help you adjust load and technique to stay active throughout recovery. Staying completely inactive is rarely necessary and can slow the rehabilitation process.

Is tennis elbow the same as golfer's elbow?

They are related but different. Tennis elbow is lateral epicondylitis and affects the outside of the elbow through the extensor tendons. Golfer's elbow is medial epicondylitis and affects the inside of the elbow through the flexor tendons. The activities that provoke each are different and so is the rehabilitation approach. We cover golfer's elbow in detail in a separate post if that sounds more like your situation.

Do I need a physician referral to see a physical therapist?

No. California's Direct Access law allows you to come directly to Victory Performance and Physical Therapy without a referral. Book online or call us and we will get you scheduled for an evaluation.

Ready to Break the Cycle

At Victory Performance and Physical Therapy in Culver City, we have helped hundreds of active adults resolve injuries that had been recurring for months or years. Tennis elbow is one of the most common, and when it is approached correctly, one of the most treatable.

Kupah James came to Victory after significant injuries from a motorcycle accident. As a fitness professional with 20 years in the industry, he knew what good rehabilitation should feel like.

"Victory is top tier in all the ways that matter and in some you wouldn't even think about. State of the art wellness technology backing your sessions with science not opinions. All of this created a recipe for warmth and a feeling of comfort that goes a long way in recovery."

That combination of clinical rigor and genuine care is what we bring to every patient who comes through our door.

📅Book your appointment at victoryperformancept.com/contact

📞 Call or text: 424-543-4336

Victory Performance and Physical Therapy | Culver City, CA | Serving active adults and athletes since 2015

Why Runners Over 40 in Culver City Need a Different Recovery Strategy

Sean Hubbard — Mon, 04 May 2026 11:52:23 +0000

If you have been running for years and feel like your body stopped cooperating somewhere in your forties, you are not imagining it. Recovery takes longer than it used to. That nagging hip flexor tightness that would have cleared up in a few days now lingers for two weeks. You can still run the distances, but you cannot bounce back from back-to-back hard days the way you once did.

This is not decline. It is biology. And with the right adjustments, most runners over 40 can continue training at a high level, stay injury-free, and often run their best times ever.

At Victory Performance and Physical Therapy in Culver City, we work with a lot of masters runners, those typically defined as athletes 40 and older, and the physiological changes that affect training and recovery are real, specific, and very manageable with the right approach.

What Actually Changes in the Body After 40

Understanding what is happening physiologically helps you train with better intention rather than just running more carefully out of vague concern.

Tendon Stiffness and Healing Speed

Tendons become less pliable and heal more slowly as we age. The cells responsible for collagen production (tenocytes) become less active, meaning the quality of collagen laid down after micro-damage is reduced. This is why Achilles tendinopathy, plantar fasciitis, and IT band problems tend to linger longer in older runners and recur more frequently if training load is not managed carefully.

It does not mean your tendons are fragile. It means they need more time between high-load sessions and more consistent strength work to stay resilient.

Muscle Protein Synthesis

After about age 35, the body becomes less efficient at using dietary protein to build and repair muscle tissue. The anabolic response to a training stimulus, the muscle-building signal that drives adaptation, is blunted compared to younger athletes. Older runners need both a higher relative protein intake and more structured recovery to get the same training adaptations.

Research by Tanaka and Seals, published in the Journal of Applied Physiology, found that masters athletes maintain impressive physiological capacity with consistent training, but that the gap between trained and untrained individuals widens significantly with age, underscoring the importance of structured training and recovery rather than simply logging miles. (Tanaka and Seals, 2003, J Appl Physiol.View on PubMed)

VO2 Max and Aerobic Capacity

VO2 max, the maximum rate at which your body can use oxygen during exercise, declines at roughly one percent per year after peak fitness age. The decline is faster in sedentary individuals. In consistently trained masters athletes, the rate of decline is significantly slower, and some components of aerobic performance remain very well preserved well into the fifties and beyond.

A study examining masters endurance athletes found that training-induced adaptations can offset much of the age-related decline in aerobic performance, with consistent exercise being the single most powerful tool for preserving cardiovascular capacity over time. (Lepers and Cattagni, 2012, Age.View on PubMed)

The takeaway: the engine can stay strong. The chassis, meaning the tendons, muscles, and connective tissue, needs more deliberate care to keep up.

Neuromuscular Response Time

Reaction time and neuromuscular coordination slow modestly with age. In practical running terms, this affects stride efficiency and can contribute to a subtle reduction in elastic energy return from each stride. It also influences single-leg stability, which is directly relevant to injury risk.

This is one reason strength training and plyometric work, introduced appropriately, are particularly valuable for runners over 40. They maintain the neuromuscular firing patterns that keep your stride crisp and your landing mechanics intact.

What Does This Mean for Your Training?

The core principle is that the inputs to performance (training stress) remain similar, but the recovery piece needs to expand significantly.

More Recovery Between Hard Efforts

Running performance is built on the adaptation that happens after a hard effort. If the next hard session arrives before recovery is complete, you are building on a compromised foundation. For runners over 40, the window between quality sessions typically needs to be longer than the plans designed for 25-year-olds assume.

This might mean two hard sessions per week instead of three, with more easy volume in between. It might mean spacing your long run and your tempo run further apart in the week.

Strength Training Is No Longer Optional

Strength training was always valuable for runners. For masters runners, it is essential.

Research published in the Physician and Sportsmedicine demonstrated that masters athletes who engaged in consistent resistance training maintained significantly more lean muscle mass than sedentary age-matched peers, and that this effect was present even in runners well into their sixties. (Wroblewski et al., 2011, Phys Sportsmed.View on PubMed)

Preserving muscle mass protects the tendons and joints above and below it. Hip strength keeps the pelvis stable and the knee tracking well. Calf and foot strength protects the Achilles and plantar fascia. Glute strength supports the entire posterior chain through the demands of long-distance running.

Two sessions of focused strength work per week, built around single-leg movements and hip loading, is a reasonable baseline for most masters runners.

Sleep and Nutrition Matter More Than They Did Before

At 25, you could absorb a poor night of sleep or a skipped meal and still have a solid training week. At 45, the margins are tighter. Sleep is when growth hormone peaks and the repair processes activated by training do most of their work. Shortchanging sleep directly impairs the tissue repair and neural recovery that your training depends on.

Protein timing matters more too. Older adults benefit from distributing protein intake more evenly across the day and prioritizing a protein-containing meal or snack within an hour or two of training to take advantage of the anabolic window when the training signal is strongest.

Are you a runner over 40 dealing with injuries that seem to take forever to heal, or training hard but not recovering like you used to? Our Doctors of Physical Therapy in Culver City can evaluate your movement, your loading patterns, and your training to help you stay in the game.

Call today: 424-543-4336

Common Injuries That Affect Masters Runners More

Certain injuries appear more frequently or are harder to manage in runners over 40. Knowing which ones to watch for helps you catch them early.

Achilles Tendinopathy. The combination of reduced tendon elasticity and slower collagen repair makes the Achilles vulnerable. Morning stiffness that takes ten or more minutes to settle is an early warning sign that should not be ignored.

Plantar Fasciitis. The plantar fascia, like other connective tissue, stiffens with age. Runners who increase their mileage too quickly or lack adequate calf and intrinsic foot strength are particularly susceptible.

IT Band Syndrome. Hip abductor strength tends to decline with age unless actively maintained. As that strength drops, the IT band absorbs more force with each stride and becomes a recurring problem.

Stress Reactions. Bone density changes after 40, particularly in women approaching and after menopause. Stress reactions, the precursor to stress fractures, can occur at lower training loads than they would have in a younger runner. Persistent, localized bone pain that worsens with activity and improves with rest warrants evaluation.

Hip Flexor and Labral Injuries. Hip mobility often decreases as we age, and tightness in the hip flexors combined with the repetitive hip cycling of running can contribute to hip flexor strains and, in some cases, labral irritation.

Running Over 40 in Culver City Is Very Possible

The Culver City running community is full of masters athletes. The LA Marathon draws significant numbers of runners in their forties and fifties. The Baldwin Hills trails and Kenneth Hahn Park are packed on weekend mornings with runners who are decades into the sport.

The local running environment actually supports smart training for older athletes. Flat sections on the Ballona Creek path are ideal for easy recovery miles. The grass and softer trails in Kenneth Hahn reduce impact loading on tendon-heavy recovery days. The variety of terrain, from flat paths to challenging climbs, allows training load to be modulated based on where you are in your recovery cycle.

What Culver City runners over 40 often need most is permission to take recovery seriously and a specific plan for keeping strength in balance with mileage.

A Runner Who Came Back Stronger

Johnny H. came to Victory Performance after running the LA Marathon while managing significant muscle tightness and stiffness. He worked with Zyan on recovery work for his shoulder, hamstrings, and post-run soreness.

"Zyan is amazing. Very knowledgeable and also very kind and personable. She has really helped loosen up a tight shoulder as well as post-running hamstring and muscle tightness. The Victory team is awesome."

Managing the recovery side of training, not just the miles themselves, is what keeps athletes running long-term.

Building a Long-Term Running Career After 40

The goal for most masters runners is not just getting through this training cycle. It is staying healthy and active for decades to come. That requires thinking differently about how you structure training.

Some principles that consistently hold up:

Polarize your training. Easy days should be genuinely easy. Hard days can be genuinely hard. The moderate-intensity zone, where many recreational runners spend most of their time, accumulates fatigue without driving significant adaptation.

Track volume in time, not just miles. A 60-minute run on trails at a conservative pace is a different physiological stimulus than 60 minutes at a harder effort on flat roads. Using time as your primary volume metric helps prevent accidental overloading.

Respect the long-run recovery window. A long run at 50 leaves most runners needing two to three days before another quality session. That is not weakness. It is smart management of a bigger recovery debt.

Get evaluated before you are injured. A movement assessment with a physical therapist can identify the specific strength deficits and mobility restrictions that your age and training history have created before they become injuries.

You Can Run Well for a Long Time

Running longevity is achievable with the right approach. The runners who stay healthy and competitive into their fifties and sixties are not the ones who push hardest. They are the ones who train with the most intelligence.

If you are a runner over 40 in Culver City or the greater Los Angeles area and want to keep training at a high level, the team at Victory Performance and Physical Therapy can help you build a plan that fits your biology and your goals.

Book your evaluation today.

📅Book Your Appointment

📞 Call: 424-543-4336

What Every Runner Should Know About Shockwave Therapy

Sean Hubbard — Mon, 27 Apr 2026 13:14:10 +0000

If you have been running consistently for any length of time, you have probably dealt with at least one injury that put you on the sideline longer than you expected. The Achilles that flared up six weeks before a race. The shin pain that showed up every time mileage climbed above a certain threshold. The heel that made the first steps out of bed genuinely unpleasant. You rest, it calms down, you go back to training, and somewhere in the back of your mind you are already waiting for it to return.

At Victory Performance and Physical Therapy in Culver City, a significant part of our patient base is made up of runners. LA Marathon athletes, Ballona Creek regulars, people training for their first 10K and veterans chasing a Boston qualifier. What they have in common is not the injury. It is the experience of trying to manage something that keeps recurring without ever really understanding why.

Shockwave therapy is one of the tools we use most consistently with this population, and most runners have never heard of it until they are already frustrated enough to try something new. This post is for those runners, and for the ones who want to understand their options before they get to that point.

✅ Key Takeaways

Runners are among the highest-risk groups for the tendon and bone stress injuries where shockwave therapy has the strongest evidence
The first systematic review focused specifically on athletes found ESWT facilitates return to sport across multiple running-related conditions with an excellent safety profile
At Victory PT, shockwave therapy is always part of a complete DPT-supervised plan, not a standalone session
The conditions most relevant to runners include Achilles tendinopathy, shin splints, plantar fasciitis, and patellar tendinopathy
No referral needed under California's Direct Access law

Why Runners Keep Getting Injured

Running is a repetitive loading activity. Every stride produces a ground reaction force of roughly two to three times body weight through the lower limb. Multiply that across a typical training week and the cumulative load on tendons, fascia, and bone is enormous.

The body adapts well to this load when training is progressed gradually and recovery is adequate. The injuries happen in the gaps between what the training demands and what the tissue can currently handle.

These gaps open up in predictable ways:

Mileage increases too quickly after a rest period or an easy training block
A hard training cycle runs into insufficient sleep, stress, or nutrition that compromises recovery
A mechanical issue like limited hip strength, restricted ankle mobility, or a subtle gait pattern quietly overloads one structure more than others
Age-related changes in tendon elasticity mean tissue that handled a certain load at 30 requires more preparation and recovery at 45

The result is the specific injuries runners deal with over and over. And because these injuries are load-related rather than traumatic, they tend to respond poorly to pure rest and well to the right kind of progressive management. This is the context in which shockwave therapy, used correctly alongside physical therapy, makes the most sense.

What Shockwave Therapy Is and How It Works

Extracorporeal shockwave therapy, or ESWT, delivers focused acoustic pulses to a targeted area of injured tissue. The mechanical energy from those pulses triggers a biological repair response called mechanotransduction, stimulating cellular activity, promoting collagen remodeling, encouraging new blood vessel formation, and in the case of bone stress injuries, activating the cells responsible for bone remodeling.

In plain language: it creates the stimulus that chronically degenerated or overloaded tissue needs to actually repair, rather than staying stuck in a cycle of partial healing and re-injury.

At Victory, shockwave sessions run 10 to 15 minutes. They are performed by your Doctor of Physical Therapy as part of a broader treatment session. Most running-related protocols involve 5 to 10 sessions spaced approximately one week apart. You can typically resume normal daily activity immediately after a session, and most people maintain a modified training load throughout the treatment course rather than stopping completely.

The treatment is not a magic fix and we do not present it as one. It works best when it is part of a plan that also addresses the loading patterns and contributing factors that drove the injury. At Victory, that is always how we use it.

What the Research Says About Shockwave Therapy in Runners and Athletes

The most relevant body of evidence for the running population comes from a systematic review published in the British Journal of Sports Medicine that was specifically designed to address a gap in the research. Previous reviews had pooled athletes and non-athletes together. This review, conducted by researchers at Spaulding Rehabilitation and published in 2023, was the first to examine ESWT exclusively in athletes, physically active individuals with sports-type injuries, and people in physically demanding occupations. (Rhim, Tenforde et al., 2023)

The findings are worth understanding directly:

ESWT alone or combined with exercise facilitates return to sport or activity across multiple conditions
The safety profile of shockwave therapy is excellent, with the most common side effects being temporary redness and soreness at the treatment site
ESWT may be considered an initial treatment option for plantar fasciitis, lateral epicondylitis, non-insertional Achilles tendinopathy, and proximal hamstring tendinopathy in athletes
MTSS was identified as a condition where ESWT may also be considered
The procedure was well tolerated in both young athletes and adults

For runners specifically, the conditions covered in that review represent the most common reasons people come through our door at Victory. This is not a treatment developed for sedentary populations that has been adapted for athletes. The evidence base in the literature now includes research specifically in people who need to get back to training.

The Running Injuries We Treat With Shockwave Therapy at Victory

Achilles Tendinopathy

The most common tendon injury in runners, affecting up to 18% of the running population and carrying a 52% lifetime incidence in former endurance runners. Mid-portion Achilles tendinopathy in particular has strong evidence supporting the combination of a loading program and shockwave therapy, especially in cases that have not responded to loading alone or where a race deadline makes recovery timelines important.

We cover Achilles tendinopathy in detail in our dedicated post: What Active Adults Need to Know About Achilles Tendinitis and Shockwave Therapy.

Plantar Fasciitis

Plantar fasciitis accounts for roughly 8% of all running injuries and is one of the conditions where shockwave therapy has the most well-established evidence base. The morning heel pain, the sharp sensation at the first steps of a run, the way it affects every mile when it is at its worst. ESWT is considered a strong option for plantar fasciitis that has not responded to stretching and conservative management.

We have a dedicated post on shockwave therapy for plantar fasciitis here: Shockwave Therapy for Plantar Fasciitis.

Shin Splints (Medial Tibial Stress Syndrome)

One of the most disruptive injuries for runners building mileage, and one of the most commonly mismanaged through repeated rest-and-return cycles that never address the underlying load and mechanical factors. The research on shockwave therapy for MTSS is promising, with systematic reviews finding reduced pain and shorter time to recovery with ESWT across included studies. Importantly, a tibial stress fracture must always be ruled out before shockwave therapy is used for shin pain.

Our full post on shin splints is here: Why Shin Splints Keep Derailing Your Training and What to Do About It.

Patellar Tendinopathy

Less common in road runners than in jumping athletes, but relevant in runners who do significant hill training, trail running, or incorporate plyometric work into their program. The Culver City Stairs and Baldwin Hills routes create meaningful eccentric knee load that can stress the patellar tendon over time. Shockwave therapy is included in evidence-based guidelines for patellar tendinopathy management, and at Victory we assess and treat this as part of our broader running injury caseload.

Why Most Runners Do Not Discover Shockwave Therapy Until They Are Already Frustrated

This is something we hear regularly at Victory. A runner comes in after months of managing an injury on their own, trying rest, trying stretching, maybe trying a cortisone injection that worked for a while. Shockwave therapy is not the first thing anyone mentions to them because it sits outside the typical pathway of GP referral to physiotherapy to injection to imaging.

The runners who find their way to Victory and to ESWT earlier in that process tend to have better outcomes, simply because chronic tendinopathy and bone stress injuries become harder to resolve the longer they have been present. Tissue that has been degenerating for six months requires more work to turn around than tissue that has been symptomatic for six weeks.

California's Direct Access law means you do not need a referral to come to us. You can call or book online and come in for a proper assessment without first going through a physician referral process. For runners with a training goal or a race on the calendar, that directness matters.

How We Work With Runners at Victory

Every runner who comes to Victory starts with a comprehensive assessment by one of our licensed Doctors of Physical Therapy. For running-related injuries, that means we are not just looking at where it hurts. We are looking at:

The specific tissue involved and the current stage of the injury
Hip and glute strength and how it affects lower limb mechanics under load
Ankle mobility and calf strength and their role in distributing impact forces
Training history, recent load increases, and recovery patterns
Running mechanics when relevant, particularly for recurrent injuries with a clear pattern
Whether imaging is needed to rule out stress fractures or confirm a clinical diagnosis

That assessment determines everything. The loading program, the manual therapy, whether shockwave therapy is appropriate and when to introduce it, and the return-to-running plan that accounts for what you are actually training for.

We do not give everyone the same program. We build programs around what we find and around what matters to the person in front of us, whether that is finishing their first half marathon or getting back to the weekly long run that keeps the rest of their life working.

If you are a runner in Culver City dealing with an injury that keeps coming back, or you want to get ahead of problems before they derail your next training cycle, our Doctors of Physical Therapy at Victory Performance and Physical Therapy are ready to help.

📞 Call or text: 424-543-4336 📅Book online at victoryperformancept.com

No referral needed. Come straight to us.

What Victory Runners Have Experienced

The running community in Culver City and the broader LA area is a meaningful part of why we do this work. Hearing from patients who came in uncertain and left ready to train is the best measure of whether what we do actually works.

Will Murphy came to Victory with a chronic calf injury during marathon training, unsure whether he would make the start line.

"CJ created a plan that not only addressed my pain but focused on long-term strength and mobility to improve my performance overall. His understanding of endurance athletes is top-tier, and he always took time to explain the purpose behind each exercise and adjustment. The combination of expert manual therapy, thoughtful progressions, and genuine care made a huge difference in my recovery."

Andria Alvarez came in during LA Marathon prep with knee issues that were threatening to end her training cycle entirely.

"Kyle was always reassessing our sessions and my at home workouts to make sure I got what I needed. Kyle and the Victory team were out there supporting everyone at the LA Marathon, and when I passed them by at Mile 20, we cheered and hugged and celebrated. The support in and out of our PT sessions is priceless."

Taylor P. Miller came to us with an ankle injury two weeks before her marathon.

Johnny Huerta came in after the LA Marathon managing post-race tightness and an ongoing shoulder issue while also living with Parkinson's disease.

"My Victory experience has been nothing short of spectacular! Zyan is amazing. Very knowledgeable and also very kind and personable. She has really helped loosen up a tight shoulder as well as post running hamstring and muscle tightness. The Victory team is awesome. Family-like vibe."

These are not exceptional stories. They are representative of the runners we work with every week.

Ready to Train Without the Recurring Injury Cycle?

At Victory Performance and Physical Therapy in Culver City, we have helped hundreds of runners work through the injuries that were keeping them from the training they cared about. Shockwave therapy is one of the tools that makes the difference in cases that have not responded to rest and standard rehabilitation alone, and the evidence base specifically in athletes continues to grow.

If you are training in Culver City, logging miles on the Ballona Creek path, grinding up the Culver City Stairs, or building toward the LA Marathon, and you have an injury that has been hanging around longer than it should, come and see us. The assessment is where everything starts.

📅Book your appointment at victoryperformancept.com

📞 Call or text: 424-543-4336

Victory Performance and Physical Therapy | Culver City, CA | Serving active adults and athletes since 2015

Why Most Shoulder Pain Does Not Need Surgery and What Shockwave Therapy Can Do About It

Sean Hubbard — Mon, 20 Apr 2026 13:26:19 +0000

For a lot of people, persistent shoulder pain comes with a quiet fear underneath it. You assume something must be torn. You picture surgery, a long recovery, months away from the things you enjoy. So you either push through and hope it resolves on its own, or you head straight to an orthopedic surgeon expecting the worst.

At Victory Performance and Physical Therapy in Culver City, we work with people at both ends of that spectrum. What we find most often is that the underlying problem is not a structural tear requiring surgery. It is a tendon condition that responds well to the right combination of physical therapy and, when appropriate, shockwave therapy. Understanding the difference between those two paths matters enormously for your outcome, your time, and your quality of life.

Here is what you need to know about shoulder pain, rotator cuff tendinopathy, and where shockwave therapy fits into treatment.

✅ Key Takeaways

Most shoulder pain in active adults is rotator cuff tendinopathy, not a structural tear, and does not require surgery
Rotator cuff tendinopathy comes in two forms, calcific and non-calcific, and the evidence for shockwave therapy differs between them
A 2024 systematic review and meta-analysis covering 16 randomized controlled trials found ESWT effective for rotator cuff tendinopathy across both types
At Victory PT, our Doctors of Physical Therapy assess the shoulder thoroughly before any treatment begins so the plan addresses what is actually there
No referral needed under California's Direct Access law

What Is Rotator Cuff Tendinopathy?

The rotator cuff is a group of four muscles and their tendons that wrap around the shoulder joint and hold the head of the upper arm bone (humerus) within the shallow socket of the shoulder blade. These tendons are responsible for shoulder stability and control across an enormous range of movement, including overhead reach, rotation, pressing, and pulling.

Rotator cuff tendinopathy refers to a painful, degenerative condition affecting one or more of these tendons, most commonly the supraspinatus tendon that runs along the top of the shoulder. It develops when the tendon is repeatedly overloaded or compressed without adequate recovery, and the tissue breaks down faster than it can repair.

The result is a shoulder that aches with overhead movement, hurts when you reach across your body, wakes you up when you roll onto it at night, or stiffens after sitting at a desk for hours. It can make lifting, swimming, throwing, or pressing exercises feel unreliable or painful.

It is worth being specific here, because there are two distinct presentations:

Non-calcific rotator cuff tendinopathy is the more common form. The tendon tissue becomes degenerated and painful without any calcium deposit involved. This is what most active adults in Culver City are dealing with when shoulder pain develops gradually from training or repetitive use.

Calcific rotator cuff tendinopathy involves calcium deposits forming within the tendon, usually the supraspinatus. This can cause significant acute pain and restricted movement when the calcium is in an active phase. The evidence for shockwave therapy is particularly strong for this presentation, and we will cover that specifically below.

Who Gets Rotator Cuff Tendinopathy

The shoulder is the most mobile joint in the body, which also makes it one of the most load-sensitive. Rotator cuff tendinopathy is remarkably common and shows up across a wide range of activities and lifestyles:

CrossFit athletes doing high volumes of overhead pressing, kipping / butterfly pull-ups, and muscle-ups
Swimmers with repetitive overhead stroke mechanics, particularly freestyle and butterfly
Tennis players and overhead throwing athletes whose shoulder mechanics place sustained load on the cuff
Weightlifters performing bench press, overhead press, or lateral raises through compromised shoulder positioning
Desk workers and remote professionals whose postural loading compresses the supraspinatus over long hours
Active adults over 40 whose tendons have accumulated load over decades of training and daily use
Anyone who has recently increased shoulder training volume without a proportional increase in recovery

One of the reasons rotator cuff tendinopathy is so often misread as something more serious is that the pain can be significant and functionally limiting even when there is no structural tear present. Imaging does not always help either. MRI studies regularly find rotator cuff abnormalities in people with no pain at all. The presence of findings on imaging does not automatically mean surgery is necessary, and this is a conversation our DPTs have with patients at Victory regularly.

Why the Shoulder Is a Complex Problem to Treat

The shoulder does not operate in isolation. It is part of a chain that includes the thoracic spine, the shoulder blade (scapula), the collarbone, and the surrounding musculature. When something in that chain is not working well, such as stiff thoracic rotation, poor scapular control, or weakness in the lower trapezius, the load gets redistributed in ways that overload the rotator cuff tendons.

This is why generic shoulder exercises downloaded from the internet often fail to resolve tendinopathy. They may load the right muscles, but they do not address why the tendon was overloaded in the first place. At Victory, our Doctors of Physical Therapy assess the whole picture before any program begins.

A thorough shoulder evaluation at Victory looks at:

Which specific tendon is involved and how the pain pattern presents
Scapular mechanics and whether the shoulder blade is moving efficiently
Thoracic mobility and how it contributes to shoulder range of motion
Rotator cuff and surrounding muscle strength across relevant movement planes
Whether there is a calcific component based on clinical presentation and history
Training patterns and technique factors that may be contributing to the overload

That assessment shapes everything that follows. Without it, you are treating a pattern, not a person.

How We Treat Rotator Cuff Tendinopathy at Victory

Physical therapy is the foundation of rotator cuff tendinopathy management and the approach with the strongest evidence base for long-term outcomes. At Victory, our treatment typically involves a combination of the following, tailored to what your assessment reveals.

Targeted Rotator Cuff and Scapular Loading

Progressive strengthening of the rotator cuff tendons, particularly the supraspinatus, infraspinatus, and subscapularis, forms the core of the rehabilitation program. We use evidence-based loading protocols that apply the right stimulus to the affected tendon while protecting the shoulder from positions that compress or overload it at the wrong stage of healing.

Scapular stability work runs alongside this. A shoulder blade that is not controlling movement efficiently puts the rotator cuff in a mechanically disadvantaged position throughout every overhead and pressing movement. Addressing this is essential for lasting results.

Manual Therapy

Hands-on work targeting the shoulder joint, thoracic spine, and surrounding soft tissue helps restore range of motion, reduce muscle guarding, and create the mobility needed for the loading program to be effective. Our DPTs at Victory integrate manual therapy with the active rehabilitation program rather than using it as a standalone treatment.

Activity and Load Management

Part of effective shoulder rehab is understanding which activities are aggravating the tendon and how to modify them so you can stay active throughout recovery. For CrossFitters, that might mean scaling pressing movements temporarily. For swimmers, it might mean adjusting stroke mechanics or reducing yardage at specific intensities. We work through this with you based on what you do and what matters to you.

Johnny Huerta came to Victory after running the LA Marathon while managing Parkinson's-related muscle tightness and a shoulder that had been bothering him.

"Zyan is amazing. Very knowledgeable and also very kind and personable. She has really helped loosen up a tight shoulder as well as post running hamstring and muscle tightness. The Victory team is awesome. Family-like vibe."

That experience reflects how we work at Victory. Individual attention from a clinician who understands your specific situation and what you are trying to get back to.

Where Shockwave Therapy Fits In for Shoulder Pain

For rotator cuff tendinopathy that has not responded adequately to physical therapy and loading alone, shockwave therapy offers a meaningful adjunct, and in some cases a strong primary intervention.

Extracorporeal shockwave therapy (ESWT) delivers focused acoustic pulses to the affected tendon tissue. The mechanical energy triggers a biological repair response, stimulating cellular activity, promoting collagen remodeling, and encouraging blood vessel formation in tissue that has poor natural healing capacity.

A 2024 systematic review and meta-analysis published in BMC Musculoskeletal Disorders analyzed 16 randomized controlled trials involving 1,093 patients and found ESWT effective for rotator cuff tendinopathy across both calcific and non-calcific presentations. (Xue et al., 2024) A separate 2024 meta-analysis of 18 randomized controlled trials in Frontiers in Medicine found ESWT more effective than placebo for relieving pain in upper limb tendinopathies including rotator cuff tendinopathy at 3 and 6 month follow-ups, with radial ESWT showing particularly strong results. (Xiong et al., 2024)

It is worth being direct about a distinction in the evidence, because we think patients deserve that clarity.

For calcific rotator cuff tendinopathy, the evidence base for shockwave is among the strongest of any tendon condition we treat. A 2024 systematic review in Physiotherapy Research International analyzing 21 randomized controlled trials found clinically significant improvements in pain and function with ESWT compared to sham treatment at 24 weeks for calcific tendinopathy. (Brindisino et al., 2024) Shockwave therapy is also thought to help with the resorption of calcium deposits, addressing the source of the problem rather than just the symptoms.

For non-calcific rotator cuff tendinopathy, the picture is more nuanced. A 2024 systematic review found ESWT superior to sham treatment for pain at short-term follow-up but with less consistency at longer follow-up timepoints. The honest interpretation is that for non-calcific presentations, ESWT is most effective as part of a comprehensive treatment plan rather than as a primary standalone intervention. At Victory, this is exactly how we use it.

We consider shockwave therapy for shoulder tendinopathy when:

There is a confirmed calcific component and the patient has not responded to conservative management alone
Non-calcific tendinopathy has been present for 8 or more weeks without adequate improvement through loading and manual therapy
The patient has a specific activity goal or timeline and a faster return to function is a priority
Clinical assessment supports tendon degeneration as the primary driver rather than acute inflammation

Dealing with shoulder pain that has been limiting your training or daily life? Our Doctors of Physical Therapy at Victory Performance and Physical Therapy in Culver City can assess what is actually going on and build a plan around your specific situation.

📞 Call or text: 424-543-4336 📅Book online at victoryperformancept.com

No referral needed. California's Direct Access law means you can come straight to us.

What Shockwave Sessions Look Like at Victory

Shoulder shockwave sessions at Victory are typically 10 to 15 minutes and are performed by your Doctor of Physical Therapy as part of your overall treatment session. Your DPT identifies the specific site of the tendon pathology and delivers the acoustic pulses to that area. For calcific presentations, the session targets the calcium deposit directly.

Most patients describe the sensation as a firm pulsing or tapping that can be moderately uncomfortable at the most sensitive point of the tendon. It is generally well tolerated.

Temporary soreness in the 24 to 48 hours following a session is a normal and expected tissue response. Most rotator cuff protocols involve 5-10 sessions spaced approximately one week apart alongside the ongoing physical therapy program. Your DPT reassesses throughout and adjusts the plan based on how your shoulder is responding.

Common Questions About Shoulder Pain and Rotator Cuff Tendinopathy

Does shoulder pain always mean something is torn?

Not at all. Rotator cuff tendinopathy, bursitis, and referred pain from the neck or thoracic spine are far more common causes of shoulder pain in active adults than structural tears. Even when imaging shows abnormalities, this does not automatically mean surgery is required. A thorough clinical assessment by a Doctor of Physical Therapy can clarify what is actually driving the pain.

How long does rotator cuff tendinopathy take to resolve?

Acute presentations caught early often improve meaningfully within 6 to 10 weeks of consistent rehabilitation. Chronic cases, particularly those involving calcific deposits or a long history of compensating around the pain, typically require 12 to 16 weeks of committed work. Shockwave therapy, when appropriate, can support and accelerate this process. And if you want to fix the root cause (strength, mobility, how you move), lasting results can take 6+ months.

Can I keep training while I treat my shoulder?

In most cases yes, with modification. Our DPTs at Victory will identify which movements are aggravating the tendon and help you adjust your training so you can stay active throughout recovery. Completely stopping all upper body activity is rarely necessary and can slow progress.

Is shockwave therapy painful?

Most patients tolerate it well and describe a tapping or pulsing sensation during the session. The most sensitive area of the tendon may feel moderately uncomfortable during treatment. A temporary increase in soreness for a day or two after a session is normal and expected as part of the tissue response.

Do I need a referral to come to Victory?

No. Under California's Direct Access law, you can come directly to Victory Performance and Physical Therapy without seeing a physician first. Call us or book online and we will get your evaluation scheduled.

Get Your Shoulder Properly Assessed at Victory

Shoulder pain that limits your training, interrupts your sleep, or makes everyday tasks uncomfortable does not have to become a long-term problem. At Victory Performance and Physical Therapy in Culver City, our Doctors of Physical Therapy are experienced in the assessment and treatment of rotator cuff conditions. We use a thorough evaluation to understand exactly what is driving your shoulder pain, build a targeted rehabilitation plan, and integrate shockwave therapy into that plan when the evidence and your presentation support it.

Kupah James is a fitness professional with 20 years of experience who came to Victory after significant injuries from a motorcycle accident. He had high expectations for what quality rehabilitation should look like.

That level of care is what every patient who walks through our door deserves and what we work to deliver.

📅Book your appointment at victoryperformancept.com

📞 Call or text: 424-543-4336

Victory Performance and Physical Therapy | Culver City, CA | Serving active adults and athletes since 2015

What Active Adults Need to Know About Achilles Tendinitis and Shockwave Therapy

Sean Hubbard — Mon, 13 Apr 2026 12:59:45 +0000

If you've been dealing with Achilles pain that settles down with rest and comes right back the moment you get active again, you already know how frustrating this injury can be. It shows up in runners, yes, but also in cyclists, hikers, CrossFit and Hyrox athletes, pickleball players, and people who simply spend a lot of time on their feet. At Victory Performance and Physical Therapy in Culver City, Achilles tendinopathy is one of the most common conditions we treat in active adults, and one of the most rewarding to work with when the right approach is used.

This post breaks down what's actually happening in the tendon, why standard rest-and-return cycles usually fail, and how we use physical therapy and shockwave therapy together to address the root cause.

✅ Key Takeaways

Achilles tendinopathy affects active adults across all activity types, not just runners
Rest alone rarely resolves it because the tendon needs progressive load to remodel and heal
Shockwave therapy has strong research support for mid-portion Achilles tendinopathy in active adults
At Victory PT, we combine a comprehensive DPT assessment, targeted loading, and shockwave therapy to get to the root of the problem
No referral needed under California's Direct Access law

What Is Achilles Tendinopathy?

Most people call it "Achilles tendinitis," but the name is a bit misleading. Tendinitis implies active inflammation, which is part of the picture early on. In chronic cases, what you are dealing with is tendinosis (tendon degeneration and pain): a breakdown of the collagen structure inside the tendon itself. And the term “tendinopathy” refers to tendon problems throughout all stages. The tissue loses its normal organized fiber arrangement, becomes thickened and disorganized, and loses its ability to handle load efficiently.

This is why passive rest so often fails. The pain settles, but the tissue quality does not improve. The moment you return to activity at full intensity, you are loading the same compromised tendon and the cycle starts over.

There are two distinct types, and they do not respond identically to treatment:

Mid-portion Achilles tendinopathy affects the middle section of the tendon, typically 2 to 6 centimeters above where it attaches to the heel bone. This is the most common presentation in active adults and the type with the strongest evidence for both loading programs and shockwave therapy.

Insertional Achilles tendinopathy affects the attachment point at the heel bone (calcaneus). It often involves bony changes and requires a modified approach. The research on shockwave for insertional cases is more variable, and our Doctors of Physical Therapy at Victory will assess this carefully before recommending it.

Knowing which type you have is one of the first things we determine, because a treatment that works well for one can aggravate the other.

Who Gets Achilles Tendinopathy?

While runners carry a well-known risk, Achilles tendinopathy affects a wide range of active adults. At Victory Performance and Physical Therapy, we see it in:

Runners and walkers logging consistent mileage in Culver City and the surrounding LA area
CrossFit, Hyrox and weightlifting athletes doing high volumes of jumping, box jumps, and Olympic lifts
Cyclists who spend long hours with the foot in a fixed plantar-flexed position
Pickleball and tennis players making repetitive lateral and forward cuts
Hikers tackling the trails around Baldwin Hills and Kenneth Hahn Park
Weekend athletes who ramp up activity without adequate preparation
Professionals on their feet all day who develop gradual overload over time

Research shows that Achilles tendinopathy accounts for up to 18% of running injuries and has a lifetime cumulative incidence of 52% in former endurance athletes. (Sports Medicine Open, 2022) But it is not exclusive to high-mileage athletes. Any activity that repeatedly loads the calf and Achilles under fatigue can contribute.

The common thread is a mismatch between load and the tendon's capacity to handle it.

Why Does It Keep Coming Back?

This is the question we hear most often from patients who come to Victory after months of managing this on their own. They rest it, it calms down, they return to activity, and within a few sessions the pain is back. Sometimes worse.

The reason is straightforward: the degenerative changes in tendinopathy do not reverse with rest. The tendon needs mechanical stimulus to remodel. Without progressive load, the tissue simply stays in a compromised state. When activity resumes, it gets loaded again before it has actually healed.

This is also why cortisone injections often provide only temporary relief for Achilles tendinopathy. They can reduce pain in the short term, but they do not address the structural changes in the tendon.

The way out of the cycle is a targeted loading program that gives the tendon what it needs to adapt and strengthen.

How We Treat Achilles Tendinopathy at Victory Performance PT

Our approach follows a clear sequence: a thorough assessment first, then a structured loading program as the foundation, with shockwave therapy integrated when the evidence and your presentation support it.

The Assessment

Every patient at Victory starts with a comprehensive movement assessment with one of our licensed Doctors of Physical Therapy. For Achilles tendinopathy, that includes:

Confirming the type and stage of tendinopathy
Evaluating calf and hip strength deficits contributing to the problem
Reviewing your activity history and how the injury developed
Assessing ankle range of motion and any biomechanical factors at play
Identifying modifiable contributors specific to your activity and lifestyle

This is the root-cause approach that drives everything we do at Victory. We are not giving everyone the same set of exercises. We are building your plan around what we actually find.

The Loading Program

The most evidence-supported treatment for mid-portion Achilles tendinopathy is a structured progressive loading program. At Victory, our DPTs use eccentric and isometric calf protocols designed to apply controlled mechanical load to the tendon and stimulate remodeling.

The specifics matter enormously. Load level, tempo, range of motion, and progression timing all affect outcomes. Getting them wrong can stall recovery or make things worse. Our team guides you through every step, monitors your response, and advances the program at the right pace.

In most cases, we keep you active at a modified level throughout recovery. Complete rest is rarely the right answer for Achilles tendinopathy.

Will Murphy came to Victory with a chronic calf and Achilles issue while training for a marathon, unsure whether he would make the start line.

Will made it to race day and ran strong.

Does Shockwave Therapy Help Achilles Tendinopathy?

For the right patient, it can make a significant difference, particularly when the loading program alone has not been enough.

Shockwave therapy, or extracorporeal shockwave therapy (ESWT), delivers focused acoustic pulses directly into the affected tendon. The process is called mechanotransduction: the acoustic energy creates a biological stimulus that promotes collagen remodeling, encourages new blood vessel formation, and helps restart the repair process in tissue that has become chronically degenerated. It is not masking pain. It is driving real tissue-level change.

A 2023 systematic review and meta-analysis in Frontiers in Immunology found support for shockwave therapy as an effective intervention for Achilles tendinopathy. (Charles et al., 2023) A systematic review published in the British Journal of Sports Medicine, the first focused specifically on athletes and physically active individuals, concluded that ESWT may be considered an initial treatment option for non-insertional Achilles tendinopathy, noting its excellent safety profile. (Rhim, Tenforde et al., 2023)

At Victory, shockwave therapy is offered as part of a complete treatment plan, not as a standalone session. We use it alongside your loading program because research consistently shows the combination produces better outcomes than either approach alone.

Shockwave therapy is particularly well suited for:

Chronic mid-portion Achilles tendinopathy that has not responded to 8 to 12 weeks of loading
Active adults with a specific event or deadline who need to accelerate recovery
Cases where the tendon has been stuck in a degenerative state after repeated rest-and-return cycles

For insertional cases, our DPTs evaluate carefully before recommending shockwave, as the evidence is less consistent and the loading protocol itself differs significantly.

Dealing with Achilles pain that keeps coming back no matter what you try? Our Doctors of Physical Therapy at Victory Performance and Physical Therapy in Culver City can assess what is actually driving it and build a plan around your specific goals.

📞 Call or text: 424-543-4336 📅Book online at victoryperformancept.com

No referral needed. Under California's Direct Access law, you can come straight to us.

What to Expect From Shockwave Therapy at Victory

When we integrate shockwave therapy into your Achilles rehab, here is what the process looks like:

Your DPT identifies the precise site and confirms ESWT is appropriate for your specific presentation
Sessions are 10 to 15 minutes, typically scheduled 5 to 7 days apart
Most patients complete 3 to 6 sessions as part of a broader treatment plan
Temporary soreness in the 24 to 48 hours after a session is a normal tissue response, not a sign of harm
Your loading program continues between sessions, because the two work together
Your DPT monitors your response and adjusts the overall plan as you progress

Throughout the process, we are also building the strength and movement quality that protects the tendon once you are back to full activity. The goal at Victory is not just to get you out of pain. It is to make sure you stay that way.

Common Questions About Achilles Tendinopathy

Can I stay active while treating my Achilles?

In most cases, yes. Our DPTs at Victory will help you identify a level of activity your tendon can tolerate without aggravating it, and we progress that threshold as recovery allows. Staying completely sedentary often slows healing and does not address the underlying problem.

How long does Achilles tendinopathy take to heal?

Acute cases caught early often improve within 6 to 8 weeks of consistent rehabilitation. Chronic cases, especially those involving repeated rest-and-return cycles over months, typically require 12 to 16 weeks of committed work. Shockwave therapy, when appropriate, can shorten that timeline. Recovery is real and achievable, but it takes consistency. And if you want to fix the root cause (strength, mobility, how you move), lasting results can take 6+ months.

Is shockwave therapy painful?

Most patients describe a tapping or pulsing sensation during treatment and some sensitivity over the most tender area of the tendon. It is generally well tolerated. Our team adjusts the parameters based on your response throughout each session.

Do I need a doctor's referral?

No. Under California's Direct Access law, you can come directly to Victory Performance and Physical Therapy without a physician referral. Call us or book online and we will get you scheduled.

Take the Next Step With Victory Performance PT

Achilles tendinopathy does not have to be a chronic problem you manage around indefinitely. At Victory Performance and Physical Therapy in Culver City, our Doctors of Physical Therapy are experienced in treating the overuse and tendon injuries that active adults deal with most. We combine evidence-based loading protocols, hands-on manual therapy, and shockwave therapy to address what is actually driving your pain and to build the resilience that keeps it from coming back.

Andria Alvarez came to us during her LA Marathon training with knee pain that was threatening to sideline her completely. She crossed the finish line.

That kind of outcome is what we work toward with every patient who walks through our door.

📅Book your appointment

📞 Call or text: 424-543-4336

Victory Performance and Physical Therapy | Culver City, CA | Serving active adults and athletes since 2015

Can Physical Therapy Help With Pain That Won't Go Away

Sean Hubbard — Mon, 06 Apr 2026 13:10:15 +0000

You’ve tried rest. You’ve tried stretching. Maybe you’ve tried a foam roller, a new pillow, a different pair of shoes, or a few sessions of massage. The pain got a little better, then came back. Now you’re stuck in a cycle: weeks or months of something that just won’t fully go away.

If that sounds familiar, you’re not alone. And physical therapy may be exactly what’s missing from your recovery.

Why Does Some Pain Stick Around?

When pain lasts longer than a few weeks, or keeps coming back even after you “rest it,” something deeper is usually going on. Your body is smart. When one area hurts or isn’t working properly, surrounding muscles, joints, and movement patterns shift to compensate. Over time, those compensations become the new normal.

Here’s the problem: the original issue might have partially healed, but the compensations it created are now causing their own set of problems. That nagging hip tightness might be driving your low back pain. The shoulder that “almost” got better might keep flaring up because the muscles around your shoulder blade never reactivated properly.

This is why rest alone doesn’t work for chronic or recurring pain. Rest can calm down symptoms. It doesn’t address the movement dysfunction that’s keeping the cycle going.

What Counts as Chronic Pain?

In clinical terms, chronic pain is pain that persists beyond the expected healing timeline, generally longer than 12 weeks. But for most active adults in Culver City, it’s simpler than that. It’s the thing that’s been bothering you for months. The low back stiffness that shows up every morning. The knee that aches after every run. The neck tension that “you’ve had forever” and never fully leaves.

Research shows that chronic musculoskeletal pain affects a significant portion of the adult population, and that it often responds poorly to passive treatments like medication, rest, or isolated modalities. The most effective long-term approach, according to a large body of evidence, is active, movement-based treatment, which is exactly what physical therapy provides.

How Physical Therapy Treats Pain That Won’t Go Away

At Victory Performance and Physical Therapy, we take a different approach to chronic pain than what many people have experienced before. We don’t just treat where it hurts. We evaluate how your entire body moves to find out why it hurts.

A comprehensive movement assessment. Your first visit includes a full evaluation of how you move, not just the painful area, but the joints and muscles above and below it. Pain in the knee often starts at the hip. Shoulder problems frequently connect to thoracic spine stiffness. Low back pain can trace back to weak glutes or a tight psoas (the deep hip flexor muscle that connects your lower spine to your legs). We look at the full picture.

Hands-on manual therapy. Joint mobilization, myofascial release, and soft tissue work help reduce pain, improve range of motion, and restore normal joint mechanics. This is the hands-on component that helps you feel better in the short term while we address the bigger issues.

Targeted strengthening. This is where the long-term change happens. Chronic pain almost always involves muscles that have become weak, inhibited, or poorly coordinated. We build a progressive strengthening program that reactivates those muscles and gives your body the stability and support it needs. You receive a personalized exercise plan through our Victory App so you can follow along with video-guided exercises between sessions.

Movement retraining. If you’ve been moving differently to avoid pain, even without realizing it, those patterns need to be corrected. Otherwise, the compensations keep creating new problems. We retrain how you squat, hinge, reach, and perform the specific activities that matter to you.

A 2021 clinical practice guideline from the Academy of Orthopaedic Physical Therapy recommends exercise-based treatment as a first-line intervention for chronic musculoskeletal pain, with manual therapy as an effective complement for improving function and reducing disability. (George et al., 2021, JOSPT)

Adrienne A. came to Victory after years of lower back pain that other providers hadn’t been able to resolve:

“I had gone to chiropractors and other physical therapists in the past, but didn’t have any success. After some time, I decided to give PT another try and found this gem that is Victory. Julia was amazing in helping me understand the root of the pain and created a plan to correct it. In less than two months, the pain was gone altogether.”

Tired of dealing with pain that keeps coming back? Our team at Victory Performance and Physical Therapy in Culver City specializes in finding the root cause, not just treating symptoms.

Call today: 424-543-4336

Why Didn’t Rest, Stretching, or Massage Fix It?

These are all reasonable things to try. And for simple, acute issues, they often help. But for chronic or recurring pain, each one has a limitation.

Rest reduces inflammation and gives tissues time to heal. But if the underlying cause of your pain is a movement dysfunction, meaning weak stabilizing muscles, poor joint mechanics, or muscle imbalances, rest won’t change any of those things. You’ll feel better for a while, then the pain returns when you go back to your normal activities.

Stretching can temporarily improve flexibility, but if tightness is your body’s response to instability, stretching can actually make things worse. A tight hamstring, for example, might be compensating for a weak core. Stretching the hamstring without strengthening the core just removes the compensation without fixing the problem.

Massage feels great and can reduce muscle tension in the short term. But muscle tension is often a symptom, not a cause. If your upper traps are tight because your scapular stabilizers aren’t doing their job, the tension will come right back after every session.

Physical therapy is different because it addresses the root cause. It combines the hands-on work that helps you feel better now with the targeted exercise that changes the pattern for good.

Is It Too Late to Start Physical Therapy for Chronic Pain?

No. And this is an important point. Many people assume that because they’ve had pain for months or years, it’s “too far gone” for physical therapy to help. That’s not what the research shows.

A Cochrane systematic review found that exercise-based physical therapy produces significant improvements in both pain and function for chronic low back pain, even in patients who had been dealing with symptoms for extended periods. The review found that exercise therapy was more effective than usual care and education alone for reducing pain. (Hayden et al., 2021, Cochrane Database of Systematic Reviews)

The difference is that chronic conditions require a more structured, progressive approach than acute injuries. At Victory, we build a plan that starts where your body is right now and progressively challenges it over time. The goal isn’t just pain relief. It’s building the strength and movement quality that keeps the pain from coming back.

Maria P. had been dealing with sciatic pain for years before coming to Victory:

“After a few weeks of physical therapy at this wonderful place, my sciatic problems have been alleviated. I am able to work and enjoy my daily routine without feeling pain.”

What Makes Victory’s Approach Different for Chronic Pain?

If you’ve been to physical therapy before and it didn’t work, there are a few things about our approach that set us apart.

We don’t use cookie-cutter protocols. Every treatment plan at Victory is built around your specific evaluation findings, your goals, and the activities you want to get back to. If you’re a runner training along Ballona Creek, your plan will look different from someone who lifts weights at their local Culver City CrossFit affiliate.

We treat the whole chain, not just the painful spot. Pain in one area almost always connects to dysfunction somewhere else. Our Doctors of Physical Therapy are trained to evaluate the entire kinetic chain, from your feet to your core to your shoulders, to find where the real breakdown is happening.

We incorporate progressive strengthening, not just stretching and modalities. Research consistently shows that strength is the foundation of lasting pain relief. We build strength into every treatment plan because that’s what creates permanent change.

We educate you on why your body is doing what it’s doing. Understanding the “why” behind your pain changes how you approach recovery. When you understand that your back pain is driven by weak hip stabilizers and not a damaged spine, it shifts your mindset from fear to empowerment.

A growing body of research supports the role of pain neuroscience education combined with exercise therapy for improving outcomes in chronic pain patients. When patients understand that chronic pain often reflects changes in how the nervous system processes signals, rather than ongoing tissue damage, they engage more actively in their recovery and report better outcomes. (Núñez-Cortés et al., 2024, PAIN)

What Does Recovery From Chronic Pain Look Like?

Recovery from chronic pain doesn’t follow a straight line. You won’t wake up one day with the pain completely gone. Instead, progress usually looks like this:

Pain becomes less frequent, from daily to a few times per week
Pain intensity drops, from a 7/10 to a 3/10
You can do more before the pain shows up: running an extra mile, sitting through a full workday, sleeping through the night
You feel stronger and more confident in your body
Flare-ups still happen occasionally, but they’re shorter and less intense, and you know how to manage them

The goal at Victory isn’t to make you dependent on physical therapy forever. It’s to give you the tools and the strength to manage your body independently. We want you to leave treatment stronger than you were before the pain started.

Take the First Step Toward Lasting Relief

If you’ve been dealing with pain that won’t go away, whether it’s been weeks, months, or years, we can help. At Victory Performance and Physical Therapy in Culver City, we specialize in helping active adults break the cycle of chronic pain and get back to doing what they love.

📅 Book Your Appointment Now

📞 Call: 424-543-4336

When Should You See a Physical Therapist (Most People Wait Too Long)

Sean Hubbard — Thu, 02 Apr 2026 13:04:37 +0000

Here’s something we see almost every week at Victory Performance and Physical Therapy in Culver City. Someone comes in with pain that started months ago, sometimes longer. They rested. They iced it. They Googled exercises and tried a few things. When none of that worked, they finally scheduled an appointment.

And almost every time, they say the same thing: “I wish I had come in sooner.”

If you’re wondering whether your pain is “bad enough” for physical therapy, the answer is almost always yes, and the sooner you start, the better your outcome is likely to be.

How Do You Know When It’s Time to See a Physical Therapist?

You don’t need to be in severe pain to benefit from physical therapy. In fact, the people who get the best results are often the ones who come in early, before a minor issue becomes a major one.

Here are the most common signs that it’s time to schedule an evaluation:

Pain that lasts longer than a week or two. Acute muscle soreness from a hard workout should resolve within a few days. If something hurts for more than a week, especially if it’s not improving, that’s your body telling you something isn’t right.

Pain that goes away and comes back. This is the pattern most active adults in Culver City ignore for the longest. Your knee hurts after your Saturday run, feels fine by Tuesday, then hurts again the following weekend. That recurring cycle means the underlying issue isn’t resolving on its own. Rest is managing the symptom, but the cause is still there.

Pain that “warms up” but doesn’t fully go away. Runners and gym-goers know this one well. The first mile or the first few reps hurt, then you loosen up and feel okay. That warmup pattern is a sign of early-stage tissue stress, not something that’s fine to push through indefinitely.

Stiffness that limits your movement. If you can’t turn your head fully, touch your toes, or reach overhead without discomfort, something is restricting your movement. Stiffness is your body’s way of protecting an area that doesn’t feel stable or safe.

An activity you had to stop doing. This is a big one. If pain has taken away something you enjoy, running, lifting, playing with your kids, hiking, your weekend pickup basketball game, that’s a quality-of-life issue worth addressing.

Something that doesn’t feel “right” even if it doesn’t hurt much. A shoulder that clicks. A knee that feels unstable. A hip that catches when you stand up from a chair. These aren’t normal, and they’re worth getting evaluated before they become painful.

Why Waiting Makes Things Worse

There’s a natural tendency to wait and see if pain resolves on its own. And for simple acute issues, like a mild muscle strain from a single event, that approach sometimes works. But for most musculoskeletal problems, especially in active adults, waiting has real consequences.

Your body compensates. When something hurts, you move differently to avoid the pain. You shift weight to the other leg. You stop using your shoulder overhead. You change your running stride. These compensations happen automatically, and over time they create new problems in other areas. The longer you wait, the more compensations your body builds, and the more work it takes to unwind them.

Tissues continue to change. A tendon that’s been overloaded doesn’t just stay the same if you rest it. It can continue to degenerate if the loading pattern that caused the problem isn’t corrected. Research shows that early, appropriate loading through physical therapy produces better tissue healing than prolonged rest for many common conditions.

It becomes harder to treat. A problem that might have taken four visits to address at week two could take twelve visits by month six. The research supports this directly. A large study of over 750,000 patients found that those who received physical therapy within 14 days of their initial visit had significantly reduced use of imaging, injections, surgery, and opioid medications, and their total healthcare costs were 60% lower over two years compared to those who delayed treatment. (Childs et al., 2015, BMC Health Services Research)

Anna S. knows this firsthand. She was bounced between multiple providers for a running injury before finding Victory:

“After being bounced around between other PTs and doctors for a running injury, I finally found Victory. The staff here is truly exceptional, and the exercises Jared, my physical therapist, gave me made a huge difference in getting me to the start (and finish!) of the London Marathon.”

Noticing something that doesn’t feel right? Don’t wait for it to get worse. Our team at Victory Performance and Physical Therapy in Culver City can evaluate what’s going on and give you a clear plan.

Call today: 424-543-4336

What Happens at Your First Physical Therapy Visit?

If you’ve never been to physical therapy, or if your past experience was a room full of people doing the same exercises with minimal supervision, here’s what to expect at Victory.

A one-on-one evaluation. Your physical therapist spends time with you. We ask about your pain history, your activities, your goals, and what you’ve already tried. This isn’t a 5-minute screen followed by a generic exercise handout.

A movement assessment. We watch how you move. Squatting, bending, reaching, walking: the specific movements depend on your issue. We’re looking at the full picture: joint mobility, muscle strength, stability, and coordination. Pain in the knee often traces back to the hip. Low back pain frequently connects to core and glute weakness. We find the root cause, not just the symptom.

A hands-on examination. Joint mobility testing, palpation, and specific clinical tests help us pinpoint exactly what structures are involved and what’s driving your pain.

A clear plan. By the end of your first visit, you’ll know what’s going on, why it’s happening, and what the plan is to address it. No vague “come back three times a week for twelve weeks.” You’ll understand the rationale behind every part of your treatment.

Darragh M. described this experience:

“Julia was awesome. Very knowledgeable and kind. Helped me figure out what was going on with my ankle and make a plan to get running again.”

What Are the Most Common Reasons People See a Physical Therapist?

Physical therapy isn’t just for post-surgical rehab or catastrophic injuries. Here’s what most of our patients at Victory are actually coming in for:

Low back pain: the single most common reason adults seek physical therapy. Whether it’s from sitting at a desk all day, picking something up wrong, or training too hard, low back pain responds well to targeted strengthening and manual therapy.

Knee pain: runner’s knee, patellar tendinopathy (tendon degeneration from overuse), IT band issues, and general knee pain from squatting and lunging. These are almost always driven by hip weakness and poor movement mechanics, not structural damage in the knee itself.

Shoulder pain: impingement, rotator cuff issues, and general shoulder tightness. Desk workers and overhead athletes are especially susceptible. The shoulder depends on muscular stability more than almost any other joint in the body.

Neck pain and headaches: especially common among people who work at computers. Forward head posture, weak deep neck flexors, and thoracic spine stiffness all contribute.

Running injuries:shin splints, plantar fasciitis, Achilles tendinopathy, and hip pain from training. Culver City runners training along Ballona Creek Trail or preparing for the LA Marathon make up a significant portion of our caseload.

Recurring pain after “recovering” from an injury: you felt better, went back to your activity, and the pain returned. This usually means the original issue wasn’t fully resolved or your rehab didn’t progress far enough.

Research Supports Starting Physical Therapy Early

A 2016 systematic review in the Journal of Orthopaedic & Sports Physical Therapy examined the research on early versus delayed physical therapy for musculoskeletal conditions. The findings consistently supported early initiation of PT. Patients who started sooner had better pain outcomes, better functional outcomes, and lower overall healthcare costs. The review also found that early physical therapy may reduce the risk of developing chronic pain and long-term disability. (Horn et al., 2016, JOSPT)

The bottom line is straightforward: if something hurts and it’s not getting better on its own, the sooner you see a physical therapist, the better your chances of a full and efficient recovery.

Stop Waiting and Start Moving Better

If you’ve been telling yourself it’s “not bad enough” or hoping it’ll go away on its own, consider this your sign to take action. The longer you wait, the more your body compensates, and the longer recovery takes when you finally do get help.

At Victory Performance and Physical Therapy in Culver City, we help active adults get ahead of their pain, not just react to it. Whether you’re a runner, a lifter, a weekend athlete, or someone who just wants to move without pain through their daily life, we can help.

You don’t need a referral. You just need to make the call.

📅 Book Your Appointment Now

📞 Call: 424-543-4336

What to Expect at Your First Physical Therapy Visit in Culver City

Sean Hubbard — Mon, 30 Mar 2026 12:52:38 +0000

Your first physical therapy visit can feel like a mystery if you have never been before. What will the therapist do? Will it hurt? How long does it take? What should you wear?

These are normal questions. And knowing what to expect beforehand makes the experience easier and more productive. This post walks you through every step of a first visit at our physical therapy clinic in Culver City, from what to bring to what you will leave with.

What Happens Before You Even Walk In?

Most of the prep work happens before your appointment.

Many clinics send intake forms ahead of time. These forms ask about your medical history, current symptoms, medications, past surgeries, and your activity level. Filling these out before your appointment saves time and gives your therapist a head start on understanding your situation.

If you are coming through California's Direct Access law, you don't need a referral. You can learn more about direct access physical therapy in California here.

What to bring:

A photo ID
Any imaging results you have (X-rays, MRI reports)
A list of current medications
Your completed intake forms

What to wear: Comfortable clothing you can move in. Athletic shorts, leggings, or joggers work well. If your issue involves your shoulder or upper body, a tank top or t-shirt is helpful. Avoid jeans, dress clothes, or anything that limits your range of motion. You don't need to bring gym shoes unless the clinic asks you to.

How Long Does a First Physical Therapy Visit Take?

Plan for about 60 minutes for your initial evaluation. Some clinics book 45 minutes, others book 75. At Victory Performance and Physical Therapy in Culver City, initial evaluations are designed to be thorough, so you won't feel rushed and the appointment is between 60-90 minutes.

This is longer than a typical follow-up visit, which usually runs 25 to 55 minutes. The extra time on your first visit allows your therapist to do a complete assessment, explain what they find, and start treatment.

What Does the Physical Therapist Ask You?

Your evaluation starts with a conversation. Your therapist will ask detailed questions about your condition. This is called the subjective exam, and it's one of the most important parts of the visit.

Expect questions like:

Where exactly is your pain or discomfort?
When did it start, and was there a specific event that caused it?
What makes it better? What makes it worse?
How does it affect your daily life, your work, and your training?
What have you tried so far (rest, ice, stretching, medication)?
What are your goals for treatment?

That last question matters more than people realize. Research shows that patients who clearly define their goals and expectations at the start of physical therapy are more likely to have successful outcomes. A study in Health and Quality of Life Outcomes found that patients whose treatment expectations were discussed early were better positioned to achieve meaningful clinical improvement (Zeppieri et al., 2017). Link to study

Your answers to these questions shape everything that follows. A runner training for the LA Marathon has different goals than a desk worker who just wants to sit without back pain. Your therapist needs to understand your life, not just your symptoms.

What Does the Physical Exam Include?

After the conversation, your therapist moves into the objective exam. This is the hands-on portion where they assess how your body is actually moving and functioning.

The specific tests depend on your condition, but a thorough evaluation for an active adult typically includes:

Observation. Your therapist looks at your posture, how you stand, and how you hold your body. Sometimes the way you carry yourself reveals patterns that contribute to pain.

Range of motion testing. They measure how far your joints move. This can be active (you move on your own) or passive (your therapist moves you). Comparing sides helps identify restrictions.

Strength testing. Your therapist tests the strength of specific muscle groups related to your problem area. Weakness in one area often contributes to pain somewhere else. For example, hip weakness is a common driver of knee pain in runners.

Special tests. These are clinical tests designed to stress specific structures like ligaments, tendons, or joints. They help narrow down the source of your symptoms. For a shoulder issue, this might involve tests for rotator cuff integrity or impingement (a condition where tendons get pinched during overhead movement). For a knee issue, it might involve tests for meniscus or ligament stability.

Movement screening. Your therapist watches you perform functional movements relevant to your activities. If you're a runner, they may watch you squat, lunge, or even run on a treadmill. If you lift weights, they may have you demonstrate a deadlift or overhead press pattern. This helps identify movement faults that contribute to your pain.

Palpation. Your therapist uses their hands to feel the tissues around your problem area. Palpation means pressing on muscles, tendons, and joints to identify areas of tenderness, swelling, tightness, or abnormal texture. This is a skilled assessment, not just poking around.

None of these tests should cause lasting pain. Your therapist will tell you what they're doing and why. If something is uncomfortable, let them know. The goal is to gather information, not push you through pain.

Will You Get a Diagnosis on Your First Visit?

A licensed physical therapist with a Doctor of Physical Therapy (DPT) degree is trained to give you a provisional diagnosis of most musculoskeletal conditions. By the end of your first visit, your therapist should be able to tell you:

What they believe is causing your pain or limitation
Why it's happening (the root cause, not just the symptom)
What the treatment plan will include
How many visits they expect you will need
What you can do at home between visits

This clarity is important. Research published in Physical Therapy shows that patients who understand their condition and have clear expectations about their treatment plan report better outcomes and higher satisfaction with care (Bialosky et al., 2010). Link to study

If your therapist identifies anything during the evaluation that falls outside the scope of physical therapy, they will refer you to the appropriate medical provider. This screening is built into every evaluation, especially for patients coming in through direct access.

Have questions about what your first visit will look like? Our team at Victory Performance and Physical Therapy is happy to walk you through the process before you come in. Call us: 424-543-4336

Will You Receive Treatment on Your First Visit?

At many clinics, yes. A good physical therapy evaluation doesn't end with just an assessment. Most therapists begin hands-on treatment during the same session.

This might include:

Manual therapy. Your therapist uses their hands to mobilize joints, release tight muscles, or improve tissue mobility. This can provide immediate relief and helps your therapist confirm their findings from the evaluation.

Initial exercises. You will likely perform 2 to 4 exercises during your first visit. These are selected based on what the evaluation revealed. Your therapist will teach you proper form and explain why each exercise matters.

Home exercise program. Before you leave, you will receive a set of exercises to do between visits. These are tailored to your specific condition and goals. Most home programs take 10 to 15 minutes per day.

Starting treatment on day one matters. A systematic review in the Journal of Orthopaedic and Sports Physical Therapy found that early initiation of physical therapy was associated with lower overall healthcare costs, fewer opioid prescriptions, and reduced need for advanced imaging and surgery (Ojha et al., 2016, JOSPT). Link to study

The sooner you start working on the problem, the faster you tend to see results.

What Should You Expect After Your First Visit?

It's normal to feel a little sore after your first evaluation. Your therapist tested your body in ways it may not be used to, and some of the treatment techniques can cause temporary soreness, similar to what you'd feel after a new workout.

This should be mild and resolve within 24 to 48 hours. If anything feels significantly worse, call your therapist. That feedback helps them adjust the plan.

After your first visit, you should feel like you understand your condition, know the plan, and have clear next steps. If you leave confused or without answers, that's a red flag about the quality of care.

How Do You Know If the Clinic Is the Right Fit?

Your first visit is also your chance to evaluate the clinic. Pay attention to these things:

Did your therapist listen? A good evaluation is a conversation, not a checklist. If your therapist rushed through questions or didn't ask about your goals, that's a concern.

Were you treated one-on-one? Some clinics have therapists juggling 3 or 4 patients at a time, with aides doing most of the hands-on work. At a clinic like Victory Performance and Physical Therapy, you work directly with your physical therapist in Culver City for the entire session.

Did you leave with a clear plan? You should know your diagnosis, your treatment goals, how many visits are recommended, and what to do at home. If you left without this, ask for clarification at your next visit.

Did they explain everything? Your therapist should explain every test, every finding, and every exercise. If something doesn't make sense, ask. A good PT welcomes your questions.

For more on what to look for in a physical therapist, read our guide on how to choose a physical therapist in Culver City.

Real Patients, Real Results

David L. had been dealing with a nagging hamstring issue for months. He put off seeing a PT because he wasn't sure what the process involved. When he finally came in for his first visit at Victory, his evaluation revealed that his hamstring pain was actually driven by poor hip stability and lumbar motor control. He left that first visit with a clear explanation, hands-on treatment that immediately reduced his symptoms, and a 3-exercise home program.

"I wish I hadn't waited so long. The eval was the most thorough assessment I've ever had. I knew exactly what was wrong and what we were going to do about it."

Rachel K. came in from Mar Vista with chronic shoulder pain that had been limiting her CrossFit training for weeks. She was nervous about her first visit because a previous experience at another clinic had been rushed and impersonal. At Victory, her therapist spent the full hour with her, tested her shoulder through every relevant movement, and identified a scapular dyskinesis pattern (an abnormal movement of the shoulder blade that affects how the shoulder joint functions). Treatment started that same day.

"It was completely different from what I'd experienced before. My therapist actually listened, explained everything, and I could already feel a difference by the time I left."

A Quick Summary of Your First PT Visit

You fill out intake forms before you arrive
You wear comfortable, movable clothing
You plan for about 60 minutes
Your therapist asks detailed questions about your symptoms, history, and goals
You go through a hands-on physical exam including movement, strength, and special tests
You receive a diagnosis and a clear treatment plan
Most clinics start hands-on treatment during the first visit
You leave with a home exercise program

Ready to Schedule Your First Visit?

If you've been putting off physical therapy because you weren't sure what to expect, now you know. At Victory Performance and Physical Therapy, we provide thorough, one-on-one evaluations designed for active adults. Our Doctors of Physical Therapy specialize in helping runners, lifters, CrossFit athletes, and everyday active people throughout Culver City and the surrounding neighborhoods get back to doing what they love.

No referral needed under California's Direct Access law. Just call and schedule.

Book Your Evaluation Now Call: 424-543-4336 Serving Culver City, Playa Vista, West Los Angeles, Palms, Marina del Rey, and Westchester.

References

Zeppieri, G., Lentz, T. A., Atchison, J. W., Indelicato, P. A., Moser, M. W., Vincent, K. R., and George, S. Z. (2017). Patient-Defined Desired Outcome, Success Criteria, and Expectation in Outpatient Physical Therapy: A Longitudinal Assessment. Health and Quality of Life Outcomes, 15(1), 29.https://hqlo.biomedcentral.com/articles/10.1186/s12955-017-0604-1
Bialosky, J. E., Bishop, M. D., and Cleland, J. A. (2010). Individual Expectation: An Overlooked, but Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain. Physical Therapy, 90(9), 1345-1355.https://pmc.ncbi.nlm.nih.gov/articles/PMC2931638/
Ojha, H. A., Wyrsta, N. J., Davenport, T. E., Egan, W. E., and Gellhorn, A. C. (2016). Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review. Journal of Orthopaedic and Sports Physical Therapy, 46(2), 56-70. https://www.jospt.org/doi/10.2519/jospt.2016.6138

How Long Does Physical Therapy Take to Work

Sean Hubbard — Thu, 26 Mar 2026 12:43:56 +0000

If you’re dealing with pain and considering physical therapy, you probably want to know one thing before anything else: how long until you feel better. It’s a fair question, and at Victory Performance and Physical Therapy in Culver City, it’s one we hear almost every day.

The honest answer is that it depends on what’s going on with your body. But unlike a vague “everyone’s different,” we can give you a realistic framework based on what the research says and what we see with our patients.

There’s also an important distinction we want to make upfront: getting out of pain and actually fixing the problem are not the same thing. At Victory, we don’t practice pain-relief physical therapy. We practice root-cause physical therapy. That difference shapes everything about how we approach your care, and how long we recommend you stick with it.

How Quickly Can You Expect to Feel A Difference?

Most patients notice some improvement within the first two to four visits. That doesn’t mean you’ll be pain-free by week two. It means you’ll start moving better, sleeping better, or noticing that the thing that’s been bothering you isn’t as sharp or constant as it was.

For many common musculoskeletal issues, meaningful reduction in symptoms happens within four to six weeks of consistent physical therapy. A 2021 clinical practice guideline published in the Journal of Orthopaedic & Sports Physical Therapy found that exercise combined with manual therapy leads to measurable improvements in pain and function within the first four weeks for most patients with musculoskeletal pain. (George et al., 2021, JOSPT)

But here’s what that research doesn’t tell you: feeling better is not the same as being fixed.

Pain is your body’s signal that something is off. When that signal quiets down, it’s easy to assume the problem is resolved. In most cases, it isn’t. The underlying strength deficits, movement compensations, and motor control issues that caused the problem in the first place are still there. They’ve just stopped shouting. If you stop treatment when the pain goes away, you’re leaving the root cause unaddressed. And it will come back.

Pain relief is a milestone, and an important one, but it’s the beginning of recovery, not the end of it. Once your symptoms settle down, the real work begins getting you back to the things you love.

Pain Relief vs. Actual Recovery: Why the Difference Matters

This is central to how we think about physical therapy at Victory.

Pain relief is a milestone, and an important one, but it’s the beginning of recovery, not the end of it. Once your symptoms settle down, the real work begins: rebuilding the strength, motor control, and movement patterns that will keep the problem from returning.

Making lasting changes to how your body moves and how your muscles function takes time. Research and clinical experience are consistent on this point: meaningful strength and motor control adaptations require a minimum of 12 weeks of progressive, structured training. For patients dealing with chronic issues, meaning pain or dysfunction that’s been present for months or years, that timeline is often longer.

This is why we don’t measure success by how quickly we can get you out of pain. We measure it by whether you’re stronger, more capable, and more resilient when you leave than when you arrived. That’s what actually prevents the problem from coming back.

What Affects How Long Physical Therapy Takes?

How long you’ve been dealing with your injury. A muscle strain you got last week is very different from shoulder pain that’s been lingering for nine months. Acute injuries, meaning things that happened recently and have a clear cause, tend to respond faster. Chronic conditions take longer because your body has had time to develop compensation patterns that need to be retrained.

What the underlying issue is. A tendinopathy (tendon degeneration and pain) requires a gradual loading program that can take 8 to 12 weeks just for symptom relief, and longer to fully rebuild tendon strength and resilience. A muscle imbalance causing low back pain might settle down in 4 to 6 weeks, but the strength and motor control work to prevent recurrence extends beyond that. A joint mobility issue from years of desk work might improve quickly with hands-on work, but the movement habits that caused it need time to change.

How consistent you are. This is the factor that matters most and the one you control entirely. Physical therapy works because it progressively changes how your body moves and how strong your supporting muscles are. That requires consistency, both in attending sessions and following through on your home exercise program.

Your overall activity level. Active adults who are already moving tend to respond faster than people who have been sedentary. If you’re a runner, a gym-goer, or someone who stays active around Culver City, hiking Baldwin Hills, cycling the Ballona Creek Trail, or training at a local gym, your body is already primed to adapt. That’s an advantage.

What Does A Typical Physical Therapy Timeline Look Like?

Here’s a realistic breakdown of what recovery looks like for common conditions we treat at Victory Performance and Physical Therapy. Note that the first timeframe reflects symptom improvement. The full recovery timeline, including the strength and motor control work needed to prevent recurrence, runs a minimum of 12 weeks.

Acute muscle strains and minor sprains: symptoms improve in 4 to 6 weeks. These are your pulled hamstrings, tweaked backs from lifting, or rolled ankles. With the right treatment and load management, pain and swelling resolve relatively quickly. The work that follows, restoring full strength and neuromuscular control, takes the remainder of your 12-week plan.

Low back pain: symptoms often improve in 4 to 8 weeks. Low back pain is complex and varies widely. If your pain is driven by weak core and glute muscles, poor movement patterns, or stiffness through the spine and hips, targeted PT can make a significant difference within this window. But low back pain has one of the highest recurrence rates of any musculoskeletal condition, which is exactly why we don’t stop at pain relief. Chronic low back pain that’s been around for months requires even more time to fully address.

Tendinopathies (Achilles, patellar, rotator cuff): 8 to 12 weeks minimum, often longer. Tendons heal differently than muscles. They need progressive loading, starting light and gradually increasing, to rebuild strength and resilience. Rushing this process is the most common reason tendon issues drag on for months or return after someone “feels better.”

Shoulder pain and impingement: 6 to 12 weeks for symptoms, 12+ weeks for full recovery. The shoulder is a complex joint that depends heavily on muscular stability. Recovery requires retraining the rotator cuff, scapular stabilizers, and overall movement patterns. Most patients see significant symptom improvement by the 8-week mark, but the strength work that protects the joint long-term continues beyond that.

Runner’s knee and IT band issues: symptoms improve in 4 to 8 weeks. These overuse injuries respond well to a combination of hip strengthening, load management, and biomechanical correction. Many of the runners we work with in Culver City return to training within this window, but we keep working on the hip strength and running mechanics that caused the problem in the first place.

Why Doesn’t Physical Therapy Work for Some People?

Let’s address this directly. When someone says PT “didn’t work,” it usually comes down to one of three things.

They stopped when the pain went away. This is the most common reason. Pain relief is a sign that treatment is working, not a signal to stop. The underlying cause is still being addressed, and stopping early leaves your body vulnerable to the same problem returning, often worse than before.

The approach wasn’t specific to their problem. Generic exercise sheets and passive treatments like ultrasound or electrical stimulation aren’t physical therapy; they’re placeholders. Effective PT involves a thorough evaluation, a personalized plan, and hands-on treatment that addresses the actual root cause.

They weren’t doing their home exercises. Your physical therapist sees you a few times a week at most. The exercises you do between sessions are what drive the long-term changes. We use an app at Victory so you can follow along with video demonstrations of your specific program, making it easier to stay on track.

Pavel S., a lifelong athlete who came to Victory after years of dealing with mobility issues, put it well:

“I visited multiple massages, acupunctures, chiropractors etc. Then I came across Victory Performance and since I opened the door and walked in I knew I am at the right place, crew is incredibly invested to fully understand your issues following it with customized work-out as solution.”

Dealing with pain that’s holding you back from the activities you love? Our team at Victory Performance and Physical Therapy in Culver City can evaluate what’s going on and give you a clear timeline for recovery, not just until you feel better, but until the problem is actually fixed.

Call today: 424-543-4336

Does Physical Therapy Work Better Than Just Waiting It Out?

This is where the research is clear. While some acute injuries will improve on their own with time, physical therapy produces better outcomes and reduces the chance of the problem coming back.

A large-scale study of over 750,000 patients found that people who started physical therapy early, within 14 days of their initial visit, had significantly lower use of imaging, injections, surgery, and opioid medications compared to those who waited. Their total treatment-related costs were also 60% lower over two years. (Childs et al., 2015, BMC Health Services Research)

The takeaway? Starting physical therapy sooner generally leads to faster recovery and less need for expensive or invasive interventions down the road.

In California, you don’t need a doctor’s referral to see a physical therapist. Under the state’s Direct Access law, you can schedule an evaluation directly. That means you don’t have to wait for an appointment with your primary care doctor first. You can start treatment right away.

How Do You Know If Physical Therapy Is Actually Working?

Good question. Progress in physical therapy isn’t always about pain going to zero. Here’s what meaningful progress actually looks like:

You can do things today that you couldn’t do two weeks ago
Your pain is less frequent, less intense, or both
You’re sleeping better because pain isn’t waking you up
You’re returning to activities you had to stop: running, lifting, playing with your kids
You need less ibuprofen or ice to get through the day
You’re stronger and moving better, even on days when you feel fine

At Victory, we track your progress objectively. We measure range of motion, strength, and functional benchmarks so you can see the improvement, not just feel it. And we keep tracking those benchmarks even after symptoms resolve, because that’s when the real strength work is happening.

Sam C., who dealt with back issues for seven years before finding Victory, described the difference:

“Victory has taken an approach that’s both personalized and extremely effective. I feel stronger and more confident than I ever have during PT treatment.”

How Many Physical Therapy Sessions Will You Need?

For most conditions, a typical plan of care at Victory involves one to two visits per week for a minimum of 12 weeks. That’s the window we’ve found necessary to drive the strength and motor control changes that produce lasting results, not just temporary relief. More complex or chronic conditions will require additional time beyond that.

A 2021 Cochrane review, one of the most rigorous types of research analysis, confirmed that exercise-based physical therapy produces meaningful improvements in both pain and function for chronic musculoskeletal conditions, with the strongest results seen in patients who maintained consistent participation. (Hayden et al., 2021, Cochrane Database of Systematic Reviews)

At Victory Performance and Physical Therapy, we don’t believe in keeping you in treatment longer than you need to be. But we also don’t believe in cutting things short just because the pain is gone. Our goal is to get you strong, confident in your movement, and genuinely resilient, not just symptom-free. That’s what evidence-based, root-cause care looks like.

Ready to Start Moving Without Pain?

If you’ve been putting off physical therapy, or if you tried it before and it didn’t work the way you expected, we’d like to show you what a different approach looks like. At Victory Performance and Physical Therapy in Culver City, every treatment plan starts with a thorough evaluation and a clear roadmap for recovery, one that doesn’t end when the pain stops.

📅 Book Your Appointment Now

📞 Call: 424-543-4336

Direct Access Physical Therapy in California: What Culver City Adults Need to Know

Sean Hubbard — Tue, 24 Mar 2026 00:16:53 +0000

Yes, you can see a physical therapist in California without a doctor's referral. It's called direct access, and it's been the law since 2014. If you're an active adult in Culver City dealing with pain or an injury, this means you can start physical therapy today without waiting for an appointment with your doctor first.

Most people don't know this. And that lack of awareness costs them time, money, and weeks of unnecessary waiting. This post explains exactly how direct access physical therapy works in California, what the limits are, when you should still see your doctor, and how to get started.

What Is Direct Access Physical Therapy?

Direct access means you can be evaluated and treated by a licensed physical therapist without first getting a referral or prescription from a physician. In California, this right is protected under Assembly Bill 1000 (AB 1000), which went into effect on January 1, 2014.

Before this law, you had to see a doctor first, get a referral, and then schedule with a PT. That process could take weeks. For someone with an acute injury or worsening pain, those weeks mattered. Direct access removes that barrier.

Today, you can call a physical therapy clinic, schedule an evaluation, and begin treatment. No middleman. No waiting room detour.

What Does California's Direct Access Law Actually Say?

The law is straightforward, but it does have limits. Here's what you need to know.

Under AB 1000, a licensed physical therapist in California can evaluate and treat you for:

Up to 12 visits, or
Up to 45 calendar days
Whichever comes first

After that window closes, your physical therapist will need a signed plan of care from a physician, surgeon, or podiatrist before continuing treatment. In most cases, your PT can coordinate this for you so the process is smooth.

Other key details:

You must be 18 years or older
You must be physically present in California during your evaluation and treatment
Your physical therapist is required to screen for conditions that fall outside their scope of practice and refer you to a physician if needed

This last point is important. Physical therapists are trained to identify red flags during your evaluation. If something about your symptoms suggests a more serious medical condition, a good PT will recognize it and make sure you see the right provider.

Can Direct Access Save You Money?

Research says yes. A study published in the Journal of Orthopaedic and Sports Physical Therapy compared patients with back and neck pain who chose direct access to physical therapy versus those who went through traditional physician referral. The direct access group had similar clinical outcomes, including comparable improvements in pain and disability. But they spent an average of $1,543 less in total healthcare costs over the following year (Denninger et al., 2018, JOSPT).

A separate systematic review and meta-analysis in Physical Therapy found that direct access to PT was associated with fewer healthcare visits and reduced imaging rates compared to physician-first access, without sacrificing clinical improvement (Hon et al., 2021, Physical Therapy).

The pattern is consistent across the research. When patients go directly to a physical therapist for musculoskeletal issues, they tend to get better just as fast while spending less on imaging, medications, and specialist visits they may not have needed.

Dealing with pain or an injury and want to skip the referral process? At Victory Performance and Physical Therapy in Culver City, you can schedule a direct access evaluation and start treatment right away.

Call today:424-543-4336

Does My Insurance Cover Direct Access Physical Therapy?

This is one of the most common questions, and the answer depends on your plan.

PPO plans in California generally cover physical therapy visits under direct access the same way they would with a physician referral. You'll pay your normal copay or coinsurance, and visits count toward your plan's PT benefit.

HMO plans often require a referral from your primary care physician, even though the state law allows direct access. This is a plan-level requirement, not a legal one. If you have an HMO, check with your insurance company before scheduling.

Medicare requires a physician referral for physical therapy. Direct access does not apply to Medicare beneficiaries. If you're on Medicare, your doctor will need to provide a referral before you can begin PT.

Workers' Compensation claims also require a physician referral.

Cash pay is always an option. If you prefer to pay out of pocket, direct access allows you to schedule immediately without involving your insurance at all.

The best step is to call the clinic you're considering and ask about your specific coverage. And remember, not all Physical Therapy is created equally.

When Should You Still See Your Doctor First?

Direct access is a powerful tool, but it's not always the right first step. There are situations where seeing your physician before starting PT makes sense.

Consider seeing your doctor first if:

Your pain started after a traumatic event like a car accident, a fall from height, or a significant impact
You have symptoms beyond pain, such as fever, unexplained weight loss, night sweats, or changes in bladder or bowel function
You have a history of cancer and are experiencing new, unexplained pain
Your symptoms are getting worse rapidly despite rest
You're unsure whether your issue is musculoskeletal in nature

A licensed physical therapist is trained to screen for these situations during your evaluation. If anything about your presentation raises concern, they'll refer you to the appropriate medical provider. This screening process is a required part of every direct access evaluation.

But for the majority of musculoskeletal issues in active adults, like a sore knee from running, a stiff low back from training, or a shoulder that hurts with overhead movements, direct access gets you to the right provider faster.

How Does a Direct Access Evaluation Work?

When you come in for a direct access visit, the evaluation is the same comprehensive process you'd receive with a referral. There's no reduced version of care.

A typical direct access evaluation at Victory Performance and Physical Therapy includes:

Full medical history review. Your therapist asks about your symptoms, how they started, what makes them worse, and what you've tried so far.
Screening for red flags. This is a critical step in any direct access visit. Your PT checks for signs that suggest your issue may need medical evaluation before PT can begin.
Movement assessment. Watching how you move through functional patterns relevant to your activities.
Strength and mobility testing. Identifying the specific deficits contributing to your pain.
Diagnosis and plan of care. You leave with a clear understanding of what's going on, why, and what the plan is to address it.

From there, treatment begins. Most patients start hands-on treatment and their first exercises during the same visit as the evaluation.

How Do You Get Started with Direct Access PT in Culver City?

The process is simple:

Call or book online. Contact the clinic directly. No referral paperwork needed.
Evaluation visit. Your physical therapist performs a thorough assessment and begins treatment.
Treatment plan. You receive a personalized plan with clear goals and a timeline.
Physician coordination (if needed). If your treatment extends beyond 12 visits or 45 days, your PT will help coordinate a physician sign-off.

That's it. No waiting for a doctor's appointment. No delay between your referral and your first PT visit. You call, you come in, you start.

Real Patients, Real Results

Marcus T. tweaked his back during a heavy deadlift session at his gym in Playa Vista. He assumed he'd need to see his doctor first, get imaging, and wait for a referral. When he learned about direct access, he called Victory the same day. His PT identified a motor control deficit in his lumbar spine, started hands-on treatment that first visit, and had Marcus back to training within four weeks.

"I thought I'd be out for months. Instead, I was in the clinic two days after the injury. No runaround, no waiting. Just treatment."

Amanda R., a runner from West Los Angeles, had been dealing with hip pain for weeks. She didn't want to wait for a referral because she had a half marathon eight weeks out. She used direct access to get into Victory, where her therapist identified a gluteal tendinopathy (a condition where the tendon on the side of the hip becomes irritated and weakened). With targeted strengthening and training modifications, she ran her race on schedule.

"I didn't even know I could see a PT without a referral. Once I found out, I was in the clinic the next day. That made all the difference."

Key Takeaways

✅ California law allows you to see a physical therapist without a doctor's referral
✅ You can receive up to 12 visits or 45 days of treatment under direct access
✅ Most PPO insurance plans cover direct access PT visits
✅ Medicare and Workers' Comp still require a physician referral
✅ Research shows direct access can save money while delivering the same outcomes
✅ Your physical therapist screens for medical red flags at every direct access evaluation

Ready to Start Physical Therapy Without the Wait?

Don't let a referral delay keep you from getting the care you need. At Victory Performance and Physical Therapy, we specialize in helping active adults throughout Culver City and the surrounding area get back to the activities they love. Our team of Doctors of Physical Therapy provides evidence-based, one-on-one care, and California's Direct Access law means you can start today.

📅Book Your Evaluation Now

📞 Call:424-543-4336

Serving Culver City, Mar Vista, Playa Vista, Palms, West Los Angeles, Marina del Rey, and Westchester.

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