Get to Know Your PT – Jessica Dietz, PT, DPT

Jessica Dietz Physical Therapist Denver

Therapydia Denver physical therapist Jessica Dietz, PT, DPT, takes some time to talk about her own experience with a torn ACL, the importance of regular physical activity, and sriracha.

When did you know that you wanted to be a physical therapist?

Since freshman year of high school after I tore my ACL. I had wonderful rehab/therapists, enjoyed the activeness of the job, and overall interacting with patients. It wasn’t until a personal experience in college when I helped my dad rehab after an unexpected stroke that I became more interested in neurorehab.

What surprised you the most about the physical therapy profession?

The reality of holistic care. I strongly believe that in order to be a great therapist you need to understand, treat, and respect all aspects of your patient.

How do you like to stay active?

Anything outdoors! I love trail running, hiking, skiing, playing tennis, gardening, etc.

What is the biggest challenge involved in being a PT?

Changes in healthcare that are primarily dictated by insurance companies. Especially the limitations towards shorter plans of care and fewer numbers of visits.

What’s your favorite song to get you motivated?

“Feel Good” by Neon Trees. It’s a song and band with an 80s vibe. You can’t help but dance when you hear it!

Are you currently pursuing any further education or certifications?

I just recently took my certification exam for becoming a neurologic specialist. Next up, I am hoping to pursue further training in NDT (a specific manual facilitation technique) and LSVT BIG/PWRI for Parkinson’s Disease.

What’s your go-to breakfast?

Open-face egg sandwich with sriracha. Sriracha is a condiment that goes on anything! 🙂

What do you wish everyone knew about PT?

To be successful with physical therapy, it is a collaboration between both the therapist and the patient. There will be skills, techniques, and education that will learn during therapy sessions but doing things like your home exercise program and performing regular physical activity is equally as important. Also, the power of regular bouts of therapy throughout a lifetime is best for prevention and identifying things before they become a problem.

In your opinion, what is the most important personality trait that a PT must have?

Good communication and being compassionate.

What do you do to de-stress/unwind?

Running, doing art projects, and cuddling with my three dogs (lab, rescue mutt, and English bulldog).

Finish this sentence: On Saturday mornings, you can usually find me…

Trail running, hiking with my dogs, or sleeping in.

What is your favorite piece of wellness advice?

Wellness is a life-long commitment where physical activity is an important piece of the puzzle. Staying active is linked to improved mood, mental health, cognition, and overall quality of life as well as reducing risk factors for serious conditions such as heart disease and stroke.

Physical Therapy at the Burton US Open

snowboarding physical therapy denver

By Aaron Page, DPT
Therapydia Denver Physical Therapist

Earlier this year, I was fortunate enough to be selected as one of the medical providers for the Burton US Open Snowboarding Championships in Vail, CO, just up the hill from our Denver clinic. Needless to say, this event brought many of its own unique and exciting challenges for a PT, but overall, it was another incredible way that we at Therapydia are able to relate to our patients and provide high-quality care in a variety of settings.

If you’re not familiar with the US Open, it is one of the largest snowboarding competitions in the country. In its 37th year overall (and 7th year in Vail), the event continues to grow and draw the top snowboarders from all around the world. Burton and the staff involved do an incredible job putting the event together—constructing a world class course in both Slopestyle and Halfpipe, as well as (more directly related to my realm) a remarkable medical support system for the riders.

Situated at the bottom of the Slopestyle course and steps away from the corral where the athletes land on the final jump, is the medical tent. In the tent is what can be described as a “Treatment and Recovery Zone” for the athletes—complete with all of the features you would expect from a small clinic. Treatment tables, compression recovery boots, foam rollers, exercise bikes, etc. all available for athletes throughout the entire event. Behind all of the equipment though, are those practitioners that help facilitate care and are what really shine through when it comes to protecting the pro athlete. The interesting thing to me was that familiarity and environment allowed the treating practitioners, physicians, and physical therapists alike, to jump right in to a quality treatment approach. Interactions with riders still began with an evaluation (though it may look slightly different than from one you see in our clinic) and focused on identifying specific needs and issues the rider may have. Ultimately for a PT in that setting, the foundation was the same: Pinpoint areas of concern (ie. limited mobility, limited flexibility, limited stability) and implement an intervention that addresses those concerns. Though the timeline and plan of care may be different for the snowboarder considering that they have to compete in the next few days, the framework is similar to any patient that we see in the clinic. Our goal was to educate the rider on what we can address together to improve their mobility, stability, and possibly strength, to get them where they needed to be for competition.

physical therapy snowboarding

Headed by Dr. Bryan Huber, Medical Director for Burton Global Snowboard Team/Team Physician for US Snowbaording and Dr. Tom Hackett, Steadman Hawkins Orthopedic Surgeon/Team Physician for the US Snowboard Team, they have developed a system and orchestrated a team that covers all aspects of care for the riders. For orthopedic surgeons, massage therapists, surgical fellows, paramedics, certified athletic trainers and physical therapists, the riders are supervised and cared for in each aspect of the event, something unique to this type of competition.

From a physical therapy perspective, unfortunately this high level of care is sometimes a rare occurrence at an event like this. More often than not, these competitions are not covered with the same detail due to the chaotic nature of trying to manage 40+ riders each day. Though some of the top riders/teams may have a PT on staff and receive quality care, being responsible for the entire team can make personalized treatment difficult following an injury when you also have to ensure the safety and care of the rest of the team. That’s where we came in that week.

physical therapy denver

With the first practice of the day at 9am, the medical tent was open and ready to assist the riders with any pain or concerns that they had. I heard from numerous riders during the first few days that they had been nursing an injury over the last few weeks but didn’t have an opportunity to follow up with a trusted medical practitioner. Some even waited intentionally because they knew they could trust the team at the Burton US Open. Engineered by Mike Giunta, owner and physical therapist at Evolution Physical Therapy in Los Angeles, this system of evaluation and collaboration with the other medical providers allowed for comprehensive, individualized care throughout the whole week. It wasn’t uncommon that a rider would come in shortly after practice, feeling the effects of being 20 feet above the deck of the halfpipe, and leave the medical tent more comfortable and confident that their issue was going to be addressed.

My time at the Burton US Open was extremely valuable. Not only was I fortunate enough to work with some of the best surgeons, ATCs, PTs, and snowboard athletes in the world, it also provided me with a renewed sense of understanding and circumstances of any patient. Now, not all of us are landing the first ever double crippler as a female in competition (shout out Maddie Mastro), but we can all relate to the challenges, on any scale, of dealing with pain and injury. The stakes are high for everyone and it is our responsibility as physical therapists to meet any patient where they are so we can fight for them to overcome their own adversity. Not just on the professional level but on any playing field: in the clinic, in the insurance industry, in the research lab, and with healthcare as a whole. I look forward to taking that back to Therapydia and continuing the high level of care for the field of physical therapy and those who need it.

What’s In a Sit-Up? Follow Wade’s Journey To Doing His First Sit-Up

Wade’s newest fitness goal comes down to doing 1 sit-up. In his words, do a sit-up, unassisted, no cheating—for the first time. Wade’s “The Sit-Up Movie” wittily chronicles his fitness journey towards his #NoMoreNevers goals as well as his battle with dermatomyositis. Throughout his short video he challenges the viewer to consider what goals they thought they could never achieve.

When Wade was 5, he was diagnosed with a rare form of arthritis called dermatomyositis. Dermatomyositis is a neuromuscular condition that causes inflammation and weakness of the muscles and skin. Growing up, Wade experienced major flexibility losses as his muscles atrophied, tightened, and shortened. Wade has been highly committed to his fitness journey over the past few years. He started exercising his upper body and core which he hadn’t really ever done before. He joined his first gym, Vital Strength and Fitness, began training for a marathon, and began preparing to do 37 burpees on his 37th birthday. Wade’s goal is to improve his functional strength and eventually begin to try out new sports for the first time.

The Ultimate Triple Threat

After a snowboarding accident, Wade began to see his physical therapist, Casey, at Therapydia Denver. His rheumatologist, Jason, his Vital personal trainer, Todd, and Casey, came together to assess what some of Wade’s barriers to his goals might be to create a holistic wellness plan. Wade needed to strengthen his core—and one way to do that would be to do a sit-up. In Wade’s case, it’s more than just increasing his muscle size in his core area (i.e. hypertrophy). It’s having all of his muscles in his core area to coordinate one major movement without any joint restrictions (i.e limited lumbar flexion). It also has a day-to-day significance—sitting up, getting out of bed, or reaching over to get some favorite snacks.


To get this goal, Wade and his team developed a weekly fitness program. It included going to personal training three times a week, physical therapy once a week, an intensive cardio regimen, and daily stretches. Unfortunately, no major effort comes with its setbacks. Wade’s dermatomyositis came out of remission for the time in 20 years. With doubled recovery times and buckets of daily medication, Wade hardly lets it slow him down from completing his prodigal sit-up. According to Wade, it’s not about some sappy monologue, he’s going to do a sit-up.

What’s your #NoMoreNevers?

Thank you Wade for sharing your dynamic fitness journey with us!

Peyton Manning’s Plantar Fascia Tear…Is this the End?

Fantasy Football Injury of the Week:  Peyton Manning and his Plantar Fascia

Yesterday we learned that Peyton Manning has a tear in his plantar fascia and will miss at least this week’s game against Chicago.  The fantasy implications of Manning missing time might be minimal (Manning is ranked 30th in my leagues this year for QBs), but as a Denver resident and Broncos fan, this is some serious news.


This week I want to focus on what exactly is a tear of the plantar fascia, what can be done to treat it, and will Manning play again this season or ever again?

What is the plantar fascia and why is a tear career threatening?

The plantar fascia is a thick band of connective tissue that supports the arch of the foot. In the physical therapy clinic, we most commonly see an acute inflammation or micro-tearing of the fascia near the heel bone, known as plantar fasciitis.  We also see very chronic cases in which there is a buildup of scar tissue at the same location from repetitive micro-tearing followed by healing.  Plantar fascia injuries are one of the more common diagnoses that we see in PT but also one of the hardest to treat, especially the chronic cases.  Even though this band is thick and tough, it’s job is to maintain your arch while supporting all of your body weight.  When the plantar fascia becomes irritated, inflamed or weakened by chronic injury, every step can be painfully perpetuating the injury.


Manning’s situation is much more severe than the common plantar fasciitis diagnosis we see at Therapydia.  In his case, he has sustained a partial rupture or larger tearing of the plantar fascia.  For any of you who have experienced the pain of plantar fasciitis yourself, that pain is magnified significantly with a partial rupture.  Imagine having a cut on the knuckle of your finger.  Every time you use or bend that finger, the cut painfully reopens and the healing has to start over.  The finger is easy to keep from moving, just buddy tape it or use a splint from the drugstore to keep it from bending.  The foot on the other hand is very difficult to immobilize so the time it takes to heal can be painfully long…..and therein lies the major problem with Peyton Manning’s foot issue.  Will there be enough time for him to return and be effective this year or will this be the end of Manning’s illustrious career?

When will Manning be back and is there anything that can be done to speed up his return?  

Unfortunately, I am not privy to all the details about Manning’s injury.  I can only speculate on what I’ve read or seen on Sportscenter.  The typical time frame for a non-operative recovery of a partial tear of most soft tissue injuries is 12 weeks or more.  This is when we often consider the injured tissue to be back to or near full strength.  However, at 4-6 weeks, the injury could be 80% healed which may be sufficient enough to allow an athlete to return to their sport.  Returning too early though can increase the likelihood of reinjury or lead to another serious problem.  See Arian Foster.

Manning has a few options that may get him back on the field quickly.  Platelet rich plasma (PRP) injections are being used more often these days to speed up the healing process.  Injecting the injured tissue with PRP provides an instant proliferation of growth factors that can quickly stimulate healing. Tenex is a minimally invasive procedure that removes the damaged or injured tissue, allowing the healthy tissue to regenerate and thrive.  Finally, Manning and his doctors may decide to do a plantar fascia release or surgical cutting of the the partially torn fascia.  By fully releasing the partially torn section of the plantar fascia, tension is released and inflamed nerve endings are no longer sending painful signals to the brain.  However, the long term risk factors of this procedure are much greater than other options including nerve damage, instability in the joint of the feet, loss of normal biomechanics of foot and ankle.  The expected recovery from these procedures is 3-6 weeks versus the 8-12 weeks or more of conservative treatment.

Again, I have very limited information on the severity of Manning’s plantar fascia injury.  He is also dealing with injuries to his throwing shoulder and ribs.  As the Denver Post points out, there are also a number of scenarios that could occur in the next several weeks that impact Manning’s return.  Nonetheless, we are here to predict when or if Manning returns from his plantar fascia tear, so here it is….

Prediction: Peyton Manning misses 4 games.  The tear is either mild enough to return in four weeks or he undergoes a minimally invasive treatment that allows him to return for an important Week 15 matchup against the Pittsburgh Steelers.  

Arian Foster, Achilles Tendon Rupture

Arian Foster, Houston Texans Running Back

Arian Foster is reported to have sustained an achilles tendon rupture in the Texans’ 44 to 26 loss to the Miami Dolphins on Sunday (video of injury here).  It has already been announced that Foster will miss the remainder of the season.  The real questions is if he will ever return to playing in the NFL and if so, at what level.  When healthy, Foster is a fantasy football team owner’s dream.  If you are playing in a keeper league,  given his past numbers and high fantasy draft stock, it is quite possible that he is on you our your opponent’s team for years to come.  

How severe is Arian Foster’s injury?

Achilles tendon injuries are classified from Grade I to Grade III.  Foster is reported to have sustained a grade III strain, also known as a complete rupture.  More information about the grading system below:


Grade I: Mild strain, disruption of a few fibers. Mild to moderate pain, tenderness, swelling, stiffness. Expected to heal normally with conservative management.

Grade II: Moderate strain, disruption of several fibers. Moderate pain, swelling, difficulty walking normally. Expected to heal normally with conservative management.

Grade III: Complete rupture, often characterized by a “pop,” immediate pain, inability to bear weight. Typically requires surgery to repair.


What is next for Foster?

Foster will likely undergo a surgical procedure to repair his achilles tendon within the next week or so.  Immediately following the surgery he will be in a cast and using crutches to avoid putting any weight on the operative limb for 2-4 weeks.  After that he will be wearing a walking boot and slowly increasing the amount of weight he is putting through his leg during walking activities.  He will likely go through a therapy protocol lasting roughly 6 months before he is able to resume athletic activities (sample rehab protocol here).  

His rehab will include pain and swelling management using modalities such as the Gameready ice machine.  He will also likely undergo hands-on therapy including joint mobilization and trigger point dry needling to decrease pain and increase mobility.  His exercise program will be geared towards strengthening and stabilization of his core and entire lower extremity to decrease the likelihood that he will suffer another season-ending injury.  Proprioceptive training is extremely important in recovering from and protecting against injury.  Here’s an example of a proprioceptive training progression:


Will Arian Foster ever be the same?

Possibly.  A study published in 2009 investigated achilles tendon ruptures in the NFL and their impact on player performance.  The researchers found that on average, players experienced a greater than 50% decrease in power ratings following an achilles tendon rupture.  Furthermore, roughly 32% of players that sustained an achilles tendon rupture never returned to play in the NFL.  

Given recent data on achilles tendon ruptures and Foster’s explosive style of play, The Therapydia PTs feel that if Foster was your first pick in a keeper league, it may be time to look for a different league.  
Prediction: Arian Foster returns next season as a much less productive back, if he returns at all.  

Will Blake Bortles miss Week 6 with an AC Sprain?

Fantasy Football Injury of the Week:  How bad is Blake Bortles Grade I AC Sprain?

Blake Bortles has not typically been on the radar of many fantasy players since he joined the league in 2014.  However in 2015 he has had a sneaky good start to the season despite Jacksonville’s 1-4 record.  In my Yahoo league, he is currently the 7th best QB.  He has better numbers this year than our very own Peyton Manning (by a longshot) and fantasy studs like Drew Brees and Matt Ryan.

Unfortunately, Bortles may suffer a bit of a setback if he is forced to miss Week 6 against Houston.  Bortles suffered a Grade/Type 1 acromioclavicular (AC) joint sprain of his throwing shoulder at some point during Jacksonville’s week 5 loss to the Buccaneers.  Anytime a quarterback sustains an injury to the throwing shoulder it can be a scary situation.  Fortunately for Bortles, a grade one AC sprain leaves us optimistic that he will be able to play this week and here’s why.

What’s the difference between Grade 1, 2, and 3 AC Sprains?

An AC sprain is typically graded in its severity from a one to a three.  It easy to visualize the severity of an AC sprain in the graphic below:


A grade/type 1 sprain is mild or partial injury to the joint ligaments or capsule.  In this grade there is a slight tear or sprain of the acromioclavicular ligament.  This ligament helps to stabilize the AC joint and ultimately the shoulder itself.  Bortles likely will rest the shoulder this week and participate in physical therapy everyday to retain his range of motion, strength, and help control the pain with modalities like the Gameready ice machine:

File_000(note: this is not Blake Bortles)

A grade/type 2 sprain is a more significant tear of the acromioclavicular ligament as well the ligament below the clavicle called the coracoclavicular ligament.  

A grade/type 3 sprain is a severe injury to the shoulder.  In this situation, both acromioclavicular and coracoclavicular ligaments are completely torn.  The shoulder is very unstable and an athlete will often choose to have surgery to stabilize the joint by placing a screw or looped suture into the collar bone to anchor it back down.  This grade of injury will mean the player misses weeks or months of their sport.

So What’s the Prognosis?

Fortunately for Bortles he has been diagnosed with the most mild form of an AC sprain, a grade one.  Early in the week his shoulder probably felt sore and a little weak or unstable  He may have had some difficulty reaching overhead or across his body and lifting activities might have been uncomfortable.  Kinesiotaping can be helpful in giving stability and pain relief during this phase of recovery.


With daily physical therapy rehab, Bortles’ symptoms will likely improve significantly or resolve completely by Sunday.  

Prediction: Blake Bortles is able to play in Week 6 against Houston


Hamstring Strains for Lynch and McCoy (9-28-15 Fantasy Football Injury of the Week)


This week we saw two key running backs leave the game early with hamstring strains.  Marshawn Lynch left the game at halftime and never returned.  The diagnosis at this time is a mild hamstring strain after an MRI was performed yesterday.  Typically you get a little more detail from these MRIs but the news has been vague and sparse.  What is interesting about Lynch’s injury is that he entered week 3 questionable to play with a calf strain.   As physical therapists that work in sports medicine rehab, it is not uncommon for us to see this type of situation where one injury quickly leads to another if an athlete tries to return to their sport too quickly.  In this case, a calf strain followed by a hamstring strain is not surprising in the least, especially for a powerful runner like Lynch.  The calf muscle (gastrocnemius and soleus) primarily acts to point the foot downward like in a heel raise A woman running in her bright colored shoes showing off her calf musclestype exercise or pushing off when running.  However, it also assists the hamstrings in bending the knee (flexion).  It makes sense that if you strain the calf muscle and it’s not contributing as much to knee flexion, then your hamstrings (the primary knee flexor) may take on the extra load and potentially lead to injury.

LeSean McCoy also left last Sunday’s game with a hamstring strain.  Unfortunately, this is the second time he has strained his hamstring since training camp.  The fact that he has now had two significant injuries to the same hamstring likely means he is going to miss some extra time.  This time around, if he doesn’t allow for adequate rest to allow the muscle to heal completely, this could be a lingering problem for the entire season.

Knowing the severity of these injuries would be helpful in determining how much time will be missed but unfortunately it is difficult to find this information.  We are going to speculate that Lynch has a Grade 1 hamstring strain and McCoy is dealing with a strain closer to a Grade 2 since this is the second time it has happened.  The image below gives a good visual of the difference between a Grade 1 vs a Grade 2 hamstring strain.

blood cell types

blood cell types

If you ever wondered what the rehab looked like for a hamstring strain, here is an excellent video of a typical exercise protocol starting from very basic strengthening exercises and progressing over time to sport specific drills.  At Therapydia Denver, Josh and I would also incorporate various type of hands on manual therapy including myofascial release, trigger point dry needling, stretching, and joint mobilizations as needed.

Prediction: LeSean McCoy misses weeks 4 and 5.  Returns week 6 against Bengals

Prediction: Marshawn Lynch misses week 4.  Returns week 5 against Bengals

Rotator Cuff Strain for Drew Brees (9-21-15 Fantasy Football Injury of the Week)

Stated Injury: Rotator Cuff Injury

New Orleans Saints quarterback Drew Brees suffered a shoulder injury in the second half of their loss to the Tampa Bay Buccaneers.  The injury appears to have happened as Brees was going through his throwing motion as an opponent’s attempt to swat the ball abruptly stopped the forward motion of his arm (video and more information here).  

Preliminary reports have referred to the injury as a “rotator cuff injury” or a “rotator cuff bruise”.  The rotator cuff is a collection of 4 muscles that run from the shoulder blade to the upper arm.  These muscles are instrumental in most movements of the arm, especially rapid overhead movements (like throwing a football).

The severety of the injury depends on what tissues have been injured (torn or bruised) and how much.  A rotator cuff strain (mild tearing of muscles or tendons) can usually be rehabilitated using stretching, strengthening and trigger point dry needling.  A full-thickness rotator cuff tear (most commonly occurring at the supraspinatus tendon) usually requires surgery and extensive rehabilitation lasting from 8-12 months prior to return to sport.  Furthermore, professional overhead athletes rarely return to previous form after a full-thickness tear that required surgery.  

Luckily, Brees was able to finish the game.  This suggests that his injury is less-serious than the one he returned from in 2006.  

Given the information at hand, the Therapydia Denver PTs believe that Drew Brees will miss one game due to a rotator cuff strain.  After a few weeks of treatment including Physical Therapy, he will return to full participation against The Dallas Cowboys on Sunday, October 4th.  

Summer Knee Pain? Trigger Point Dry Needling May Be The Solution.

run assessment denver

Summer in Colorado brings warmer temperatures, longer days and inevitably more time spent outdoors. Many Coloradans choose to take advantage of summer by hiking or running on our vast network of urban and mountain trails. Oftentimes, this increase in miles traveled on our feet can lead to pain in and around the knee, specifically the kneecap. This pain is technically termed patellofemoral pain syndrome, but is commonly referred to as hiker’s or runner’s knee.

How Do I Know If I Have Hiker’s Or Runner’s Knee?

Another sign that you may be at risk for developing hiker’s or runner’s knee is a knock kneed (valgus) position during activities like squatting or walking up or down stairs. This position makes it more likely that your knee will become irritated or painful. The hallmark sign of hiker’s or runner’s knee is pain around or under the kneecap. This pain is usually worsened with squatting and walking up or down stairs or hills.

runner knee signs


Image credit:

What Is Patellofemoral Pain Syndrome?

Patellofemoral pain refers to pain arising from excessive or faulty contact between the kneecap (patella) and the bottom portion of the thigh bone (femur). The patella lies in a groove between two rounded portions of the bottom of the femur.  It is essentially like the patella is sitting in a valley between two hills.patella pain running

During weight bearing activity where the knee is bending and straightening (such as walking, hiking or running), the patella glides up and down in the valley between the hills. If the patella does not glide perfectly in the valley, it may grind awkwardly on one or both of the hills.  This grinding causes irritation, popping, pain and sometimes swelling.

What Causes Patellofemoral Pain Syndrome?

The patella is a sesamoid bone, meaning that it is suspended between two tendons rather than being attached to another bone by a ligament. The top portion of the patella is connected to the quadriceps tendon, which then attaches to the quadriceps muscle group. The bottom portion of the patella is connected to the patellar tendon, which then attaches to the shin bone (tibia).  This unique arrangement allows the patella to be pulled one way or another based on variability in muscle strength and flexibility.

patellofemoral dry needling

Image credit:

The most common strength/flexibility issue leading to patellofemoral pain involves weakness in muscles on the inside of the thigh (vastus medialis obliquus) coupled with tightness in the muscles and tendons on the outside of the thigh (vastus lateralis, iliotibial band).  This weakness on the inside and tightness on the outside pulls the patella to the outside, causing it to grind up on the lateral hill rather than gliding perfectly in the valley.

Another common flexibility issue leading to patellofemoral pain involves tightness in the muscles on the back side of the thigh, also known as the hamstrings. Tightness in the hamstring group pulls the shin bone backwards, thus increasing the amount of force with which the patella is sitting in the valley. This increased force can lead to grinding and irritation between the patella and the femur, even if it is gliding in the correct portion of the valley.

How Can Trigger Point Dry Needling help?

Trigger Point Dry Needling (also known as functional dry needling or intramuscular manual therapy) involves inserting a tiny filiform needle into a taut band of muscle tissue, also known as a trigger point.  This causes the muscle to momentarily cramp and eventually release.  This treatment option is extremely effective in releasing muscle tension and restoring normal flexibility and function rapidly.

When addressing patellofemoral pain, releasing muscle tension and restoring normal muscle flexibility can decrease the likelihood that the patella will be pulled out of the valley and cause grinding, irritation and pain.  Releasing tension in the hamstring group can help decrease the amount of force with which the patella is pushing into the valley.  Coupled with specific strengthening and stretching exercise as prescribed by your Physical Therapist at Therapydia, Trigger Point Dry Needling is an effective tool in combating knee pain in hikers and runners.