Physical Therapy or Surgery for Carpal Tunnel Syndrome?

Researchers in Madrid, Spain tested whether physical therapy or surgery was the better treatment option for people with Carpal Tunnel Syndrome (CTS). The researchers recruited 120 women who had been diagnosed with CTS and split them into two equal groups: surgery or physical therapy. In the surgery group, the treatment was a carpal tunnel release operation, which is the standard surgery for CTS. In the physical therapy group, treatment was 3 sessions of physical therapy. To track progress, researchers focused on pain intensity while also looking at functional status, severity of symptoms, and self-perceived improvement. The participants were evaluated at the beginning of the study and after 1, 3, 6 and 12 months. 92% of the participants completed the treatment and all follow-up visits.

Analysis of the data showed that the physical therapy group had lower pain and improved function at the 1- and 3-month follow-ups. Changes in pain and function were similar between the two groups at the 6- and 12-month follow-ups. Both groups also showed similar improvements in severity of symptoms.

This research suggests that while long-term outcomes of carpal tunnel treatment are similar when comparing surgery and physical therapy, pain and function are improved in the short-term with physical therapy. Based on these results, choosing physical therapy for carpal tunnel treatment can reduce pain and improve function better than surgery in the short term and produce results similar to surgery in the long term.

If you have carpal tunnel syndrome, we can help! Give us a call to set up an appointment.

Conditioning and Injury Prevention for Skiers

Ski season is here! Do these exercises to stay in shape and help prevent injury:

Over the next few weeks, we will post a few exercises and stretches per week to make sure you are all set to hit the slopes. These exercises are mostly equipment free so you can do them at home, at the gym, and even at your desk at work!




Stand with your feet about shoulder width apart. Lower your hips as if you were sitting in a chair positioned behind you. Keep your knees in line with your second toe and don’t let them go forward past your toes. Then, when your knee joint is around a 90-degree angle, straighten your legs. Be sure to keep normal posture in your back throughout the movement.


Quad Stretch:

quadricep stretch

Stand on one leg and bring your other foot up behind you. Hold the top of your foot with the hand of the opposite side (i.e. hold R foot with L hand, and vice versa). Tuck in your stomach and shift your hip forward. Keep your knee pointed down at the ground, and hold the stretch for 30-45 seconds.

If you are noticing any knee pain while skiing or snowboarding, check out our Knee Pain Explained blog post, and give us a call at (303) 494-4100 if your pain persists!

Exercises for General Fitness

Although some gyms are reopening in the area, you may still feel more comfortable keeping your workouts at home. These exercises are mostly equipment free so that you can work on your fitness while sheltering in place. You can do all of these together as a single workout or spread them out throughout the day.

Double leg Squat

Stand with your feet about shoulder-width apart and lower your hips as if you were sitting in a chair positioned behind you. Keep your knees in line with your second toe and don’t let them go forward over your toes. Then, when your knee joint is around a 90-degree angle, straighten your legs. Be sure to keep normal posture in your back throughout the movement.

Calf Raises

Standing with your feet a little less than shoulder width apart, raise your heels with your calf muscles, then slowly lower yourself back into the starting position

Single Leg Squat

Position yourself near a wall or sturdy beam you can use for support. Shift your weight onto one leg and once you are balanced, lower yourself slowly over your planted foot while keeping your knee in line with your second toe (your knee shouldn’t be moving side to side). Push up through your toes to straighten your leg. Your quads should be doing most of the work, with your hip muscles working to stabilize the hip joint.

Stair Step-ups

Stand about a step length away from a stair, then place one foot on the stair in front of you. Straighten your forward leg to bring your torso and both feet onto the stair. Carefully step backward onto the ground with the same leg you stepped up with. Alternate legs each rep, 10 step-ups for each leg.

Lunges (alternating legs)

Start by standing with your back straight and feet a little less than shoulder width apart. Then place one leg slightly more than a step’s length in front of you, keeping your knee in line with your second toe, and making sure your knee does not go past the front of your foot. To return to the start position, push up through your toes to activate your quad muscles and straighten your leg. Repeat, alternating which leg is forward each rep.

Lateral Lunges

Standing with your feet slightly less than shoulder-width apart, step to the right with your right foot and slowly lower yourself over your right leg by allowing your knee to bend (your knee should be above your foot, not inside or outside of it). Then straighten your leg to step back to the starting position and do the same movement with the other leg.

Side-lying leg raise

Lie on one side with your arm under your head for support. Engage your abs to stabilize yourself, place your hand on your hip or on the ground for extra support. Then, keeping your legs straight, raise your upper leg 10-12 inches.

Glute Bridge

Lying on your back, place your knees at about a 90-degree angle with your feet flat on the ground. Pushing through your feet, raise your hips a few inches off the ground so that they are in line with your knees and shoulders. Lower back down to the starting position.

Single-leg Glute Bridge

Lying on your back, place one leg so that the knee is at 90 degrees with this foot flat on the ground, and the other leg is flat on the ground. Raise the flat leg off the ground a few inches, then push through your grounded foot to raise your hips a few inches so they are in line with your shoulders and knees, then lower to the starting position.

Chair Dips

Sit on the edge of a sturdy chair and place your palms on either side of your hips. Shift your weight onto your palms, lifting your butt forward and off the seat of the chair. With bent knees, bend your elbows and lower your upper body until your elbows make a 90-degree angle. Straighten your arms and repeat. To increase the difficulty, extend your legs.

Lateral Raise

Stand with feet hip to shoulder-width apart. While keeping your arm straight, raise your arm out to the side until your hand is level with your shoulder. This exercise can be done with weights in both hands at once, but using one arm at a time also helps train your abs and balance.

Knee Push-ups

Position yourself the same way as you did for the knee planks, but prop your upper body up with your hands instead of your elbows. Your hands should be slightly wider than your shoulders. Lower yourself by flexing your elbows, and push yourself back up using your chest and triceps.

If knee push-ups are too easy for you, extend your legs so your toes are on the ground and not your knees:

Back extension (level 1)

Lying on your stomach, place hands on butt or lower back. Then pull back your shoulder blades and use your lower back muscles to extend your spine

**you may not have the same level of movement as in the video, this is fine, just stay in a range that is comfortable**

Back extension (level 2)

Lying on your stomach, extend your arms in front of you. Raise your arms slightly, about an inch. Then while pulling your arms and shoulder blades back, use your lower back muscles to extend your spine.

**you may not have the same level of movement as in the video, this is fine, just stay in a range that is comfortable**

Knee Planks

Start lying with your stomach on the floor, then prop your upper body up on your elbows by placing them under your shoulders. Raise your hips so that your elbows, forearms, and knees are the only body parts touching the ground, then activate your abdominal muscles to stabilize your body in that position.

Bicycle crunches (level 1)

Lying on your back, engage your abs and while keeping your legs at a 90-degree angle, raise one leg up at a time. You should feel this exercise in your abs, not your hip flexors.

Bicycle crunches (level 2)

Lying on your back, engage your abs and lift your legs so your hips and knees are both forming a 90-degree angle. Slowly lower one leg while keeping the knee at 90 degrees, lightly tap your heel and raise your leg to the starting position. Alternate legs.

Bicycle crunches (level 3)

Lying on your back, engage your abs and lift one leg so the hip and knee form a 90-degree angle. Lower the lifted leg while straightening the knee, lightly tap your heel on the ground, then raise your leg to the starting position. While raising one leg to the starting position, lower the other leg. Your legs should be alternating movements (as one is going up, the other is going down).


  • Quads – stand on one leg and bring your other foot up behind you, holding the top of your foot with the hand of the same side (e.g. hold R foot with R hand, and vice versa). Tuck in your stomach and shift your hip forward. Keep your knee pointed down at the ground, and hold the stretch for 30-45 seconds.
  • Iliotibial Band – Lie on your back with your legs extended. Lift your right leg up and position it across your body so that your right hip is above your left. Keep your shoulders on the ground, and hold the stretch for 30-45 seconds.
  • Calves – Position yourself about a stride length away from a wall or sturdy beam, facing the wall. While keeping the heel of your back foot on the ground, step toward the wall or beam and lower yourself slowly over your front foot until you feel a stretch in the calf muscle of the rear leg.

Preparing Your Body for Hiking

Exercises and Stretches for Hiking

The major muscle groups involved in hiking are your quadriceps and glutes, which work together with other smaller muscles that stabilize your hip, knee, and ankle joints. Before getting out on the trail, it is important to make sure these muscles are conditioned for the kind of activity you will be putting them through. Below are a few stretches and exercises to get you ready for the trail. But before you do your exercises, make sure your body is warmed up by just walking around for a few minutes.

man doing warm-up

Single Leg Balancing

Hiking trails usually have uneven and sometimes unpredictable walking surfaces, so ankle stability is key to making sure you don’t roll or sprain your ankle. This exercise will strengthen the muscles in your lower leg that that hold your ankle joint in place. Start by simply standing on one leg without holding on to anything for balance. If this is too easy, you can place a pillow on the floor to make balancing more difficult.

man standing on one leg

Bridging and Side Raises

When hiking uphill, your glutes do most of the work required. These exercises focus on the glutes, but will also help to strengthen your abdominal muscles and other muscles around the hip.

To perform the bridging exercise, lie on the floor and slide your feet towards you until your knees are at about a 90 degree angle. Then, lift your hips up until your torso, hips, and knees are in a straight line. Slowly lower your hips to the ground and repeat. If the two-legged exercise feels too easy, do the exercise as shown in the second picture with one leg.

man performing bridging exerciseman performing one-legged bridge exercise

For the side raises, lie on your side and keep your legs straight. Then raise your top leg up until your raised foot is about 12 inches above the foot on the ground. Slowly lower your leg back down and repeat with both legs.

man doing side leg raise exercise

Stretches before you begin

Quad stretch

Standing upright, raise your foot up behind you to a point where you can grab it with the hand on the same side of your body (left leg with left hand; right leg with right hand). Stabilize yourself against a wall or countertop if needed, then hold your leg in a flexed position for 30-45 seconds and repeat for the opposite leg.

man stretching quad

Hip side stretch

Standing upright, place one hand on your hip and bend sideways at the waist while keeping your chest facing forward. While bending, reach over the top of your head with your free hand. You should feel a stretch in the area between the top of your hip and your bottom rib. Hold this position for 30-45 seconds and switch sides.

man stretching hip

And with that, you are ready to hit the trails!

man giving high five


Antoinette, Olaf, and Balto enjoying a nice hike in Moab!

Daniel getting a good view after hiking up some rocks at the Garden of the Gods!








Olaf and Antoinette staying active on their recent ski trip! How do you stay active? If injury currently limits your activities, come in and we can help you get your active life back!

staying active on a ski trip

Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management


According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States. even though “there has not been an overall change in the amount of pain that Americans report.”

In March 2016, the CDC released opioid prescription guidelines in response to a growing opioid epidemic. The guidelines recognize that prescription opioids are appropriate in certain cases such as cancer treatment and end-of-life care, and also in certain acute care situations if dosed properly.

But for other pain management, the CDC recommends non-opioid approaches including physical therapy.

Patients should choose physical therapy when…

  • … The risks of opioid use outweigh the rewards.
    Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. The CDC guidelines state that because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” . Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.
  • … Patients want to do more than mask the pain.
    Opioids reduce pain by blocking pain signals to the brain. Physical therapists treat pain through movement while working with patients to improve or maintain their mobility and quality of life.
  • … Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
    The CDC cites “high-quality evidence” that supports exercise as part of a physical therapy treatment plan for these conditions.
  • … Your clinician prescribes opioids for pain. 
    The CDC recommends that patients should receive “the lowest effective dosage,”. Clinicians should prescribe opioids along with non-opioid therapies, such as physical therapy.
  • … Pain lasts 90 days.
    Clinicians now consider the pain “chronic,” and the risks for continued opioid use are increased. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that non-opioid therapies are “preferred” for chronic pain and that opioid therapy should be an option only if expected benefits for both pain and function are going to outweigh risks to the patient.

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.

The CDC states “Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions,”

Physical therapists play a valuable role in patient education, including setting realistic expectations for recovery with or without opioids.

Compliments of Move Forward: Physical Therapy Brings Motion to Life

Tips to Prevent Skiing-Related Knee Injuries

The most common injuries in skiing happen to the lower limb, most commonly the knee. The introduction of releasable bindings has decreased the rate of leg fractures by 90% in the past 30 years, but knee sprains (including ACL and/or MCL tears) are on the rise accounting for about 30% of all skiing injuries.

The most common injury is the medial collateral ligament (MCL) tear, which is typically treated without surgery.  In skiing, the MCL is often torn when the ski tips are pointed toward one another in a snowplow position (the common slow or stop position) and the skier falls down the hill. MCL tears are more common among beginning and intermediate skiers than advanced and elite skiers.  When skiing you may prevent an MCL tear by:

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