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Dry Needling by a Physical Therapist: What You Should Know

Wed, 24 Jun 2020 20:06:23 GMT

Dry needling is a technique physical therapists use (where allowed by state law) for the treatment of pain and movement impairments. The technique uses a "dry" needle, one without medication or injection, inserted through the skin into areas of the muscle.

Other terms commonly used to describe dry needling, include trigger point dry needling, and intramuscular manual therapy.

Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Dry needling is a part of modern Western medicine principles and supported by research 1.

What is a Trigger Point?

A trigger point is a taut band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch, and touching a trigger point may cause pain to other parts of the body.

What Kind of Needles Are Used?

Dry needling involves a thin filiform needle that penetrates the skin and stimulates underlying myofascial trigger points and muscular and connective tissues. The needle allows a physical therapist to target tissues that are not manually palpable.

Physical therapists wear gloves and appropriate personal protective equipment (PPE) when dry needling, consistent with Standard Precautions, Guide to Infection Prevention for Outpatient Settings, and OSHA standards. The sterile needles are disposed of in a medical sharps collector.

Why Dry Needling?

In cases when physical therapists use dry needling, it is typically 1 technique that's part of a larger treatment plan.

Physical therapists use dry needling to release or inactivate trigger points to relieve pain or improve range of motion. Preliminary research 2 supports that dry needling improves pain control, reduces muscle tension, and normalizes dysfunctions of the motor end plates, the sites at which nerve impulses are transmitted to muscles. This can help speed up the patient's return to active rehabilitation.

As part of their entry-level education, physical therapists are well educated in anatomy and therapeutic treatment of the body. Physical therapists who perform dry needling supplement that knowledge by obtaining specific postgraduate education and training. When contacting a physical therapist for dry needling treatment, be sure to ask about their particular experience and education.

Physical Therapy Guide to Chronic Pain Syndromes

Wed, 24 Jun 2020 19:55:50 GMT

Chronic pain is a condition that occurs when the brain concludes there is a threat to a person's well-being based on the many signals it receives from the body. This condition can and often does occur independently of any actual body tissue damage (due to injury or illness), and beyond normal tissue healing time.

It is estimated that 116 million Americans have chronic pain each year. The cost in the United States is $560–$635 billion annually for medical treatment, lost work time, and lost wages.

The causes of chronic pain vary widely. While any condition can lead to chronic pain, there are certain medical conditions more likely to cause chronic pain. These include:

Trauma/injury

Diabetes Mellitus

Fibromyalgia

Limb amputation

Reflex Sympathetic Dystrophy

Some diseases, such as cancer and arthritis, cause ongoing pain. With chronic pain, however, pain is created in the nervous system even after physical tissues have healed.

Chronic pain affects each person experiencing it differently. In some cases, chronic pain can lead to decreased activity levels, job loss, or financial difficulties, as well as anxiety, depression, and disability. Physical therapists work together with chronic pain patients to lessen their pain and restore their activity to the highest possible levels. With treatment, the adverse effects of chronic pain can be reduced.

For more resources on pain, and use of opioids for pain management, visit our Health Center on Pain and our Health Center on Opioid Use for Pain Management.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our safe pain management page.

What Is Chronic Pain?

Pain is an unpleasant sensation that we usually associate with injury or tissue damage but can be present in the absence of tissue damage as well. Pain can be acute or chronic.

Acute pain lasts for a short time – up to 12 weeks. It is a warning that tissue damage has occurred or may occur, or to help us prevent injury or disease. For instance, if we touch a hot stove, the body sends a danger message to the brain that there is a threat to tissues to prevent further injury. A sore foot can signal a need to change your footwear. In some cases, the danger messages may be due to some disease process, and your brain may interpret those messages as pain. This can cause you to seek medical attention – diagnosis and treatment – for what may be a serious condition. Signaling pain in this manner is the body's way of protecting us and is a good thing.

Chronic pain is any discomfort or unpleasant sensation that lasts for more than three months – or beyond an expected normal healing time. Often, those who have chronic pain believe they have an ongoing disease or that their body has not healed, when this may not be the case. Chronic pain is likely not warning you of possible injury or danger; instead, the pain centers in the brain may be causing you to hurt even though there are no new causes of pain occurring in the body. Anyone can develop chronic pain at any age. The brain changes in chronic pain:

When you are injured or develop a painful disease, nerves send information from the problem area to the brain.

The brain analyzes this information coming from the body to determine if there is a threat to the body and whether action needs to be taken to prevent harm.

When pain is constant or chronic, the brain and nervous system go on "high alert," becoming more sensitive.

Cells that conduct sensation in the nervous system can also become more sensitive when on high alert, making it easier for the brain to interpret these sensations as a threat and thus cause you to have more pain. These changes in the brain and central nervous system induce and maintain chronic pain symptoms.

When pain is chronic: Pain sensations are activated in the brain; The brain continues to interpret all sensations from the problem areas as a danger, even when there is no more tissue damage. This makes it easier for the pain centers in the brain to activate; Pain messages come from many different areas of the brain – areas that may control fight or fear reactions, movement, emotions, problem-solving, and learning. Almost any system of the body can be affected by chronic pain.

The brain and nervous system continue reacting by causing you to continue to be in pain. This process increases sensations, emotions, or thoughts about the problem area. At this point, any sensory input can activate the pain centers. Even thinking about it or reading the word pain can trigger pain sensations. The pain is in the brain: To protect you, your brain is deciding to increase the alert level for sensations you feel.

How Does It Feel?

How chronic pain feels varies with each individual; it is very personal. How often it occurs, how severe it is, or how long it lasts is not predictable from one person to another.

Common complaints related to chronic pain include:

It may seem as if "everything hurts, everywhere."

There may be sudden stabs of pain.

It may seem as if the pain "has a mind of its own."

You feel symptoms even if you are not doing anything to cause them.

It feels worse when you think about it.

It feels worse when you experience upsetting circumstances in your life.

You may feel more anxious and depressed.

You may feel your symptoms spread from one area to another area.

You may feel fatigued, and afraid to do your normal activities.

These complaints are common when you have chronic pain. However, it does not necessarily mean that your physical condition is worsening; it may just mean that your system has become more sensitive.

Signs and Symptoms

Research finds the following signs may be associated with a chronic pain syndrome:

Fearfulness. It is easy to begin to fear increased pain when you have a chronic pain condition. As a result, you may begin to avoid activity. You may find that you rely more on family members to help with daily functions.

Body stiffness when you try to become more active. Stiffness may make you feel as if your body is less able to perform daily activities.

Deconditioning. Not moving your body results in less tolerance when you want to become more active. If you are inactive for a long time, muscles weaken and shrink from not being used. This can also increase your risk of falling.

Decreased circulation. Lack of activity decreases the circulation of much-needed blood to your cells. Tissues in your body may not get as much oxygen as they need. As a result, they may not be as healthy as they can be. This can cause you to feel fatigued, and lack energy.

Weight gain and/or a worsening of other conditions. Decreased activity can lead to unwanted weight gain. Added pounds and inactivity can aggravate symptoms of other conditions such as diabetes and high blood pressure. Chronic pain conditions are also commonly associated with feelings of anxiety or depression.

Increased use of medication. Chronic pain patients can have the tendency to increase their medication over time to seek relief.

Individual behaviors can include:

Seeking out of many different doctors or health care providers and facilities to find relief.

Difficulties with job performance. Some people with chronic pain even seek work disability.

Avoidance of social situations or family members.

When pain is ongoing, you may find you have feelings of bitterness, frustration, or depression. Some people report they have thoughts of suicide. If you are having these feelings, tell your doctor. This is important, so that you can get appropriate medications to help you feel better.

How Is It Diagnosed?

Your physical therapist will perform a thorough evaluation. He or she will:

Ask specific questions about your past and present health and use of medication.

Ask about your symptoms: their location, intensity, how and when the pain occurs, and other questions, to form a clear picture of your individual situation.

Ask you to fill out pain and function questionnaires, to understand how the pain is affecting your daily life.

Perform tests and movements with you. The tests help to identify problems with posture, flexibility, muscle strength, joint mobility, and movement. Special tests help to rule out any serious health problem such as pressure on a nerve or an underlying disease.

Observe how you use your body for home, work, and social/leisure activities. This information helps your therapist prescribe a program that will boost your quality of life, and get you moving your best.

Imaging tests such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are often not helpful for diagnosing the cause of chronic pain. However, if your physical therapist suspects that your pain might be caused by any serious underlying condition, he or she will refer you to your physician for evaluation.

Your physical therapist will work with your physician to provide the best diagnosis and treatment for your chronic pain.

How Can a Physical Therapist Help?

Your physical therapist will work with you to educate you on chronic pain, find solutions to improve your quality of life, and get you moving again! He or she will help you improve movement, teach you pain management strategies, and, in many cases, reduce your pain.

Not all chronic pain is the same. Your therapist will evaluate your clinical examination and test results and design an individualized treatment plan that fits you best.

Physical therapy treatments may include:

Education to improve your knowledge and understanding of chronic pain -- how it occurs and what you can do about it. Your therapist will teach you how to manage your pain and help you work toward performing your normal daily activities again.

Strengthening and flexibility exercises to help you move more efficiently with less discomfort. Your therapist will design a program of graded exercises for you -- movements that are gradually increased according to your abilities. Graded exercises help you improve your coordination and movement, reducing the stress and strain on your body and decreasing your pain. Carefully introducing a graded exercise program will help train your brain to sense the problem area in your body without increasing its danger messages.

Manual therapy, which consists of specific, gentle, hands-on techniques that may be used to manipulate or mobilize tight joint structures and soft tissues. Manual therapy is used to increase movement (range of motion), improve the quality of the tissues, and reduce pain.

Posture awareness and body mechanics instruction to help improve your posture and movement. This training enables you to use your body more efficiently while performing activities and even when you are resting. Your therapist will help you adjust your movement at work, or when performing chores or recreational activities, to reduce your pain and increase your ability to function.

The use of ice, heat, or electrical stimulation has not been found to be helpful with chronic pain. Your physical therapist, however, will determine if any of these treatments could benefit your unique condition.

4 Tips to Stay Active and Independent As You Age

Wed, 24 Jun 2020 19:43:00 GMT

Aging can have a bad reputation; however, there is no reason that growing older can’t be a journey full of adventure and opportunities to live life to the fullest. All you need is proper guidance, proactive steps, and a positive attitude.

And there is proof. Research suggests that improvements in physical function are possible well into older adulthood, and supports that continued activity as you age helps fight cognitive decline.

With the guidance of a physical therapist, you can improve mobility, maintain your independence, and continue participating in your favorite daily activities. As a movement expert, a physical therapist can provide an evaluation and design a treatment program to address any of your ailments and deficiencies, make modifications based on other preexisting conditions, and help you achieve your goals.

The following tips can keep you active and independent as you age:

Staying fit. Whether you are participate in regular exercise or just want to stay fit for daily activities, exercise is necessary. Exercise is proven to help improve balance, strengthen bones, and prevent heart and brain conditions. A prescribed strength training and aerobic exercise program will help you maintain and strengthen critical muscle groups needed for your life.

Staying balanced. Maintaining balance and avoiding falls are imperative to maintaining a quality of life and living independently. A physical therapist can prescribe a customized program of static and dynamic balance activities and exercises to improve your balance and prevent dangerous falls.

Assessing the terrain. A physical therapist can make recommendations that make your home and other environments safe by eliminating dangerous barriers. Typically this means removing throw rugs, loose carpets, clutter, and modifying entry thresholds with ramps.

Staying engaged. Successful aging is not only impacted by one’s environment, but also how one interacts with their environment. Fear and social isolation are substantial factors that increase fall risk and jeopardize independence. To ensure active and successful aging, continue to engage with friends, family, and the community. Social experiences with friends and family help diminish fear and improve physical and mental capabilities.

Physical Therapy and Yoga

Wed, 24 Jun 2020 19:04:03 GMT

Stephanie Carter Kelley, PT, PhD, discusses how she’s incorporated yoga into her physical therapist practice.

This video was produced by the Ohio Physical Therapy Association.

https://youtu.be/z43LmxvRbSU

Pick a Popsicle Stick: Fun Physical Activities for Kids

Wed, 24 Jun 2020 18:32:37 GMT

Physical therapist Sara Bellanca, PT, DPT, leads fun physical activities for kids using popsicle sticks drawn from a cup to prompt each new movement activity.

https://youtu.be/pN19I9XPtRA

Sara received a doctor of physical therapy degree from Ithaca College. She is a school-based physical therapist who works with children who have developmental disabilities at Mary Cariola Center in Rochester, New York. Her passion lies in helping children of all abilities have fun doing physical activities, as they work on important skills that are crucial to their development, function, and independence.

Physical Therapy Guide to Spinal Muscular Atrophy

Wed, 24 Jun 2020 18:13:01 GMT

Spinal muscular atrophy (SMA) is a common, inherited neuromuscular disease that causes low muscle tone (hypotonia) and progressive muscle weakness and wasting (atrophy). All motor skills can be affected by the disease, including walking, eating, and breathing. SMA is a leading cause of death in infants. It affects approximately 1 in 10,000 babies born in the United States, of any race or gender. Approximately 1 in every 50 Americans is a genetic carrier of SMA. Physical therapists help children with SMA develop muscle strength and movement abilities to function at the highest level possible.

What is Spinal Muscular Atrophy?

Spinal muscular atrophy (SMA) is a genetic (inherited) neuromuscular disease. The large motor nerves of the spinal cord are abnormal in people with SMA because a gene (the Survival Motor Neuron-1 or SMN1 gene) is missing or altered. Without the gene, or with a damaged gene, the nerves do not have a specific protein that allows them to control muscles. The decrease of the SMN1 protein results in improper functioning, and eventually death of the motor nerve cells in the spinal cord. The severity of SMA is related to the amount of the SMN1 protein that is absent in the motor nerve cells (more protein allows for more function). Severity of the disease ranges from mild muscle weakness, to total paralysis and the need for support to breathe.

Signs and Symptoms

Muscle weakness is a hallmark feature of SMA. The muscle weakness is associated with other impairments, such as: Muscle wasting (atrophy).

Low muscle tone that makes the child’s body feel loose or “floppy” (hypotonia).

Absent or markedly decreased deep tendon reflexes (eg, knee-jerk reflex).

Involuntary tongue movements.

Hand tremors.

Tight joints that do not bend or stretch all the way, or possibly don’t move at all.

Spinal deformity (scoliosis).

Respiratory infections and lung disease.

The course of SMA varies with each individual, and symptoms range from mild to severe. The onset of SMA can occur from birth to adulthood. The progression of the disease varies, but generally as an individual ages, muscle strength decreases and symptoms progress. However, some people with SMA live a normal lifespan.

How Is It Diagnosed?

Diagnosis of SMA begins by observing whether an individual has any of the signs and symptoms of the disease. When SMA is suspected, a simple blood test can identify an estimated 95% of all cases of SMA by revealing the specific mutation that causes the disease. The other 5% of cases are caused by a rare mutation, and must be identified through further testing. A muscle biopsy may be performed to identify any nerve deterioration, and electromyography (EMG) will test how well the nerves are controlling the muscles.

When diagnosed, SMA is classified into 1 of several types:

Type I SMA (Werdnig–Hoffmann Disease). Type I SMA is the most frequently diagnosed and most severe form of SMA. The disease is apparent at birth or in the first 6 months of life, and the child never learns rolling or independent sitting. The child has severe, generalized muscle weakness, and low muscle tone (hypotonia). Infants typically have muscle wasting (atrophy), weakness in the head and neck, arms, legs, and trunk, and decreased movement. Involuntary movements of the tongue and tremors in the hand may be seen. The child may develop respiratory infections.

Type II SMA (Intermediate Form). In Type II SMA, the disease develops between the ages of 6 months and 18 months, and causes less severe weakness than Type I SMA. Children with Type II SMA are able to learn to sit up and to stand, but usually are not able to walk independently without braces and assistive devices, such as walkers or crutches. Tongue movements and hand tremors may be seen, but are less apparent than in Type I SMA. Contractures (tightening) of joints and scoliosis are common. Respiratory infections and complications occur as the disease progresses, and the need for help with breathing is common in the later stages of the disease.

Type III SMA (Kugelberg–Welander Disease). Type III SMA has a later onset and better prognosis. Type III SMA is usually diagnosed between the ages of 18 months and 3 years, or even later in mild cases, where weakness is not noticeable until late childhood. Children are able to achieve developmental milestones and independent walking, and often they maintain walking until adolescence or adulthood. Walking may be characterized by a lack of balance, frequent falls, scoliosis, knee extension that is more than usual and causes the knee to “bend backward” slightly, and excessive waddling. The muscle weakness mainly affects the muscles around the hips, and is less severe than in Types I and II.

Rare SMAs

Other forms of SMA are rare and are caused by different genes than the SMN1 gene. These forms of SMA include distal spinal muscular atrophy, Kennedy disease, and other classifications. Your physical therapist will educate you about the rarer forms of the disease.

How Can a Physical Therapist Help?

Evaluation is important for guiding the treatment of a child with SMA. Your physical therapist will conduct a thorough evaluation that includes taking the child’s health history and examining the child’s posture, muscle strength, motor activities that include walking, joint motion, respiratory function, participation with family and friends, and quality of life.

Treatment is important to allow children with SMA to achieve the highest level of independent living and mobility possible, and to prevent or delay the development of complications. Physical therapists work closely with the child and family to develop the most appropriate goals for each child based on functional levels and interests.

Your child's treatment may include:

Therapeutic Exercises and Strength Training. Physical therapists use different therapeutic exercises to help children with SMA improve and maintain mobility, and prevent or slow the progression of contractures and respiratory failure. Therapeutic exercises may include strengthening and aerobic at levels appropriate for the specific child.

Strengthening Exercises. Your physical therapist can help your child slow any deterioration in muscle strength and prolong your child’s ability to walk. Physical therapists design strengthening exercises to keep children with SMA active and moving. They identify games and fun tasks that can be used during therapy or taught to the family to maintain strength.

Improving Developmental Skills. Your physical therapist will develop strategies to help your child learn developmental skills that will improve:

Head and trunk control

Floor mobility, such as rolling and crawling

Changing positions, such as pulling up to stand

Learning upright positions and skills, such as sitting, standing, and walking

Aquatic Therapy or Hydrotherapy. Some physical therapists specialize in aquatic therapy and use the physical properties of water to provide strength training, walking and balance exercises, and aerobic training, without the risk of fatigue or overworked muscles.

Standing Programs. Standing programs for children who can't walk are used to maintain muscle flexibility and length, prevent contractures, promote musculoskeletal development, and prevent bone-mineral density loss. Your physical therapist can design standing programs to be used at home or at school, as appropriate.

Management of Respiratory Complications. Physical therapists teach parents and caregivers how to perform chest drainage techniques, and help with coughing and breathing techniques to keep children with SMA breathing well. Your physical therapist will provide chest physical therapy as appropriate, and teach the family some blowing games (like bubbles) to improve breathing.

Management of Contractures. Physical therapists help prevent joint tightness (contractures) and increase flexibility in children with SMA by designing specific programs in range-of-motion exercises, positioning, and regular stretching. Your physical therapist may recommend the use of splints, braces, or standing devices, as appropriate.

Feeding. Physical therapists work closely with speech or occupational therapists to promote healthy feeding in children with SMA. They will help position the child in appropriate head and body postures to allow the most effective feeding.

Management of Scoliosis and Skeletal Deformities. Physical therapists can assist in the prevention or reduction of scoliosis and skeletal deformities by designing specific programs to improve movement, and maintain healthy positioning at all times. They will recommend wheelchair modifications and the use of braces to ensure the safety and health of each individual child, as needed. If a child requires surgery for scoliosis or other joint deformities, intensive preoperative and postoperative physical therapy can help prevent respiratory complications and loss of strength or function.

Assistive Devices. Many children with SMA require adaptive or assistive devices to help them maintain function at some point during the course of the disease, and especially following surgery. Physical therapists work with other rehabilitation specialists to select and modify assistive devices to meet each individual child's specific needs. Types of assistive devices range from those that position a child for feeding or playing, to motorized wheelchairs.

Can This Injury or Condition Be Prevented?

SMA is a genetic disorder that is passed from parent to child. Most people have 2 copies of the SMN1 gene. Individuals who have 1 faulty copy and 1 functioning copy of the gene are called carriers. Carriers do not have SMA, but they may pass the faulty gene on to their children. SMA is an autosomal recessive genetic disorder, which means that generally both parents must pass on the mutation for the child to have SMA. Because the specific mutation that causes SMA has been identified, genetic testing using a simple blood test can identify carriers of SMA. However, most people do not know they are carriers until they have a child with SMA.

Excellent prenatal care is important for all pregnant women. Testing can be performed during the pregnancy to determine if a baby has SMA. Once a child is diagnosed with SMA, physical therapists and other health care professionals can reduce some of the additional complications that occur following birth, such as developmental delay, poor feeding, abnormal postures and scoliosis, loss of joint range of motion, abnormal movement or walking patterns, and respiratory problems.

Physical Therapy Guide to De Quervain’s Tendinitis

Wed, 24 Jun 2020 17:30:56 GMT

De Quervain's (dih-kwer-VAINS) tendinitis is a condition that causes pain and tenderness at the thumb side of the wrist, at the base of the thumb and forearm. Pain is worsened with grasping or extending the thumb (pulling it back like "thumbing a ride"). People of all ages can develop this condition, which usually happens when the tendons are strained by prolonged or repetitive use of the hand, rapid or forceful hand use, or use of the hand or arm in an awkward position. Tendons at the wrist become irritated and thickened, resulting in pain when moving the thumb and grasping objects. Common forms of treatment for De Quervain’s include splinting and range-of-motion exercises. Injection for cortisone by a doctor is common treatment. Persistent cases may require surgery.

What is De Quervain’s Tendinitis?

De Quervain's tendinitis is a common condition involving tendons of the wrist. Tendons are tough cords or bands of connective tissue that attach muscles to a bone. The thumb and wrist extensor tendons (Abductor Pollicus Longus and Extensor Pollicus Brevis) are encased in a "sheath" or a tunnel at the wrist, which keeps the tendons in place. De Quervain's tendinitis can occur gradually or suddenly, when the tendons become inflamed or thickened from overload or repetitive use, and have difficulty sliding through the extensor tunnel.

Risk factors for developing De Quervain's tendinitis include:

Chronic overuse of the hand.

Excessive use of the thumb from texting and gaming.

Being female (women are 8 to 10 times more likely to develop this condition than men).

Pregnancy.

Using the hand or arm in a position that feels awkward.

Participation in sports that stress the hand and wrist, such as golf and tennis.

Age greater than 40 years.

Race; members of the black community may be more likely to experience this problem.

How Does It Feel?

A person who has De Quervain's tendinitis may:

Feel localized tenderness, pain, and, swelling at the wrist near where the thumb is attached to the forearm.

Have difficulty pinching or grasping with the thumb or hand.

Feel pain when moving the wrist from side to side or twisting it.

Experience limited motion and feeling of weakness in the thumb.

Have difficulty flexing the thumb.

Notice a "catching" or "snapping" sensation with movement of the thumb (a less common symptom).

Active use of the hand with activities, such as writing, opening jars, lifting a child, hammering, sports, and any workplace or home activity that involves pinching or grasping with the thumb, can provoke the symptoms of pain, stiffness, and weakness.

Note: Other conditions of the wrist and hand can cause symptoms similar to those stated here. Your physical therapist will help to identify any underlying problems of your joints, tissues, or nerves that may be causing similar symptoms.

How Is It Diagnosed?

Your physical therapist will ask you how and when you first experienced symptoms, and what it feels like at the present time. Your therapist will perform a physical exam that will include feeling for tender spots, measuring the flexibility and range of motion of the thumb and wrist, and testing the strength of the thumb muscles and grip. Your physical therapist will also perform a Finkelstein test, which gently stretches the tendons on the thumb side of the wrist through the extensor tunnel. Pain during this test is common with De Quervain’s tendinitis.

Your physical therapist will also perform other tests to rule out any underlying conditions that may mimic De Quervain's symptoms.

How Can a Physical Therapist Help?

If your physical therapist confirms De Quervain’s Tendinitis from an evaluation, they will work with you to develop an individualized plan with you for this condition.

Your physical therapist will review and evaluate how you use your hand and wrist for functional activity. The review will include your daily activities, work, and sports activities. The physical therapist will try to help you identify what activities or positions that you use that may contribute to the problem. They will instruct you how to make changes in your function to help healing and reduce risk of the problem in the future.

Specific instructions may include avoiding repetitive thumb and/or wrist movements, avoid flexing the thumb, and avoid moving the hand toward the pinkie finger as much as possible. You should also avoid forceful hand movements, and any movements or activities that increase pain.

The therapist may provide a wrist splint to position your wrist and thumb for rest, and to provide compression to help pain and swelling.

Your therapist may also work with you to reduce pain and inflammation.

Ultrasound therapy may be applied to improve pain. This treatment uses ultrasonic sound waves applied over the involved area to improve circulation, reduce swelling, and aide healing of the tissues and tendons.

Iontophoresis is another option to reduce swelling and pain. Iontophoresis is a type of electrical stimulation that is used to administer medication to the problem area through your skin.

Ice or heat may be recommended for short term pain relief. Your therapist will advise you for what is best for your condition.

Exercise is prescribed to improve range of motion and prevent stiffness. Early on, exercise is restricted to avoid aggravating the condition. As the condition improves, exercises will be progressed to improve strength for functional activity, as well as improve active range of motion of the thumb and wrist.

If your symptoms do not respond to conservative care, your physical therapist will refer you to a physician who will determine if you need medication, injection, or surgical care for further recovery.

How Can a Physical Therapist Help Before & After Surgery?

If your De Quervain's problem does require surgery, your physical therapist may fit a splint to your hand and wrist after the procedure. Your physical therapist will help you to control any swelling, maintain and improve your hand and wrist flexibility, build your strength, and improve your range of motion, allowing you to safely return to your preinjury activity levels.

Can This Injury or Condition Be Prevented?

It may be possible to prevent De Quervain's tendinitis. Some risk factors cannot be controlled, such as gender, race, or age; however, physical therapists recommend that you:

Avoid chronic overuse of the hand.

Avoid or restrict overly forceful use of the wrist.

Avoid excessive use of the thumbs for texting and gaming.

Avoid putting the wrist and hand in awkward positions while using the hand or arm.

Train and condition in sports, such as golf and tennis to minimize wrist and thumb strain.

Your physical therapist can teach you correct and safe hand and wrist positions to maintain during your daily home, work, and sport activities.

7 Tips to Avoid Aches and Pains While Gardening

Wed, 24 Jun 2020 16:57:05 GMT

Common gardening activities, such as digging, planting, weeding, mulching, and raking can cause stress and strain on muscles and joints.

The following tips can help minimize aches and pains:

1. Get moving before you garden.

A 10 minute brisk walk and stretches for the spine and limbs are good ways to warm up.

2. Change positions frequently to avoid stiffness or cramping.

Be aware of how your body feels as you work in your garden. If a part of your body starts to ache, take a break, stretch that body part in the opposite direction it was in, or switch to a different gardening activity. For example, if you've been leaning forward for more than a few minutes, and your back starts to ache, slowly stand up, and gently lean backwards a few times.

3. Use a garden cart or wheelbarrow to move heavy planting materials or tools.

Lift with your knees and use good posture while moving a cart or wheelbarrow.

4. Give your knees a break.

Use knee pads or a gardening pad. If kneeling or leaning down to the ground causes significant pain in your back or knees, consider using elevated planters to do your gardening. If kneeling on both knees causes discomfort in your back, try kneeling on one and keep the other foot on the ground.

5. Maintain good posture.

Use good body mechanics when you pick something up or pull on something, such as a weed. Bend your knees, tighten your abdominals, and keep your back straight as you lift or pull things. Avoid twisting your spine or knees when moving things to the side; instead, move your feet or pivot on your toes to turn your full body as one unit.

6. Take breaks.

If you haven't done gardening or other yard work in a while, plan to work in short stints, building in time for breaks before you start feeling aches and pains.

7. Keep moving after you garden.

End your gardening session with some gentle backward bending of your low back, a short walk and light stretching, similar to stretches done before starting.

If your aches and pains aren't managed with these tips and discomfort lingers, a physical therapist can help.

4 Ways Physical Therapists Manage Pain

Wed, 24 Jun 2020 15:35:34 GMT

Physical therapy is among the safe and effective alternatives to opioids recommended by the Centers for Disease Control and Prevention for the management of most non-cancer related pain.

Whereas opioids only mask the sensation of pain, physical therapists treat pain through movement, hands-on care, exercise, and patient education.

Here's how physical therapists manage pain:

1. Exercise.

A study following 20,000 people over 11 years found that those who exercised on a regular basis, experienced less pain. And among those who exercised more than 3 times per week, chronic widespread pain was 28% less common1. Physical therapists can prescribe exercise specific to your goals and needs.

2. Manual Therapy.

Research supports a hands-on approach to treating pain. From carpal tunnel syndrome2 to low back pain3, this type of care can effectively reduce your pain and improve your movement. Physical therapists may use manipulation, joint and soft tissue mobilizations, and dry needling, as well as other strategies in your care.

3. Education.

A large study conducted with military personnel4 demonstrated that those with back pain who received a 45 minute educational session about pain, were less likely to seek treatment than their peers who didn't receive education about pain. Physical therapists will talk with you to make sure they understand your pain history, and help set realistic expectations about your treatment.

4. Teamwork.

Recent studies have shown that developing a positive relationship with your physical therapist and being an active participant in your own recovery can impact your success. This is likely because physical therapists are able to directly work with you and assess how your pain responds to treatment.

Read more about Pain and Chronic Pain Syndromes.

Physical Therapy Guide to Stroke

Mon, 22 Jun 2020 20:05:57 GMT

Stroke (when a blood vessel in the brain is blocked or ruptured) is the third leading cause of death in the United States, and is a leading cause of serious, long-term disability in adults. Stroke can happen to anyone at any time—regardless of race, sex, or even age—but more women than men have a stroke each year, and African Americans have almost twice the risk of first-ever stroke than Caucasians. Approximately two-thirds of those who experience a stroke are over 65 years of age. Almost 800,000 people in the United States have a stroke each year. Physical therapists provide treatments for people who have experienced stroke to restore their movement and walking ability, decrease their disability, and improve their quality of life.

If you have 1 or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you:

Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body

Sudden confusion or trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden, severe headache with no known cause

If You Think Someone Might Be Having a Stroke

Act F.A.S.T.! Emergency treatment with a clot-buster drug called t-PA can help reduce or even eliminate problems from stroke, but it must be given within 3 hours of when symptoms start. Recognizing the symptoms can be easy by remembering to think F.A.S.T.

F=Face. Ask the person to smile. Does one side of the face droop?

A=Arms. Ask the person to raise both arms. Does one arm drift downward?

S=Speech. Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?

T=Time. If you observe any of these signs, call 911 and note the time that you think the stroke began.

Research shows that people with stroke who arrive at the hospital by ambulance receive quicker treatment than those who arrive by their own means.

What Is Stroke?

Stroke is a term used when a blood vessel in the brain is blocked (65% of all strokes) or ruptures. It is also called a cerebral vascular accident (CVA). If the blood flow is stopped or altered, a part of the brain does not receive enough oxygen. Millions of brain cells die every minute during a stroke, increasing the risk of permanent brain damage, disability, or death.

An ischemic stroke, the most common type, occurs when a blood vessel is blocked. One frequent cause of blockage is a blood clot or a build-up of fatty deposits (arteriosclerosis) in blood vessels that supply the brain.

A hemorrhagic stroke occurs when a blood vessel leaks or ruptures because of a weakened region of a vessel or in an area of the brain with a cluster of abnormally formed vessels.

Signs and Symptoms

If you are having a stroke, you might:

Feel a sudden numbness or weakness of the face, arm, or leg, especially on one side of the body

Be confused about where you are or what you're doing

Have trouble speaking or understanding what others are saying

Have trouble seeing in one or both of your eyes

Have trouble walking, be dizzy, or lose your balance

Have a sudden, severe headache that seems to come out of nowhere

Some people experience a transient ischemic attack (TIA), a "mini-stroke" that produces stroke-like symptoms, but no permanent damage because the blood flow is altered for only a short period of time. Recognizing and seeking treatment for TIAs can reduce your risk of a major stroke.

Stroke can cause a range of long-term problems, such as:

Inability or difficulty moving one side of the body (hemiparesis or hemiplegia)

Severely limited movement or stiffness in the arms and legs (spasticity)

Balance problems

Weakness on one side of the body

Off-and-on numbness

Loss or lack of sensation

Sensitivity to cold temperatures

Memory loss

Slowed or slurred speech

Difficulty remembering words

How Is It Diagnosed?

Physicians or emergency medical personnel will assess a stroke based on the signs and symptoms. Stroke is often confirmed by examining the patient, using clinical tests and taking images of the brain, usually with a CT scan or MRI. Since research has proven that early treatment can reduce the effects of stroke and save lives, efforts are being made to get persons suspected of having a stroke to a hospital stroke unit, rather than the emergency department. Physicians may use a classification system, called TOAST, to determine the type of stroke, so that treatment can begin quickly.

How Can a Physical Therapist Help?

Physical therapists are part of the stroke rehabilitation team. Rehabilitation begins very soon after a stroke; your physical therapist’s main goal is to help you return to your activities at home, at work, and in your community.

After examining you and evaluating your condition, your physical therapist will develop an individualized plan to help you achieve the best possible quality of life. The plan will focus on your ability to move, any pain you might have, and ways to prevent problems that may occur after a stroke.

One of the first things your physical therapist will teach you is how to move safely from your bed to a chair, and to perform exercises in bed. As you become more mobile, your physical therapist will teach you strengthening exercises and functional activities.

Later, your physical therapist will:

Help you improve your balance and walking.

Fit you with a wheelchair, if needed.

Provide training to your family and caregivers.

Train you in how to use devices that can help you keep mobile when a stroke has affected your ability to move, walk, or keep your balance: orthoses, prostheses, canes, walkers, wheelchairs, and perhaps even robotics.

Treatment for stroke varies. Your specific treatment will depend on the results of your physical therapist's evaluation, and on how long it's been since you had your stroke. Recovery from a stroke depends on the size and location of the stroke, how quickly you received care, and your other health conditions. Your physical therapist will help you regain functional skills to allow you to participate in your specific life activities.

Relearning How to Use Your Upper Body, How to Walk, and How to Perform Daily Activities

Your physical therapist will design an exercise and strengthening program based on tasks that you need to do every day, selecting from a variety of treatments. Physical therapist researchers are at the forefront of innovating many of these techniques:

Constraint-induced movement therapy (CIMT). CIMT is used to strengthen an arm affected by the stroke. Your physical therapist will apply a mitten or a sling on your strong arm to keep you from fully using it. This constraint "forces" you to use your arm or hand affected by the stroke to perform daily tasks, which helps build your strength and control. CIMT requires that the constraint be used for several hours a day, several days a week to be successful.

Functional electrical stimulation (FES). This treatment helps move your muscles if they are very weak. For instance, your physical therapist might use FES to treat a painful or stiff shoulder.

Motor imagery and mental practice. These tools are used to help strengthen the arms, hands, feet, and legs. Working with your physical therapist, you will "rehearse" a movement without actually performing it, which stimulates the part of your brain that controls the movement.

Positioning. Proper positioning helps reduce any muscle pain, spasms, slowness, or stiffness that can result from stroke. Your physical therapist will teach you how to safely move ("transfer") from a sitting to a standing position, and how to support yourself when sitting or lying down, using foam wedges, slings, and other aids.

Virtual reality and interactive video games may be used to provide experiences similar to real life. Using a keyboard and mouse, a special wired glove, or sensors on your body, you can practice daily tasks as your therapist helps you "rewire" your brain and nerve connections. Your therapist may teach you how to continue these activities at home.

Partial body weight support (BWS). BWS is used to help support you as you walk, usually on a treadmill. Your physical therapist will gradually decrease the amount of support as your posture, strength, balance, and coordination improve.

Biofeedback. This treatment helps make you aware of how your muscles work and how you might be able to have better control over them. Your therapist will attach electrodes to your skin to provide measurements of muscle activity that are displayed on a monitor. Your physical therapist will work with you to help you understand and change those readings.

Your needs will change over time, and your physical therapist may consider using aquatic therapy, robotics, or support devices to assist in your recovery. Even after rehabilitation is completed in a facility, your physical therapist will continue to see you as needed to assess your progress, update your exercise program, help you prevent further problems, and promote the healthiest possible lifestyle.

5 Signs of a Stroke

Mon, 22 Jun 2020 19:47:06 GMT

A stroke occurs when a blood vessel in the brain is blocked or ruptures. It is the third leading cause of death in the United States, and is a leading cause of serious, long-term disability in adults. Almost 800,000 people in the United States have a stroke each year.

Stroke can happen to anyone at any time—regardless of race, sex, or even age—but more women than men have a stroke each year, and African Americans have almost twice the risk of first-ever stroke than Caucasians. Approximately two-thirds of those who experience a stroke are over 65 years of age.

If you have 1 or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you:

Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body

Sudden confusion or trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden, severe headache with no known cause

If You Think Someone Might Be Having a Stroke

F=Face. Ask the person to smile. Does one side of the face droop?

A=Arms. Ask the person to raise both arms. Does one arm drift downward?

S=Speech. Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?

T=Time. If you observe any of these signs, call 911 and note the time that you think the stroke began.

Research shows that people with stroke who arrive at the hospital by ambulance receive quicker treatment than those who arrive by their own means.

Physical Therapy Guide to Alzheimer's Disease

Fri, 19 Jun 2020 20:06:48 GMT

Alzheimer’s disease is a condition that damages brain cells. About 10% of Americans aged over 65 years — around 5.6 million people — have Alzheimer's disease. There are also around 200,000 people who are diagnosed with the disease before age 65. The disease causes memory loss and other problems. People with Alzheimer's disease may have difficulty performing simple tasks. Physical therapists work with families to help people with Alzheimer's disease keep moving safely and living their best lives.

What Is Alzheimer's Disease?

Alzheimer's disease is a progressive condition. It damages brain cells and affects how we speak, think, move, and deal with other people. It can lead to a decline in memory and the ability to perform daily activities.

Alzheimer's disease is the fifth leading cause of death among American adults aged over 65 years.

The risk of getting Alzheimer's disease increases with age. People rarely develop the disease before age 60. Most people with the disease do not have a family history of it.

CAUTION: One of the major symptoms of Alzheimer's disease is confusion. However, there are several other possible causes of confusion.

If confusion comes on suddenly, see a doctor or a neurologist immediately.

If confusion occurs or gets worse after a fall or a head injury, call 911.

Signs and Symptoms

There are 10 warning signs of possible Alzheimer's disease:

Memory changes that disrupt daily life.

Difficulty making decisions, especially in planning or solving problems.

Difficulty completing familiar tasks.

Confusion about time and/or place.

Trouble understanding visual images or the way things fit together (spatial relationships).

Finding the right words to say when speaking or writing.

Misplacing items and losing the ability to retrace your steps.

Poor or decreased judgment about safety.

Withdrawal from work or social activities.

Changes in mood or personality.

People with Alzheimer's disease may get lost in once-familiar places. In the later stages of the disease, they might get restless and wander. Often, this restlessness happens in the late afternoon and evening (called "sundowning"). They may withdraw from their family and friends or see or hear things that are not there. They may falsely believe that others are lying, cheating, or trying to harm them.

Along with these "cognitive" symptoms, performing simple tasks may become difficult in the later stages. Ultimately, they may need help eating, bathing, toileting, and dressing. People with Alzheimer’s disease are usually able to walk until the very last stage of the disease. They might, however, lose strength and balance, which can lead to an increased risk of falls.

How Is It Diagnosed?

The exact cause of Alzheimer's disease remains unknown. It is likely due to many factors that make diagnosis difficult. There is no single test for Alzheimer’s disease. Health care providers who are trained to work with older people may notice the early signs. It may take days or weeks for the medical team to complete a set of tests to make a diagnosis.

Researchers are getting closer to making a diagnosis by using brain imaging. Scans that may help with diagnosis include a CT scan, an MRI, a PET scan, or ultrasound. These tests can show abnormal brain structure or function. Mental-function tests and other tests also may be used.

Physical therapists may recognize early signs or symptoms of the disease. If a physical therapist suspects Alzheimer’s disease, he or she will make a referral to a specialist.

How Can a Physical Therapist Help?

Physical Therapy for Patients With Alzheimer's Disease

Physical therapists are in a great position to help people age well. Research shows that:

Physical activity can improve brain function and memory. This is true for healthy older adults or for those with mild cognitive problems.

Regular exercise may delay the onset of Alzheimer's disease in healthy older adults.

Regular exercise may delay a decline in the ability to perform tasks in people who have Alzheimer's disease by improving their strength, balance, and walking ability.

Physical therapists are movement experts. They design exercise programs for people with a variety of health conditions, including Alzheimer's disease. They can play a key role in preventing decline.

In the early and middle stages of Alzheimer's disease, physical therapists help people stay mobile. With this help, people can continue to perform their roles at home and in the community.

In the later stages of the disease, physical therapists can help people keep doing daily activities for as long as possible. This reduces the burden on family members and caregivers. They can instruct caregivers and family on how to improve safety and manage their loved one’s needs. Through a home assessment, physical therapists can help make the home safer. Physical therapy can help improve quality of life and may delay the need for facility-based care.

People with Alzheimer's disease develop other conditions related to aging. These can include arthritis, falling, or broken bones. Physical therapists pay close attention to how the disease can affect these other health conditions.

Physical therapists are trained to use a variety of teaching methods, techniques, and unique approaches to treating people with Alzheimer’s disease, including:

Sight, sound and touch cues. The physical therapist may use sight cues, such as raising both arms to get a person to stand up. Verbal cues are short, simple, spoken instructions. Touch cues might include taking someone's hand to get them to walk.

Mirroring. The physical therapist serves as a "mirror" to show an individual how to move. For example, to help the person raise his or her right arm, the physical therapist would raise his or her left arm.

Task breakdown. Physical therapists can break down tasks into short, simple step-by-step "pieces." This technique can be used, for example, to teach a person how to safely move from lying in bed to sitting in a chair.

Hand-over-hand guidance. The physical therapist takes the patient’s hand or touches another body part to guide them through a motion.

Muscle training. To help someone walk safely, the physical therapist can train a person’s muscles to "learn" to respond to changes like uneven or unstable surfaces.

Training Family Members and Caregivers

Family members may need instruction on how to safely move, lift, or transfer someone with Alzheimer's disease. Physical therapists can instruct caregivers on how to prevent injury to themselves and to the person with the disease. In addition to hands-on care, physical therapists teach people how to use equipment and assistive devices. Individuals may learn how to use equipment such as:

Special seating.

Canes.

Long-handled reaching tools (reachers).

Physical Therapy Guide to Patellofemoral Pain

Fri, 19 Jun 2020 18:33:04 GMT

Patellofemoral pain is pain at the front of the knee, under or around the kneecap (patella). PFP is one of the most common types of knee pain experienced in the United States. It often occurs among athletes, active teenagers, older adults, and people who perform physical labor. Patellofemoral pain affects more women than men. It accounts for 20% to 25% of all reported knee pain. Physical therapists design treatment programs for people with PFP to help reduce pain and improve function.

What Is Patellofemoral Pain?

PFP may occur after a sudden increase in activities like running or jumping. Research suggests that PFP results from activity levels that are increased faster than the knee can adapt. Other contributing factors to PFP may include:

Weakness of the thigh muscles.

Specializing in a single sport, which requires repeating the same movements again and again.

Certain hip and knee coordination patterns during running and jumping activities.

PFP does not go away on its own. If you have symptoms of PFP, it’s important to seek care from a physical therapist so you can return to the activities that you enjoy.

How Does It Feel? People with PFP may experience pain:

When walking up or down stairs or hills.

When playing a sport.

With deep knee bending (squatting).

When walking on uneven surfaces.

With activity, but improving with rest.

After sitting for long periods of time with the knee bent.

How Is It Diagnosed?

Patellofemoral (Kneecap) Pain

Your physical therapist will review your health history and conduct a series of tests to evaluate you and your knee. PFP is diagnosed by analyzing any movement that causes pain, and ruling out other possible conditions.

Your physical therapist may analyze your walking and running patterns. They may test the strength of your hip and thigh muscles to find out if weakness is contributing to your pain. Medical imaging, such as an X-ray or MRI, is not helpful in diagnosing PFP. However, your physical therapist may consult with an orthopedic physician who may order imaging to rule out other conditions.

How Can a Physical Therapist Help?

If PFP is diagnosed, your physical therapist will develop an exercise and rehabilitation program just for you. Your program may include:

Strengthening exercises. Your physical therapist will teach you exercises to help strengthen the muscles around the hip and the knee itself. Research shows that this type of exercise therapy is the best approach to managing PFP.

Taping. Your physical therapist may teach you how to apply tape to your knee, which may improve your ability to perform exercises that would normally be painful. However, taping alone will not resolve PFP. It must only be used along with your exercise program.

Shoe inserts. Your physical therapist may recommend shoe inserts to help reduce your pain when exercising. But inserts alone, like taping, will not treat PFP. Your physical therapist will design an exercise program to fit your specific needs and goals.

Coordination training. Based on your activity level, your physical therapist may help retrain your hip and knee movement patterns to reduce your knee pain.

This type of training is effective for athletes, in particular, and may focus on movements like:

Stair climbing.

Squatting.

Running and jumping.

Cross-training guidance. Physical therapists help athletes and active people perform different movements (cross-training). This helps them stay active until they can return to a favorite activity.

Return to full activity. Your physical therapist will help guide a gradual return to your favorite activities, such as running and jumping, and will teach you good overall exercise habits to help maximize the health of your knee.

Physical Therapist's Guide to Bell's Palsy

Fri, 19 Jun 2020 18:17:15 GMT

Bell’s palsy is a form of temporary facial paralysis that can affect a person’s daily function, communication with others, self-esteem, and quality of life. It occurs when the nerve that controls movement on 1 side of the face becomes inflamed. Bell’s palsy usually begins with a sudden feeling of weakness or paralysis on 1 side of the face.

CAUTION: These symptoms also can indicate a severe condition, such as a stroke. IF YOU EXPERIENCE ANY TYPE OF FACIAL WEAKNESS, SEEK MEDICAL CARE IMMEDIATELY! Call an ambulance if the weakness is accompanied by:

Pain in the ear, cheek, or teeth
Loss of facial sensation
Confusion
Weakness of arms or legs
Vision changes
Fever
Headache

What Is Bell Palsy?

Bell’s palsy is a form of temporary facial paralysis that can affect a person’s daily function, communication with others, self-esteem, and quality of life. It occurs when the nerve that controls movement on 1 side of the face becomes inflamed. The condition often comes on suddenly, causing varying degrees of facial weakness, but begins to recover naturally.

Bell Palsy: See More Detail

In 70% of cases, patients with complete facial paralysis (and 94% of patients with partial paralysis) recover within 6 months. However, 30% of patients do not recover completely.

Although the cause of Bell’s palsy remains unclear, it is thought that some cases might be caused by the herpes virus. Other risk factors include: pregnancy, obesity, chronic high blood pressure, diabetes mellitus, upper respiratory infections, and severe preeclampsia (a complication of pregnancy).

Facial weakness or paralysis also may be caused by several other conditions including trauma, a congenital (present at birth) condition, surgery, or tumors.

How Does it Feel?

Bell’s palsy usually begins with a sudden weakness on 1 side of your face or a sudden feeling that you can’t move 1 side of your face.

Bell’s palsy can worsen quickly. Other symptoms may include:

Inability to close the eye on the affected side
Drooping of the affected side (within a few hours to overnight)
Teariness or dryness of the affected eye
Pain in or behind the ear on the affected side
Sensitivity to sound
Drooling
Loss of the sense of taste
Difficulty speaking due to weakness around the mouth

How Is It Diagnosed?

Diagnosis of Bell’s palsy will often involve your doctor observing your facial movements such as blinking your eyes, lifting your brow, smiling, and frowning, among other movements.

The examining physician may additionally recommend magnetic resonance imaging (MRI) for an individual with facial weakness or paralysis to rule out more serious conditions such as a tumor or stroke. Once testing has ruled out other possible conditions, the physician will likely diagnose Bell’s palsy, and recommend treatment by a physical therapist.

People diagnosed with Bell’s palsy often receive a course of steroid medication to reduce the swelling around the nerve that controls the movement of the face. In some cases, individuals are given an antiviral medication as well. Your physician will provide a referral for physical therapy.

How Can a Physical Therapist Help?

In the first couple of days to a week after symptoms start, your physical therapist will evaluate your condition, including:

Review your medical history, and discuss any previous surgery or health conditions
Review when your current symptoms started and what makes them worse or better
Conduct a physical examination, focusing on identifying the patterns of weakness that are caused by Bell palsy:
- Facial movements of the eyebrow
- Eye closure
- Ability to use the cheek in smiling
- Ability to use the lips in a pucker
- Ability to suck the cheeks between the teeth
- Raising the upper lip
- Raising or lowering the lower lip

Your physical therapist will immediately:

Educate you about how to protect your face and your eye
Show you how to manage your daily life functions while you have facial paralysis
Explain the expected path to recovery, so that you will know the signs and symptoms of recovery
Evaluate your progress, and determine whether you need to be referred to a specialist if progress is not being made

The first priority is to protect your eye. The inability to completely and quickly close your eye makes the eye vulnerable to injury from dryness and debris. Debris can scratch the cornea—the transparent front part of the eye that covers the iris, pupil, and front chamber of the eye—and could permanently harm your vision. Your physical therapist will immediately show you how to protect your eye, such as:

Using self-made and commercial patches
Setting a regular schedule for refreshing eye fluids
Carefully closing the eye with your fingers

If you have partial facial movement, your therapist will teach you a few general facial exercises to do at home. These exercises will help you learn to move the weak side of your face and help you use both sides of your face together. One of the exercises is a gentle blowing action through your lips.

During Recovery

Your physical therapist will help you regain the healthy pattern of movements that you need for facial expressions and function. Recovery can be challenging because:

Normally, the ability to make facial expressions and many facial movements is "automatic";—that is, you're born with this ability and never had to think about it before
Unlike other muscles in your body, the facial muscles do not have sensors that tell your brain all of the necessary "details" about how to move

Your physical therapist will be your coach throughout this challenging time, guiding you through special exercises that are designed to help you relearn facial movements based on your particular movement problems. Your exercises may change over the course of recovery:

"Initiation" exercises. In the early stages, when you might have difficulty producing any facial movement at all, your therapist will teach you exercises that cause ("initiate") facial movement. Your therapist will show you how to position your face to make it easier to move (called "assisted range of motion") or how to "trigger" the facial muscles to do what you want them to do.

"Facilitation" exercises. Once you're able to initiate movement of the facial muscles, your therapist will design exercises to increase the activity of the muscles, strengthen the muscles, and improve your ability to use the muscles for longer periods of time ("facilitate" muscle activity).

Movement control exercises. Your therapist will design exercises to:

Improve the coordination of your facial muscles
Refine your facial movements for specific functions, such as speaking or closing your eye
Refine movements for facial expressions, such as smiling
Correct abnormal patterns of facial movement that can occur during recovery

To work on coordinating your facial muscles, you'll need to have a sufficient level of activation of facial muscles first. Your therapist will determine when you're ready.

Relaxation. During recovery, you might have facial spasms or twitches. Your physical therapist will design exercises to reduce this unwanted muscle activity. The therapist will teach you how to recognize when you are activating the facial muscle and when the muscle is at rest. By learning to contract the facial muscle forcefully and then stop, you will be able to relax your facial muscles at will and decrease twitches and spasms.

After Recovery

Some people might have greater difficulty moving their face after a period of improvement in facial movement, which can make them worry that the facial paralysis is returning. However, actual recurrence of facial paralysis of the Bell Palsy type is uncommon.

New difficulty in moving the face is more likely the result of increasing the strength of the facial muscles without improving the ability to coordinate and control the movement. To keep this from happening, your physical therapist will show you what facial movements you should avoid during recovery. For instance, the following might lead to abnormal patterns of facial muscle use:

Trying to make the biggest facial movement or muscle contraction that you can, such as smiling as much as you can
Chewing gum with great force
Blowing up a balloon with all of your effort to work the facial muscles

Your therapist will coach you to use your face as naturally as possible, without trying to restrict facial expressions because they look "different."

Physical Therapist's Guide to Turf Toe

Fri, 19 Jun 2020 18:17:08 GMT

Physical Therapist's Guide to Turf Toe

Turf toe injury is an injury to the main joint of the big toe. The formal medical name for the condition is metatarsophalangeal (MTP) joint sprain. This injury occurs when the big toe is forced into extreme positions of hyperextension (where the toe moves back toward the top of the foot past its normal range of motion). It occurs primarily in athletic environments, particularly in football, such as when an athlete pushes off to sprint or is tackled with the front of the foot fixed and jammed into the ground, causing the toe to get stuck or caught in a hyperextended position. In most circumstances, a turf toe injury does not require surgery and can be treated effectively by a physical therapist.

What is Turf Toe?

There are 2 joints in the big toe. These joints allow the toe to move in an upward motion and bend in a downward motion. The big toe plays a significant role in our ability to walk and run; when the foot touches the ground and prepares to take another step, the big toe is the last joint through which the foot pushes off to move the body forward. The primary joint that this motion occurs through is the metatarsophalangeal joint, where the metatarsal, the first long, straight bone of the foot, attaches to the phalange, the first shorter bone of the toe.

If the big toe is forced into an extremely unnatural position, the MTP joint and surrounding structures may be injured. These structures may include ligaments, muscle tendons, or the small bones that sit under the big toe, called the sesamoid bones. All of these structures play a role in maintaining the integrity and function of the MTP joint; they are often grouped together and termed the plantar complex . Sometimes, 1 of the soft-tissue structures is simply stretched when the toe is bent back toward the top of the foot. However, a turf toe injury may involve a subluxation (where 1 bone of the joint slips out of place, but comes back to its normal position) or a dislocation (where the 2 bones of the joint are completely separated).

How Does it Feel?

The most common symptoms associated with a turf toe injury are:

Localized pain at the MTP joint
Feeling a "pop" at or around the MTP joint at the time of the injury
Swelling
Bruising
Tenderness to touch
Cramping in the arch of the foot
In more severe injuries, a disfiguring of the MTP joint (as in a dislocation)

How Is It Diagnosed?

Turf toe injuries are typically classified into grades 1 to 3 to describe the severity of the injury and to guide treatment:

Grade 1: stretching of the plantar complex
Grade 2: partial tearing of the plantar complex
Grade 3: complete tearing of the plantar complex

Diagnosis of turf toe injury starts with an interview to learn the mechanism of injury and your symptoms. Your physical therapist will perform a gentle clinical examination to assess the toe's movement and muscle function as well as to note any swelling or tenderness in the area. Your physical therapist may ask you if you are able to walk on your foot and, if so, will analyze your gait pattern. If your therapist suspects a fracture of 1 of the bones or a tearing of the muscle-tendon unit, your physical therapist may refer you to an orthopedic physician who specializes in foot and ankle injuries for diagnostic imaging (i.e., x-ray, MRI).

How Can a Physical Therapist Help?

Immediately following a turf toe injury, the RICE protocol is recommended: Rest, Ice, Compression, and Elevation. The goal of the RICE protocol is to decrease pain and swelling and protect the joint from further injury until it can be more thoroughly assessed. Most turf toe injuries do not require surgery and are treated with physical therapy. The treatment depends on the severity of the injury.

Grade 1. To treat a Grade 1 injury, your physical therapist may use narrow athletic tape to immobilize your big toe with your second toe to restrict painful motion. Your physical therapist may also place a firm insert in your shoe to limit motion and promote healing. In many cases, an athlete may be able to return to sport soon after a Grade 1 injury.
Grade 2. Treating Grade 2 injuries may require immobilizing the foot in a brace or walking boot, and allowing several weeks of rest.
Grade 3. Treatment of Grade 3 injuries is dependent on the severity of the damage to the structures of the foot. Surgery may be required if there is a fracture of a bone, damage to the cartilage (the tissue that lines the bones of the joints), a complete tearing of the tendon, or excessive movement of the joint that causes repetitive instability (subluxation or dislocation).

In each case, your physical therapist will work with you to design an individualized treatment program specific to the exact nature of your condition and your goals. Treatment may include:

Range of Motion Exercises. It is important to regain a full range of motion of your big toe. Your motion may be limited after a turf toe injury, particularly one that requires immobilization in a brace or boot. Your physical therapist will teach you gentle stretching exercises to help regain motion.

Muscle Strengthening. It is common to lose strength in the muscles of your leg, particularly around your foot and ankle after a turf toe injury due to the limited weight-bearing and activity that is required to allow the injury to heal. Your physical therapist will determine which muscles are weak and teach you specific exercises to treat them, such as strengthening with resistance bands, balance activities, and functional activities, like stair climbing.

Manual Therapy. Many physical therapists use manual (hands-on) therapy to gently move and manipulate muscles and joints to improve their motion and strength. These techniques can target areas that are difficult to treat on your own. Manual therapy can be especially effective for joints that become stiff following immobilization; with turf toe injury, your physical therapist will use different techniques to mobilize your big toe as well as the other joints of your foot and ankle that may have become stiff during your recovery.

Patient Education. Your physical therapist will educate you on the dos and don’ts following turf toe injury to ensure that your recovery is a smooth one. Your physical therapist will work with you to develop an individualized rehabilitation program, including expected timelines and goals to give you a roadmap for your return to full activity.

Can this Injury or Condition be Prevented?

There are certain external factors that may increase the risk of turf toe injury, such as competing on artificial turf surfaces and wearing shoes with highly flexible soles. Care can be made to ensure that your footwear is supportive and appropriate for the surface on which the sport is being played. Additionally, performing preventative flexibility and strengthening activities for the foot and ankle may improve your body's ability to withstand the stresses placed on the body during athletic activities.

Physical Therapist's Guide to Total Knee Replacement (Arthroplasty)

Fri, 19 Jun 2020 18:16:51 GMT

The knee is the most commonly replaced joint in the body. The decision to have knee replacement surgery is one that you should make in consultation with your orthopedic surgeon and your physical therapist. Usually, total knee replacement surgery is performed when people have:

Knee joint damage due to osteoarthritis, rheumatoid arthritis, other bone diseases, or fracture that has not responded to more conservative treatment options
Knee pain or alignment problems in the leg that cause difficulty with walking or performing daily activities, which have not responded to more conservative treatment options

What is a Total Knee Replacement (TKR)?

A total knee replacement (TKR), also known as total knee arthroplasty, involves removing the arthritic parts of the bones at the knee joint (the tibia, sometimes called the shin bone; the femur, or thigh bone; and the patella, or kneecap) and replacing them with artificial parts. These parts consist of a metal cap at the end of the femur and a cemented piece of metal in the tibia with a plastic cap on it to allow the surfaces to move smoothly. When appropriate, the back part of the kneecap also may be replaced with a smooth plastic surface.

How Can a Physical Therapist Help?

The physical therapist is an integral part of the team of health care professionals who help people receiving a total knee replacement regain movement and function, and return to daily activities. Your physical therapist can help you prepare for and recover from surgery, and develop an individualized treatment program to get you moving again in the safest and most effective way possible.

Before Surgery

The better physical shape you are in before TKR surgery, the better your results will be (especially in the short term). A recent study has shown that even 1 visit with a physical therapist prior to surgery can help reduce the need for short-term care after surgery, such as a short stay at a skilled nursing facility, or a home health physical therapy program.

Before surgery, your physical therapist may:

Teach you exercises to improve the strength and flexibility of the knee joint and surrounding muscles.
Demonstrate how you will walk with assistance after your operation, and prepare you for the use of an assistive device, such as a walker.
Discuss precautions and home adaptations with you, such as removing loose accent rugs that could cause you to “catch” your leg on them when maneuvering with an assistive device, or strategically placing a chair so that you can sit instead of squatting to get something out of a low cabinet. It is always easier to make these modifications before you have TKR surgery.

Longer-term adjustments that are recommended prior to surgery include:

Stopping smoking. Seek assistance or advice from your physician on stopping smoking, as you schedule and plan for your surgery. Being tobacco-free will improve your healing process following surgery.
Losing weight. Losing excess body weight may help you recover more quickly, and help improve your function and overall results following surgery.

Immediately Following Surgery

You may stay in the hospital for a few days following surgery, or you may even go home on the same day, depending on your condition. If you have other medical conditions, such as diabetes or heart disease, you might need to stay in the hospital or go to a skilled nursing facility for a few days before returning home. While you are in the hospital, a physical therapist will:

Educate you on applying ice, elevating your leg, and using compression wraps or stockings to control swelling in the knee area and help the incision heal.
Teach you breathing exercises to help you relax, and show you how to safely get in and out of bed and a chair.

Show you how to walk with a walker or crutches, and get in and out of a car.

Help you continue to do the flexibility and strengthening exercises that you learned before your surgery.

As You Begin to Recover

The goal of the first 2 weeks of recovery is to manage pain, decrease swelling, heal the incision, restore normal walking, and initiate exercise. Following those 2 weeks, your physical therapist will tailor your range-of-motion exercises, progressive muscle-strengthening exercises, body awareness and balance training, functional training, and activity-specific training to address your specific goals and get you back to the activities you love!

Range-of-motion exercises. Swelling and pain can make you move your knee less. Your physical therapist can teach you safe and effective exercises to restore movement (range of motion) to your knee, so that you can perform your daily activities.

Strengthening exercises. Weakness of the muscles of the thigh and lower leg could make you need to still use a cane when walking, even after you no longer need a walker or crutches. Your physical therapist can determine which strengthening exercises are right for you.

Body awareness and balance training. Specialized training exercises help your muscles "learn" to respond to changes in your world, such as uneven sidewalks or rocky ground. When you are able to put your full weight on your knee without pain, your physical therapist may add agility exercises (such as turning and changing direction when walking, or making quick stops and starts) and activities using a balance board that challenge your balance and knee control. Your program will be based on the physical therapist’s examination of your knee, on your goals, and on your activity level and general health.

Functional training. When you can walk freely without pain, your physical therapist may begin to add activities that you were doing before your knee pain started to limit you. These might include community-based actions, such as crossing a busy street or getting on and off an escalator. Your program will be based on the physical therapist's examination of your knee, on your goals, and on your activity level and general health.

The timeline for returning to leisure or sports activities varies from person-to-person; your physical therapist will be able to estimate your unique timeline based on your specific condition.

Activity-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation that is tailored to your job activities (such as climbing a ladder) or sport activities (such as swinging a golf club) and the demands that they place on your knee. Your physical therapist can develop an individualized rehabilitation program for you that takes all of these demands into account.

Can this Injury or Condition be Prevented?

If you have knee pain, you may be able to delay the need for surgery by working with a physical therapist to improve the strength and flexibility of the muscles that support and move the knee. This training could even help you avoid surgery altogether. Participating in an exercise program designed by a physical therapist can be one of your best protections against knee injury. And staying physically active in moderately intense physical activities and controlling your weight through proper diet might help reduce the risk of osteoarthritis of the knee getting worse.

Physical Therapist's Guide to Diabetes

Fri, 19 Jun 2020 18:16:37 GMT

Diabetes is a condition in which the body either does not produce enough of the hormone insulin, or the cells in the body do not react normally to insulin. When either of these conditions occurs, it causes the level of glucose (sugar) in the blood to become too high. High blood glucose can cause many health problems.

In 2012, nearly 30 million Americans, or 9.3% of the population, had diabetes. Only an estimated 21 million Americans currently know they have diabetes; another 8.1 million may be unaware that they have the disease. Diabetes rates are almost double for Native Americans and African Americans. About 86 million Americans have "prediabetes," a condition in which blood glucose levels are abnormal but are not yet considered diabetic. In 2010, diabetes was the seventh leading cause of death in the United States. Worldwide, 382 million people were known to have diabetes in 2013.

Diabetes can affect anyone at any age, and can be related to physical problems such as weakness, loss of endurance, obesity, balance problems, and a sedentary lifestyle. Physical activity and exercise are important and effective ways to lower high blood glucose levels. Physical therapists help people with diabetes improve or avoid related problems, and can teach sedentary people how to add physical activity to their daily lives in safe, effective, and enjoyable ways.

What Is Diabetes?

Diabetes, also known as diabetes mellitus, is a disease in which the body does not produce, or properly use, insulin. Insulin is a hormone produced by the pancreas that allows glucose (sugar) to enter cells and provide the necessary energy for daily activities. When the pancreas doesn't produce enough insulin, or when muscle, fat, and liver cells don't properly respond to insulin, glucose builds up in the blood (hyperglycemia). This can be toxic to cells throughout the body. In addition, because the cells don’t have enough glucose to use for energy, they use an abnormal amount of fats for fuel (ketoacidosis) and may become undernourished.

There are 3 types of diabetes:

Type 1 diabetes develops most often in children and young adults. The immune system destroys insulin-producing cells (beta cells) of the pancreas.
Type 2 diabetes can develop at any age and is usually preventable. The cells of the body become resistant to insulin, and the pancreas can't produce enough insulin to override the resistance.
Gestational diabetes develops in women during pregnancy. This condition occurs more often in African Americans, Native Americans, Hispanic Americans, and women with a family history of diabetes. It is also associated with obesity and inactivity.

Although the exact cause of diabetes is unknown, factors such as poor diet, obesity, and lack of exercise play important roles in developing type 2 diabetes.

Complications of all types of diabetes can include:

Heart disease
Heart attack
Stroke
High blood pressure
Retinopathy (eye disease)

Vision problems
Blindness

Kidney disease
Neuropathy (nervous system disease)

Foot and hand pain
Inner-ear nerve damage, which causes balance problems

Peripheral vascular disease
Reduced muscle strength and physical function
Kidney disease
Skin problems, including sores, ulcers, and infections
Cell death (necrosis), particularly in toes and feet
Amputations
Premature death

A related condition is called "prediabetes" or "insulin resistance." Blood sugar levels are normal or only moderately elevated and often are accompanied by elevated insulin levels, but have not yet reached the diabetic stage. With prediabetes, you have a greater risk not only for diabetes, but for heart attacks and strokes.

Signs and Symptoms

Signs and Symptoms

Signs of diabetes include:

Slow-healing sores
High blood pressure
Frequent infections, such as gum or skin infections and vaginal or bladder infections
Unexplained weight loss

Diabetes symptoms include:

Increased thirst
Frequent urination
Constant or extreme hunger
Fatigue
Sweating
Tingling, burning, or numbness in feet and hands
Blurred vision
Pain in joints or muscles
Cramping in the legs when walking
Pain or limping with walking
Weakness
Chronic pain

The American Diabetes Association provides information on target blood glucose levels and other measurements.

How Is It Diagnosed?

Diabetes is diagnosed by a physician, based on a test of your blood glucose level. This test is often ordered by a physician when a person reports some of the signs and symptoms listed in the previous section, or has risk factors determined by a physician. If you are diagnosed with diabetes, a physical therapist can evaluate your symptoms and problems associated with the condition. A physical therapist will identify physical problems that can be helped with an individualized exercise program, and provide specialized treatments based on your needs and goals.

How Can a Physical Therapist Help?

Physical therapists help people with diabetes participate in safe, effective exercise programs to improve their ability to move, perform daily activities, reduce their pain, and possibly lower their blood glucose levels. Physical therapy treatments also can help people with diabetes heal any associated skin problems faster than they would without treatment.

Your physical therapist will examine your record of blood glucose levels, and will check your skin for wounds. Your physical therapist will conduct a complete assessment of your strength, flexibility, endurance, and balance, and use the results of the testing to design an individualized treatment program that addresses your problems and needs. Your treatment program can help improve your:

Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement . These might begin with “passive” motions that the physical therapist performs for you to gently move your joints, and progress to “active” exercises and stretches that you do yourself.

Strength. Your physical therapist will choose and teach you the correct exercises and equipment to use to steadily and safely restore your strength.

Flexibility. Your physical therapist will determine if any muscles are tight, begin to help you gently stretch them, and teach you stretches that you can do yourself.

Endurance. Regaining your endurance is important. If you are suffering from weakness due to inactivity, your physical therapist will teach you exercises to improve endurance, so you can return to your normal activities.

Balance and coordination. Regaining your sense of balance is important in order to prevent falling. Your physical therapist will teach you exercises to improve your balance ability. Coordination is also essential for daily and work activities. Your physical therapist can teach you exercises and movements that restore your coordination.

Walking ability. Your physical therapist can improve your walking ability and comfort by adjusting and refitting your shoes, or by adding shoe inserts or orthotics that support your feet and ankles. Your physical therapist can teach you to use support equipment, such as walkers and canes, to help you walk safely.

Pain levels. Physical therapy treatment is a safe way to treat chronic pain . Your physical therapist may use different types of treatments and technologies, and choose the most effective and safe exercises for you to perform to control and reduce pain. If you have diabetic nerve pain (neuropathy), your physical therapist can teach you how to protect painful areas and make them less sensitive.

Blood glucose levels. Physical activity, such as prescribed exercise, can help lower your blood glucose levels. Your physical therapist can design a safe, individualized exercise program for you to help control and lower your blood glucose levels each day.

Healing of sores. Your physical therapist can apply different types of bandages, dressings, lotions, and treatments to help sores heal faster than they would on their own. Your physical therapist also may check your footwear for proper fit and overall condition, and teach you to perform daily foot and skin checks to prevent wounds, sores, and blisters. from developing.

Home exercise. Your physical therapist will teach you strengthening, stretching, and aerobic exercises to perform on your own at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.

Ability to perform daily and work activities. Your physical therapist will discuss your activity goals with you and use them to set your recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible.

Always talk with a physical therapist before you begin an exercise program that addresses your diabetes symptoms.

If Surgery Is Required

If a part of your body, such as your foot or lower leg, becomes too damaged by high blood glucose levels and the effects of diabetes requires amputation, your physical therapist can help you prepare for surgery and recover from it afterward. Your physical therapist can help you manage pain, heal faster, learn how to use any needed prosthetics, regain your walking ability, and get back to being physically active as soon as possible.

How Can a Physical Therapist Help Before & After Surgery?

Can this Injury or Condition be Prevented?

Type 1 diabetes cannot be prevented because science has yet to determine its cause(s).

Type 2 diabetes can often be prevented by keeping one’s weight at a normal level in relation to one’s height, avoiding obesity by eating a healthy diet, and exercising regularly. A physical therapist can develop an individualized exercise plan to help prevent the development of type 2 diabetes, or the progression of prediabetes to diabetes.

Prediabetes can be reversed or kept from progressing to full diabetes by:

Exercising
Performing enough physical activity each week
Eating a healthy diet (and being aware of and reducing sugar intake)
Avoiding obesity or becoming overweight

The risk for gestational diabetes can be reduced by the same measures that can help prevent type 2 diabetes: eating healthy foods, staying active, and exercising regularly. Losing extra pounds prior to pregnancy is highly recommended.

The complications from diabetes, listed above, can be limited and prevented by controlling your blood glucose levels each day with good nutrition and daily exercise.

Sores on the feet can be prevented by daily foot and skin inspection, by wearing properly fitting shoes and orthotics, and by practicing good foot care that you can learn from your physical therapist.

Physical Therapist's Guide to Total Hip Replacement (Arthroplasty)

Fri, 19 Jun 2020 18:16:24 GMT

Total hip replacement (arthroplasty) is a common surgical intervention that is performed for severe arthritis or hip fracture when conservative treatments are ineffective. The goal of total hip replacement surgery is to relieve pain, improve joint mobility, and restore or improve a person’s ability to safely perform functional activities like walking, standing, stair climbing, or running. Physical therapists work with people who have had a total hip replacement to strengthen their muscles and restore their movement to its highest potential.

What is Total Hip Replacement (Arthroplasty)?

Total hip replacement surgery removes damaged bone and cartilage that may be contributing to a painful, dysfunctional hip, and replaces the damaged hip with a prosthetic (artificial) hip.

The hip joint is a ball-and-socket joint. The ball is part of the femur (thigh bone) and the socket is part of the hip bone/pelvic bone. The type of hip replacement surgery performed varies with each individual's physical condition.

The 2 types of hip replacement surgeries are:

Total hip replacement (arthroplasty)

With total hip replacement (arthroplasty), the ball and the socket are both replaced with artificial parts. Total hip replacement is performed to treat conditions including:

Osteoarthritis of the hip
Rheumatoid arthritis
Traumatic arthritis
Ankylosing spondylitis
Avascular necrosis (loss of bone tissue)
Certain hip fractures
Benign and malignant tumors

Partial hip replacement (hemiarthroplasty)

A partial hip replacement (hemiarthroplasty) only replaces the ball of the hip joint; the hip socket remains strong and doesn’t need to be replaced. Hemiarthroplasty is performed when there is damage only to the “femoral” or thigh portion of the hip joint. This is mostly performed in patients who are elderly and frail, and for fractures involving the ball or the neck of the femur (thigh bone).

How Does it Feel?

Before surgery, people who have elected to undergo total hip replacement may describe severe pain in the hip and groin that can extend down the thigh. The pain may significantly affect a person’s ability to walk, climb stairs, sit down or stand up, perform daily activities, and sleep on the affected side.

Immediately after total hip replacement surgery, you will experience stiffness in the hip and leg, and muscle weakness. Initially, pain is managed primarily with medication. Your physical therapist also may recommend ice packs to help reduce discomfort and swelling, and teach you gentle exercises and movements to begin to improve your motion and strength.

How Is It Diagnosed?

To be considered for a total hip replacement, most individuals will have already been seen by a medical professional. Your physician will order x-rays to assess whether there are changes to the bones and cartilage of your hip. If you have had a fall, x-rays will also guide the attending health care professionals in determining if there is a fracture and if it requires surgery in order for you to regain your function. A physical therapist will evaluate your range of motion, strength, and how much your hip pain impacts your functional mobility. Factors can include how you get in and out of bed, sit down and stand up, squat down, walk, and navigate stairs and curbs. The results of these evaluations will help determine whether you might benefit from total hip replacement surgery.

Hip replacements are most often performed in adults aged 60 to 80 years. Your medical team will help you determine if you are a good candidate for surgery based on your x-rays and your physical assessment. Risk factors that may interfere with your recovery, such as advanced age, obesity, or a history of smoking or excessive alcohol use will be taken into account.

How Can a Physical Therapist Help?

Before Surgery

Your physical therapist can help educate you about what to expect from your surgery, and give you exercises to condition your body before surgery.

In preparation for surgery, your physical therapist may teach you:

Flexibility and strengthening exercises for the lower extremities
How to use a walker or crutches for walking and for navigating steps
Any precautions to take after surgery

Your physical therapist also may recommend that you make changes in your home to improve safety and help your recovery, including the use of a raised toilet seat, hand rails on stairs, a bed rail, and a tub seat or grab bars in the shower. These changes ideally should be made before you have surgery, so your home is prepared for your return.

After Surgery

On the first or second day after your surgery, a physical therapist will come to your bedside to begin your postoperative treatment. Your physical therapist will review any postsurgical precautions to take to prevent reinjury and to help restore your full function.

Depending on your particular case/surgical procedure, you may be asked to limit the amount of weight you put on the surgical leg. It may be as little as a toe touch, or as much weight bearing as you can tolerate. Your physical therapist will teach you how to correctly put weight on the affected leg, and will recommend an assistive device, such as a walker or crutches, to minimize discomfort as you work to restore your physical function.

During your acute-care recovery (the first 3 to 5 days after surgery), your physical therapist will work with you to help you safely:

Turn in bed and get up to a sitting position.
Get out of bed to stand and move to a chair.
Walk with the assistive device (walker or crutches) for short distances.
Perform gentle range-of-motion and strengthening exercises in bed.

After surgery, your physical therapist may advise you not to:

Bend your new hip more than 90°.
Bend forward more than 90° (eg, you will not be able to bend over to put on your socks and shoes for a while).
Cross your leg with your new hip over the other leg.
Turn the leg with the new hip inward.

Physical therapy will continue for a number of weeks after your surgery. Depending on your overall situation, you may need to recover in a short-term rehabilitation facility. Some patients are discharged to their home without nursing home care, depending on the help available at home and their ability to stay safe. Your physical therapist will help make this determination for you.

As you progress in your recovery, you will continue to work on:

Walking and stair climbing
Balance – after surgery your balance may be impaired, which could put you at risk for falls
Transferring to the bed, a chair, and a car
Full movement of your leg and new hip (such as putting on socks and shoes)
Specific muscle strengthening exercises to improve your ability to stand and walk safely and independently

When you can perform these activities without help or guidance, you will be ready to fully function at home. However, you may still need to continue physical therapy in an outpatient clinic.

Outpatient physical therapy sessions will continue your work on range-of-motion (movement) and stretching exercises, and weight-bearing activities to restore your function to its highest possible level. At this point, your physical therapy will focus on activity-specific rehabilitation for your specific goals, such as a return to work or sport. Your physical therapist will incorporate exercises that simulate those activities. Your exercise regimen may include lifting techniques, pushing, pulling carts, climbing ladders, agility exercises, or light jogging, depending on your specific goals, your recovery progress, and your activity level.

Can this Injury or Condition be Prevented?

It may be possible to prevent or slow the onset of osteoarthritis, a condition that can require total hip replacement surgery, by choosing a healthy lifestyle, such as participating in regular exercise and eating a healthy diet. Your physical therapist can teach you conditioning, strengthening, and flexibility exercises to help you maintain peak fitness throughout your life span.

More than 95% of hip fractures are caused by falls. The best way to prevent the need for unplanned total hip replacement surgery is to prevent a fall. Your physical therapist can help you reduce your chances of falling by evaluating your fall risk and prescribing balance activities and regular weight-bearing exercises. Your physical therapist also can recommend changes in your home environment to improve your safety, such as removing trip hazards like unstable rugs, or adding grab bars in the bathroom.

Physical Therapist's Guide to Rotator Cuff Tear

Fri, 19 Jun 2020 18:16:17 GMT

The "rotator cuff" is the group of 4 muscles and their tendons responsible for keeping the shoulder joint stable. Injuries to the rotator cuff are common—either from accident or trauma, or with repeated overuse of the shoulder. Risk of injury can vary, but generally increases as a person ages. Rotator cuff tears are more common later in life, but also can occur in younger people. Athletes and heavy laborers are often affected; older adults can injure the rotator cuff when they fall on or strain the shoulder. When left untreated, a rotator cuff tear can cause severe pain and a decrease in the ability to use the arm. Physical therapists help people with rotator cuff tears address pain and stiffness, restore movement to the shoulder and arm, and improve their activities of daily living.

What is a Rotator Cuff Tear?

The "rotator cuff" is a group of 4 muscles and their tendons (tissues that attach muscles to bones), which connects the upper arm bone, or humerus, to the shoulder blade. The important job of the rotator cuff is to keep the shoulder joint stable. Sometimes, the rotator cuff becomes inflamed or irritated due to heavy lifting, repetitive arm movements, or trauma such as a fall. A rotator cuff tear occurs when injuries to the muscles or tendons cause tissue damage or disruption.

Rotator cuff tears are called either "full thickness" or partial thickness," depending on how severe they are.

Full-thickness tears extend from the top to the bottom of a rotator cuff muscle/tendon.
Partial-thickness tears affect at least some portion of a rotator cuff muscle/tendon, but do not extend all the way through.

Tears often develop as a result of either a traumatic event or long-term overuse of the shoulder. These conditions are commonly called “acute” or “chronic.”

Acute rotator cuff tears are those that occur suddenly, often due to traumas, such as a fall or lifting of a heavy object.
Chronic rotator cuff tears are much slower to develop. These tears are often the result of repeated actions with the arms working above shoulder level, such as with ball-throwing sports or certain work activities.

People with chronic rotator cuff injuries often have a history of rotator cuff tendon irritation that causes shoulder pain with movement. This condition is known as shoulder impingement syndrome.

Rotator cuff tears also may occur in combination with injuries or irritation of the biceps tendon at the shoulder, or with labral tears (to the ring of cartilage at the shoulder joint). Your physical therapist will explain the particular details of your rotator cuff tear.

Rotator Cuff Tear: See More Detail

How Does it Feel?

People with rotator cuff tears can experience:

Pain over the top of the shoulder or down the outside of the arm
Shoulder weakness
Loss of shoulder motion
A feeling of weakness or heaviness in the arm
Inability to lift the arm to reach up, or reach behind the back
Inability to perform common daily activities due to pain and limited motion

How Is It Diagnosed?

To help pinpoint the cause of your shoulder pain, your physical therapist will complete a thorough examination that will include learning details of your symptoms, assessing your ability to move your arm, identifying weakness, and performing special tests that may indicate a rotator cuff tear. For instance, your physical therapist may raise your arm, move your arm out to the side, or raise your arm and ask you to resist a force, all at specific angles of elevation.

In some cases, the results of these tests might indicate the need for a referral to an orthopedist or other professional for imaging tests, such as ultrasound imaging, magnetic resonance imaging (MRI), or a computed tomography (CT) scan.

How Can a Physical Therapist Help?

Once a rotator cuff tear has been diagnosed, you will work with your orthopedist and physical therapist to decide if you should have surgery or if you can try to manage your recovery without surgery.

If you don't need surgery, your physical therapist will work with you to restore your range of motion, muscle strength, and coordination, so that you can return to your regular activities. In some cases, you may learn to modify your physical activity so that you put less stress on your shoulder.

If you decide to have surgery, your physical therapist can help you both before and after the procedure.

Regardless of which treatment you have—physical therapy only, or surgery and physical therapy—early treatment can help you speed the healing process and avoid permanent damage.

If You Have an Acute Injury

If a rotator cuff tear is suspected following a trauma, seek the attention of a physical therapist or other health care provider to rule out the possibility of serious life- or limb-threatening conditions. Once serious injury is ruled out, your physical therapist will help you manage your pain and will prepare you for the best course of treatment.

If You Have a Chronic Injury

A physical therapist can help manage the symptoms of chronic rotator cuff tears as well as improve how your shoulder works. For large rotator cuff tears that can't be fully repaired, physical therapists can teach special strategies to improve shoulder movement. However, if physical therapy and conservative treatment alone do not improve your function, surgical options may exist.

If You Have Surgery

If your condition is severe, you may require surgery to restore use of the shoulder; physical therapy will be an important part of your recovery process. The repaired rotator cuff is vulnerable to reinjury following shoulder surgery; working with a physical therapist is crucial to safely regaining full use of the injured arm. After the surgical repair, you will need to wear a sling to keep your shoulder and arm protected as the repair heals. Your physical therapist will apply treatments during this phase of your recovery to reduce pain and gently begin to restore movement. Once you are able to remove the sling for exercise, your physical therapist will begin your full rehabilitation program.

Your physical therapist will design a treatment program based on both the findings of the evaluation and your personal goals. Your physical therapist will guide you through your postsurgical rehabilitation, which will progress from gentle range-of-motion and strengthening exercises to activity- or sport-specific exercises.

Your treatment program most likely will include a combination of exercises to strengthen the rotator cuff and other muscles that support the shoulder joint. The time line for your recovery will vary depending on the surgical procedure and your general state of health, but return to sports, heavy lifting, and other strenuous activities might not begin until 4 months after surgery and full return may not occur until 9 months to 1 year after surgery. Following surgery, y our shoulder will be susceptible to reinjury. It is extremely important to follow the postoperative instructions provided by your surgeon and physical therapist.

Your rehabilitation will typically be divided into 4 phases:

Phase I (maximal protection). Phase 1 of treatment lasts for the first few weeks after your surgery, when your shoulder is at the greatest risk of reinjury. During this phase, your arm will be in a sling. You will likely need assistance or need strategies to accomplish everyday tasks, such as bathing and dressing. Your physical therapist will teach you gentle range-of-motion and isometric strengthening exercises, provide hands-on treatments (manual therapy), such as gentle massage, offer advice on reducing your pain, and may use techniques such as cold compression and electrical stimulation to relieve pain.
Phase II (moderate protection). This next phase has the goal of restoring mobility to the shoulder. You will reduce the use of your sling, and your range-of-motion and strengthening exercises will become more challenging. Exercises will be added to strengthen the "core" muscles of your trunk and shoulder blade (scapula), and the rotator-cuff muscles that provide additional support and stability to your shoulder. You will be able to begin using your arm for daily activities, but will still avoid heavy lifting. Your physical therapist may use special hands-on mobilization techniques during this phase to help restore your shoulder's range of motion.
Phase III (return to activity). This phase has the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities, but you will still be unable to participate in activities such as sports, yard work, or physically strenuous work-related tasks. Your physical therapist will advance the difficulty of your exercises by adding weight or by having you use more challenging movement patterns. A modified weight-lifting/gym-based program may also be started during this phase.
Phase IV (return to occupation/sport). This phase will help you return to work, sports, and other higher-level activities. During this phase, your physical therapist will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. For others, it may include practice in lifting heavier items onto shelves, or instruction in proper positioning for everyday tasks such as raking, shoveling, or doing housework.

Can this Injury or Condition be Prevented?

A physical therapist can help you reduce the worsening of the symptoms of a rotator cuff tear and may decrease your risk of worsening a tear, especially if you seek assistance at the first sign of shoulder pain or discomfort. To avoid developing a rotator cuff tear from an existing shoulder problem, it is imperative to stop performing actions that could make it worse. Your physical therapist can help you strengthen your rota t or cuff muscles, train you to avoid potentially harmful positions, and determine when it is appropriate for you to return to your normal activities.

To maintain shoulder health and prevent rotator cuff tears, physical therapists recommend that you:

Avoid repeated overhead arm positions that may cause shoulder pain. If your job requires such movements, seek out the advice of a physical therapist to learn arm positions that may be used with less risk.
Apply rotator-cuff muscle and shoulder-blade strengthening exercises into your normal exercise routine. The strength of the rotator cuff is just as important as the strength of any other muscle group. To avoid potential harm to the rotator cuff, general strengthening and fitness programs may improve shoulder health.
Practice good posture. A forward position of the head and shoulders has been shown to alter shoulder-blade position and create shoulder impingement syndrome.
Avoid sleeping on your side with your arm stretched overhead, or lying on your shoulder. These positions can begin the process that causes rotator cuff damage and may be associated with increasing your pain level.
Avoid smoking; it can decrease the blood flow to your rotator cuff.
Consult a physical therapist at the first sign of symptoms.

Physical Therapist's Guide to Proximal Humerus Fractures

Fri, 19 Jun 2020 18:16:07 GMT

A proximal humerus fracture is a serious injury to the humerus bone in the shoulder joint that requires immediate treatment to preserve function of the shoulder. A fracture to the humerus bone is a possible consequence of a traumatic event, such as a fall or forceful collision. Depending on the specific location and type of fracture to the proximal humerus, surgical intervention may be required. Whether surgical or nonsurgical treatment is needed, physical therapy treatment is essential to safely and effectively restore shoulder function, and return an individual to normal activity.

What is a Proximal Humerus Fracture?

The humerus is one of the long bones of the arm. The distal, or bottom, end contributes to the elbow joint. The proximal, or top, end contributes to the shoulder joint. During a traumatic event, like a fall, any part of the humerus is susceptible to injury. Other bones, including the clavicle (collarbone) or scapula (shoulder blade) can also be injured. However, a fracture to the proximal humerus is especially concerning due to its location and proximity to other important structures, such as the rotator cuff muscles, the brachial plexus (a web of nerves from the neck that supplies the arm), and certain tissues within the shoulder-joint capsule.

Fractures of the proximal humerus typically occur as the result of a trauma, such as a fall where the individual lands directly on the shoulder, a forceful collision, or a more complicated event, such as a car accident. Typically, the position of the arm and body at the time of the trauma will determine how the bone fractures. Individuals of any age and gender may suffer this type of fracture. Individuals who suffer from osteoporosis, or the weakening of bone tissue, may have an increased risk of fracture during any traumatic event.

How Does it Feel?

An individual with a proximal humerus fracture may experience the following symptoms immediately following the injury:

Pain
Swelling
Bruising
Severely restricted movement of the shoulder
Numbness and tingling in the arm, forearm, or hand
Deformity (an unusual appearance) of the upper arm

How Is It Diagnosed?

Proximal humerus fractures are diagnosed by a thorough physical examination and diagnostic imaging. An x-ray is often taken to confirm the fracture. If further information is needed, such as investigating if any soft tissues are also injured, an MRI or CT scan may be required.

Fractures to the proximal humerus are typically classified as:

Nondisplaced . The pieces of bone at the fracture site are separated, but not out of position. This type of fracture may not require surgery.
Displaced . The pieces of bone at the fracture site are separated and shifted out of position. This type of fracture typically requires surgery.

Surgical intervention for proximal humerus fractures involves realigning and fixing the fractured bone segments using screws, plates, or rods. If there is more severe damage to the shoulder joint, a more advanced surgical procedure may be needed. If your injury requires surgery, your orthopedic surgeon will review your injury, diagnostic imaging findings, and surgical plan with you in detail.

How Can a Physical Therapist Help?

Following a proximal humerus fracture, physical therapy will be crucial to restore proper function of your shoulder and arm. If surgery is required, physical therapy will typically begin 1 to 4 weeks following the surgery, depending on the specific surgical intervention required.

If surgery is not required, your physician and physical therapist will determine when the best time is to begin physical therapy, based on your bone healing and symptoms. After a traumatic injury like a fracture, individuals lose range of motion, strength, and often develop different movement patterns caused by injury limitations. Your physical therapist will develop an individualized treatment plan to address your specific condition, and help you return to your desired activities.

Your physical therapy treatment may include:

Range of Motion Exercises. Due to their limited movement following a proximal humerus fracture, individuals lose their range of shoulder motion and may develop stiffness of the shoulder joint. Your physical therapist will assess your shoulder motion compared to expected normal motion and the motion of shoulder of your noninjured arm, and lead you through a program of motion exercises to restore shoulder function.

Strengthening Exercises. The muscles of the shoulder and upper back work together to allow for normal upper-body motion. Based on the way the shoulder joint is designed (a ball-and-socket joint, like a golf ball on a golf tee), there are many directions in which the shoulder may move. Therefore, balanced strength of all the upper body muscles is crucial to make sure that the shoulder joint is protected and efficient with its movements. When there is a fracture to the proximal humerus (near the “ball” segment of the joint), the muscles around the shoulder girdle weaken, as they are not being used normally; this process is called "atrophy." There are many exercises that can be done to strengthen the muscles around the shoulder, so that each muscle is able to properly perform its job. Often, building strength after a fracture can take weeks to months due to atrophy. Your physical therapist will help you develop a strengthening program that is safe and comprehensive.

Manual Therapy. Physical therapists are trained in manual (hands-on) therapy. When appropriate, based on the stage of healing at your fracture site, your physical therapist will gently move your shoulder joint and surrounding muscles as needed to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.

Modalities. Your physical therapist may recommend therapeutic modalities, such as ice and heat to aid in pain management.

Functional Training. Whether you work in a factory, are a mother of a young child, work as a secretary, or are an older adult, the ways in which you perform your normal daily activities are important. Improper movement patterns after a fracture may come back to haunt you, as they may lead to future secondary injuries. Physical therapists are experts in assessing movement quality. Your physical therapist will be able to point out and correct faulty movements, so you are able to regain use of, and maintain, a pain-free shoulder.

Can this Injury or Condition be Prevented?

Unfortunately, the unexpected traumatic events that are responsible for proximal humerus fractures cannot be directly prevented. However, based on the individual, certain precautionary measures can be taken to decrease the risk of any fracture:

For older individuals or individuals with known balance problems, removing fall-risk hazards in the home, such as loose rugs is beneficial. It is also important to encourage the use of handrails, assistive devices, and proper shoes.
For athletes participating in contact sports, it is important to always use proper protective equipment, as required by the rules and regulations of the specific sport.
For individuals with low bone density, following prescribed guidelines for appropriate vitamins and minerals, such as calcium and vitamin D, is helpful to maximize healthy bone composition.

Physical Therapist's Guide to Peroneal Tendinopathy

Fri, 19 Jun 2020 18:15:47 GMT

Overuse injuries in sports account for 50% of all injuries. A majority of overuse injuries occur in runners, with 20% of injuries affecting the lower leg, 15% the ankle, and 15% the foot.

Peroneal tendinopathy is a type of overuse injury that often occurs in athletes, like long-distance runners and basketball players. Dancers, people who have had ankle sprains, or those who simply have weak ankles are also often affected. Peroneal tendinopathy is characterized by an aching along the outside surface of the ankle that worsens with activity, yet improves with rest. A physical therapist can help relieve symptoms caused by this condition by providing treatments, including stretching and strengthening exercises to help the ankle become more mobile, strong, and stable.

What is Peroneal Tendinopathy?

Peroneal tendinopathy is characterized by an aching pain and swelling in the peroneal tendons located in the lower, outside portion of the ankle. A tendon is soft-tissue that attaches a muscle to a bone. The muscles involved in this condition are the 2 peroneal muscles in the lower leg, called the peroneus longus and the peroneus brevis. (In some texts, the muscles are referred to as the fibularis longus and the fibularis brevis.)

The peroneus longus muscle originates on the fibula bone, which is located on the outside of the lower leg. It wraps around the bone on the outside of the ankle (the lateral malleolus) and attaches to the plantar (bottom) aspect of the base of the big toe. The peroneus brevis muscle also originates on the fibula, but attaches to the base of the fifth toe. These muscles are responsible for moving the foot in an outward direction, and pointing the toe and foot downward. Together, they help to balance and stabilize the foot and ankle. Most ankle sprains occur as a result of the ankle rolling inward. One reason for this is that the peroneal muscles and tendons are not as strong as the muscles on the inside of the ankle. If these muscles are weak, they may not be able to prevent the ankle from rolling inward. These muscles and tendons can also be overworked if the foot isn’t hitting the ground in proper alignment. If the foot hits the ground more on the outside of the foot (supination), the peroneal muscles have to work harder to stabilize the force of gravity with weight-bearing activities. Proper footwear or orthotics can help with proper foot alignment.

Peroneal tendinopathy will usually worsen with activity, such as running or walking and improve with rest. It is an overuse injury, meaning the tendons can become enlarged, thickened, and possibly swollen.

How Does it Feel?

Symptoms of peroneal tendinopathy include:

An aching pain on the outside of the ankle, especially with activity
Lateral (outside) ankle pain that decreases with rest
Swelling or tenderness to touch behind the ankle bone on the outside of the ankle
Pain and weakness when actively moving the foot in an outward direction or when pointing it down
Pain when pushing off the ball of the foot during walking or running
Pain when walking on a sloped terrain that turns the foot outward
Pain when stretching the foot in an inward and downward direction

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes asking about your health history. Your physical therapist may perform strength and motion tests on your ankle, ask about your job duties and hobbies, evaluate your gait (how you walk), and check for any muscle weakness in the entire leg and in your core. Your therapist will also check your posture and evaluate what type of shoes you wear to determine if they support your foot properly. Your physical therpist will gently touch your ankle in specific areas to determine which tendon or tendons may be inflamed. Special tests may be performed to determine exactly which tendons are involved.

How Can a Physical Therapist Help?

It is important to get proper treatment for peroneal tendinopathy as soon as it occurs. A degenerated tendon that is not treated can begin to tear, causing a more serious condition. With an early diagnosis, physical therapy can successfully treat peroneal tendinopathy. Your physical therapist will develop a treatment plan specific to your condition and goals. Your individual treatment program may include:

Pain Management. Your physical therapist will help you identify and avoid painful movements, allowing the inflamed tendon to heal. Ice, ice massage, or moist heat may be used for pain management. Therapeutic modalities, such as iontophoresis (medication delivered through an electrically charged patch) and ultrasound may be applied.

Manual Therapy. Your physical therapist may use manual therapy (hands-on) techniques to gently mobilize the joints in your foot, ankle, and lower leg. Soft-tissue mobilizations may also be performed to loosen any tightness, increase circulation, and relieve pain and swelling.

Range-of-Motion Exercises. You will learn exercises to help the ankle, foot, and toes to move properly, in order to normalize your gait pattern when walking or running. Stretching exercises will help ease any tightness in the calf muscles and the tissues in the bottom of the foot.

Strengthening Exercises. Your physical therapist will determine which muscle groups require strengthening to enable you to return to walking or running without pain. Navigating uneven surfaces, such as grass, sand, gravel, or trails requires significant ankle strength to avoid unnecessary stress on the ankle. Your physical therapist may teach you to perform resistance exercises with bands, weights, or medicine balls to strengthen the muscles in the ankle, foot, and lower leg.

Functional Training. As your symptoms improve, your physical therapist will help you return to your previous level of activity and sport. Sport-specific exercises will simulate certain activities. You may perform single-leg balance exercises or train on uneven surfaces to challenge the muscles that balance and stabilize the ankle. Your physical therapist will design an individual home-exercise program to perform after formal therapy has ended, to continue building your ankle and foot strength.

Patient Education: Your physical therapist will recommend proper footwear for the activities you enjoy, so that your foot and ankle have proper support. It may be necessary to get fitted for a custom foot orthotic (corrective inserts for your shoes) to wear, especially when performing more demanding activities, such as running or walking on uneven surfaces. You will also learn how to gradually increase and maintain your training regimen to reduce any chance of future injury.

Can this Injury or Condition be Prevented?

Peroneal tendinopathy can be prevented by:

Keeping the entire leg strong and flexible, including the hip, knee, and ankle.
Choosing proper footwear for running and walking activities.
Slowly increasing your running and walking mileage or speed.
Gradually adding hills or uneven terrain to your exercise route.
Changing footwear when necessary to properly support the foot.

Physical Therapist's Guide to Ankle Impingement

Fri, 19 Jun 2020 18:15:28 GMT

Ankle impingement occurs when either soft or bony tissues are compressed within the ankle joint at the extreme end of a motion, such as pointing the foot sharply downward. It typically affects people who experience forces through their ankle at these "end-range" positions, such as dancers, gymnasts, or people performing kicking activities. Additionally, people who perform repetitive tasks that involve squatting or stair-climbing are susceptible to this condition. Physical therapists help people with ankle impingement reduce their pain, heal and strengthen the affected area, and improve their overall balance.

What is Ankle Impingement?

Ankle impingement can be categorized into 2 types:

Anterior ankle impingement
Posterior ankle impingement

Anterior ankle impingement involves pain on the front side of your ankle. Inflammation and swelling occur due to repetitive stresses at end-range positions of the ankle, such as when one jumps, squats, or descends stairs. These may eventually lead to development of bone spurs (a bony overgrowth) in the ankle joint space. An additional cause of anterior ankle impingement is ankle instability. Ankle instability is a looseness of the ankle joint that develops after repeated ankle sprains, causing damage to ligaments in the ankle. This damage can cause the ligaments to become scarred and take up more joint space. Tissue in the joint space is then compressed, causing pain during activities that require ankle dorsiflexion (stretching your toes up toward your shin). Examples of these activities include squatting, jumping, and stair-climbing.

Posterior ankle impingement involves pain on the back side of your ankle, especially during activities that involve pointing your toes. The pain is caused by compression of soft or bony tissue between the shin bone (tibia) and the heel bone (calcaneus). Some people have a small extra bone in the back of their ankle called the Os Trigonum. This little bone can lead to posterior impingement because of compression between the shin bone and the heel bone, when the foot is pointed. Additionally, large amounts of force on the ankle occasionally may cause small pieces to break off the ankle bone, which can also become compressed when the ankle moves into "end-range plantar flexion" (moving the foot or toes downward toward the sole of the foot). Compression of tissue causes inflammation and swelling that leads to pain.

Signs and Symptoms

With anterior ankle impingement, you may experience:

Pain on the front and/or outside of the ankle joint
A feeling of ankle instability
Decreased ankle range of motion when stretching your toes up toward your shin
Pain at the end-range of stretching your toes toward your shin
Tenderness at the front of the ankle when touched

With posterior ankle impingement, you may experience:

Pain on the back of your ankle, especially during activities that involve pointing your toes
Decreased range of motion when pointing your toes
Tenderness on the back of the ankle when touched

How Is It Diagnosed?

Your examination will begin with your personal health history and current symptoms. Your physical therapist will ask you when your symptoms began, where the location of your pain is, and what activities cause you pain. Your physical therapist will perform a physical examination to evaluate your ankle strength, range of motion, sensation, and structural stability as well as your balance. Your physical therapist also will perform special tests, such as gently moving your ankle to see if it causes symptoms.

To diagnose posterior ankle impingement in dancers, the exam may be specialized to that activity. For example, a physical therapist may ask a ballet dancer to demonstrate the “en pointe” position, which involves standing on the tips of the toes.

To provide a definitive diagnosis, your therapist may collaborate with an orthopedist or other health care provider. The most accurate method to diagnose ankle impingement is by X-ray or magnetic resonance imaging (MRI), which can be ordered by the orthopedist.

How Can a Physical Therapist Help?

Once you have been diagnosed with ankle impingement, your physical therapist will work with you to achieve your functional goals, and help you return to activities you previously performed without pain. Your treatment may include:

Pain Management. Your physical therapist may use ice massage or electrical stimulation, if you have inflammation causing pain. Your physical therapist may ask you to reduce your activity level for a while, so the inflammation in your ankle can decrease.

Range-of-Motion Exercises. Your physical therapist may gently move your ankle through its available range of motion, or teach you the proper motions to move through in order to increase its mobility and decrease stiffness. If necessary, your physical therapist may perform joint mobilizations—skillfully moving the joint in a particular direction to improve its motion.

Muscle-Strengthening Exercises. It is important to strengthen the muscles acting on the foot, ankle, and lower leg to promote proper joint mechanics. When the muscles are strong and working properly, the joint space in the ankle is maintained, which decreases the risk of compression of soft or bony tissues.

Balance Exercises. Your physical therapist may give you balance exercises to challenge the way your body reacts to outside forces. These exercises make you more aware of where your body is in space. Improving your balance will lead to a more stable ankle, because your body can more easily respond to challenges.

Functional Training. Once your physical therapist has helped decrease your ankle pain and inflammation, you will progress to more activity-specific tasks. Your physical therapist will help ensure that your ankle can withstand challenges during occupational, sport, or artistic activities.

Can this Injury or Condition be Prevented?

No injury is ever completely preventable. However, there are some actions that active and at-risk people can take to reduce the risk of ankle impingement, including:

Using correct techniques when performing physical activities.
Wearing proper footwear; eg, basketball players can wear high-top shoes to improve their ankle stability.
Avoiding overtraining; conditions like ankle impingement tend to be brought on by repetitive stresses.

Physical Therapist's Guide to Ankylosing Spondylitis

Fri, 19 Jun 2020 18:15:17 GMT

Physical Therapist's Guide to Ankylosing Spondylitis

Ankylosing spondylitis (AS) is an inflammatory disease that causes pain and stiffness in the spine, pelvis, and other joints, like the hips, knees, feet, and shoulders. AS is a chronic (lifelong) disease, and it is hereditary. Although a majority of people who have AS carry a gene called HLA-B27, about 80% of people who have inherited the gene from a parent with AS do not develop the disease. The onset of AS is usually diagnosed in individuals between 17 and 45 years of age. Males are diagnosed 2 to 3 times more often than females, and tend to have more severe disease symptoms than females. Physical therapists help people with AS maintain productive lives by working with them to increase their strength, muscle flexibility, and joint mobility, and to improve their posture.

What is Ankylosing Spondylitis?

Ankylosing spondylitis (AS) is an inflammatory disease affecting the spine, pelvis, and joints throughout the body. AS causes abnormal bone growth, and causes joints to fuse (grow together) in the spine and in the sacroiliac joints (located between each hip and the pelvis). Vital organs like the heart, lungs, and eyes may also be affected. Rare complications include inflammation of the heart, scarring of the nerves of the spine, and kidney problems related to the long-term use of medication.

Although there is currently no cure for AS, proper treatment can help decrease the pain and stiffness associated with the disease. Medications decrease inflammation and localized swelling. If the hip joint becomes stiff and painful, total hip replacement may be performed.

How Does it Feel?

The first and most common symptom experienced with the onset of AS is pain in the sacroiliac joints and the low back. You may also gradually experience hip and shoulder pain. Pain is often accompanied by morning stiffness or stiffness after periods of prolonged inactivity, and usually improves after exercise or activity. Other common symptoms are fever, generalized fatigue, and loss of appetite.

Bony fusion or ankylosis typical of AS in the joints of the neck, spine, and hips causes progressive stiffness and can reduce your ability to turn your head, stand upright, or bend. AS can make maintaining good posture difficult, and can cause you to stoop forward. Poor posture makes it easier to lose your balance, and causes difficulty in walking, increasing the risk of falling. In advanced cases, osteoporosis (thinning of the bones) may occur, which increases the risk of fractures.

Inflammation is very common in AS. The inflammation usually is felt at the sites where ligaments and tendons attach to the bone. These sites are tender to touch and sometimes called “hot spots.” The heel and the back of the foot are common sites for tender spots, which can cause difficulty in standing and walking.

People with AS may develop difficulty breathing because the lungs and the joints where the ribs and spine attach become stiff, limiting chest expansion and causing shortness of breath, and increasing the risk of chest infections.

AS can also affect the soft tissues of the eye (in about 40% of cases), resulting in swelling in the eye (uveitis). Individuals may also experience eye redness, pain, "floaters," and an increased sensitivity to light.

How Is It Diagnosed?

If you see your physical therapist first for symptoms, such as chronic back pain, the physical therapist will take your medical history, and ask you to describe how your symptoms occurred, what symptoms you experienced first, and if they get worse with inactivity and better with activity.

Your physical therapist will perform a thorough evaluation of your posture, and the range of motion (movement) of your spine, hips, knees, and shoulders. Your physical therapist will also check to see if you have any tender spots around your spine, hips, and sacroiliac joints, and gently assess your ability to bend forward, bend backward, squat, and walk.

When your physical therapist suspects AS, your physical therapist will also measure your chest expansion when you take a deep breath and exhale. That will indicate how the AS may be affecting your rib joints and breathing function.

Your physical therapist will also observe your ability to walk and how you move from sitting to standing, and test your balance to determine if you have a fall risk.

If your physical therapist suspects AS, the physical therapist will consult with your physician for further tests, such as an X-ray or MRI of the spine and sacroiliac joints. Blood tests and genetic testing may also be recommended; a blood test positive for the HLA-B27 gene can indicate a risk of developing AS.

How Can a Physical Therapist Help?

Physical therapy will help improve your posture and joint mobility, reduce pain, and help you perform your everyday functional activities more easily. Your physical therapist may teach you:

Posture Training to improve your posture and help you avoid slouching or forward bending. This training is important to ensure that you maintain an upright posture.

Strengthening Exercises to strengthen your back and abdominal muscles and help you maintain proper posture and walking, and perform your activities of daily living.

Flexibility Exercises to maintain and improve joint mobility. Exercises for your leg and chest muscles, and gentle range-of-motion exercises help keep the spine and other joints from getting stiff. Aquatic exercises have been shown to decrease joint pain and improve movement in patients with AS.

Stretching Exercises for the trunk muscles to improve chest expansion.

Deep-Breathing Exercises to improve chest expansion and help you breathe better. Improved breathing increases oxygen and blood flow in the body, which can help decrease stiffness, pain, and fatigue.

Pain Management Techniques, such as using ice or heat packs to manage inflammation and pain in the joints. Your physical therapist may prescribe a TENS unit, which is an electrical stimulation treatment used to alleviate pain.

Individual Activities to improve your functional ability and energy, and help reduce fatigue. Your physical therapist will teach you how to move your body efficiently when performing daily activities to avoid strain. Your physical therapist may recommend using an assistive device, such as a cane or walker to improve your walking, lessen pain, and lower your risk of falling.

Your physical therapist will partner with you to ensure that you maintain your best posture, flexibility, joint mobility, and muscle strength, so you can lead a productive, fulfilling life. We are here to help!

After Surgery

If your hip joints have developed severe arthritis, your physician may recommend a total hip replacement. Your physical therapist will help you improve your walking, your joint range of motion, and your leg strength following surgery, so you can safely return to your usual daily activities.

Can this Injury or Condition be Prevented?

AS is an inherited disease and it cannot be prevented. However, functional limitations may be reduced or prevented by participating daily in a program of posture correction, stretching, and strengthening exercises.

Physical Therapist's Guide to Benign Paroxysmal Positional Vertigo (BPPV)

Fri, 19 Jun 2020 18:14:50 GMT

Every year, millions of people in the United States develop vertigo , a sensation that you or your surroundings are spinning.The sensation can be very disturbing and may increase the risk of falling. If you've been diagnosed with benign paroxysmal positional vertigo (BPPV), you're not alone—at least 9 out of every 100 older adults are affected, making it one of the most common types of episodic vertigo. The good news is that BPPV is treatable. Your physical therapist will use unique tests to confirm vertigo, and use special exercises and maneuvers to help.

What Is BPPV?

Benign paroxysmal positional vertigo is a common inner-ear problem affecting the vestibular system, a system used to maintain balance. BPPV causes short periods of dizziness when your head is moved in certain positions, relative to gravity. Benign means that this disorder is not life threatening, and generally, the disorder is not progressive. Paroxysmal means that the vertigo (spinning sensation) occurs suddenly. Positional means that the vertigo is triggered by changes in head position, most commonly when lying down, turning over in bed, or looking up. This dizzy or spinning sensation is called vertigo.

A layer of calcium carbonate material is present naturally in 1 part of your inner ear (the utricle). BPPV occurs when pieces of this material break off and move to another part of the inner ear, the semicircular canals (usually the posterior canal). These tiny calcium crystals (otoconia) are sometimes called “ear rocks.”

When you move your head a certain way, the crystals move inside the canal and stimulate the nerve endings, causing you to become dizzy. The cause of BPPV is usually not known; however, the crystals may become loose due to trauma to the head, infection, conditions, such as Meniere’s disease, or aging. BPPV is more common among females, and it may be hereditary.

How Does it Feel?

BPPV occurs most commonly following position changing, such as lying down, turning over in bed, bending over, and looking up. A short delay, often less than 15 seconds, may follow a position change before symptoms start. This dizzy sensation, called vertigo, is brief and intense and usually lasts for about 15-45 seconds. However, symptoms may last for up to 2 minutes if the crystals become stuck to part of the inner ear. The episodes of vertigo occur frequently for weeks or months at a time. During these episodes, you may feel like the room is spinning around you, and you also may feel lightheaded, off balance, and nauseous.

Signs and Symptoms

The signs and symptoms of BPPV usually last less than a minute. The signs and symptoms may come and go or may disappear for a period of time, and then recur. Movement of the head causes most of the signs and symptoms of BPPV, which may include:

Dizziness
A sense that you or your surroundings are spinning or moving (vertigo)
A loss of balance or unsteadiness
Nausea
Vomiting

How Is It Diagnosed?

The diagnosis of BPPV is based on whether you have a particular kind of involuntary eye movement (called "nystagmus"), and whether you have vertigo when your head is moved into certain positions. Your physical therapist will perform tests that move your head in specific ways to see whether vertigo and involuntary eye movement results. These tests will help the therapist determine the cause and type of your dizziness, and whether you should be referred to a physician for any additional testing.

The positional tests are meant to recreate BPPV symptoms. By moving your head into certain positions and watching your eyes, your physical therapist may determine the appropriate repositioning maneuver needed to reduce or eliminate your vertigo.

Many different types and causes of dizziness exist, and dizziness is difficult for people to describe, making BPPV and other causes of dizziness more challenging to diagnose. When talking to your clinician, be as specific as possible when describing your symptoms.

For example, explain if you have lightheadedness or if you see or feel the room spinning during an episode. Also, describe how long your symptoms last (seconds, minutes, hours, or days). Do your best to describe what makes your dizziness better or worse. For example, is your dizziness made worse by movement or position changes? Is your dizziness eased by stillness or rest?

Be sure to discuss any recent illnesses or injuries, problems with your immune system, changes in medications or hormones, or headaches. These clues will be very insightful for your physical therapist and can assist in establishing an accurate diagnosis, or indicate the need for a referral to another specialist.

How Can a Physical Therapist Help?

Fortunately, most people recover from BPPV with a simple but very specific head and neck maneuver performed by a physical therapist. Your physical therapist will guide you through a series of 2-4 position changes. Each position may be held for 30 seconds to 2 minutes, as prescribed by your physical therapist. These repositioning treatments are designed to move the crystals from the semicircular canal back into the appropriate area in the inner ear (the utricle). A repositioning treatment called the Epley maneuver is used for the resolution of posterior canal BPPV, the most commonly involved canal. No medication has been found to be effective with BPPV and, in some cases, medication could cause more harm.

In a very few cases, BPPV cannot be managed with treatment maneuvers, and a surgical procedure called a “posterior canal plugging” may be considered—but, surgical intervention is rare.

Can this Injury or Condition be Prevented?

No known ways exist to prevent BPPV, especially when caused by such factors as head injury or aging. Once a person has experienced BPPV, symptoms can return if new crystals break off and get into the semicircular canal, or if you dislodge loose crystals by placing your head in a certain position. Some people report that their BPPV symptoms recur predictably, perhaps seasonally, or with changes in the weather.

Within 3 years of having BPPV, about 50% of people may have a recurrence. BPPV resulting from head trauma is more likely to recur. Once a person has experienced BPPV, symptoms can return if new crystals break. Although your BPPV might return, you'll be able to recognize the symptoms and keep yourself safe until you can get help. Your physical therapist will apply the appropriate maneuver to return the crystals to their correct position in the inner ear, and also will teach you how to do exercises that can reduce or eliminate the symptoms.

Physical Therapist's Guide to Biceps Tendon Rupture

Fri, 19 Jun 2020 18:14:33 GMT

A biceps tendon rupture occurs when the biceps muscle is torn from the bone at the point of attachment (tendon) to the shoulder or elbow. Most commonly, the biceps tendon is torn at the shoulder. These tears occur in men more than women; most injuries occur at 40 to 60 years of age due to chronic wear of the biceps tendon. In younger individuals, the tear is usually the result of trauma (such as an auto accident or fall). Biceps tendon ruptures can also occur at any age in individuals who perform repetitive overhead lifting or work in occupations that require heavy lifting, and in athletes who lift weights or participate in aggressive contact sports.

Physical therapists help individuals regain flexibility, strength, and function in their arms following biceps tendon ruptures.

What is a Biceps Tendon Rupture?

The shoulder is a ball-and-socket joint made up of 3 bones: the upper-arm bone (humerus), the shoulder blade (scapula), and the collar bone (clavicle). The ball at the top of the upper-arm bone is called the head of the humerus. The socket on the shoulder blade is called the glenoid fossa. A tendon is a fibrous bundle that attaches a muscle to a bone. The muscles and tendons of the rotator cuff hold the ball into the socket of the shoulder. The biceps muscle has 2 tendons that attach it to the shoulder and travel the length of the upper arm and insert just below the elbow. The biceps muscle is responsible for bending (flexing) the elbow and rotating the forearm. One of the tendons is called the "long head" of the biceps muscle; it attaches to the upper-arm bone. The second area of attachment is called the "short head" of the biceps; it attaches the muscle to a bony bump on the shoulder blade called the coracoid process.

Most commonly, the biceps tendon will tear at the long head of the biceps at the upper-arm bone, leaving the second attachment at the shoulder blade intact. The arm can still be used after this type of rupture, yet weakness will be present in the shoulder and upper arm. A tear can either be partial, when part of the tendon remains intact and only a portion is torn away from the bone, or complete, where the entire tendon is torn away from the bone.

How Does it Feel?

After sustaining a biceps tendon rupture, you may experience:

Sharp pain in the upper arm or elbow
Hearing a "pop" or snap at the shoulder or elbow
Bruising and swelling in the upper arm to elbow
Weakness in the arm when bending the elbow, rotating the forearm, or lifting the arm overhead
Tenderness in the shoulder or elbow
Muscle spasms in the shoulder and arm
A bulge or deformity in the lower part of the upper arm (a "Popeye arm")

How Is It Diagnosed?

In most cases, a thorough history and physical examination of the involved arm can diagnose a biceps tendon rupture. Your physical therapist will ask you several questions regarding your medical history, your regular daily tasks at home and at work, and your recreational or sports activities. Your physical therapist will ask how the injury happened and where you are having pain and/or weakness.

Your physical therapist will examine your entire upper arm for bruising or swelling, and gently touch it to determine if there is any tenderness over the biceps region at the shoulder, upper arm, or elbow. Your physical therapist also will examine the amount of motion and strength present on the involved side in the shoulder, forearm, and elbow, compared to the noninvolved side. Functional testing may also be performed to determine what daily tasks are difficult for you to perform (eg, lifting an object, reaching overhead, reaching behind the body, or rotating the forearm to open a door).

How Can a Physical Therapist Help?

A biceps tendon rupture often is treated without surgery. Your physical therapist will design an individualized treatment program to help heal your injury in the safest and most efficient way possible. Treatment may include:

Rest. You will be instructed in ways that allows the limb to rest to promote healing.

Icing. Your physical therapist will show you how to apply ice to the affected area to manage pain and swelling.

Range-of-Motion Activities. Your physical therapist will teach you gentle mobility exercises for the shoulder, elbow, and forearm, so your arm does not get stiff during the healing process.

Strengthening Exercises. As the pain and swelling ease, gentle strengthening exercises with resistant bands or light weights will be added.

Functional Activities. You will learn exercises to help you return to the activities you performed before the injury.

Education. Your physical therapist will teach you how to protect your joints from further injury. You will learn how to properly lift objects once the arm is healed, and how to avoid lifting objects that are simply too heavy.

Can this Injury or Condition be Prevented?

To prevent a biceps tendon rupture, individuals should:

Maintain proper strength in the shoulder, elbow, and forearm.
Avoid repetitive overhead lifting and general overuse of the shoulder, such as performing forceful pushing or pulling activities, or lifting objects that are simply too heavy. Lifting more than 150 pounds can be dangerous for older adults.
Use special care when performing activities, such as lowering a heavy item to the ground.
Avoid smoking; it introduces carbon monoxide into the body and leaves less oxygen for the muscles to grow and heal.
Avoid steroid use, as it weakens muscles and tendons.

Physical Therapist's Guide to Core Muscle Injury (Sports Hernia)

Fri, 19 Jun 2020 18:14:11 GMT

Core muscle injury, often misleadingly called a “sports hernia,” is a condition that mainly affects athletes who play soccer, hockey, football, and rugby, and who run track. It is more common in males than females. A full 94% of these injuries occur gradually from unknown causes; the other 6% are caused by a specific traumatic incident, such as being "checked" from behind while playing hockey. Stress from repetitive twisting, kicking, and turning at high speeds is a likely cause of injury. Casual exercisers and nonathletes can also experience this kind of injury. Physical therapists can help individuals with core muscle injury improve their abdominal and hip strength and flexibility in order to safely return to their desired sport or activities. Physical therapists are also part of the prehabilitation and rehabilitation team for people who require surgery for core muscle repair.

What is a Core Muscle Injury?

Core muscle injuries have been called athletic pubalgia and sports hernia, but this injury does not fit the common definition of a “hernia,” where an organ or soft tissue protrudes outside its normal cavity. There is no defect in the abdominal wall or herniation of the abdominal contents with a sports hernia. Injury occurs in the form of tears and weakening in the deep layers of the abdominal wall.

Repetitive hip and pelvic motions typical in sports can cause injury to the lower abdominal area. Imbalances between the hip and abdominal muscles can, over time, cause overuse and injury. Weakness and lack of conditioning in the abdominals also might contribute to the injury. Ironically, aggressive and unsafe abdominal exercise programs can also cause or aggravate a core muscle injury. A core muscle injury usually occurs where the abdominal muscles attach in your pelvis. There is no protrusion of organs, but there are tears in tendons and muscles, such as those surrounding the hip. This makes the term “hernia” a misnomer, as the term hernia means when organs from your abdomen come out through spaces, such as the inguinal canal. Nerve irritation can also occur, contributing to the uncomfortable symptoms.

How Does it Feel?

Chronic groin pain is a hallmark symptom of core muscle injury. It occurs in 5% to 18% of athletes, and varies with the sport being played. Sharp groin pain with exertion is also a typical symptom. Pain often occurs exclusively with intense sprinting, kicking, twisting, or "cutting," and subsides rapidly with rest. Significant training and competition time can be lost due to related chronic groin pain.

With core muscle injury you may experience:

Sharp or stabbing pain in the groin region that occurs mainly with running, sprinting, cutting, pivoting, kicking, or twisting.
Pain felt while performing abdominal sit-ups.
Pain that is often isolated to 1 side of the groin.
Pain that radiates into the inner thigh.
Pain isolated to the groin when coughing or sneezing.
Minimal to no pain in the groin when resting, sitting, or sleeping.
Tenderness to touch or pressure on the lower abdominal area.

Note: If you have groin pain that isn’t relieved with rest from activity, you could have other potentially serious medical conditions involving the digestive, urinary, or reproductive systems. Consult your physician.

How Is It Diagnosed?

If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes taking your health history. Your therapist may ask whether you:

Have groin pain that occurs when you are sprinting, twisting, or kicking.
Have had any injuries to your hip, low back, or groin.
Have recently completed any intense abdominal or core strengthening exercises.
Get relief from your groin pain if you rest or don’t participate in your regular sport or exercise routine.
Feel pain in your groin when coughing, sneezing, or "bearing down."
Recall a particular movement or incident when you first felt pain in the area.
Experience groin pain that limits your desired level of sport performance.

Your physical therapist also will conduct standard strength tests of your hip muscles, and tests to measure the flexibility of your hip and thigh muscles. Your physical therapist will assess how well you can isolate or contract certain muscles. A thorough examination of your hip and low back movements may also be performed.

Your physical therapist may use additional tests to investigate for knee joint or lumbar spine injuries.

To provide a definitive diagnosis, your physical therapist may collaborate with a sports medicine physician or other health care provider. The physician may order further tests—such as magnetic resonance imaging (MRI) — to rule out other injuries to your hip, low back, or pelvis, and further confirm the diagnosis of a core muscle injury.

How Can a Physical Therapist Help?

Conservative treatment of core muscle injuries includes rest and physical therapy. Your physical therapist will provide treatments to target the key problems found during the examination. Your therapist will design an individualized treatment program for you that targets your condition and goals, to help you safely return to your sport or normal activity levels.

Some cases of more severe injury may require surgery. Most patients with a core muscle injury are advised to first attempt a conservative course of treatment for 4 to 6 weeks. If groin pain continues to occur after that time, surgery may be recommended. If you decide to have surgery, your therapist can help you regain your strength and flexibility following the procedure.

Treatment Without Surgery

Physical therapy will focus on addressing the key problems that are found during your evaluation. The key issues that are often found with this injury include poor hip strength and flexibility, and a reduced ability to activate or turn the abdominal muscles to stabilize the pelvis.

Targeted physical therapy treatments will address your condition without worsening or reproducing your pain.

Your physical therapist will also caution you to avoid certain activities and exercises that cause groin pain. Ice may also be applied to decrease pain in the area of injury. Your therapist may advise you to:

Avoid aggressive or painful stretching.
Avoid stretching your trunk and upper body.
Avoid doing sit-ups.

Your physical therapy treatment may include:

Icing and compression. During the initial phases of injury or when high levels of pain are being experienced, application of ice to the area may decrease pain levels.
Stretching. Your physical therapist may help you perform hip and low back exercises to gently stretch and strengthen your muscles. Your therapist will educate you on the proper duration and frequency of exercises to improve muscle flexibility and decrease pain.
Muscle retraining. Your physical therapist will teach you to target or activate the abdominal and hip muscles. This is a key part of your treatment; certain muscles may not be "firing" or contracting due to pain and inhibition.
Strengthening. Targeted hip strengthening and nonaggravating core strengthening will be started once you are no longer experiencing pain.
Manual therapy. Hands-on stretching, soft-tissue mobilization, and joint mobilization may be performed by your physical therapist based on your evaluation. Manual (hands-on) therapy may be performed to improve your hip-joint mobility and range of motion, or ease muscle pain and improve flexibility.
Return-to-sport drills. Once you are able to progress without pain during treatment, your physical therapist will add movements specific to your sport or activity into your treatment program. For instance, you may return to running and light sport drills to prepare your body for the stress of full participation in your sport.

Can this Injury or Condition be Prevented?

Core muscle injury is challenging to prevent because of the inherent stress and strain placed on the pelvis and hips during certain sports. That being said, a prevention program should be directed at those at the highest risk—males participating in soccer, hockey, and football. That program includes:

Abdominal and core stabilization exercises
Exercises to strengthen the hip adductor muscle
Exercises to help decrease stress across the pelvis and lower abdominal area, where the sports hernia injury often occurs

6 Exercises to Promote Balance That You Can Do at Home

Thu, 18 Jun 2020 16:19:13 GMT

Falls are common in people over 65 years of age and can result in serious injury, and even death.

According to the Centers for Disease Control and Prevention, 2.5 million older adults are treated in the emergency room for fall injuries each year. The average health care cost per fall is $35,000.

Performing safe home exercises can help strengthen your lower body to promote balance and reduce your overall fall risk, among other health benefits.

Always check with your health care provider before beginning a home exercise program. A physical therapist (PT) will evaluate your balance and recommend appropriate exercises that are tailored to your specific needs and goals and are safe for you to perform at home.

Here are some exercises your PT might recommend:

For safety, position yourself near a countertop or sturdy surface that you can use for support.

1. Standing March

Standing near a sturdy support, begin marching in place slowly for 20-30 seconds. As this becomes easier, your PT may challenge your balance and change up the pace and surface you are marching on: from hardwood to carpet, foam pad, grass, etc.

2. Standing 3-Way Kicks

Standing on 1 leg (with a soft, unlocked knee), slowly raise your other leg out in front of you. Keep your extended leg as straight as possible and return it to the center. Then gently lift the same leg out to the side and back down, and then extend your leg behind your body and back down. Perform as many as you can each way. Your PT may increase the difficulty of this exercise by removing the supporting surface.

3. Sidestepping

Facing a countertop or wall (with your hands on the counter or wall for support as needed), step sideways in 1 direction with your toes pointed straight ahead until you reach the end of the wall or counter. Then, return in the other direction. As this becomes easier, a PT may add in the use of a resistance band at the knees or just above the ankles.

4. 1-Leg Stand

Stand on 1 leg as long as you are able, up to 30 seconds. Remember to remain near a sturdy support surface that you can hold on if needed. Alternate legs and try to do this 3-5 times on each leg. As this becomes easier, challenge yourself by doing other tasks while standing on 1 leg, such as brushing your teeth, talking on the phone, or while doing the dishes. Balance exercises can easily be integrated into your daily routine this way.

5. Sit to Stand and Stand to Sit

Rise out of a chair without using your arms to push up. If this is difficult at first, place a firm pad underneath you on the chair seat to raise you. As you return to a seated position, slowly lower yourself all the way back down and ease into your seat (rather than dropping into the chair). Perform as many times as you are able. This can easily be done while watching TV.

6. Heel-to-Toe Standing or Walking

Place 1 foot directly in front of the other, so the heel of the front foot touches the toe of the back foot. Hold this position for as long as you are able, or up to 30 seconds. As this becomes easier, try taking a few steps in this heel-to-toe format, as if you are walking on a tight rope. Remember to use something to hold on to for safety.

Many factors can contribute to a lack of balance and falling. Older adults, especially those who have experienced dizziness, stumbling, or falls, should obtain a comprehensive evaluation from a PT or another qualified health professional. Some PTs specialize in balance and falls management.

Physical Therapist's Guide to Ulnar Collateral Ligament Injury

Mon, 13 Apr 2020 13:37:58 GMT

Physical Therapist's Guide to Ulnar Collateral Ligament Injury

Ulnar collateral ligament (UCL) injuries generally occur when repetitive stress damages the inside of the elbow, compromising stability. UCL injuries are most common in athletes who play "overhead" sports, such as volleyball and baseball, which require using the arms in an overhead position. These injuries are occurring in greater frequency with the rise of sport specialization. They are often referred to as "Tommy John" injuries, named after the famous baseball pitcher who underwent the first surgery for a UCL injury in 1974. A physical therapist can help improve your arm's strength and range of motion, and your body's overall stability and balance following a UCL injury.

What Are Ulnar Collateral Ligament Injuries?

The ulnar collateral ligament is a band of tissue that connects the inside of your upper arm (humerus) to the inside of your forearm (ulna). This ligament helps to support and stabilize your arm when you perform a motion, such as throwing a ball. A UCL injury may at first cause pain and tightness in the area. However, over time and with repetitive stress or trauma, the UCL can become stretched and even tear. Surgery is not always necessary to heal a UCL injury, but it may be performed if pain persists or the elbow feels unstable upon a return to sport or other activities.

Signs and Symptoms

With a UCL injury, you may experience:

Soreness or tightness along the inside of your elbow
Minor swelling and possible bruising along the inside of your arm
Possible numbness and tingling in your arm
Instability at your elbow joint (a feeling like your elbow might “give out” when you move it through certain motions)
Pain when using your arm in an overhead position (eg, throwing/pitching a ball, swinging a racquet)
Difficulty warming up for a sport, or needing a longer time to warm up
Poorer performance (eg, a decrease in pitching speed)

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes taking your health and activity history. Your physical therapist may ask you questions including:

When and how did this injury occur? (Sudden or gradual?)
How long have you had pain?
Have you had any numbness and tingling in your arm?
Did you feel a "pop" near your elbow when throwing or performing an overhead activity?
Have you experienced any instability (eg, a feeling of your arm “giving out”) when performing an overhead activity?
Have you experienced a decrease in job or sport performance?
What other sports or activities do you participate in?
Have you had to stop playing your sport, or performing your job, because of the injury to your elbow?

Your physical therapist may gently touch the area around your elbow joint to locate the specific area of pain. Your physical therapist may slightly bend your arm while applying pressure along the outside of your elbow joint, or ask you to mimic a throwing motion as the therapist resists against it.

To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic surgeon. The surgeon may order further tests, such as magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA), to confirm the diagnosis and to rule out other possible damage.

How Can a Physical Therapist Help?

Your physical therapist can help improve your arm's strength and range of motion following a UCL injury, and help restore your shoulder and core stability, coordination, and balance. Your therapist also will work with you before and after any necessary surgery, and can help identify other issues that may have contributed to your injury, such as range of motion and strength deficits, or improper throwing mechanics. Your physical therapist will help you:

Boost your healing process. Decreasing stress across the injured area is the best way to promote healing of a UCL injury. Your physical therapist will likely tell you to take some time off from your sport or other activity. Your therapist may educate you on the RICE (rest, ice, compression, elevation) principle and may implement "cross-friction massage" to help the body supply nutrients to the injured ligament.

Strengthen your muscles. After your injury your arm may feel weaker. Strengthening the muscles of your shoulder, upper back, and shoulder blades in addition to those of the forearm will help decrease the stress at the elbow joint. Addressing lower-body balance or any weakness through your hips and trunk also may help decrease stress across your elbow.

Improve your range of motion. After your injury you may notice more difficulty straightening or bending your arm. Your physical therapist will work with you to improve your arm's range of motion, including possibly stretching your shoulder to help decrease stress on your elbow when performing overhead movements.

Correct your movements. While every sport requires different arm positions, certain positions may put an athlete at greater risk for injury to the elbow. Examining and modifying the movements you perform may help you safely return to your sport. Your physical therapist will help design a specific program to allow a gradual full return to activity.

Prepare to return to sport. An important component of preparing for a return to sports after an UCL injury is preparing the arm to properly withstand the stress placed on it during throwing or other overhead motions. Your physical therapist will work with you to establish and implement a progressive program to prepare you for a return to practice and competition.

If Surgery Is Required

If surgery is necessary, your physical therapist may measure your arm strength and range of motion prior to surgery to define a baseline goal to achieve following the procedure.

Immediately following surgery, your arm will likely be placed in a splint, brace, or sling to protect your elbow. Physical therapy will begin within the first week to 10 days following surgery. Your physical therapist will:

Provide appropriate guidance. You will receive an individualized treatment program of gradual rehabilitation that will ensure you heal in the safest and most effective way possible.

Protect the graft/repair site in the early postoperative period. You will be provided a brace that will likely need to be worn for 5 to 6 weeks, depending on your surgeon’s preference. Your physical therapist will show you how to ensure you don’t bend your arm too much or rotate your shoulder too far during this time.
Improve how far you can move your shoulder and elbow. When you are ready, your physical therapist will help you gently bend and straighten your arm through different exercises and stretching techniques. Your therapist also will gently stretch your shoulder to help decrease stress across the elbow.
Improve the strength of your arm. Through a series of exercises, your physical therapist will work with you to improve your arm strength. Your hand grip and forearm strength will likely be the first things you will work on following surgery. As you progress, the exercises will begin to focus more on your shoulder blade and upper back muscles.
Improve muscle strength and coordination. As you begin to heal and progress, your exercises will become more specific to your sport or other activity.

Resuming sport-specific activities. An athlete who has experienced a UCL injury can begin to return to throwing at approximately 6 months after surgery. The return is based on the surgeon and physical therapist providing clearance to do so.

Returning to full competition. An athlete generally can be cleared to return to game competition approximately 12 to 14 months after surgery.

Physical Therapist's Guide to Cuboid Syndrome

Wed, 08 Apr 2020 13:32:08 GMT

Physical Therapist's Guide to Cuboid Syndrome

Cuboid syndrome is a condition caused by a problem with the cuboid bone, producing pain on the outer side, and possibly underside, of the foot. The cuboid bone is part of the calcaneocuboid joint that helps you maintain foot mobility when walking. Problems can develop with the cuboid bone that make it shift and dislodge from its normal position, causing pain and difficulty standing or walking. Cuboid syndrome most often affects athletes and dancers, although anyone can experience it. Age does not seem to play a role in developing the syndrome.

The prevalence of cuboid injuries in the United States is not clear; however, it has been diagnosed in 6.7% of patients with inversion ankle sprains (when the ankle rolls outward and the foot rolls inward). Approximately 4% of athletes who report foot injuries have symptoms from the cuboid bone. Cuboid syndrome is found in about 17% of professional ballet dancers. It can occur from trauma or without any recalled injury. Physical therapists design individualized treatment programs to help people with cuboid syndrome reduce their pain, regain lost strength and movement, and get back to their normal lives.

What Is Cuboid Syndrome?

The cuboid bone is one of the 26 bones of the foot. It is located on the outer side of the foot, about halfway between the pinky toe and the heel bone. The cuboid bone moves and shifts to a small degree during normal foot motion. Certain forceful movements or prolonged positions can cause the cuboid bone to move too far, which interferes with its normal position or motion. This causes immediate foot pain, which can feel worse when standing or walking on the foot.

Cuboid syndrome often occurs suddenly. It may occur with ankle sprains, as the foot rolls in, or when a person stomps the foot hard onto a hard surface, such as concrete, particularly if the person is wearing rigid or high-heeled shoes. Hard landings onto the feet from a jump, or falling from a height onto the feet can also create enough force to affect the cuboid bone’s position and cause a problem.

A cuboid bone injury can develop from maintaining prolonged foot positions, such as standing or walking in high heels, or remaining in a toe-pointed (ballet dancer’s) position, for a long time. Peroneal tendon problems, such as weakness, tendonitis, or tendinopathy, also can contribute to, or occur at the same time as, cuboid syndrome.

The majority of people who suffer cuboid syndrome have flat feet, although the condition can even occur in people with very high arches.

How Does it Feel?

Cuboid syndrome causes sharp pain on the outer side, and possibly underside, of the foot. The pain does not usually spread to the rest of the foot or leg. It often starts quite suddenly and lasts throughout the day. Pain can worsen with standing or walking, and can make walking on the foot impossible. The pain is often completely relieved by taking weight off the foot. When not putting weight on the foot, a person can usually move the foot around freely and with little to no pain. Without treatment, however, the pain during standing and walking can persist for days, weeks, or longer.

Surgery is not usually necessary for treatment of cuboid syndrome. Your physical therapist can help determine if cuboid syndrome is present, and design the correct treatment program for you, based on your particular condition and goals.

Signs and Symptoms

Cuboid syndrome can cause any of the following symptoms:

Sharp pain on the outer side, and possibly underside, of the foot
Increased pain when standing and/or walking
Limping when walking, or an inability to walk on the foot at all
Reduced pain when no weight is put on the foot
Possible mild swelling on the outer side of the foot

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes taking your health history. Your therapist will also ask you detailed questions about your injury, such as:

How and when did the pain start?
What type of discomfort do you feel, and where do you feel it?
What can’t you do right now, in your daily life, work, or sport, due to the pain?

Your physical therapist will perform tests on your body to find physical problems, such as:

Misalignment of the cuboid bone
Weakness or tightness in the muscles of the foot and leg
Joint stiffness
Difficulty standing and/or walking

If your physical therapist finds any of the above problems, physical therapy treatment may begin right away, to help get you on the road to recovery and back to your normal activities.

If more severe problems are suspected or found, your physical therapist may collaborate with a physician to obtain special diagnostic testing, such as an X-ray. Physical therapists work closely with physicians and other health care providers to make certain that you receive an accurate diagnosis and proper treatment.

How Can a Physical Therapist Help?

Cuboid syndrome often responds to treatment quickly.

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but noticeable improvement can be achieved in 1 or 2 clinical visits, with full recovery within a few weeks or less when a proper treatment program is implemented.

During the first 24 to 48 hours following your diagnosis of cuboid syndrome, your physical therapist may advise you to:

Avoid all jumping, hopping, and running activities.
Limit prolonged walking.
Wear flat, stiff-soled shoes.
Stay active around the house, and go on short walks several times per day. Movement will decrease pain and stiffness, and help you feel better.
Apply ice packs to the affected area for 15 to 20 minutes every 2 hours.

Your physical therapist will work with you to:

Reposition the cuboid and stabilize it. Your physical therapist may use their hands (manual therapy) to reposition the cuboid bone back to its normal position, so that it can move more normally. This can potentially relieve most of the pain, and restore the ability to stand and walk. The physical therapist then may use various exercises and techniques to support the cuboid bone’s corrected position. These may include foot exercises, taping of the foot, and advice on footwear and when to return to activity.

Reduce pain and other symptoms. Your physical therapist will help you understand how to avoid or modify the activities that caused the injury, so healing can begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and symptoms. The focus will be placed on physical therapy, icing, and gentle movement to reduce pain without the need for pain medication.

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the foot or in any stiff joints. These might begin with "passive" motions that the physical therapist performs for you to move a joint, and progress to active exercises and stretches that you do yourself. You can perform these motions at home and in your workplace to help hasten healing and pain relief.

Improve flexibility. Your physical therapist will determine if any muscles in the area are tight, start helping you stretch them, and teach you stretching exercises to do at home.

Improve strength. If your physical therapist finds any weak muscles, the therapist will choose, and teach you, the correct exercises to steadily restore your strength and agility. When addressing cuboid syndrome, foot and ankle muscle exercises are commonly taught to strengthen the muscles and tendons around the cuboid bone, arch of the foot, and ankle.

Improve endurance. Restoring muscular endurance is important after an injury. Your physical therapist will develop a program of activities to help you regain the endurance you had before the injury, and improve it.

Learn a home program. Your physical therapist will teach you strengthening, stretching, and pain-reduction exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.

Return to activities. Your physical therapist will discuss your activity levels with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist may teach you how to choose the best footwear, to avoid putting unwanted pressure on the cuboid bone, and to add specialized support such as orthotics.

Once your pain is gone, it will be important for you to continue your foot exercises at home, to help keep your foot healthy and pain free.

In all but the most extreme cases, physical therapist treatment provides excellent results. Surgery and pain medication (such as opioid medication) are not usually needed for this condition.

Can this Injury or Condition be Prevented?

Risk factors for cuboid syndrome include:

Foot bone instability
A sprained ankle
Being overweight
Wearing poorly-fitted or poorly-made shoes or orthotics
Performing extreme or extended exercises
Allowing insufficient recovery time after exercise
Conducting physical training on uneven surfaces
Wearing high heels or rigid heels
Stomping the foot
Landing hard on the feet from a jump

To prevent cuboid syndrome individuals should:

Avoid forceful stomping on hard surfaces, such as concrete or rock, especially when wearing rigid heels or high-heeled shoes.
Limit forceful stomping activities in general.
Perform cool-down and gentle stretching exercises following high-level sport or dance activities.
Limit wearing rigid-heeled or high-heeled shoes when running, dancing, prolonged walking, or simply being active.
Seek advice on proper footwear.
Discuss your occupation with a physical therapist, who can provide an analysis of your job tasks and offer suggestions for reducing your risk of injury.
Keep your muscles strong and flexible. Participate in a consistent program of physical activity to maintain a healthy weight and fitness level.

To prevent recurrence of cuboid syndrome, follow the above advice, and:

Continue the new foot exercises that you learned from your physical therapist to maintain your improvements.
Continue to do any other home exercises your physical therapist taught you to help maintain your improvements.
Continue to be physically active and stay fit.

New Guidelines for Managing Heart Failure with Physical Therapy

Mon, 10 Feb 2020 15:47:40 GMT

Heart failure is a chronic, progressive condition that affects more than 5.7 million adults. It happens when the heart loses its ability to efficiently pump blood to the feet and hands, organs, and skin.

While there is no cure, you can manage heart failure with appropriate medical treatments and lifestyle changes. The American Heart Association recommends that people with heart disease:

Eat a healthy diet.
Stop smoking.
Practice good sleep habits.
Manage stress.
Get the right amount of physical activity and exercise.

Physical activity is essential to preventing and managing heart failure and other chronic diseases. Exercise leads to fewer symptoms, a greater sense of well-being, and increases the heart’s ability to pump blood. It even helps improve mood.

Seeing a physical therapist is key to managing heart failure.

New guidelines say people with a recent heart failure diagnosis should seek care from a physical therapist. A PT will assess your function. They will design a physical activity and exercise plan for your unique needs and goals. They will work with you to achieve the right amount and duration of exercise to reduce your exercise- and activity-related symptoms. In addition to medical management, exercise plays a critical role in stabilizing, slowing, or even reversing the progression of heart failure.

Exercise can be hard and scary for those new to it or who have existing heart disease. Getting help from a physical therapist will ensure that you are monitored for safety when starting your exercise program. Your PT also will provide patient education and help you develop strategies for behavior change.

It takes time and discipline to develop good exercise habits, but the benefits are well worth it. Regular exercise reduces hospital visits, prevents a variety of chronic illnesses, and improves the quality of life for those with heart failure. Working with a physical therapist can help you manage and maximize your heart health for the rest of your life.

What’s the bottom line? Your heart will love exercise. A physical therapist can help.

9 Things Your Physical Therapist Wants You To Know About Aging Well

Mon, 13 Jan 2020 19:38:44 GMT

We can't stop time. But with the right type and amount of physical activity, we can help stave off many age-related health problems and live life to its fullest.

Physical therapists are movement experts who can help you optimize quality of life through prescribed exercise, hands-on care, and patient education.

Here are 9 things physical therapists want you to know to age well:

1. Chronic pain doesn't have to be the boss of you.

According to the Centers for Disease Control and Prevention (CDC), in 2016, an estimated 20.4% (50 million) US adults experienced chronic pain, contributing to indirect medical costs, lost work time, and wages. Physical therapist-supervised exercise, mobility, and pain management treatment plans can ease pain while moving and at rest, improving your overall quality of life.

2. You can get stronger when you're older.

Research shows improvements in strength and physical function are possible in your 60s, 70s, and even 80s and older, with an appropriate exercise program. Progressive resistance training, in which muscles are exercised against resistance that gets more difficult as strength improves, has been shown to prevent frailty.

3. You may not need surgery or medication for low back pain.

Low back pain is often overtreated with surgery and medications despite a wealth of evidence demonstrating physical therapy can be an effective alternative—and with much less risk.

4. You can lower your risk of diabetes with exercise.

Nearly 30 million Americans have diabetes, and only 21 million know they have it. Obesity and physical inactivity can put you at risk for this disease. But a regular appropriate physical activity routine is one of the best ways to prevent, and manage, type 2 diabetes.

5. Exercise can help you avoid falls—and keep your independence.

About 1 in 4 US older adults fall each year. Despite this statistic falling is not a normal part of aging, and you can reduce your risk of falls. A physical therapist can help assess your risk, design an individualized prevention plan to include exercises and balance training, address underlying medical conditions, and more.

6. Your bones want you to exercise.

Osteoporosis or weak bones affects more than half of Americans over the age of 50. Exercises that keep you on your feet like walking, jogging, or dancing, and resistance exercises, such as weightlifting, can improve bone strength or reduce bone loss.

7. Your heart wants you to exercise.

Heart disease is the number 1 cause of death in the US. Exercise is one of the top ways of preventing it and other cardiovascular diseases. Research shows that if you already have heart disease, appropriate exercise can improve your health.

8. Your brain wants you to exercise.

Physically active people—even later in life—are less likely to develop memory problems or Alzheimer's disease, a condition affecting more than 40% of people over the age of 85.

9. You don't "just have to live with" bladder leakage.

More than 13 million women and men in the US have bladder leakage. Don't spend years relying on pads or rushing to the bathroom. Learn more about treatment from a physical therapist.

ChoosePT.com is the official consumer information website of the American Physical Therapy Association (APTA) .

Physical Therapist's Guide to Cubital Tunnel Syndrome

Fri, 20 Dec 2019 18:15:47 GMT

Cubital tunnel syndrome is the second most common nerve compression occurring in the arm. (Carpal tunnel syndrome is the most common.) It is a condition caused by increased pressure on the ulnar nerve at the elbow. This pressure can result in discomfort and pain, and may progress to loss of function of the hand. Cubital tunnel syndrome generally affects men more than women, especially those with jobs that require repetitive elbow movements and a bent elbow position, such as using tools like drills at work, talking on the phone, doing computer work, painting, or playing an instrument. Physical therapists help people with cubital tunnel syndrome reduce pain and swelling and restore normal movement and function to the arm, wrist, and hand.

What is Cubital Tunnel Syndrome?

Cubital tunnel syndrome is caused by compression of the ulnar nerve when it passes under a bony bump (the medial epicondyle) on the inside portion of the elbow. In this area, the nerve is relatively unprotected and can be trapped between the bone and the skin in a tunnel called the cubital tunnel. Although it is not an actual bone, this area is commonly called your “funny bone.” When you hit the funny bone just the right way, you have actually hit the ulnar nerve. This contact sends a sensation of tingling, numbness, burning and/or pain along the inside of your arm and down to the ring and little fingers. When the ulnar nerve is compressed, it causes the same type of symptoms. The ulnar nerve can be pinched at any point along its length, but the most common site of compression is on the cubital tunnel.

Cubital tunnel syndrome often results from prolonged stretching of or pressure on the ulnar nerve. When the arm is bent for a long time, such as when holding the phone, it stretches the ulnar nerve across the inside of the elbow, creating a traction force that decreases the blood flow to the nerve and may cause nerve irritation. Prolonged pressure on the nerve may happen, for example, when the elbow and lower arm lean against a table and the ulnar nerve is pushed over the bone, which may cause the sensation of tingling, numbness, burning and/or pain along the inside of your arm and hand.

Signs and Symptoms

Cubital tunnel syndrome can occur after a traumatic incident, such as an elbow fracture, or develop slowly over time. It usually begins with numbness and/or tingling, or burning on the inside of the forearm extending down into the hand. Typical symptoms include:

Intermittent pain, numbness, and tingling brought on by sustained bending of the elbow
Tenderness on the inside of the elbow where the nerve is close to the surface

Later symptoms sometimes include:

Difficulty gripping and holding on to objects
Muscle wasting of the small muscles of the hand
A hand deformity in which the small and ring fingers bend inward, referred to as an "ulnar claw hand"

CAUTION: More severe symptoms, especially those with muscle wasting and hand deformities, should be evaluated by a physician.

How Is It Diagnosed?

Cubital tunnel syndrome can be diagnosed by a physical therapist or a physician. Your physical therapist will typically perform a comprehensive evaluation that should include assessment of your neck to rule out compression of the nerve where it starts in the neck. To confirm the compression of the ulnar nerve is occurring at the elbow, your physical therapist may use the following tests and examination:

Observation and inspection of the elbow and forearm
Touching and moving the arm in the area of the nerve to determine its relationship to the elbow and its stability in the groove behind the elbow where the nerve travels
Tapping the nerve at the elbow (the Tinel's sign test)
Assessing the flexibility of the ulnar nerve
A sensory examination that includes both light touch, a test of the ability to distinguish between sharp or dull stimulus, and the ability to distinguish 1 point from 2 points (2-point discrimination)
Checking the strength of specific muscles of your hand
Checking your pinching and gripping ability

Cubital tunnel syndrome can be accurately diagnosed clinically without additional testing. Occasionally you may be referred for electrodiagnostic tests called electromyography (EMG) and/or a nerve conduction study (NCS). These tests evaluate the ability of the nerve to conduct signals along its full length. They can help determine the exact site of the compression and estimate the extent of the compression.

If your physical therapist considers your symptoms to be more severe, the therapist may refer you to a physician for an additional assessment.

How Can a Physical Therapist Help?

Many cases of mild to moderate cubital tunnel syndrome can be treated without surgery. Your physical therapist will determine the activities that bring on your symptoms. The recommendations at this point will be to avoid those activities for a time. Remember, the nerve is irritated and at times swollen. If the irritation and swelling can be reduced, the symptoms should resolve.

In more advanced cases, your physical therapist will modify your activity and may recommend you use a splint to take the pressure off the nerve. As your condition begins to improve, your physical therapist may teach you:

Range-of-motion exercises. Your physical therapist will show you specific exercises to help return full length to the muscles of the arm that have shortened due to protective posturing, and to maintain the normal length of those that have remained unaffected.

Muscle strengthening exercises. Improving strength in the surrounding muscles can help reduce pain and improve functional ability.

Nerve gliding exercises. Nerves have the ability to be stretched, just like muscles or joints. Nerve tissue is the strongest, longest tissue in the body and the one most sensitive to stretching. In cubital tunnel syndrome, the nerve can become tight or trapped; these exercises are an effective means of promoting blood flow to the ulnar nerve and gently stretching it.

Ergonomic training. Your physical therapist will teach you ways to avoid positions and postures that compress or put prolonged stretch on the ulnar nerve. You may need to learn how to modify work and self-care activities to prevent further nerve irritation.

If Surgery Is Required

More severe or prolonged cases of cubical tunnel syndrome may require surgery. The longer you have experienced symptoms and the more you experience weakness, numbness, tingling, and pain the more likely you are to need surgery. The goal of surgery is to relieve the pressure on the ulnar nerve.

Your physical therapist will design an individual program of postsurgical physical therapy based on the nature of your operation and the surgeon’s instructions. Each surgery will require a unique treatment regimen, but your postsurgical rehabilitation will involve many of the elements discussed above. Activity modification will be a big part of your postsurgical rehabilitation to prevent recurrence of your symptoms.

Can this Injury or Condition be Prevented?

Little is known about prevention of cubital tunnel syndrome. Often, the syndrome is not diagnosed until symptoms are already present. However, some general precautions may be taken.

Obesity has been linked by some researchers to cubital tunnel syndrome. Healthy lifestyle choices and a reduction in your weight may help prevent its development.
People in occupations that require holding the elbow in a bent position, such as computer programmers, should be encouraged to perform consistent positional changes to take stress off the ulnar nerve.
Diabetes has been recognized as a risk factor.
Knowledge of how to avoid positions and activities that can cause ulnar nerve irritation may help prevent injury. Modifications to daily activities such as avoiding positioning the elbow in a bent position for a prolonged period of time, and not resting the elbow on hard surfaces can help. At work, finding ways to limit repetitive motions and the use of vibratory tools (such as drills) may decrease risk.

Your physical therapist will teach you movement and lifestyle modifications to help prevent recurrence of cubital tunnel syndrome once it has been diagnosed.

3 Ways a Physical Therapist Can Help Manage Headaches

Fri, 13 Dec 2019 15:22:58 GMT

Headaches affect 47% of the global population and are described by the type and location of pain in the head. Many headaches are harmless and resolve gradually. However, more frequent moderate to severe headaches can impact your ability to do daily activities and quality of life.

Different types of headaches include:

Tension
Cervicogenic or neck muscle-related
Migraine
Secondary headaches from an underlying condition, such as fever, infectious disease, sinus disorder, or in rare cases, a tumor or more serious illness
Unspecified headaches

A physical therapist will perform a clinical examination to diagnose the type of headache and develop an effective treatment plan. Physical therapy has been proven to:

Decrease or resolve the intensity, frequency, and duration of headache
Decrease medication use
Improve function and mobility
Improve ease of motion in neck
Improve quality of life

A physical therapist treatment plan may include:

Manual therapy: Proven hands-on techniques are designed to alleviate joint and muscle stiffness, increase mobility of the head and neck, decrease muscle tension and spasms, and improve muscle performance.

Exercise: Research has shown that various types of specific exercises will decrease pain, improve endurance, decrease inflammation, and promote overall healing. In addition to individualized prescribed exercises, customized home-exercise programs are an essential part of the treatment plan.

Education: Educational strategies have been found helpful at lessening severity and/or frequency of headaches. These strategies include identifying highly individualized triggers (ie, dietary, sleep, movement/postural habits, stressors, hydration). Effective strategies to alleviate symptoms also include a wide variety of relaxation techniques.

MoveForwardPT.com, the official consumer Website of the American Physical Therapy Association,© 2017
https://www.moveforwardpt.com/Resources/Detail/3-ways-physical-therapist-can-help-manage-headache

Workplace Wellness

Wed, 04 Dec 2019 15:40:18 GMT

Working at a computer work station all day can take a toll on the body. Repetitive activities and lack of mobility can contribute to aches, pains, and eventual injuries.

Sitting at a desk while using the keyboard for hours on a day to day basis can result in poor circulation to joints and muscles. It can also create an imbalance in strength and flexibility of certain muscles, and muscle strain. These issues can be easily remedied by taking frequent short breaks, or "micro breaks," throughout your day.

Get out of your chair several times a day and move around—even for 30 seconds
Roll your shoulders backwards
Turn your head side to side
Stretch out your forearms and your legs

Additionally, specific guidelines for your work station can help maximize your comfort and safety.

Your chair should have the following:

Wheels (5 for better mobility)
The ability to twist freely on its base
Adjustable height
Adjustable arm rests that will allow you to sit close to your desk
Lumbar support
Seat base that adjusts to a comfortable angle and allows you to sit up straight

The position of the keyboard is critical:

The keyboard should be at a height that allows you to have your forearms slightly below a horizontal line—or your elbows at slightly more than a 90 degree angle.
You should be able to slide your knees under the keyboard tray or desk.
Avoid reaching for the keyboard by extending your arms or raising your shoulders.
Try to avoid having the keyboard on top of your desk. That is too high for almost everyone—unless you can raise your seat. The elbow angle is the best test of keyboard position.

The position of your computer monitor is important:

The monitor should be directly in front of you.
The top of the monitor should be at your eye level, and at a distance where you can see it clearly without squinting, or leaning forward or backward.
If you need glasses for reading, you may need to have a special pair for use at your computer to avoid tipping your head backward to see through bi-focals or other types of reading glasses.

How can a physical therapist help?

Many physical therapists are experts at modifying work stations to increase efficiency and prevent or relieve pain. Additionally, if you are experiencing pain that isn't relieved by modifications to your work station, you should see a physical therapist who can help develop a treatment plan to relieve your pain and improve your mobility.

10 Ways Exercise Helps During Cancer Treatment

Fri, 11 Oct 2019 19:50:05 GMT

Exercise provides short- and long-term benefits for people undergoing cancer treatment.

Physical therapists can design safe exercise plans to help people remain physically active.

Exercise during cancer treatment can:

1. Reduce fatigue

Exercise helps boost energy and endurance during cancer treatment.

2. Maintain muscle strength

Safe exercise can help keep your muscles strong.

3. Reduce stress

Exercising during cancer treatment can help ward off anxiety, fear, and depression.

4. Prevent or reduce lymphedema and swelling

Special physical therapy treatments address lymphedema and swelling.

5. Reduce pain

Safe and comfortable exercise is proven to be effective in reducing pain.

6. Prevent and reduce weight gain

Staying physically active can help you maintain a healthy weight.

7. Reduce brain fog

Exercise has an immediate and long-lasting effect in reducing brain fog.

8. Reduce bone density loss

Certain exercises done while standing and moving can stimulate your bones to stay healthy and strong, helping to avoid fractures.

9. Improve the survival rate

Research studies have suggested that consistent exercise during cancer treatment may have beneficial effects that improve the outcome of that treatment.

10. Assist athletes to continue sports training

Athletes undergoing cancer treatment may not have to give up their sport. A physical therapist can help design a special exercise plan that includes an athlete’s chosen sport, a modified version, or aspects of it.

For more information and resources, visit our health center about physical therapy for cancer-related problems.

Authored by Andrea Avruskin, PT, DPT

ChoosePT.com is the official consumer information website of the American Physical Therapy Association (APTA) .

Recognizing Signs of a Concussion

Mon, 07 Oct 2019 17:41:46 GMT

A concussion is a mild traumatic brain injury caused by a direct blow to the head, face, or neck. In the United States, an estimated 300,000 sports-related concussions occur annually.

In high school gender-comparable sports, girls have a higher concussion rate than boys. Female athletes have also been shown to have a greater recovery time in postconcussion symptoms as compared to males.

Signs of a Concussion

Concussion symptoms usually appear within minutes of the injury, but some symptoms may take several hours to occur. Any athlete who has lost consciousness during a sports-related impact should be examined for a concussion or a spine injury.

A headache is the most common complaint of an athlete with a concussion. If you suspect your child has suffered a concussion, they may exhibit the following symptoms, which may worsen with stress or activity:

Loss of consciousness
Headache
Feeling in a “fog”
Difficulty remembering
Behavioral changes (irritability, rapid changes in mood, exaggerated emotions, aggressiveness, depression, decreased tolerance to stress, etc)
Nausea/vomiting
Difficulty with balance
Pupils that are enlarged or not equal in size
Double or blurred vision
Slurred speech
Difficulty falling asleep
Excessive drowsiness

What to do if you suspect a concussion in an athlete:

Do not allow them to return to any sporting event.
The athlete should be allowed to rest until there is a resolution of symptoms. This allows the brain to recover. Rest involves allowing time to sleep or take frequent naps. Minimizing distractions, such as television, Internet, reading, or phone use is important.
It is unnecessary to wake the athlete up every hour. This disturbs sleep patterns, which can interfere with the healing process of the brain.
The athlete should avoid pain relievers, like aspirin or other anti-inflammatory medications. These may increase the risk of bleeding in the brain.
The athlete should not be left alone following the injury. Symptoms should be monitored closely. If they worsen, the athlete may need to be evaluated in the emergency room to determine if a more serious brain injury exists.

3 Tips for Backpack Safety

Wed, 11 Sep 2019 18:47:51 GMT

Children—or anyone—should follow these simple tips when wearing a backpack.

1. Wear both straps.

Use of one strap causes one side of the body to bear the weight of the backpack. By wearing two shoulder straps, the weight of the backpack is better distributed across the shoulders.

2. Wear the backpack over the strongest mid-back muscles.

Pay close attention to the way the backpack is positioned on the back. It should rest evenly in the middle of the back. Shoulder straps should be adjusted to allow the child to put on and take off the backpack without difficulty and allow free movement of the arms. Straps should not be too loose, and the backpack should not extend below the low back.

3. Lighten the load

Keep the load at 10-15% or less of the child's body weight. Carry only those items that are required for the day or find a new lightweight backpack. Organize the contents of the backpack by placing the heaviest items closest to the back. Some students have two sets of books so as not to have to carry the heavy books to and from school. A backpack with wheels can also help if the child has to carry greater than 15% of their body weight.

How a Physical Therapist Can Help

A physical therapist can help you choose a proper backpack and fit it specifically to your child. Children come in all shapes and sizes, and some have physical limitations that require special adaptations.

Additionally, a physical therapist can help improve posture problems, correct muscle imbalances, and treat pain that can result from improper backpack use. Physical therapists can also design individualized fitness programs to help children get strong and stay strong—and carry their own loads!

Physical Therapist's Guide to Clavicle Fracture

Mon, 12 Aug 2019 17:57:53 GMT

Physical Therapist's Guide to Clavicle Fracture

The clavicle, or collarbone, connects the arm to the body, helping to stabilize the shoulder and arm as they move. Clavicle fracture is a common shoulder injury, making up 4% of all fracture types and 35% of all shoulder injuries. The injury is most often caused by trauma, such as a direct blow to the shoulder or a fall, and is most often diagnosed in people under the age of 20. It is seen most often in young men, as a result of sports injuries. As people age, it is more likely to occur with a fall. It also becomes more common for women to fracture their collarbones with age, and less likely for men.

Most clavicle fractures are treated without surgery, but more complex fractures may require surgery. In either case, a physical therapist can help promote healing and a safe return to normal activity by providing pain management, guided exercise, and functional training.

What is Clavical Fracture?

The clavicle (collarbone) is found on the front of the shoulder and connects the arm to the body by a joint at the sternum, or breast bone (the sterno-clavicular joint), and by a joint at the scapula, or shoulder blade (the acromio-clavicular joint). The clavicle helps stabilize the shoulder during movement, and helps to protect nerves and blood vessels underneath the shoulder.

Clavicle fractures are classified according to the place where the bone is broken. The 3 classifications are:

Midshaft (middle of the bone)

75% to 80% of all clavicle fractures
Usually occurs in younger persons

Lateral-end (near the acromio-clavicular joint)

15% to 25% of all clavicle fractures

Medial-end (near the sterno-clavicular joint)

Rare; 5% of all clavicle fractures

Fractures are classified as:

Nondisplaced. The pieces of the fractured bone remain lined up.
Displaced. The 2 parts of the fractured bone do not line up.
Comminuted . Splinters or multiple small pieces of bone are found at the fracture site. Sometimes the fracture fragments can pierce the skin, causing a compound fracture .

How Does it Feel?

If you break your clavicle (collarbone), you will experience pain in the area of the break. You may see purple bruising in the area that may spread to the shoulder and arm. Swelling will occur at the injury site, and in the arm. You may see a bump in the area of the break from the bone lifting the skin, like a tent. It is common to feel movement of the bone as it shifts. It will feel tender to touch, and most people with this injury will not be able to lift their arm. They will hold their arm close in to the body, and support the arm with the other hand.

Signs and Symptoms

Pain is usually felt in the area of the clavicle. Arm pain or changes in sensation may occur in more severe cases.
Bruising.
Swelling.
Inability to lift the arm.
Grinding sensation with movement.
A bump at the injured area.

How Can a Physical Therapist Help?

Most clavicle fractures are treated without surgery. The involved arm will be placed in a sling or a figure-8 brace to secure it and support its weight for comfort. Physical therapy usually begins early to help reduce pain and swelling. When you can tolerate movement of the arm, your physical therapist will prescribe gentle exercises of the involved shoulder and elbow to prevent stiffness, and to help you begin to recover full movement.

As healing progresses, pain and swelling gradually resolve. When your physician sees adequate healing your physician will ask your physical therapist to help guide you towards reducing the use of your brace. Also under the guidance of your physical therapist, your exercises will be gradually progressed to a more active level to prevent weakness and stiffness, and regain full movement.

After 6 to 8 weeks, or when the bone shows adequate healing, more strenuous strengthening exercises will begin. Your physical therapist will design a return-to-activity training program for you, specific to your activities of daily living, work, and sport.

Healing times vary among individuals due to differences in age, health, and the complexity of the injury. Most patients return to nonstrenuous daily activity after about 6 weeks, and strenuous job duties after 9 to 12 weeks.

Following Surgery

Physical therapy rehabilitation after surgery is similar to that provided for nonsurgical cases, but progression of the program will follow a strict schedule set by the surgeon. Physical therapy typically begins immediately following the operation, and continues for 8 to 12 weeks.

The first week after surgery, your physical therapist will help you control pain and swelling, and may begin some gentle motion exercises. You will be wearing a sling or brace for support and comfort. Over the next few weeks, your physical therapist will help you gradually increase your exercise program.

After 4 weeks, if x-rays show good position and stability, your physical therapist will guide you to achieve a full range of motion of your shoulder. At 6 to 8 weeks, if x-rays show adequate healing, treatment will progress to include strengthening and resistance exercises.

These time frames will vary among individuals based on differences in age, health, the complexity of the injury, and the surgical procedure.

How Can a Physical Therapist Help Before & After Surgery?

Not all clavicle fractures can be prevented. However, you can reduce your risk of injury by wearing appropriate protective gear when participating in sports, such as shoulder pads for football. You can also reduce your risk by avoiding falls. To reduce your fall risk, it is important to maintain strength and fitness throughout your life

Physical Therapist's Guide to Calf Strain

Mon, 22 Jul 2019 15:12:22 GMT

Physical Therapist's Guide to Calf Strain

A calf strain is an injury to the muscles in the calf area (the back of the lower leg below the knee). The calf muscle is actually composed of up to 9 separate muscles, any of which can be injured individually or together. Calf strains can occur during hi-speed motions like running and jumping, or from any type of forceful or uncoordinated movement. Calf strains are a well-known problem for runners, soccer and basketball players, gymnasts, and dancers. Although global statistics are sparse, one 8-year study of professional soccer players revealed a 13% calf-strain injury rate. Advancing age can increase the vulnerability of the calf to injury and strain with less forceful movements. Physical therapists treat individuals with calf strains by reducing pain, restoring muscle strength and flexibility, and increasing their recovery speed.

What is a Calf Strain?

The “calf muscle” consists of 9 different muscles. The gastrocnemius, soleus, and plantaris muscles attach onto the heel bone, and work together to produce the downward motion of the foot. The other 6 muscles cause knee, toe, and foot movements in different directions; these muscles are the popliteus, flexor digitorum longus, flexor hallucis longus, tibialis posterior, and the fibularis (or peroneal) longus and brevis. They extend from the lower leg bones around the sides of the ankle and attach to various parts of the foot and toes. Injuries to these 6 muscles are sometimes wrongly attributed to the first 3 muscles mentioned here, as the pain is felt in similar areas of the calf.

A calf strain is caused by overstretching or tearing any of the 9 muscles of the calf. Calf strains can occur suddenly or slowly over time, and activities, such as walking, climbing stairs, or running can be painful, difficult, or impossible.

A muscle strain is graded according to the amount of muscle damage that has occurred:

Grade 1. A mild or partial stretch or tearing of a few muscle fibers. The muscle is tender and painful, but maintains its normal strength. Use of the leg is not impaired, and walking is normal.
Grade 2. A moderate stretch or tearing of a greater percentage of the muscle fibers. A snapping or pulling sensation may occur at the time of the injury and after the injury. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. Use of the leg is visibly impaired, and limping when walking is common.
Grade 3. A severe tear of the muscle fibers, sometimes a complete muscle tear. A “popping” sound may be heard or felt when the injury occurs. Bruising is apparent, and sometimes a “dent” in the muscle where it is torn is visible beneath the skin. Use of the leg is extremely difficult, and putting weight on the leg is very painful.

When muscles are strained or torn, muscle fibers and other cells are disrupted and bleeding occurs, which causes bruising. Within a few hours of the injury, swelling can occur, causing the injured area to expand and feel tight and stiff.

After a severe calf strain, bruising may also be seen around the ankle or foot, as gravity pulls the escaped blood toward the lower part of the leg.

How Does it Feel?

If you strain your calf muscles, you may feel:

Sharp pain or weakness in the back of the lower leg. The pain can quickly resolve, or can persist.
A throbbing pain at rest with sharp stabs of pain occurring when you try to stand or walk.
A feeling of tightness or weakness in the calf area.
Spasms (a gripping or severe tightening feeling in the calf muscle).
Sharp pain in the back of the lower leg, when trying to stretch or move the ankle or knee.
A “pop” or hear a “pop” sound at the time of injury (with a Grade 3 calf strain).

Signs and Symptoms

With a calf strain, you may experience:

A snap or pull felt or heard at the time of injury (with a Grade 1 and 2 calf strain). A "pop" may be felt or heard at the time of injury of a Grade 3 calf strain.
Pain and weakness in the calf area.
Swelling in the area.
Tightness in the area.
Bruising.
Weakness in the calf when trying to walk, climb stairs, or stand.
Limping when walking.
Difficulty performing daily activities that require standing and walking.
An inability to run or jump on the affected leg.

How Is It Diagnosed?

If you see your physical therapist first, your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will ask you:

What were you doing when you first felt pain?
Where did you feel the pain?
Did you hear or feel a "pop" when it occurred?
Did you receive a direct hit to your calf area?
Did you see severe swelling in the first 2 to 3 hours following the injury?
Do you feel pain when moving your ankle or knee, standing, or walking?

Your physical therapist will perform special tests to help determine whether you have a calf strain, such as:

Watch how you walk, and see if you can bear weight on the injured leg.
Test the different calf muscles for weakness.
Look for swelling or bruising.
Gently feel parts of the muscle to determine the specific location of the injury (palpation).

Your physical therapist may use additional tests to assess possible damage to specific muscles of the lower leg.

In certain cases, your physical therapist may collaborate with an orthopedist or other health care provider. The orthopedist may order further tests, such as an x-ray or magnetic resonance imaging (MRI), to confirm the diagnosis and to rule out other potential damage. These tests, however, are not commonly required for a calf strain.

How Can a Physical Therapist Help?

Your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments that you can do at home to help you return to your normal lifestyle and activities.

The First 24 to 48 Hours

Your physical therapist may advise you to:

Rest the area by avoiding walking or any activity that causes pain. Crutches or a brace may be recommended to reduce further strain on the muscles when walking.
Apply ice packs to the area for 15 to 20 minutes every 2 hours.
Compress the area with an elastic bandage wrap.
Insert heel lift pads into both of your shoes.
Consult with another health care provider for further services, such as medication or diagnostic tests.

Treatment Plan

Your physical therapist will provide treatments to:

Reduce Pain. Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electricity, taping, exercises, heel lifts, and hands-on therapy, such as massage.

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the knee and ankle. These might begin with "passive" motions that the physical therapist performs for you to gently move your knee and ankle, and progress to active exercises and stretches that you perform yourself to increase muscle flexibility.

Improve Strength. Certain exercises will benefit healing at each stage of recovery; your physical therapist will choose the appropriate exercises, and teach you how to safely and steadily restore your strength and agility. These may include using cuff weights, stretchy bands, weight-lifting equipment, and cardio exercise equipment, such as treadmills or stationary bicycles.

Speed Recovery Time. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

Return to Activities. Your physical therapist will collaborate with you to decide on your recovery goals, including your return to work or sport, and will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will apply hands-on therapy, such as massage, and teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Prevent Future Reinjury. Your physical therapist can recommend a home-exercise program to strengthen and stretch the muscles around your ankle and knee to help prevent future reinjury of your calf. These may include strength and flexibility exercises for the calf, toe, knee, and ankle muscles.

If Surgery Is Necessary

Surgery is rarely necessary in the case of calf strain, but if a calf muscle fully tears and requires surgical repair, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the safest and speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

Calf strains can be prevented by:

Increasing the intensity of any activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
Always warming up before starting a sport or heavy physical activity.
Following a consistent strength and flexibility/stretching exercise program to maintain good physical conditioning, even in a sport's off-season.
Wearing shoes that are in good condition and fit well.

Physical Therapist's Guide to Hyperkyphosis

Mon, 15 Jul 2019 19:34:12 GMT

Hyperkyphosis is a spinal deformity causing a forward-curved posture of the upper back (thoracic spine). Posture is the characteristic way you position your body; posture changes many times throughout the day due to a variety of factors, including what you are doing and how long you have been doing it. Sometimes, however, a person's posture can cause the thoracic curvature to become excessive and stiff, making it difficult to change. Such is the case with hyperkyphosis (sometimes called “humpback,” “round back,” or “dowager’s hump”). This condition can affect people of all ages, but the thoracic curvature most often begins to increase in people over 40 and continues with advancing age. It is believed that 20% to 40% of older adults—both men and women—will develop hyperkyphosis

What is Hyperkyphosis?

Hyperkyphosis is a spinal deformity that occurs when the natural forward-curving shape of the upper back becomes excessive. It results in the appearance of rounded shoulders with the head and neck positioned forward of the trunk. People with this condition often have difficulty standing up straight. The worsening of the curvature is associated with a higher risk of health problems, including back and neck pain, breathing difficulties, and falls.

Hyperkyphosis can result from conditions such as osteoporosis or thinning bones, and fractures of the vertebrae that result from osteoporosis or Scheuermann's disease. However, research has found that two-thirds of people with hyperkyphosis do not have spinal fractures. Suspected causes for development of this spinal deformity when vertebral (spinal) fractures are not present are:

Poor habitual posture
Muscle weakness
Degenerative disc disease
Ligament degeneration
Hereditary factors

Signs and Symptoms

The most prominent symptom of hyperkyphosis you might notice is the appearance of a rounded back.

You may not immediately recognize a change in your back posture because in most cases, the change is gradual over time. Friends and family may notice it before you do.
Other subtle signs can include changes in the way your shirts fit, feeling like it takes a lot of effort to stand or sit up straight, and feeling more fatigued with walking and other activities.

CAUTION: If you notice a sudden increase in the curvature of your back, call your doctor. A sudden change in the curve of the spine can be associated with other health problems.

Untreated hyperkyphosis can cause:

Difficulty in the performance of normal tasks such as bathing, getting out of a chair, bending, or walking
Decreased flexibility and strength of the trunk muscles
Associated changes in alignment that result in a change of the body’s center of gravity and increase the energy expenditure necessary to complete common tasks
Balance changes due to the shift in the center of gravity that can increase the risk of falls and related injury
Upper back pain
Spinal fractures as the condition advances

If you have advanced hyperkyphosis, you may experience:

Difficulty breathing even though you do not have a history of lung or heart disease
A lessening of the distance between your lowest ribs and your pelvic bones; in this case, pulmonary function tests may be prescribed to measure whether your hyperkyphosis is restricting your breathing

How Is It Diagnosed?

Hyperkyphosis will be assessed first with a visual inspection of your back. Your spinal curve may be measured using a flexible ruler or X-ray. If an X-ray is taken, a radiologist will measure the spinal angles on the X-ray. If a curve measures greater than 40°, hyperkyphosis is diagnosed.

Sometimes spinal changes occur because of fractures due to thinning bones or a condition called osteoporosis. Spinal changes also can result from degenerative disc disease or arthritis. These problems are commonly associated with aging. Other problems not associated with aging could also cause a sudden change in posture; however, problems such as a tumor, infection, or neurologic changes are uncommon. Your physician may prescribe imaging tests such as X-rays or an MRI of the thoracic spine to determine whether you have any of these less common conditions affecting your posture.

If you have advanced hyperkyphosis, you may experience difficulty breathing even though you do not have a history of lung or heart disease. You may also notice that there is lessening of the distance between your lowest ribs and your pelvic bones. In this case, pulmonary function tests may be prescribed to measure whether your hyperkyphosis is restricting your breathing.

How Can a Physical Therapist Help?

A physical therapist can help rehabilitate the postural changes and functional limitations associated with hyperkyphosis.

Your physical therapist will begin by reviewing your past and present medical history with you as well as what medications you normally take. If you report a sudden change in your posture, severe pain, or a significant change in your physical function, you will be referred to your primary care physician. A sudden increase in the rounding of your back may indicate a more serious health problem.

When a more serious problem is ruled out, your physical therapist will perform special tests to assess your unique condition. Your physical therapist will begin by observing, measuring, and recording your postural alignment, trunk strength, range of motion, and flexibility in movement. If you are experiencing difficulty walking or keeping your balance, your physical therapist will observe your movement and perform tests to determine the level of difficulty, and whether you have an increased risk of falling.

Your physical therapist will design a treatment program to address your specific needs and goals. Your treatment may include:

Postural alignment training , stretching, and strengthening exercises to help reduce the spinal curvature, decrease pain, and prevent the condition from advancing. Adherence to the prescribed program in the clinic as well as at home is essential for success. Most often, altering the way you sit, stand, and complete your daily activities has the greatest impact on lessening or slowing the progression of the curve.
Balance exercises and walking (gait) training to increase your tolerance of activity and improve your safety by reducing your risk of falls.
Education to improve your activities of daily living and ease your physical functioning. Your physical therapist can teach you how to safely get in and out of bed, in and out of the bathtub, or out of a chair, and how to bend and walk with more ease.
Breathing exercises to help improve your tolerance for physical activity by increasing your lung capacity.
Myofascial/soft tissue manual therapy (hands-on massage techniques), and in some cases joint mobilization (gentle movements guided by your physical therapist) to help improve spinal flexibility.
Specialized braces or therapeutic taping to help reduce the angle of the curve.
Pain management using modalities such as heat, ice, and/or electrical stimulation such as transcutaneous electrical nerve stimulation (TENS). Your physical therapist will choose what modality will be most beneficial to you—and help reduce the need for pain medication, such as opioids.

Remember, all cases of hyperkyphosis are different. Your physical therapist will choose the best treatment options for you based on your specific condition.

Can this Injury or Condition be Prevented?

Research has not shown that hyperkyphosis can be prevented. However, it has shown that maintaining and improving posture and physical fitness can reduce hyperkyphosis and prevent it from worsening with the normal aging process.

Protecting your spine in daily activity may also be important in preventing progression or worsening of hyperkyphosis. Your physical therapist may advise you to:

Avoid bending too far from the waist or twisting your trunk too far.
Avoid carrying heavy objects.
Keep your posture upright when you cough or sneeze: don’t bend forward.
Avoid exercises that involve a lot of bending forward such as toe-touches, sit-ups, or crunches.
Change how you get in and out of bed. By rolling to your side when you get up, you can help to lessen hyperkyphosis progression.
Make changes to your environment to help support your posture, such as using a back cushion and a supportive chair when sitting. Talk to your physical therapist about specific recommendations for your needs.
Maintain bone health to prevent thinning bones. It is well known that weight-bearing exercises and getting enough calcium and vitamin D are important for strong bones. Some people may be prescribed other medications for bone health. Talk with your doctor and physical therapist to find solutions for your particular needs.

Soreness vs Pain: What's the Difference?

Wed, 10 Jul 2019 19:42:06 GMT

There are many benefits to exercise, including the potential for improved physical and mental wellbeing. However, there may also be some physical discomfort associated with these activities due to the stresses placed on the body.

When experiencing discomfort, it is important to understand the difference between exercise-related muscular soreness and pain. Muscular soreness is a healthy and expected result of exercise. Pain may be indicative of injury.

But pain is personal, and the degree of injury does not always equal the degree of pain. Also, different people have a different pain tolerance. Understanding pain is helpful to managing pain.

Individual Activity Threshold

In order to make physical improvements, your body needs to be pushed to an appropriate level where gains can occur.

Each person's body has a different activity threshold dependent upon many factors, including age, baseline strength, and participation level. Remaining on the safe side of your threshold will result in muscular soreness. Exceeding your threshold will result in pain.

One of the expected outcomes of exercise, when done appropriately, is that this threshold will progressively increase. For example, when an individual begins running, their safe threshold may be 5 minutes of running. After several weeks of progressive increases in duration, this runner's threshold may increase to 20-30 minutes.

To maximize your exercise gains and minimize injury risk, it is important to be realistic about your activity threshold and to be able to differentiate between moderate muscle soreness and pain.

Soreness vs. Pain: How To Tell the Difference

The chart below highlights key differences between muscle soreness and pain.

	Muscle Soreness	Pain
Type of discomfort:	Tender when touching muscles, tired or burning feeling while exercising, minimal dull, tight and achy feeling at rest	Ache, sharp pain at rest or when exercising
Onset:	During exercise or 24-72 hours after activity	During exercise or within 24 hours of activity
Duration:	2-3 days	May linger if not addressed
Location:	Muscles	Muscles or joints
Improves with:	Stretching, following movement, and/or more movement, with appropriate rest and recovery	Ice, rest, and more movement, except in cases of significant injury
Worsens with:	Sitting still	Continued activity after appropriate rest and recovery
Appropriate action:	Get moving again, after appropriate rest and recovery, but consider a different activity before resuming the activity that led to soreness	Consult with medical professional if pain is extreme or lasts >1-2 weeks

Muscle Soreness

After activity, muscular soreness typically peaks 24-72 hours after activity. This is the result of small, safe damage to muscle fibers and is called Delayed Onset Muscular Soreness (DOMS). During this time, your muscles may be tender to touch and feel tight and achy. Movement may initially be uncomfortable but moving and gently stretching your muscles will help to decrease soreness. During the few day period that you experiencing muscular soreness, you might consider performing alternate exercise activities in order to give your sore muscles an opportunity to recover while strengthening other muscles.

Pain

In contrast to muscular soreness, you may experience pain during or after performing exercise. This may feel sharp. This pain may linger without fully going away, perhaps even after a period of rest. This may be indicative of an injury. Pushing through injury can worsen the problem. If you feel that your pain is extreme or is not resolving after 7-10 days you should consult with a medical professional.

How a Physical Therapist Can Help

A physical therapist can be a valuable resource to you throughout your exercise journey. Before beginning an exercise routine, your physical therapist can perform a variety of pre-activity assessments to determine your readiness for exercise. Based on this, your physical therapist may also recommend specific exercises that will best prepare you for your desired activities. They will also discuss the best strategies for introducing and progressing exercise activities while minimizing your chance of becoming injured.

In the unfortunate situation when exercise leads to an injury, your physical therapist will assist in your recovery in many ways. They will help with initial pain management, identify and address all factors that may have contributed to your injury to prevent further problems and provide specific recommendations regarding reintegration into exercise as appropriate.

Physical therapists treat chronic pain through movement, hands-on care, and patient education. The CDC recommends safer alternatives like physical therapy before using opioids to manage pain. Learn more.

Avoid Chronic Disease With Regular Physical Activity

Thu, 27 Jun 2019 14:18:23 GMT

Most Americans don’t move enough despite proven benefits, such as reduced risk of cancer and chronic diseases, and improved bone health, cognitive function, weight control, and overall quality of life.

The second edition of the Physical Activity Guidelines for Americans , reports that approximately 80% of US adults and adolescents are insufficiently active. As a result, many Americans currently have or are likely to experience chronic diseases, including heart disease, diabetes , obesity , and depression.

The good news is that regular physical activity can prevent and improve many chronic conditions. America, it's time to get moving!

How Much Physical Activity Should I Do?

According to the guidelines, the following is recommended:

Preschool-aged children (ages 3 through 5 years) should be physically active at least for 3 hours, if not more. Adult caregivers should encourage active play that includes a variety of activity types and limits sitting-around time, such as screen time.
Children and adolescents (ages 6 through 17 years) need at least 60 minutes or more of activity a day. This includes activities to strengthen bones, build muscles, and get the heart beating faster.
Adults should do at least 150 minutes of moderate-intensity aerobic activity a week, and at least 2 days for muscle-strengthening activities. Adding more time provides further benefits.
Older adults (ages 65 and older) should do at least 150 minutes of aerobic activity a week and include muscle-strengthening activities 2 days a week. You should also add components, such as balance training as well. If you have limitations due to preexisting conditions, consult with a health care provider and be as physically active as your abilities allow.
Pregnant and postpartum women who were physically active before pregnancy can continue these activities during pregnancy and in the postpartum period, but they should consult their health care provider about any necessary adjustments.
Adults with chronic health conditions and disabilities, who are able, should do at least 150 minutes of moderate-intensity activity a week. You should consult with a health care provider about the types and amounts that are appropriate for you.

How a Physical Therapist Can Help

Physical therapists are movement experts who optimize quality of life through prescribed exercise, hands-on care, and patient education.

After making a diagnosis, physical therapists create personalized treatment plans that help their patients improve mobility, manage pain and other chronic conditions, recover from injury, and prevent future injury and chronic disease.

Physical therapists empower people to be active participants in their own treatment, and they work collaboratively with other health professionals to ensure patients receive comprehensive care.

Physical Therapist's Guide to Bunion (Hallux Valgus)

Tue, 25 Jun 2019 20:15:29 GMT

Physical Therapist's Guide to Bunion (Hallux Valgus)

A bunion (hallux valgus) is a large bump on the side of the foot that develops at the base of the big toe. It is common for a bunion to become inflamed and swollen, causing foot pain. Although anyone can develop a bunion, the condition most often occurs in women and older adults. Over time, the joint may enlarge and become stiff and painful, causing problems with shoe fit, pain, and difficulty walking. Physical therapists help people with bunions improve the angle of the big toe, improve their muscle strength and walking ability, and reduce their pain.

What is a Bunion?

A bunion is a bump on the side of the foot that develops at the base of the big toe when the toe deviates inward. A bunion is classified as mild, moderate, large, or severe, depending on the size of the measured angle at the toe. An angle of 20° or greater is considered abnormal.

There are several factors that may cause bunions, including:

Heredity
How the foot is shaped
Flat arches
Joint laxity (too much flexibility in the joint at the base of the big toe)
Osteoarthritis

Tight footwear has often been blamed for bunions, but recent research suggests that footwear may not be a factor in their development. However, tight footwear can irritate a bunion by rubbing on the tissue at the joint, creating more swelling and pain.

How Does it Feel?

How a bunion feels varies with each individual. There is no relationship between the severity of a bunion and the symptoms experienced. Not all bunions cause symptoms; however, people with bunions report mild to severe symptoms, including:

Pain and swelling in the big toe joint that worsens with standing and walking.
Gradual enlargement of the bump on the side of the foot, which can become inflamed and swollen causing foot pain.
Pain when wearing shoes, making it difficult to find comfortable or stylish footwear.
Changes in how you walk.
Increased difficulty walking.
Changes in balance, increasing the risk of falling, particularly in older adults.
Crossing of the big toe and lesser toes, causing crowding of the toes, and possibly causing additional deformities and pain.
Reduced quality of life related to foot pain.

Signs and Symptoms

If you see your physical therapist first, the physical therapist will ask about your medical history, how your symptoms developed, and how they are currently affecting you. Your physical therapist will observe your walking pattern, particularly how you bear weight on the affected foot, and examine the foot and the big toe to observe any swelling, deformity, or tenderness. Your physical therapist will test the strength of your foot and big toe, and measure your foot's flexibility and range of motion, and will check your footwear for proper fit, and for wear patterns. If your bunion is classified as severe, your physical therapist may recommend a consultation with an orthopedic foot surgeon.

How Can a Physical Therapist Help?

Your physical therapist will treat your bunion symptoms with pain management, exercise, gait training, and education regarding proper footwear and self-care for symptom management. The goal of physical therapy treatment is to improve the angle of the big toe, improve muscle strength, and reduce pain.

Your physical therapy treatments may include:

Manual Therapy. Your physical therapist may use manual (hands-on) therapy to help improve the position of the big toe Your physical therapist will gently move your big toe and ankle to reduce joint tightness and any stiffness of the surrounding tissues, and increase the big toe's bending range of motion.

Exercise. You will be taught range-of-motion, stretching, and strengthening exercises to improve the alignment of the big toe when standing, and improve your walking pattern. Your physical therapist will design an individualized exercise program based on your specific needs.

Balance Training. To help reduce the risk of falling, your physical therapist will teach you standing and walking exercises to improve your balance during movement.

Symptom Management. You will learn how to use intermittent foot elevation, self-massage, and ice or heat packs to manage any inflammation/swelling and pain.

Your physical therapist may also apply specialized taping of the big toe to improve the big toe's alignment, and reduce pain. Your physical therapist will recommend the best footwear for your condition.

Orthotics and Devices. Your physical therapist may recommend the use of splints, foot orthotics, or assistive devices, depending on your condition, and will train you in their use. They may include:

Splints and toe separators to reduce pain and pressure on the big toe.
Custom arch supports (foot orthotics) to help keep the foot and ankle in a midline position during walking.
A cane, walker, or crutches (assistive devices) to reduce pain and improve walking ability.

Activity Training. As you regain strength and flexibility, your physical therapist will provide activity training specific to your job, leisure activity, or sport.

After Surgery

If your bunion deformity progresses to a point where you cannot find comfortable footwear, or walking becomes difficult, you may choose surgery to correct the position of the big toe. A physical therapist can help after your surgery to restore the strength and flexibility of the big toe, reduce pain, and improve your walking ability.

Rehabilitation varies with each individual, based on their condition and the type of surgical procedure performed.

After most surgeries, you will wear a special postoperative shoe to protect your foot, and avoid putting pressure on the surgical area for about 4 weeks.

A hospital physical therapist will teach you how to walk with a cane, walker, or crutches to avoid putting weight on the surgical area, and to help ensure that the bones will heal well. You will also be given instruction in the use of ice packs and leg elevation to control pain and swelling.

Rehabilitation with a physical therapist should begin 3 to 4 weeks after surgery, and continue for 4 to 6 weeks. Treatments will include the elements listed above. The first session will focus on pain and swelling reduction with the use of mild ankle range-of-motion exercises, ice packs, and mild massage. You will begin gait training with specific instructions from your physical therapist, and perform exercises in the clinic and at home.

Postoperative physical therapy will emphasize walking and learning how to push off of your big toe properly to restore normal walking ability. It will also include exercise to strengthen the big toe and ankle, and movement to restore better bending of the big toe. It is important to regain strength and bending in the big toe to restore your full walking ability. You will be encouraged to perform a home-exercise program between physical therapy visits as well as after the visits are completed, to help you return to your job, leisure, or sport activities.

Can this Injury or Condition be Prevented?

There is no evidence that bunions can be prevented, but you may be able to prevent a problem from becoming worse, and possibly prevent surgery by:

Wearing appropriate footwear. For example, it is important to avoid wearing shoes that squeeze the toes together. Wearing shoes with a wider toe box will reduce the inward pressure on the big toe, and help keep the outside of the foot from rubbing against the shoe.
Using splints/orthotics. There are many types of splints, padding, and big toe supports available that are designed to keep your toe properly aligned and reduce big toe pressure. Research suggests that using shoe inserts or arch supports (foot orthotics) can help prevent the arch from flattening during walking, and reduce big toe pressure.

Your physical therapist can review your options with you, and recommend the best solutions for your particular needs.

7 Myths About Physical Therapy

Wed, 19 Jun 2019 13:34:49 GMT

Physical therapists are movement experts who help people reduce pain, improve or restore mobility, and stay active throughout life. But there are some common misconceptions that often discourage people from seeking physical therapist treatment.

It's time to debunk 7 common myths about physical therapy:

1. Myth: I need a referral to see a physical therapist.

Fact: A recent survey by the American Physical Therapy Association (APTA) revealed 70% of people think a referral or prescription is required for evaluation by a physical therapist. However, a physician’s referral is not required in order to be evaluated by a physical therapist. Some states have restrictions about the treatment a physical therapist can provide without a physician referral. Check out APTA's direct access summary chart (.pdf) to see the restrictions in your state.

2. Myth: Physical therapy is painful.

Fact: Physical therapists seek to minimize your pain and discomfort—including chronic or long-term pain. They work within your pain threshold to help you heal, and restore movement and function. The survey found that although 71% of people who have never visited a physical therapist think physical therapy is painful, that number significantly decreases among patients who have seen a physical therapist in the past year.

3. Myth: Physical therapy is only for injuries and accidents.

Fact: Physical therapists do a lot more than just stretch or strengthen weak muscles after an injury or surgery. They are skilled at evaluating and diagnosing potential problems before they lead to more serious injuries or disabling conditions—from carpal tunnel syndrome and frozen shoulder, to chronic headaches and lower back pain, to name a few.

4. Myth: Any health care professional can perform physical therapy.

Fact: Although 42% of consumers know that physical therapy can only be performed by a licensed physical therapist, 37% still believe other health care professionals can also administer physical therapy. Many physical therapists also pursue board certification in specific areas such as neurology, orthopedics, sports, or women’s health, for example.

5. Myth: Physical therapy isn't covered by insurance.

Fact: Most insurance policies cover some form of physical therapy. Beyond insurance coverage, physical therapy has proven to reduce costs by helping people avoid unnecessary imaging scans, surgery, or prescription drugs. Physical therapy can also lower costs by helping patients avoid falls or by addressing conditions before they become chronic.

6. Myth: Surgery is my only option.

Fact: In many cases, physical therapy has been shown to be as effective as surgery in treating a wide range of conditions—from rotator cuff tears and degenerative disk disease, to meniscal tears and some forms of knee osteoarthritis. Those who have recently seen a physical therapist know this to be true, with 79% believing physical therapy can provide an alternative to surgery.

7. Myth: I can do physical therapy myself.

Fact: Your participation is key to a successful treatment plan, but every patient still needs the expert care and guidance of a licensed physical therapist. Your therapist will leverage his or her specialized education, clinical expertise, and the latest available evidence to evaluate your needs and make a diagnosis before creating an individualized plan of care.

Top 4 Running Injuries Physical Therapists Help Manage

Fri, 14 Jun 2019 17:30:14 GMT

There are numerous benefits to running, including improved cardiovascular, mental, and physical health, to name a few. Avid runners would love to live an injury-free life, but unfortunately running can be very hard on the body due to the repetitive impact of the activity.

A physical therapist can work with you to prevent or manage common running-related injuries with personalized treatment plans. After making a diagnosis, a physical therapist can help their patients improve mobility, manage pain and other chronic conditions, recover from injury, and prevent future injury and chronic disease. Here are the top running injuries and how a physical therapist can help:

1. Runner's knee

Approximately 40% of running injuries involve the knee, so it's no wonder runner's knee, or patellofemoral pain syndrome, is the top running injury. Runner's knee manifests as cartilage irritation under the patella, or kneecap, and is often caused by inward foot rolling during running, in combination with weak upper leg muscles. It can feel like an aching pain right around your kneecap and can be exacerbated by squatting movements as well as walking stairs, sitting, or standing.

Treating runner's knee:

Treatment for runner's knee involves strengthening the upper leg and thigh muscles. Standing hamstring and quadriceps stretches, quadriceps sets, and straight-leg raises are a few exercises physical therapists will use to treat runner's knee. Learn more.

2. Achilles tendonitis

Achilles tendonitis is responsible for about 11% of all runners' injuries. The Achilles tendon attaches the heel to the 2 major calf muscles. Achilles tendonitis is a tightening and irritation of the Achilles and is most often caused by weak calf muscles in runners who sprint and run hills.

Treating Achilles tendonitis:

The 3 goals of physical therapist treatment for Achilles injuries are pain relief, instilling proper movement, and building muscle strength and balance. The first line of treatment for Achilles tendonitis is rest, ice, and often an anti-inflammatory medicine. Light stretching of the affected area, followed by strengthening exercises targeting the calf and Achilles area. Learn more.

3. Plantar fasciitis

Plantar fasciitis is the most common running injury to the foot, affecting around 15% of runners. Put simply, it is caused by small tears and inflammation of the tendons connecting the heel to the ball of the foot. Plantar fasciitis will often feel like a bruise in the middle of your foot and can be most painful right when you get out of bed in the morning. Runners who have low arches or feet that roll inward or outward while running are most prone to this injury. Standing for long periods of time also can cause plantar fasciitis.

Treating plantar fasciitis:

There is not a "quick-fix" for plantar fasciitis. A physical therapist treatment plan may include stretches for the ankle and plantar fascia, the use of a night splint to maintain proper ankle and toe positions and fitted footwear inserts. Learn more.

4. Shin splints

Running after an extended time off can cause "shin splints," or medial tibial stress syndrome. Shin splints are tears in the muscles that surround the shinbone or tibia. Repetitive jumping or running, excessive hip motion, a high body mass index, and a previous running injury are common risk factors of shin splints.

Treating shin splints:

When shin splints occur, just like Achilles tendonitis, rest and ice are the first course of action. A physical therapist treatment plan may include stretches targeting the affected muscles in the leg, calf, and foot, therapeutic massage, taping the foot to reduce load, and suggestions on proper and more supportive running shoes. Learn more.

Authored by the Ohio Physical Therapy Association

MoveForwardPT.com, the official consumer Website of the American Physical Therapy Association,© 2017
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Physical Therapist's Guide to Neck Pain

Mon, 03 Jun 2019 15:19:27 GMT

Physical Therapist's Guide to Neck Pain

Neck pain is pain felt in the back of the neck – the upper spine area, just below the head. When certain nerves are affected, the pain can extend beyond the back of the neck to areas such as the upper back, shoulder, and arm. It is estimated that neck pain affects approximately 30% of the US population each year. Neck pain can be caused by sudden trauma such as a fall, sports injury, or car accident, or by long-term problems in the spine.

Neck pain most frequently affects adults aged 30 to 50 years. Some studies indicate that women are more likely to suffer neck pain than men. Poor posture, obesity, smoking, repetitive lifting, office and computer work, and involvement in athletic activity are all risk factors for developing neck pain.

People with neck pain can have difficulty performing activities such as working, driving, playing sports, or simply turning their heads. The majority of neck pain episodes do not require surgery and respond best to physical therapy. Physical therapists design individualized treatment programs to help people with neck pain reduce or eliminate pain, regain normal movement, and get back to their regular activities.

How Does it Feel?

People with neck pain may experience stiffness in the neck, and may describe the pain they feel as:

Sharp
Stabbing
Dull
Aching
Throbbing
Tingling

Neck pain caused by irritated nerves may extend into the upper back, shoulder blades, shoulders, arms, or hands. This condition is called “radiculopathy.” Your physical therapist can help determine if this condition is occurring, and will work closely with your physician and surgeon to determine the correct treatment.

Signs and Symptoms

The type and location of your symptoms depend on the tissue or structure that is affected, and the severity of the injury.

Neck pain can cause any of the following signs:

Inability to bend or rotate the neck
Difficulty looking up
Difficulty looking over the shoulder
Weak arm and shoulder muscles
Muscle spasms

Neck pain can cause any of the following symptoms:

Pain in the neck, upper back, shoulders, arms, or hands
Numbness or tingling in the neck, shoulders, arms, or hands
Weakness in the arms
Increased pain when coughing, sneezing, reaching, or sitting
Inability to stand straight or sit up straight
Stiffness when trying to move, or a feeling of being "stuck" in a position such as stooped forward, or with the head leaning to the side
Tight muscles
Headaches
Inability to remain in one position for a long period of time, such as sitting or standing, due to pain
Pain that is worse in the morning or at night
Difficulty sleeping due to pain

How Is It Diagnosed?

Your physical therapist will conduct a thorough examination that includes taking your health history. He or she will also ask you detailed questions about your pain or injury, such as:

How and when did the pain start?
What type of discomfort do you feel, and where do you feel it?
At what time of day is it worse?
What can’t you do right now in your daily life due to the pain?

Your physical therapist will perform tests on your body to find physical problems, such as:

Difficulty moving
Weakness or tightness in the muscles
Loss of skin sensation (numbness) in some areas
Loss of reflexes
Joint stiffness
Poor posture
Difficulty walking

If your physical therapist finds any of the above problems, physical therapy treatment may begin right away to help get you on the road to recovery and back to your normal activities.

If more severe problems are found with any of the testing, your physical therapist may collaborate with a physician or surgeon to obtain special diagnostic testing, such as an MRI. Your physical therapist will work closely with physicians and other health care providers to make sure that you receive an accurate diagnosis and the treatment and care you need.

How Can a Physical Therapist Help?

Recent research has shown that physical therapy is a better treatment than surgery or pain medication (such as opioid medication) for relieving many cases of neck pain. Physical therapy treatments often can help people avoid the need for surgery or medication altogether.

The time it takes to heal each condition varies, but an individualized physical therapy program can be effective and efficient, and help heal neck pain in a matter of weeks.

Your physical therapist may advise you to:

Rest the painful area by avoiding activity that causes worsening symptoms in the neck or arms.
Stay active around the house, avoid prolonged bed rest, and go on short walks several times per day. Movement will decrease pain and stiffness, and help you feel better.
Perform the simple neck movements he or she will teach you. These can help reduce stiffness and pain and restore normal motion of the neck.
Apply moist heat or ice packs to the affected area for 15 to 20 minutes every 2 hours.
Sit in firm chairs. Soft couches and easy chairs may make your problems worse.
Consult with a physician for further services, such as medication or medical tests.

Your physical therapist will work with you to:

Reduce pain and other symptoms. Your physical therapist will help you understand how to avoid or modify the activities that caused the injury, so healing can begin. He or she may use different types of treatments and technologies to control and reduce your pain and symptoms. These may include gentle hands-on techniques, known as manual therapy, that he or she will perform for you; specific neck movements that you will be taught to perform yourself; and the use of technologies, such as electrical stimulation or traction, as required. Physical therapists examine each person individually to determine exactly what type of approach will help reduce pain.

Avoid surgery. In most cases, a physical therapist can design an individualized treatment program to help relieve neck pain—even severe radiculopathy (pain that travels from the neck down into the arm or hand)—to help individuals with neck pain avoid surgery. In rare cases, radiculopathy requires surgery to relieve its cause.

Improve posture. If your physical therapist finds that poor posture has contributed to your neck pain, he or she will teach you how to improve your posture so healing can occur.

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might include "passive" motions that the physical therapist performs for you to move your spine, or active exercises and stretches that you do yourself. You can perform these motions at home, in your workplace, and before your sports activities to help hasten healing and pain relief.

Improve flexibility. Your physical therapist will determine if any of the involved muscles are tight, and teach you gentle stretching exercises that you can perform at home. He or she also may supervise your performance of special stretches during your physical therapy treatments.

Improve strength. If your physical therapist finds any weak or injured muscles, he or she will choose and teach you the correct exercises to gently restore your strength and agility. For neck pain, “core strengthening or stabilization” is commonly used to restore the strength and coordination of muscles around your spine.

Improve endurance. Restoring muscular endurance is important for people with neck pain. Your physical therapist will develop a program of activities to help you regain the endurance you had before the neck pain started.

Learn a home program. Your physical therapist will teach you strengthening, stretching, and pain-reduction exercises to perform at home. These exercises will be specific for your needs. If you do them as prescribed by your physical therapist, you can speed your recovery.

Return to Activities. Your physical therapist will discuss your activity levels with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. For spine problems like neck pain, your physical therapist may teach you correct ways to lift objects (called “body mechanics”) that will help protect your spine from further injury.

As your neck pain is improving, it will be important for you to continue your new posture and movement habits to keep your neck healthy and pain free.

Following Surgery

In rare cases of neck pain, surgery is necessary to relieve pressure on a nerve or on the spinal cord. If you undergo surgery, your physical therapist will work closely with you and your surgeon to help you regain motion and strength more quickly than you could on your own, and help you return to your daily activities as quickly as possible.

Can this Injury or Condition be Prevented?

To prevent neck pain, people should:

Maintain good posture (avoid slouching) at all times. That means keeping the spine and head in proper alignment during sitting, standing, and all daily activities.
Keep your muscles strong and flexible. Participate in a consistent program of physical activity to maintain a healthy fitness level.
Use proper body mechanics when lifting, pushing, pulling, or performing any action that puts extra stress on your spine.
Maintain a healthy weight. This will reduce the stress on your spine.
Stop smoking.
Discuss your occupation with a physical therapist, who can provide an analysis of your job tasks and offer suggestions for reducing your risk of injury.

To prevent recurrence of neck pain, follow the above advice, and:

Continue the new posture and movement habits that you learned from your physical therapist to keep your back healthy.
Continue to do your home-exercise program as taught to you by your physical therapist. This will help maintain your improvements.
Continue to be physically active and stay fit.

Physical Therapist's Guide to Plica Syndrome

Tue, 21 May 2019 14:17:18 GMT

Plica syndrome is an irritation of a small portion of tissue in the knee joint that is part of the joint capsule (synovial membrane). The synovial membrane produces fluid that helps to keep the knee joint lubricated. When this tissue on the inside of the kneecap becomes irritated, it results in knee pain and tenderness to touch. Often the result of overuse, plica syndrome also may result from a direct-hit injury. Plica syndrome is most often treated with physical therapy to improve mobility and strengthening at the knee to decrease tension and irritation.

What is Plica Syndrome?

Plica syndrome is an irritation of a portion of the synovial membrane in the knee. The synovial membrane encloses the knee joint and contains the fluid that keeps the joint lubricated. Plica syndrome results when the synovial lining becomes irritated, typically the result of repetitive friction to the tissue, or in some cases a direct hit to the knee that traumatizes the tissue. As a result, this tissue will become thick and painful. Repetitive friction is due to abnormal forces at the knee, most likely in the kneecap and surrounding musculature, or may be caused by muscular weaknesses or structural abnormalities at the hip or foot, which place increased tension on the knee. Plica syndrome also can be caused or made worse by increased activities.

Plica syndrome may result from a combination of several different factors, including:

Decreased mobility of the kneecap
Quadricep (front of the thigh) muscle or hip muscle tightness
Muscular imbalances in the quadricep, hamstring (back of the thigh), or hip muscles
Improper technique with repetitive activities
Change in an exercise routine or sport activity
Abnormal hip or knee structure
Abnormal hip or knee mechanics
Injury

How Does it Feel?

People with plica syndrome may experience:

Pain and tenderness to touch in the front of the knee, and on the inside of the kneecap
A "catching" or "snapping" sensation when bending the knee
Dull knee pain at rest, which increases with activity
Tightness in the knee

How Is It Diagnosed?

Your physical therapist will review your medical history and complete a thorough examination of your knee. The goals of the initial examination are to assess the degree of the injury and determine the cause and contributing factors to your injury. Your physical therapist will assess the mobility and strength of both lower extremities, including your foot and ankle as well as your knee and hip. Most often your physical therapist will be able to feel a thickened piece of irritated tissue on your knee.

It is also common for your physical therapist to perform a movement assessment, which may include watching you walk, step onto a stair, squat, or balance on one leg.

Your physical therapist also may ask questions about your daily activities, exercise regimens, and footwear to identify other contributing factors.

Imaging techniques, such as X-ray or MRI, are often not initially obtained. In the case of persistent pain, your physician may decide to obtain an MRI to help identify the source of your pain.

Whether your pain was caused by a single injury or repetitive irritation, your initial examination as well as treatment will be similar. Initially, the primary goals are to calm down the inflamed tissue. Your physical therapist will then address any underlying issues that may cause continued tissue irritation.

How Can a Physical Therapist Help?

You and your physical therapist will work together to develop a plan to achieve your specific goals. To do so, your therapist will select treatment strategies in any or all of the following areas:

Pain. Many pain-relief strategies may be implemented, such as applying ice to the area or using therapies like iontophoresis (a medicated patch placed on the skin that is electrically charged and used to decrease pain and inflammation). Your physical therapist will work with you to reduce your pain as much as possible without the use of pain medication, including opioids.
Range of motion. Your knee, hip, or foot may be moving improperly, causing increased strain at the front of the knee. Self-stretching and manual therapy techniques (massage and movement) applied to the lower body to help restore and normalize motion in the knee, hip, and foot can decrease this tension.
Manual therapy. Your physical therapist may apply hands-on treatments to move your muscles and joints in order to improve their motion and strength, most likely in your knee and hip. These techniques often address areas that are difficult to treat on your own.
Muscle strength. Muscular weaknesses or imbalances can result in abnormal forces being applied to the front of the knee. Based on your specific condition, your physical therapist will design a safe, individualized, progressive resistance program for you, likely including your core (midsection) and lower extremities, and concentrating on the muscles surrounding the hip and knee. These exercises may be completed in different positions such as lying down, sitting, or standing. Your physical therapist will choose what exercises are right for you, based on your age and physical condition.
Functional training. Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension on the knee and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your goals and movement assessment, your physical therapist will create a series of activities that will help you learn how to use and move your body correctly to safely perform the tasks required to achieve your goals.
Education. Your physical therapist will work with you to identify and change any external factors causing your pain, such as exercise selection, the amount of exercise you do, or your footwear. Your physical therapist will assess your current condition and lifestyle, recommend improvements, and develop a personal exercise program to help ensure a pain-free return to your desired activities.

Physical therapy promotes recovery from plica syndrome by addressing all contributing factors, such as pain and any lack of strength, flexibility, or body control. Your physical therapist also may recommend a period of relative rest, then carefully guide your progression back to normal activity levels.

When Surgery Is Required

If your plica syndrome pain does not improve following several weeks of physical therapy, arthroscopic surgery may be required. Your surgeon will make small incisions in the front of the knee and remove the irritated tissue. Following surgery, your initial rehabilitation will focus on decreasing pain and restoring mobility and strength. Your physical therapist will then address specific factors that caused your plica to become irritated, in order to minimize the risk of further injury. As you progress, your physical therapist will help you systematically reintroduce activities, including stair climbing, squatting, and desired recreational

Can this Injury or Condition be Prevented?

Maintaining appropriate lower-extremity (leg, ankle, foot) mobility and muscular strength, and paying particular attention to your exercise routine—especially changes in an exercise activity and the volume of exercises performed—are the best methods for preventing plica syndrome. Some patients with abnormalities in knee structure, however, may be more susceptible to developing plica syndrome.

If you are experiencing plica syndrome, your physical therapist will help guide you through a rehabilitative process based on your unique condition that will progressively reintegrate more demanding activities into your routine without overstraining your knee. Keep in mind that returning to activities too quickly often leads to persistent pain, and makes the condition more difficult to fix. Once you have completed your rehabilitation, your newfound strength, flexibility, and knowledge may help you prevent the syndrome from recurring.

Understand your Healthcare Responsibility

Wed, 15 May 2019 15:30:40 GMT

Understanding your insurance responsibilities can be very confusing. Here is a break down of the most commonly used terms and what they mean.

Please feel free to call us with any insurance questions you have. We are always here to help!

Tammy, Jeannie or Becca in Hubbard 330-534-8500
Alyssa in Cortland 330-637-0080
Sherry in Kinsman 330-876-2255

5 Tips to Safely Benefit From Walking for People With Arthritis

Mon, 06 May 2019 17:29:57 GMT

Walking is a safe, enjoyable, low-cost and low-impact physical activity enjoyed in all seasons and locales, individually or in a group. Those living with arthritis, an estimated 54 million American adults, can enjoy and benefit from improved strength and endurance from walking.

The following are a few tips to help make a walking program safe and enjoyable for those with arthritis:

1.Talk before you walk.

Have a conversation with your physical therapist to discuss if anything would prevent you from walking for routine exercise. How far or how long should you walk? What intensity or speed? Are there any barriers to keep you from starting a walking routine?

2. "Walk a mile in your shoes."

Much has been written about the health benefits of walking in both thinly or thickly padded shoes. There is some evidence that inserts and orthotics may help. Talk to your physical therapist about appropriate recommendations for footwear and inserts.

3. Walk with a buddy.

A walking buddy or group may improve your experience and safety. Such social walkers have less depression. Walking with a pet can be great too, but it can present its own challenges. Be sure you are walking a well-trained and leashed dog.

4. Listen to your body.

Modify your distance, time, and activity level based on what your joints are telling you that day. Sharp stabbing joint pains are a warning sign to reduce activity. Seek guidance from your physical therapist if joint pain is persistent.

5. Move safely and use assistance as needed.

Start slowly as needed. Practice consciously landing softly with each stride. A walking stick or hiking poles may relieve joint pressure and help with balance. Build the distance and time spent walking with permission from your body.

Access more tools and resources about walking with arthritis with Walk With Ease, a program from the Arthritis Foundation to guide you in developing your walking program.

MoveForwardPT.com, the official consumer Website of the American Physical Therapy Association,© 2017
https://www.moveforwardpt.com/Resources/Detail/5-tips-to-safely-benefit-from-walking-people-with-

Physical Therapist's Guide to Tarsal Tunnel Syndrome

Mon, 29 Apr 2019 14:35:53 GMT

Tarsal tunnel syndrome (TTS) is a condition that develops when a nerve within the tarsal tunnel of the inner ankle is compressed. TTS can lead to alterations in sensation and movement of the foot, ankle, and lower leg, and/or pain. It is often associated with conditions causing increased compression or swelling in the lower leg. Physical therapists help people experiencing TTS to relieve their pain and restore their normal function.

What is Tarsal Tunnel Syndrome?

Often described as the carpal tunnel syndrome of the lower extremity, tarsal tunnel syndrome is a condition that results from the compression of the posterior tibial nerve as it runs through the tarsal tunnel (a structure made up of bone and tissue (retinaculum) on the inside of the ankle). As it passes through the tarsal tunnel, the tibial nerve divides into 3 branches that provide sensation for the heel and bottom of the foot, and aid in the foot's function. When this structure becomes compressed, symptoms, such as pain, numbness, and/or tingling may occur and radiate into the lower leg, foot, and toes. Individuals may also experience muscle weakness in the area.

How Does it Feel?

The most common symptoms of TTS result from irritation of the tibial nerve and its branches. People with TTS may experience:

Pain, numbness, or tingling in the foot or ankle, which may radiate into the lower leg, foot, and toes
Weakness in the muscles of the lower leg and foot
Weakness of the big toe
Foot swelling
Symptoms that increase with prolonged standing or walking
Symptoms that decrease with rest
Altered temperatures of the foot and ankle
Pain that disrupts sleep

How Is It Diagnosed?

There are several tests that can help a clinician determine if TTS is present. Your physical therapist and/or physician will first take a comprehensive health history, and inquire about your current symptoms. Then your physical therapist may conduct tests, such as:

Gently tapping over the posterior tibial nerve in an attempt to reproduce your symptoms.
Tensing of the posterior tibial nerve, a maneuver that looks and feels like a "stretch," in an attempt to reproduce your symptoms.
Conducting a nerve condition study—a diagnostic test to determine the speed at which a nerve conducts information.
Ruling out other conditions, such as plantar fasciitis (inflammation of the tissue that runs along the bottom of the foot).

How Can a Physical Therapist Help?

Physical therapists play a vital role in helping people experiencing TTS to improve and maintain their daily function and activities. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals.

Because the signs and symptoms of TTS can vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:

Nerve Gliding Activities. Gentle exercises that move and "glide" the nerves may help reduce symptoms and improve function.

Muscle Strengthening Exercises. Strengthening activities for any muscles affected by TTS, such as the tibialis posterior muscle in the back of your lower leg.

Balance and Coordination Activities. Work to improve your balance and coordination, which are often affected by TTS.

Orthotics/Taping/Bracing. Apply ankle taping, a custom orthotic, or bracing to position the foot to decrease stress on the posterior tibial nerve.

As with many conditions, education is key. Understanding the underlying mechanisms of TTS, and learning to recognize early signs and symptoms of stress may help you better manage the condition.

Can this Injury or Condition be Prevented?

Although there are no proven strategies for preventing TTS, there are ways to minimize stress to the foot and ankle, such as choosing appropriate footwear, wearing custom orthotics, minimizing the amount of time spent standing on hard surfaces, and improving and maintaining strength in the muscles of your legs, ankles, and feet. These strategies can be discussed further with your physical therapist.

In addition, early detection of the signs and symptoms of TTS will help you and your medical providers begin appropriate management of the condition, which may enhance your long-term well-being.

Physical Therapist's Guide to Golfer's Elbow (Medial Epicondylitis)

Thu, 25 Apr 2019 18:54:33 GMT

Physical Therapist's Guide to Golfer's Elbow (Medial Epicondylitis)

Medial epicondylitis (commonly called golfer's elbow or thrower's elbow) is a condition that develops when the tendons on the inside of the forearm become irritated, inflamed, and painful due to repetitive use of the hand, wrist, forearm and elbow. It is often diagnosed in people who perform repetitive motions, such as swinging a golf club or tennis racket, or activities requiring gripping, twisting, or throwing. Even using a computer or performing yard work can cause the condition. It is most common in men over the age of 35. A physical therapist can help decrease the pain caused by medial epicondylitis, and improve the affected elbow's motion, strength, and function.

What is Medial Epicondylitis (Golfer's Elbow)?

Medial epicondylitis is a condition that occurs when the tendons on the inside of the forearm become irritated, inflamed, and painful due to repetitive use of the hand, wrist, and forearm. A tendon is a soft tissue that attaches a muscle to a bone. The group of muscles affected by medial epicondylitis are those that function to flex (bend) the wrist, fingers, and thumb and pronate (rotate palm-down) the wrist and forearm. The muscle group comes together into a common sheath and attaches to the humerus bone of the upper arm. This bony prominence, called the medial epicondyle, is located along the inside of the elbow. Pain occurs on or near the medial epicondyle, at the area where the tendon connects to the bone. Repetitive forces can cause the tendon to become tender and irritated, and without treatment, can cause it to even tear away from the bone. In addition, as the muscle groups travel across both the elbow and the wrist, they function to stabilize at the elbow allowing for wrist movement. As this is a 2-joint tendon, it is more vulnerable to injury.

How Does it Feel?

Persons with medial epicondylitis may experience:

Pain along the inside of the forearm with wrist, hand, or elbow movements.
Pain or numbness and tingling that radiates from the inside of the elbow down into the hand and fingers, with gripping or squeezing movements.
Tenderness to touch and swelling along the inside of the forearm.
Weakness in the hand and forearm when attempting to grip objects.
Elbow stiffness.

How Is It Diagnosed?

Your physical therapist will perform an evaluation and ask you questions about pain or other symptoms you are feeling. Your physical therapist may perform strength and motion tests on your wrist, forearm, and elbow; ask about your job duties and hobbies; evaluate your posture; and check for any muscle imbalances and weakness that can occur anywhere along the path from your shoulder blade to your hand. Your physical therapist will gently touch your elbow in specific areas to determine which tendon or tendons may be inflamed. Special muscle tests, such as bending the wrist or rotating the forearm with resistance, also may be performed to ensure a proper diagnosis.

How Can a Physical Therapist Help?

It is important to get proper treatment for medial epicondylitis as soon as it occurs, as tendons do not have a good blood supply. An inflamed tendon that is not treated can begin to tear, causing a more serious condition.

When a diagnosis of medial epicondylitis is made, you will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

Pain Management. Your physical therapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, ice massage, or moist heat may be used for pain management. Therapeutic modalities, such as iontophoresis (medication delivered through an electrically charged patch), and ultrasound may be applied. Bracing or splinting may also be prescribed. In severe cases, it may be necessary to rest the elbow and not perform work or sport activities that continue causing pain, which may slow the recovery process.

Manual Therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and elbow, forearm, and wrist stretches to help the muscles regain full movement. Your therapist may also do manual stretching and manual techniques to your shoulder and thoracic spine, as your tendons along the medial elbow can be affected by muscle imbalances all the way up the chain.

Range-of-Motion Exercises. You will learn mobility exercises and self-stretches to help your elbow and wrist maintain proper movement.

Strengthening Exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific condition, as your pain subsides. You may use weights, medicine balls, resistance bands, and other types of resistance training to challenge your weaker muscles. You will receive a home-exercise program to maintain your arm, forearm, elbow, and hand strength long after you have completed your formal physical therapy.

Patient Education. Education is an important part of rehabilitation. Your physical therapist may suggest adjustments to how you perform various tasks, and make suggestions to improve your form and reduce any chance of injury. Adjustments made in your golf swing, throwing techniques, or work tasks can help reduce pressure placed on the tendons in the forearm region.

Functional Training. As your symptoms improve, your physical therapist will help you return to your previous level of function. Functional training will include modifications in specific movement patterns, promoting less stress on the medial tendons. As mentioned previously in patient education, you and your physical therapist will decide what your goals are, and safely get you back to your prior performance levels as soon as possible.

Can this Injury or Condition be Prevented?

Understanding the risk of injury and being aware of your daily movements can help prevent the development of medial epicondylitis. Individuals should:

Maintain proper form and technique when performing repetitive work tasks or sports movements, like golf swings.
Maintain shoulder, forearm, and wrist muscle strength.
Perform gentle forearm muscle stretches before and after performing tasks.
Use proper posture and body mechanics when lifting heavy objects to reduce joint strain.

Physical Therapist's Guide to Shoulder Dislocation: Treatment After Surgery

Wed, 17 Apr 2019 12:53:00 GMT

Physical Therapist's Guide to Shoulder Dislocation: Treatment After Surgery

Dislocations are among the most common traumatic injuries affecting the shoulder. Because the shoulder is the most mobile joint in the body and has such a wide range of motion, it is the joint most likely to dislocate. A dislocation is the separation of 2 bones where they meet at a joint. Athletes, nonathletes, children, and adults can all dislocate their shoulders. Dislocations can occur during contact sports and everyday accidents, such as falls. Depending on the severity of your injury, your age, and your activity level, surgery may be needed to address the damage to the shoulder when it dislocates. Please see the Physical Therapist’s Guide to Shoulder Dislocation for more details about the injury and rehabilitation, if surgery is not required.

This Guide describes how physical therapists help individuals restore movement, strength, and function following surgery for a dislocated shoulder.

How Can a Physical Therapist Help?

When a shoulder is damaged by an injury causing dislocation, surgery may be required. The orthopedic surgeon will suture and repair the damaged tissue to restore the structural integrity of the joint and stabilize the shoulder.

Following shoulder stabilization surgery, your arm will be placed in a sling, usually for 4 to 6 weeks. During this time, you will not be allowed to use your arm for everyday activities.

Right after surgery, your shoulder will be painful and stiff, and it might swell. Your health care team will provide you with methods to control pain and swelling, such as icing and training on proper positioning.

Your physical therapist will guide you through your postsurgical rehabilitation. Your therapist will design a specialized treatment program based on your condition and goals. Treatments may range from gentle range-of-motion and strengthening exercises to activity- or sport-specific exercises. The timeline for your recovery will vary, depending on the surgical procedure and your general state of health, but a full return to sports, heavy lifting, and other strenuous activities might not begin until 4 to 6 months after surgery.

CAUTION: Your shoulder will be very susceptible to reinjury. It is extremely important to follow the postoperative instructions provided by your surgeon and physical therapist.

Physical therapy after your shoulder surgery is essential to restore your shoulder’s function. Your rehabilitation typically will be divided into 4 phases:

Phase I (maximal protection). This phase lasts for the first few weeks after your surgery, when your shoulder is at the greatest risk of reinjury. Your arm will be placed in a sling, and you likely will need assistance or special strategies to accomplish everyday tasks, such as bathing and dressing.

Your physical therapist will teach you gentle range-of-motion and very light strengthening exercises using only the weight of your arm. Your therapist may provide hands-on techniques, such as gentle massage, to help ease any pain, swelling, and stiffness, and will offer advice on how you can reduce your pain. Cold compression or electrical stimulation also may be applied for pain relief. Some of the treatments begun in this phase may continue as needed, until approximately the 12-week mark.
Phase II (moderate protection). This phase typically begins about 1 month following surgery, with the goal of restoring mobility to the shoulder. You will reduce the use of your sling, and your range-of-motion and strengthening exercises will progressively become more challenging throughout this period. In the early parts of this phase, strengthening will not include extra resistance; that will be included at a later point in your rehabilitation.

Your physical therapist will add exercises to strengthen the "core" muscles of your trunk and shoulder blade (scapula), and your "rotator cuff" muscles—the ones that provide additional support and stability to your shoulder. You will be able to begin using your arm for daily activities, but you'll still avoid any heavy lifting with your arm both during physical therapy and at home. Your physical therapist may use special joint mobilization techniques during this phase to help restore your shoulder's range of motion. With clearance from your surgeon, you may begin light cardiovascular activities, such as riding a stationary bike or walking on a treadmill.
Phase III (return to activity). This phase will typically begin about 3 months after surgery, with the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities, but you will still be unable to participate in activities such as sports, yard work, or physically strenuous work-related tasks. Your physical therapist will increase the difficulty of your exercises as you progress. You might be able to start a modified weight-lifting or gym-based program during this phase.
Phase IV (return to occupation/sport). This phase will typically begin about 4 months after surgery with the goal of helping you return to sports, work, and other higher-level activities. Your physical therapist will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. For others, it may include practice in lifting heavier items onto shelves or instruction in raking, shoveling, or housework. Your physical therapist also might recommend a shoulder brace to allow you to gradually and safely return to your regular activity level without reinjury.

Can this Injury or Condition be Prevented?

Shoulder dislocation may be preventable. See your physical therapist if you:

Have pain in your shoulder, especially when performing forceful activities, such as throwing a ball or lifting objects overhead
Have symptoms that feel as though your shoulder is “slipping," “shifting,” or “moving”
Hear a popping sound in your shoulder

Your physical therapist can guide you through strengthening exercises and special drills to improve the ability of your shoulder muscles to respond to forceful physical demands as needed. If you are at risk for shoulder dislocation, your physical therapist can show you positions to avoid to help prevent injury. The riskiest position is that of raising the arm overhead while it’s rotated outward, as happens with overhand throwing. Physical therapists help people modify their movements to avoid this position, or teach pitchers and other athletes strengthening exercises and correct body mechanics to lessen the chance of injury.

Physical Therapist's Guide to Shoulder Dislocation: Overview

Mon, 08 Apr 2019 14:13:06 GMT

The shoulder is the most mobile joint in the body and is the most likely joint to dislocate. A dislocation is the separation of 2 bones where they meet at a joint. Shoulder dislocations most often occur during contact sports, but everyday accidents, such as falls, also can cause the joint to dislocate. Athletes, nonathletes, children, and adults can all dislocate their shoulders. A dislocated shoulder usually requires the assistance of a health care professional to guide the joint back into place. After the joint is realigned, a physical therapist directs the rehabilitation of the shoulder, and helps the affected individual prevent reinjury.

CAUTION: A shoulder dislocation requires immediate medical attention, especially if you experience:

Numbness in your arm or hand
Discoloration of your arm or hand
A feeling of coldness in your arm

Any of these conditions may indicate injury to a nerve or blood vessel. Seek medical help immediately.

What is a Shoulder Dislocation?

The shoulder includes the clavicle (collar bone), scapula (shoulder blade), and humerus (upper-arm bone). The rounded top of the humerus and the cup-like end of the scapula fit together like a ball and socket. A shoulder dislocation can occur with an injury, such as when you "fall the wrong way" on your shoulder or outstretched arm, forcing the shoulder beyond its normal range of movement and causing the humerus to come out of the socket. Dislocation can result in damage to many parts of the shoulder, including the bones, the ligaments, the labrum (the ring of cartilage that surrounds the socket), and the muscles and tendons around the shoulder joint.

Shoulder Dislocation

Joints may dislocate when a sudden impact causes the bones in the joint to shift out of place. Dislocations are among the most common traumatic injuries affecting the shoulder.

How Does it Feel?

With most shoulder dislocations, you will feel the humerus coming out of the socket, followed by:

Pain
Inability to move the arm
Awkward appearance of the shoulder

If you have any signs or symptoms of a nerve or blood-vessel injury, as listed above, seek immediate medical attention.

The humerus usually remains out of the socket until a physician guides it back into place. X-rays are routinely taken after the dislocation is moved back into place to make sure that you don’t have a fracture.

Occasionally, the shoulder may go back into place on its own. You might not even realize that you have dislocated your shoulder; you may only feel that you have injured it. If you have injured your shoulder and have pain, seek medical attention.

How Can a Physical Therapist Help?

After the dislocated humerus has been moved back into position, your arm will be placed in a sling to protect you from reinjury and to make your shoulder more comfortable. Your physical therapist can review your health and injury history and conduct a physical examination to determine your rehabilitation needs. Based on the results of the examination and your goals, your physical therapist will guide you through a rehabilitation program to restore your mobility, strength, joint awareness, and sport-specific skills. Your therapist also will show you how to control your pain and relieve any inflammation.

Your treatment program may include:

Range-of-motion exercises. Swelling and pain can reduce your shoulder movement. Your physical therapist will teach you how to perform safe and effective exercises to restore full range of motion to your shoulder. Your physical therapist might apply manual (hands-on) therapy to help decrease pain in the shoulder.

Strengthening exercises. Poor muscle strength can cause the shoulder joint to remain unstable and possibly reinjure it. Based on how severe your injury is and where you are on the path to recovery, your physical therapist can determine which strengthening exercises are right for rehabilitation of your shoulder.

Joint awareness and muscle retraining. Specialized exercises help your shoulder muscles relearn how to respond to sudden forces. Your physical therapist will design individualized exercises to help you return to your regular activities.

Activity- or sport-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation tailored to the demands your activities place on your shoulder. Your physical therapist can develop a program that takes all of these demands (as well as your specific injury) into account. For example, if you are an overhead thrower, such as a baseball pitcher, your physical therapist will guide you through a throwing progression and pay specific attention to your throwing mechanics.

Can this Injury or Condition be Prevented?

Shoulder dislocations are dependent on how loose the shoulder is, and are more likely to occur during sports or aggressive activities. Your physical therapist can advise you about the positions that frequently cause dislocations, and teach you ways to reduce your risk of dislocation. See your physical therapist if you:

Have pain in your shoulder, especially when performing forceful activities
Have symptoms that feel as though your shoulder is "slipping," “shifting,” or "moving"
Hear a popping sound in your shoulder accompanied by pain

Have pain in your shoulder, especially when performing forceful activities
Have symptoms that feel as though your shoulder is "slipping," “shifting,” or "moving"
Hear a popping sound in your shoulder accompanied by pain

If you already have a history of shoulder dislocation, you are at a greater risk for reinjury if your shoulder does not heal properly or if you do not regain your normal shoulder strength or joint awareness. Research shows that a high percentage of dislocated shoulders will dislocate again. Physical therapists play an important role in helping people prevent recurring shoulder problems.

If you return to sports or activities too soon following injury, you could cause a reinjury. Your physical therapist can determine when you are ready to return to your activities and sports by making sure that your shoulder is strong and ready for action. Your physical therapist may recommend a shoulder brace to allow you to gradually and safely return to your previous activities.

Physical Therapist's Guide to Shoulder Bursitis

Mon, 01 Apr 2019 13:55:41 GMT

Shoulder bursitis is a painful condition that affects people of all ages. The condition tends to develop more in middle-aged, elderly, and individuals who have muscle weakness. Shoulder bursitis can have many causes, but the most common is a repetitive activity, such as overhead reaching, throwing, or arm-twisting, which creates friction in the upper shoulder area. Athletes often develop shoulder bursitis after throwing, pitching, or swimming repetitively. The condition can happen gradually or suddenly, or can be a result of an autoimmune disease. It can also occur without any specific cause. Physical therapy can be a very effective treatment for shoulder bursitis to reduce pain, swelling, stiffness, and associated weakness in the shoulder, arm, neck, and upper back.

Shoulder impingement and tendinitis can occur along with shoulder bursitis. A physical therapist can effectively treat all of these conditions together.

What is Shoulder Bursitis?

Shoulder bursitis (also called subacromial bursitis) occurs when the bursa (a fluid-filled sac on the side of the shoulder) becomes damaged, irritated, or inflamed. Bursitis ("-itis"); means "inflammation") means the bursa has become irritated and inflamed, which causes pain. Normally, the bursa acts as a cushion for the rotator cuff tendon of the supraspinatus muscle that sits under the bursa, and prevents the tendon from rubbing on the acromion bone above the bursa. Certain positions, motions, or disease processes can cause friction or stress on the bursa, leading to the development of bursitis. When the bursa becomes injured, the tendon doesn't glide smoothly over it, and can become painful.

Shoulder bursitis can be caused by:

Repetitive motions (overhead reaching or lifting, throwing, or twisting of the arm)
Muscle weakness or poor muscle coordination
Incorrect posture
Direct trauma (being hit, or falling on, the side of the shoulder)
Shoulder surgery or replacement
Calcium deposits in the shoulder
Overgrowth or bone spurs in the acromion bone
Infection
Autoimmune diseases, such as rheumatoid arthritis, gout, psoriasis, or thyroid disease
Muscles or tendons in the shoulder area rubbing the bursa and causing irritation

How Does it Feel?

With shoulder bursitis, you may experience:

Pain on the outer side or tip of the shoulder
Pain when you push with your finger on the tip of the shoulder
Pain when lying on the affected shoulder
Pain that worsens when lifting the arm to the side
Pain when rotating the arm
Pain when pushing or pulling open a door

How Is It Diagnosed?

If you see your physical therapist first, the physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist also will ask you detailed questions about your injury, such as:

How and when did you notice the pain?
Have you been performing any repetitive activity?
Did you receive a direct hit to the shoulder, or fall on it?

Your physical therapist also will perform special tests to help determine the likelihood that you have shoulder bursitis. Your physical therapist will gently press on the outer side of the shoulder to see if it is painful to the touch, and may use additional tests to determine if other parts of your shoulder are injured. The physical therapist also will observe your posture, and how you lift your arm.

Your physical therapist will test and screen for other, more serious conditions that could cause shoulder pain. To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an X-ray to confirm the diagnosis and to rule out other damage to the shoulder, such as a fracture.

How Can a Physical Therapist Help?

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but results can often be achieved in 2 to 8 weeks, when a proper stretching and strengthening program is implemented.

During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:

Rest the area by avoiding lifting or reaching overhead, or any activity that causes pain.
Apply ice packs to the area for 15 to 20 minutes every 2 hours.
Consult with a physician for further services, such as medication or diagnostic tests.

Your physical therapist will work with you to:

Reduce Pain and Swelling. If repetitive activities have caused the shoulder bursitis, your physical therapist will help you understand how to avoid or modify the activities to allow healing to begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, specific exercises, and hands-on therapy, such as specialized massage.

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the shoulder and arm. These might begin with "passive" motions that the physical therapist performs for you to gently move your shoulder joint, and progress to active exercises and stretches that you do yourself.

Improve Flexibility. Your physical therapist will determine if any shoulder, arm, chest, or neck muscles are tight, start helping you to stretch them, and teaching you how to stretch them.

Improve posture. If posture problems are found to be related to your condition, your physical therapist will work with you to help improve your posture to help alleviate your pain, and prevent future recurrence.

Improve Strength. Shoulder bursitis is often related to weak, injured, or uncoordinated shoulder muscles. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to use to steadily restore your strength and agility. These may include using cuff weights, stretch bands, and weight lifting equipment.

Improve Endurance. Regaining your muscular endurance in the shoulder is important after an injury. Your physical therapist will teach you exercises to improve your muscular endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as upper-body ergometers, treadmills, or stationary bicycles.

Learn a Home Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.

Return to Activities. Your physical therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

If Surgery Is Necessary

Surgery is not commonly required for shoulder bursitis. But if surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.

Can this Injury or Condition be Prevented?

Your physical therapist can recommend a home-exercise program to strengthen and stretch the muscles around your shoulder, arm, chest, and neck to help prevent future injury. These may include strength and flexibility exercises for the shoulder, arm, chest, neck, and core muscles.

To help prevent a recurrence of the injury, your physical therapist may advise you to:

Follow a consistent flexibility and strengthening exercise program, especially for the shoulder muscles, to maintain good physical conditioning, even in a sport's off-season or after you retire from sports.
Always warm up before starting a sport or heavy physical activity.
Learn and maintain good posture.
Gradually increase any demanding activity, rather than suddenly increasing the activity amount or intensity. This includes household activities, office work, or athletics.
Learn and maintain correct posture.

Physical Therapist's Guide to Scoliosis

Tue, 26 Mar 2019 13:46:29 GMT

Physical Therapist's Guide to Scoliosis

Scoliosis is a condition that affects the normal shape of the spine, altering a person's overall trunk alignment and posture. Scoliosis causes the spine to move to the side and turn. This condition can occur at any time during the lifespan, but is more commonly detected during adolescence. Scoliosis affects 2% to 3% of the general population, and is more common in females than males. Scoliosis ranges from mild to severe cases, requiring a variety of treatments. The more severe cases may require surgery. Scoliosis is best managed with a team approach that includes the family, orthopedic physician or surgeon, orthotist, and physical therapist.

What is Scoliosis?

The Scoliosis Research Society defines scoliosis as a curvature of the spine to the side that also includes rotation. As previously mentioned, scoliosis causes postural and trunk alignment changes that cannot be corrected by “standing up straight. On an x-ray, the spine may appear to have an "s" or "c" shape. The severity of scoliosis is determined by measuring the angle of the curvature, also called a Cobb angle. A minimum of "10° of Cobb" needs to be present for a diagnosis of scoliosis.

Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, is diagnosed in children aged 10-18 years. Idiopathic means no identifiable cause is known, but 30% of children with AIS have some family history of the condition.

Other types of scoliosis include congenital, neuromuscular, and early onset (infantile and juvenile).

Congenital scoliosis is caused by a deformity in the bones of the spine that occurs during a baby's early development in the womb.
Neuromuscular scoliosis is caused by a medical condition of the nervous system, such as cerebral palsy or muscular dystrophy, which triggers weakening of the muscles that support the spine.
The cause of early onset scoliosis is not known. Early onset scoliosis includes infantile scoliosis diagnosed from birth to 3 years of age, and juvenile scoliosis diagnosed before the age of 10.

How Does it Feel?

Scoliosis is usually a pain-free condition, but pain may occur as the spine curves abnormally and affects the surrounding muscles and joints. These changes may alter a person's alignment, posture, and movement patterns, causing irritation and pain. Muscles that usually support the spine may become imbalanced in scoliosis, leading to a loss of strength and flexibility. A person with scoliosis may note:

Uneven shoulder height.
Uneven hip height.
An uneven waistline.
A general sense that the 2 sides of the body don't line up.
Pain in the areas surrounding the spine, including the shoulder, pelvis, and hip.
Pain with specific movement or activity.

A primary goal of physical therapy is to identify conditions, such as scoliosis, help the individual restore and maintain mobility so they can function at their personal best, and improve their quality of life.

How Is It Diagnosed?

Scoliosis is usually detected during a physical examination or school screening performed by a pediatrician, school nurse, or physical therapist, with the goal of early detection and treatment.

An initial visit with a physical therapist includes a thorough medical history, and specific questions about the family health history and current activities. Your physical therapist will closely examine the spine in several positions and check factors, such as strength and flexibility, and any feelings of tenderness or swelling. You or your child may be asked to briefly demonstrate the activities or positions that cause difficulty or pain.

The physical therapist also will identify symptoms the individual is experiencing that are caused by the curve to the spine. If the patient goes to the physical therapist before seeing a physician, the individual will be referred to an orthopedic physician, since a radiograph is needed to confirm a diagnosis of scoliosis.

How Can a Physical Therapist Help?

The variety of treatment options for scoliosis includes physical therapy, bracing, and surgery. Determining the best course of treatment is based on the type and severity of the scoliosis, the patient’s age, and the guidelines established by the Scoliosis Research Society.

Physical therapists can provide care during any of the phases of scoliosis treatment, including bracing or postsurgery. They will evaluate and assess the posture and movement patterns of the whole body, noting any limitations caused by changes in the spine, and address other symptoms, such as pain and muscle imbalances.

Your physical therapist will work with you and your child to develop an individualized plan tailored to the type and severity of the scoliosis as well as patient goals. Your physician will continue to closely monitor progress throughout the course of rehabilitation.

Physical therapy treatments may include:

Range-of-Motion Exercises. Your physical therapist will design a gentle range of motion treatment program to prevent limitations or to increase the body's range of motion, if movement limitations are present.

Strength Training. Your physical therapist will design a treatment program to strengthen any muscles surrounding the spine or in other parts of the body that have been weakened by the change in the spine’s position, such as the hips, shoulders, or even the head and feet.

Manual Therapy. Physical therapists are trained to gently restore motion to joints and muscle tissue that may have become restricted due to scoliosis. They may use their hands to help guide and retrain movement patterns.

Modalities. Several additional treatments, such as ice, heat, electrical stimulation or ultrasound may aid in achieving physical therapy goals. Your physical therapist will choose the most appropriate modalities for your particular case.

Functional Training. Physical therapists are trained to be experts in assessing movement patterns, providing education on proper movement patterns, and retraining the body for optimal movement.

Education. Your physical therapist will provide information about scoliosis and the effects on the body and movement.

Can this Injury or Condition be Prevented?

Scoliosis cannot be prevented. Research is ongoing regarding treatments to stop the progression of scoliosis, such as bracing. A recent study has demonstrated that bracing is effective at limiting the progression of spinal curves. The primary goals of physical therapy are to manage symptoms and maximize each individual's functional capacity. A team approach to treating scoliosis works best.

Physical Therapist's Guide to Wrist Fracture

Wed, 20 Mar 2019 14:50:24 GMT

Physical Therapist's Guide to Wrist Fracture

A wrist fracture is a break in one of the bones near the wrist. In the United States, 1 out of every 10 broken bones diagnosed is a wrist fracture. Injury can occur as a result of a trauma, such as falling while playing sports or simply tripping when walking down a sidewalk. Children are susceptible to wrist fractures because of the high-risk sports they commonly play. A child may sustain a wrist fracture falling off a bike, playing football or soccer, or falling off playground equipment. Wrist fractures are also common in women after menopause, and frequently occur in the elderly population due to falls. A physical therapist can help individuals who have sustained a wrist fracture regain normal wrist motion, strength, and function, and learn how to prevent future fractures.

What Is Wrist Fracture?

A fracture is a crack or a break in a bone. Wrist fractures due to falls happen most often when people stretch the arm straight out to catch themselves as they fall. The wrist is made up of 8 small bones called carpal bones, and 2 bones in the forearm called the radius and the ulna. A wrist fracture is diagnosed when any of those bones breaks or cracks. The most frequently fractured bone is the radius, the bone in the forearm that is closest to the thumb.

There are 3 types of bone fractures:

Type 1 – a "nondisplaced" fracture, where the bone is broken but is still in a normal position.
Type 2 – a fracture where a fragment of bone is shifted from its normal position.
Type 3 – the most serious type of fracture, with multiple breaks of the bone or bones.

Type 1 and 2 fractures usually are treated without surgery. Type 3 fractures, however, usually require surgery.

Wrist Fractures

How Does it Feel?

A fractured wrist is usually painful and movement is affected. If you have sustained a wrist fracture, you may experience:

Pain in the area of the fracture, which could be anywhere in the wrist, depending on which bone was affected. The pain can radiate from the wrist into the fingers, and even into the forearm.
Swelling in the wrist and possibly in the hand, usually on the top surface of the wrist and hand.
Tenderness to touch in the wrist.
Difficulty and pain when moving the wrist or fingers

How Is It Diagnosed?

An x-ray is the best way to diagnose a wrist fracture. If you have sustained a fall and are experiencing any of the symptoms mentioned above, you need to visit an emergency room, an urgent-care center, or your physician to get a complete diagnostic x-ray.

If a physical therapist suspects that you have a wrist fracture, the therapist may arrange for an x-ray and refer you to an appropriate physician. Your physical therapist can check for damage to other joints and muscles, and make sure that the nerves and blood vessels in your wrist, forearm, and hand have not been affected by the broken bone. In most cases, people with fractures visit a physician with a specialty in managing bones and joints (an orthopedist). Depending on the type of fracture, the physician might prescribe a cast or a sling to immobilize the area for a period of time until the fracture is healed. The amount of healing time varies, depending on the individual and the type of fracture, and can be anywhere from 4 to 10 weeks. If the fracture is severe, surgery will be required. The recovery time may be longer following surgery, depending on the severity of the injury.

How Can a Physical Therapist Help?

Your physical therapist will work with you following a wrist fracture to help you regain normal wrist motion, strength, and function, and will provide education and training to help you prevent future fractures.

While Your Wrist Is In a Cast or a Sling

While your bone heals, your arm will be in a cast or a sling to keep it still and promote healing. During that time, it is important to ensure that the arm does not get too stiff, weak, or swollen. Depending on the amount of activity that is allowed for your type of fracture, your physical therapist will prescribe gentle exercises to keep your shoulder, elbow, and fingers moving while you are in the cast or sling.

Most people with wrist fractures will slowly return to exercising the other arm and the legs, so that the rest of the body doesn't get out of shape while the fracture is healing. Your physical therapist can help you adapt your exercise program, so that you can maintain your overall strength and fitness without interfering with the healing of your wrist.

When the Cast or Sling Is Removed

After your cast or sling is removed, your wrist will most likely be stiff, and your arm will feel weak. Your physical therapist will examine your wrist, and select treatments to improve its function and restore strength to your arm.

Your rehabilitation will include treatments to:

Reduce Pain. Your physical therapist might use either warm or cold therapeutic treatments, or electrical stimulation, to help control pain or swelling in your wrist, hand, or arm.

Relieve Stiffness. Your physical therapist may use skilled hands-on techniques (manual therapy) to enable your joints and muscles to move more freely with less pain.

Increase Your Strength and Ability to Move. Physical therapists prescribe several types of exercises during recovery from a wrist fracture. Early on, your physical therapist can help you begin to gently move your elbow, using "passive range-of-motion" exercises. As your arm gets stronger, you can exercise it yourself without weights ("active range-of-motion" exercises). Once the bone is well-healed, you can begin to perform resistance exercises, using weights or elastic bands. In addition to prescribing range-of-motion and strengthening exercises, your physical therapist can help you retrain your muscles to react quickly when you need to protect yourself from a fall.

Get Back to Your Daily Activities. Your physical therapist will help you remain independent by teaching you how to perform your daily activities (eg, dressing, working on a computer, and cooking), even while wearing a cast or a sling. Once you can move your arm freely without pain, your physical therapist may begin adding activities that you were doing before your injury, such as using your arm for dressing, grooming, and housekeeping. Your physical therapist will design your individualized program based on an examination of your wrist, goals, level of physical activity, and general health.

Prepare for More Demanding Activities. Depending on the requirements of your job or the type of sports you play, you might need additional physical therapy tailored to meet specific demands. Your physical therapist will develop a specialized program to address your unique needs and goals.

Prevent Long-Term Disability. Everything your physical therapist prescribes for you will help prevent long-term disability by:

Returning the arm to a strong level of fitness.
Restoring full movement and strength in a safe manner, while healing occurs.
Assessing the fracture to make sure that you can return safely to previous home and work activities.
Guiding you to a safe return to sports and other physical activities. A return too early after a fracture may increase the risk of another fracture.
Recommending protective equipment, such as wrist guards, for use during sports.

Can this Injury or Condition be Prevented?

In addition to helping individuals prevent long-term disability following a wrist fracture, physical therapists can help different at-risk populations prevent fractures.

For the aging population, avoiding falls and other trauma is the best way to prevent fractures. Physical therapists are experts at determining your risk of falling, and can teach you how to perform balance exercises and take precautions to avoid falls. They also can perform work and home safety evaluations to make sure that your daily environment is safe.
For postmenopausal women with osteoporosis leading to a higher risk of wrist fracture, a physical therapist can teach weight-bearing exercises to help build stronger bones. Your physical therapist also may refer you to a nutritionist for vitamin D supplements or other dietary changes to help make your bones stronger. Education in proper posture and body mechanics and joint protection techniques can be helpful in preventing strain on the wrist and arms.
For children, wearing proper protective gear, such as wrist guards, can reduce the risk of a wrist fracture when playing certain sports. Making sure that playground equipment your child uses is safe and built on a soft surface can also reduce the risk of wrist fractures due to falls.

Physical Therapist's Guide to Spinal Stenosis

Thu, 14 Mar 2019 15:16:13 GMT

It is estimated that as many as 80% of us will experience some form of back or neck pain at some point in our lifetimes. Spinal stenosis can be one cause of back and neck pain. It affects your vertebrae (the bones of your back), narrowing the openings within those bones where the spinal cord and nerves pass through.

What Is Spinal Stenosis?

Spinal stenosis is a narrowing within the vertebrae of the spinal column that results in too much pressure on the spinal cord (central stenosis) or nerves (lateral stenosis). Spinal stenosis may occur in the neck or in the low back.

The most common causes of spinal stenosis are related to the aging process in the spine:

Osteoarthritis is a deterioration of the cartilage between joints. In response to this damage, the body often forms additional bone (called "bone spurs") to try to support the area. These bone spurs might cause pressure on the nerves at the point where the nerves exit the spinal canal.
Normal aging can result in a flattening of the disks that provide space between each set of vertebrae. This narrowed space allows less room for the nerve to exit from the spinal cord.

Spinal injuries, diseases of the bone (such as Paget disease), spinal tumors, and thickening of certain spinal ligaments also may lead to spinal stenosis.

In most cases, symptoms of spinal stenosis can be effectively managed with physical therapy and other conservative treatments. Only the most severe cases of spinal stenosis need surgery or spinal injections.

Spinal Stenosis

Signs and Symptoms

Spinal stenosis may cause symptoms such as:

Pain, numbness, tingling, or weakness in your arms and shoulders, legs, or trunk
Occasional problems with bowel or bladder function

If you have spinal stenosis in the neck (cervical spinal stenosis), you may have weakness, numbness, and pain in one or both arms and often in the legs, depending on which nerves are affected. You may or may not have pain in the neck itself.

If you have spinal stenosis in the low back (lumbar spinal stenosis), you may have pain, numbness, and weakness in the low back and one or both legs, but not in the arms. Your symptoms may get worse with walking and improve with sitting.

How Is It Diagnosed?

Because the symptoms of spinal stenosis are often similar to those of other age-related conditions, a careful diagnosis is important. Your physical therapist will conduct a thorough evaluation, including a review of your medical history, and will use screening tools to determine the likelihood of spinal stenosis. Your physical therapist may:

Ask you very specific questions about the location and nature of your pain, weakness, and other symptoms
Ask you to fill out a body diagram to indicate specific areas of pain, numbness, and tingling
Perform tests of muscle strength and sensation to determine the severity of the pressure on the nerve root
Examine your posture and observe how you walk and perform other activities
Measure the range of motion of your spine and your arms and legs
Use manual therapy to evaluate the mobility of the joints and muscles in your spine
Test the strength of important muscle groups

If you have muscle weakness, loss of sensation, or severe pain, diagnostic tests such as an X-ray or MRI may be needed. Physical therapists work closely with physicians and other healthcare providers to ensure that an accurate diagnosis is made and the appropriate treatment is provided.

Research shows that in all but the most extreme cases of spinal stenosis (usually involving muscle weakness or high levels of pain), conservative care, such as physical therapy, achieves better results than surgery.

How Can a Physical Therapist Help?

Your physical therapist's overall purpose is to help you continue to participate in your daily activities and life roles. He or she will design a treatment program based on both the findings of the evaluation and your personal goals. The treatment program likely will be a combination of exercises.

Your physical therapist will design a specialized treatment program to meet your unique needs and goals. Your program may include:

Gentle Movement. Your physical therapist may teach you specific movements to help take pressure off the nerve root, which can help alleviate pain.

Stretching and Range-of-Motion Exercises. You may learn specific exercises to improve mobility in the joints and muscles of your spine and your extremities. Improving motion in a joint is often the key to pain relief.

Strengthening Exercises. Strong trunk (abdomen and back) muscles provide support for your spinal joints, and strong arm and leg muscles help take some of the workload off your spinal joints.

Aerobic Exercise. You may learn aerobic exercise movements to increase your tolerance for activities that might have been affected by the spinal stenosis, such as walking.

This might sound like a lot of exercise, but don't worry: research shows that the more exercise you can handle, the quicker you'll get rid of your pain and other symptoms!

Your physical therapist may decide to use a combination of other treatments as well, including:

Manual Therapy. Your physical therapist may conduct manual (hands-on) therapy such as massage to improve the mobility of stiff joints that may be contributing to your symptoms.

Use of Equipment. Your physical therapist may prescribe the use of rehabilitation equipment—such as a special harness device that attaches to a treadmill to help reduce pressure on the spinal nerves during walking.

Postural Education. You may learn to relieve pressure on the nerves by making simple changes in how you stand, walk, and sit.

Can this Injury or Condition be Prevented?

Spinal stenosis usually is a natural result of aging. Research has not yet shown us a way to prevent it. However, we do know that you can make choices that lessen the impact of spinal stenosis on your life and even slow its progression.

Regular exercise strengthens the muscles that support your back, keeps the spinal joints flexible, and helps you maintain a healthy body weight.
Using supportive chairs and mattresses and avoiding activities that can lead to injury—such as heavy, awkward, or repetitive lifting—can help protect your back.

Your physical therapist can help you develop a fitness program that takes into account your spinal stenosis. There are some exercises that are better than others for people with spinal stenosis, and your physical therapist can educate you about what exercises and activities you should avoid. For instance, because walking is usually more painful than sitting, bicycling may be a better way for you to get regular physical activity. All low back pain is different and unique to each individual. Your physical therapist will design a specialized exercise program for you based on your movement exam, your health profile, and your goals.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have spinal stenosis. You may want to consider:

A physical therapist who is experienced in treating people with pain, orthopedic, or musculoskeletal diagnoses.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with spinal stenosis.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Physical Therapist's Guide to Groin Strain

Thu, 07 Mar 2019 18:25:38 GMT

A groin strain is an injury to the groin—the area of the body where the abdomen meets the leg and the inner thigh muscles attach to the pubic bone. Typically, groin strains occur in the muscles of the upper inner thigh near the pubic bone or in the front of the hip. This injury tends to be more common in athletes and men; however, certain activities can increase the risk for anyone to experience a groin strain. Groin strains can occur during sprinting or any type of activity requiring forceful movement of the leg, such as jumping, kicking the leg up, or changing directions while running. Groin strains account for 10% of all hockey injuries and 5% of all soccer injuries. Physical therapists treat groin strains by reducing pain and helping patients improve muscle strength and leg motion and to increase the speed of recovery.

What is a Groin Strain?

A groin strain is an overstretch or tearing injury to the muscles of the inner thigh or front of the hip. Groin strains make walking, lifting the knee, or moving the leg away from or toward the body difficult and painful. Groin strains can occur from overuse of the muscles, or from a sudden contraction of the muscles.

Injury occurs when the muscles are either too forcefully contracted or too forcefully overstretched. Groin strains are graded according to the amount of muscle damage that occurs:

Grade 1: Mild or partial stretch, or a tear of a few muscle fibers. The muscle is tender and painful, but maintains its normal strength. Use of the leg is not impaired, and walking is normal.
Grade 2: Moderate stretch, or tearing of a greater percentage of the muscle fibers. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. Use of the leg is noticeably impaired, and limping when walking is common.
Grade 3: Severe tear of the muscle fibers, sometimes a complete muscle tear. A “popping” sound may be heard or felt when the injury occurs. Bruising is apparent, and sometimes a “dent” in the muscle may be seen under the skin at the site of the tear. Use of the leg is severely difficult, and putting weight on the leg is very painful.

Groin Strain

When groin muscles are strained or torn, muscle fibers and other cells are disrupted. Bleeding can occur, which causes bruising. Within a few minutes to a few hours after the injury, swelling can occur, causing the injured area to expand and feel tight and stiff.

Although groin strains most often occur in athletic activities such as football, soccer, and dance, they also can occur during everyday activities, such as lifting heavy items or slipping while walking.

How Does it Feel?

A groin strain causes sharp pain or spasms in the groin area or lower abdominal region. The pain can quickly resolve, or it can persist, developing into a throbbing pain at rest with sharp stabs of pain when you try to move your leg or walk. A lower-grade strain can be relatively pain free with everyday activities and walking, but aggravated with quick movements of the legs such as cutting, kicking, performing sit-ups, or sprinting/running. Higher-grade strains can cause the muscles to feel tight or weak. Simple movements that involve trying to lift the leg or knee, or bringing the knees together, can provoke pain, and even cause the groin muscles to spasm. If the groin strain involves a Grade 3 (complete) tear, a "pop" may be felt or heard when the muscle tears at the time of injury, and using the leg at all can be extremely painful.

Signs and Symptoms

With a groin strain, you may experience one or more of the following symptoms in the groin area or lower abdomen:

Pain, a deep ache, and/or spasms
Swelling
Bruising
Tightness

You might also experience one or more of the following symptoms:

Weakness in the leg when trying to walk, climb stairs, or move the leg
Limping when walking
Difficulty performing daily activities that require standing and walking

How Is It Diagnosed?

If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes taking your health history. The first goal of your physical therapist is to exclude any other serious conditions causing your symptoms that would warrant a referral to another health care provider. Since groin pain can be present with other diagnoses involving your hip, pelvis, or lower back, your physical therapist may ask specific questions or use additional tests to assess the possible contribution of these other regions to your pain.

Your physical therapist may ask you:

What were doing when you first felt pain?
Where did you feel the pain?
Did you hear a “pop” when it occurred?
Did you receive a direct hit to your leg or groin area?
Did you notice any swelling in the first 2 to 3 hours following the injury?
Do you feel pain when lifting your leg, walking, moving the leg away from you, or drawing your knees together?

Your physical therapist will perform special tests to help determine a diagnosis of a groin strain, such as:

Gently moving your leg away from your body
Asking you to resist against his or her hand as he or she tries to gently push your leg outward (muscle strength test)
Gently feeling parts of the muscle to determine the specific location of the injury (palpation)

To provide a final diagnosis, your physical therapist may collaborate with an orthopedist or other health care provider. The orthopedist may order further tests—such as an X-ray or magnetic resonance imaging (MRI)—to confirm the diagnosis and to rule out other potential issues. These tests, however, are not commonly required for groin strain.

How Can a Physical Therapist Help?

Your physical therapist will design a specific treatment program to speed your recovery. This program will include exercises and treatments you can do at home to help you return to your normal lifestyle and activities.

The First 24 to 48 Hours

Immediately following your consultation, your physical therapist may advise you to:

Rest the area by avoiding walking or any activity that causes pain. Crutches may be recommended to reduce further strain on the muscles when walking.
Apply ice packs to the area for 15 to 20 minutes every 2 hours.
Compress the area with an elastic bandage wrap.
Consult with another health care provider for further services, such as medication or diagnostic tests.

Your physical therapist will design an individualized treatment plan for you based on your unique condition and goals. Your plan may include treatments to:

Reduce pain. Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation (TENS), taping, exercises, and hands-on therapy, such as massage. These treatments can lessen the need for pain medication, including opioids.

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might begin with "passive" motions that the therapist performs for you to gently move your leg and hip joint, and progress to active exercises and stretches that you perform yourself.

Improve strength. Certain exercises will benefit healing at each stage of recovery; your physical therapist will choose and teach you the appropriate exercises to steadily restore your strength and agility. These may include using cuff weights, stretchy bands, weight-lifting equipment, and cardio-exercise equipment, such as treadmills or stationary bicycles.

Speed recovery time. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

Promote a safe return to activities. Your physical therapist will collaborate with you to decide on your recovery goals, including your return to work or sport, and will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will apply hands-on therapy, such as massage, and teach you exercises and work retraining activities. Your therapist also may teach you sport-specific techniques and drills to help you achieve any sport-specific goals.

Prevent future reinjury. Your physical therapist can recommend a home-exercise program to strengthen and stretch the muscles around your hip, upper leg, and abdomen to help prevent future reinjury of your groin. These may include strength and flexibility exercises for the leg, hip, and core muscles.

If Surgery Is Necessary

Surgery is rarely necessary in the case of groin strain, but if a groin muscle fully tears and requires surgical repair, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

The following recommendations can help you prevent a groin strain:

Increase the intensity of activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
Always warm up before starting a sport or heavy physical activity.
Follow a consistent strength and flexibility exercise program to maintain good physical conditioning, even in a sport's off-season.
Strengthen the muscles of the inner thigh and groin.
Wear shoes that are in good condition and fit well.
Use correct lifting techniques.

Your physical therapist can help you learn more about any of the above recommendations, and offer specific training to help you achieve them.

Physical Therapist's Guide to Elbow Bursitis

Wed, 27 Feb 2019 15:11:47 GMT

Elbow (olecranon) bursitis, commonly known as "baker's elbow," "student's elbow," or "Popeye elbow," involves swelling at the tip of the elbow, on the back of the arm. The condition can be painless, or it can be painful at rest and when leaned on, as when writing with the arm pressing on a table. Elbow bursitis can have many causes, but the most common is trauma, whether a direct hit, or smaller bumps or pressure applied over time. Elbow bursitis is commonly seen in students or office workers who lean their elbows on hard desks or armrests for long periods of time; however, its occurrence is not related to any particular age or ethnic group. The condition can also be caused by infection or autoimmune conditions. Sometimes, however, a specific cause cannot be determined. Physical therapists treat individuals with elbow bursitis to reduce their pain, swelling, stiffness, and any associated weakness in the elbow or upper extremity.

What is Elbow Bursitis?

Elbow bursitis (also called olecranon bursitis) occurs when the bursa (a fluid-filled sac on the tip of the elbow) becomes damaged, irritated, or inflamed. Normally, the bursa acts as a cushion for the tip of the elbow (ulna) bone. Certain types of pressure, traumatic blows, or repetitive motions can cause constant friction or irritation of the bursa, leading to the development of bursitis ("itis" means "inflammation of"). When the bursa becomes injured, it can swell and become painful.

Elbow bursitis can be caused by:

Repetitive motions (playing sports, such as tennis or golf; prolonged leaning on the elbows, as when typing on a computer keyboard)
Direct trauma (being hit or falling on the tip of the elbow)
Elbow surgery or replacement
Infection
Autoimmune conditions

How Does it Feel?

With elbow bursitis, you may experience:

Swelling on the tip or back of the elbow
Redness on the tip of the elbow
Pain when you push with your fingers on the tip of the back of the elbow
Pain when leaning on the arm, as when the arm is resting on an armrest or on the edge of a desk or table
Stiffness in the elbow joint, and difficulty bending the elbow

How Is It Diagnosed?

If you see your physical therapist first, your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your injury, such as:

How and when did you notice the swelling and/or pain?
Have you been performing any repetitive activity?
Did you receive a direct hit to the elbow, fall on it, or lean on it for a long period of time?

Your physical therapist also will perform special tests to help determine the likelihood that you have elbow bursitis. Your physical therapist will gently press on the back side of the elbow to see if it is painful to the touch, and may use additional tests to determine if other parts of your elbow are injured. Your therapist also will observe how you can move your elbow and arm, and test your strength and flexibility.

Your physical therapist will test and screen for other, more serious conditions that could cause elbow pain or swelling. To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an x-ray to confirm the diagnosis and to rule out other damage to the elbow, such as a fracture or infection.

How Can a Physical Therapist Help?

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but results can be achieved in 2 to 8 weeks or less, when a proper swelling management, stretching, and strengthening program is implemented.

During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:

Apply light compression by wrapping the elbow a specific way, using a compressive wrap.
Rest the area by avoiding any activity that causes pressure or pain on the elbow.
Apply ice packs to the area for 15 to 20 minutes every 2 hours.
Consult with a physician for further services, such as medication or diagnostic tests.

Your physical therapist will work with you to:

Reduce Pain and Swelling. If repetitive activities have caused the elbow bursitis, your physical therapist will help you understand how to avoid or modify the activities, to allow healing to begin. Your physical therapist may use different types of treatments and electrothermal modalities to control and reduce your pain and swelling

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the elbow and arm. These might begin with "passive" motions that the therapist performs for you to gently move your elbow joint, and progress to active exercises and stretches that you do yourself.

Improve Flexibility. Your physical therapist will determine if any of your arm muscles are tight, start helping you to stretch them, and teach you how to stretch them.

Improve Strength. If your physical therapist finds any weak or injured elbow muscles, your therapist will choose, and teach you, the correct exercises and equipment to steadily restore your strength and agility.

Improve Endurance. Restoring your arm's muscular endurance is important after an injury. Your physical therapist will develop a program of activities to help you regain the endurance you had before the injury, so you can return to doing the things you like to do.

If Surgery Is Necessary

Surgery is not commonly required for elbow bursitis, but if surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. Your physical therapist will help you minimize swelling and pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.

Can this Injury or Condition be Prevented?

Your physical therapist can recommend a home program to help prevent elbow bursitis. It may include strength and flexibility exercises for the arm muscles.

To help prevent a recurrence of the injury, your physical therapist may advise you to:

Avoid leaning on your elbow as much as possible.
Use a wrist guard/pad on your desk to cushion your elbow when you do lean on it.
Use a proper typing arm position that does not involve leaning on the elbows.
Avoid hard hits or prolonged pressure to the tip of the elbow.
Use elbow pads during sports or other physically challenging activities to protect your elbow.
Follow a consistent flexibility and strengthening exercise program, especially for the elbow muscles, to maintain good physical conditioning, even in a sport's off-season.
Always warm up before starting a sport or heavy physical activity.
Gradually increase any athletic activity, rather than suddenly increasing the activity amount or intensity.

Physical Therapist's Guide to Wrist Tendinitis

Mon, 18 Feb 2019 19:05:08 GMT

Physical Therapist's Guide to Wrist Tendinitis

Wrist tendinitis is a condition that most commonly occurs in individuals who perform repetitive activities using the hand and arm. These include computer users, factory workers, and athletes who throw and catch balls and play racquet sports. In the United States, the incidence of tendinitis as an occupational injury in people who work full time is 1.1 per 100,000. Overuse tendinitis is responsible for 25% to 50% of all sports injuries in the United States. Older individuals are often more at risk for wrist tendinitis due to a loss of elasticity in the wrist tendons. Physical therapists help people with wrist tendinitis reduce their pain, increase their wrist flexibility and strength, and return to their previous functional activities and sports.

What is Wrist Tendinitis?

Wrist tendinitis is a condition where 1 or more tendons in the wrist become inflamed and irritated. There are several tendons in the wrist that connect the muscles of the forearm and hand to the bones of the wrist and hand. These tendons are the small rope-like structures that you can see connecting to the fingers on the back of your hand. There are a number of conditions that can affect the tendons in this area.

Wrist tendinitis applies to the early stages of tendon inflammation and irritation.
Tendinopathy is the name given to the condition when it persists over time, is not treated, and becomes chronic.
Tenosynovitis is the term given to an irritation that develops when the synovial sheath (through which some of these tendons glide) thickens and restricts the tendon.
De Quervain's Tendinitis applies to tendinitis that develops on the thumb side of the wrist.

How Does it Feel?

Several tendons in the wrist can become irritated with wrist tendinitis. Pain symptoms associated with the condition include:

Pain where the arm meets the hand, which can radiate up into the elbow.
Pain on the thumb side of the wrist (radial) or the little-finger side of the wrist (ulnar).
Pain that only occurs when the wrist is under strain, which can become constant pain when left untreated.
Pain when putting pressure on the hand, such as using the arms to push yourself up out of a chair to stand.

Besides pain, other symptoms include:

Stiffness of the wrist, and a decreased ability to bend and extend the wrist.
Inflammation or swelling in the wrist area.
Tenderness to touch in the wrist and/or forearm muscles.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation of your entire arm to include the shoulder, elbow, wrist, and hand. The therapist will ask you to describe the types of activities you normally perform using your arm at home, at work, and for recreation, and which of these activities causes pain or stiffness in the area. You will be asked how long the pain has been occurring and how it is affecting your regular activities of daily living. Your physical therapist will check your range of motion and strength in your entire upper arm. Your therapist will gently touch specific areas of your wrist and forearm to determine which wrist tendons are involved, and check for any swelling in the area.

How Can a Physical Therapist Help?

Physical therapy is a highly effective treatment for wrist tendinitis. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

Pain Management. Your physical therapist will help you identify and avoid painful movements, and show you how to correct abnormal postures to reduce stress on the wrist. Your therapist may recommend resting the wrist short-term, and applying ice to the area to help alleviate pain. Your physical therapist also may apply a wrist brace to restrict wrist movement, allowing the tendons to heal.

Manual Therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and wrist stretches to get your wrist moving properly.

Range-of-Motion Exercises. You will learn exercises and stretches to reduce stiffness and help your wrist, hand, and forearm begin to move properly.

Strengthening Exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific areas of weakness. The entire arm, including the shoulder, elbow, and wrist, can potentially be weakened and contribute to the movement dysfunction that causes tendinitis. Your physical therapist will design an individualized home-exercise program to meet your specific needs and goals, which you can continue long after you have completed your formal physical therapy.

Patient Education. Depending on the specific activities you plan on resuming, your physical therapist will teach you ways to perform actions, while protecting your wrist and hand. For example, keeping the wrist in a neutral position to reduce excessive force while performing repetitive tasks, and taking frequent breaks are ways to decrease your chances of reinjury.

Functional Training. As your symptoms improve, your physical therapist will teach you how to correctly perform functional movement patterns using proper wrist mechanics, such as typing on a computer or swinging a racquet. This training will help you return to pain-free function on the job, at home, and when playing sports.

Can this Injury or Condition be Prevented?

To prevent wrist tendinitis, physical therapists recommend that you:

Avoid repetitive wrist and hand movements.
Warm up the muscles around the wrist and hand before starting an activity.
Perform regular stretches to maintain flexibility in the wrist and forearm before and after exercise or activity.
Perform regular upper-body strengthening exercises to enable the wrist and hand to tolerate sports and other activities of daily living, with less stress to the joint.
Follow joint protection techniques when using the wrist, such as balancing rest with work, and using the larger muscles of the arm for heavier tasks.
Do not continue an activity that is painful or uncomfortable to the wrist and hand.

Physical Therapist's Guide to Gait Dysfunctions

Fri, 15 Feb 2019 15:20:46 GMT

Physical Therapist's Guide to Gait Dysfunctions

Gait dysfunctions are changes in your normal walking pattern, often related to a disease or abnormality in different areas of the body. Gait dysfunctions are among the most common causes of falls in older adults, accounting for approximately 17% of falls. This guide will help you better understand how gait dysfunctions are categorized, and how treatment by a physical therapist can help you regain a healthy gait. Physical therapists are experts at identifying the root causes of gait dysfunctions, and designing treatments that restore gait.

What are Gait Dysfunctions?

Gait dysfunctions make the pattern of how you walk (ie, your gait) appear “abnormal." Most changes in gait are related to underlying medical conditions. Gait dysfunctions can be related to disorders involving the inner ear; nervous system disorders such as Parkinson's disease; muscle diseases such as muscular dystrophy; and musculoskeletal abnormalities such as fractures. In many cases, treatment of the underlying medical condition will help normalize the gait pattern.

Common classifications of gait dysfunction include:

Anatalgic. This type of gait dysfunction is often caused by bearing weight on a painful leg. It can be related to arthritis or a traumatic injury, and is what many people refer to as a "limp." People with this dysfunction take slow and short steps, and quickly try to shift their weight off of the sore leg, ankle, or foot, and back onto the unaffected leg.
Cerebellar Ataxia. This gait dysfunction is often seen in individuals who have a condition of the cerebellum (a region of the brain), drug or alcohol intoxication, multiple sclerosis, or have experienced a stroke. The affected individual will have a wide-based stance (feet wide apart), and display inconsistent and erratic foot placement.
Parkinsonian . This type of gait dysfunction is often related to Parkinson’s disease and is characterized by short, shuffled steps.
Steppage. This dysfunction occurs in people with "foot drop" (an inability to lift the ankle), which is related to conditions, such as lumbar radiculopathy and neuropathy. Because the ankle will "slap" off of the ground, the individual will often lift the leg higher at the knee and hip, to clear the foot when taking a step./li>
Vestibular Ataxia. This pattern is often related to vertigo, Meniere’s disease (an inner-ear condition), and labyrinthitis (a type of inner-ear disorder in 1 ear). It causes people to walk unsteadily, often falling toward 1 side.
Waddling. This pattern often arises from muscular dystrophy and myopathy, and causes individuals to walk on their toes, while swaying side-to-side.

Note: These are only a few of the many possible gait dysfunctions. If you suspect you are walking differently, call your physical therapist for a gait assessment.

How Is It Diagnosed?

There are many different strategies and tools that can help a physical therapist diagnose a gait dysfunction. While other health care professionals are educated in the screening for potential conditions related to the gait abnormality, a physical therapist is the expert in diagnosing the actual type of gait dysfunction. Your physical therapist will ask you questions, such as:

When did you notice you were walking differently?
Is the problem getting better or worse?
Has it resulted in a fall or any additional problems?
Are you in pain while you walk?
Have there been any recent changes in your medical history, including changes in medications?

Your physical therapist will also conduct certain tests to learn more about your condition. Your assessment may include:

Observation . Your physical therapist will ask you to walk back and forth, to observe any abnormalities in your gait pattern.
Gait speed measurements . Your physical therapist will time your walking speed. Studies have shown that complications like falling are related to how fast you walk.
Balance tests . Your physical therapist may also assess your balance to determine your risk of falling.
Strength and range-of-motion measurements . These tests can help determine whether the dysfunction is due to musculoskeletal limitations. A physical therapist may utilize tools, such as a goniometer to measure your joint motion, or dynamometer to measure your strength.
Reflex and sensation screenings . These measurements will help your physical therapist determine whether a neurological (brain or nervous system) condition is present.

How Can a Physical Therapist Help?

Physical therapists play a vital role in helping individuals improve their gait. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals. Your physical therapist will design an individualized program to treat your specific condition.

The treatment strategy may include:

Pre-Gait Training. Your physical therapist may begin your treatment by having you perform activities and exercises that will help you understand how to improve your gait, without taking a single step. These exercises may include simple activities, such as having you stand and lift your leg in place, to more complex strategies like stepping in place and initiating contact with your heel to the ground, prior to other portions of the foot.

Gait Training. Your physical therapist will help you focus on retraining the way you walk. Because the underlying condition may be vestibular, neurological, or muscular, variations in the training exist. Your physical therapist will design the safest and best training for your specific condition.

Balance and Coordination Training. Your physical therapist may prescribe balance activities for you to perform to help stabilize your walking pattern.

Neuromuscular Reeducation. Your physical therapist may employ neuromuscular reeducation techniques to activate any inactive muscle groups that may be affecting your gait.

Bracing or Splinting. If the gait dysfunction is due to significant weakness or paralysis of a ligament, your physical therapist may teach you how to use adaptive equipment, like a brace or splint, to help you move.

Can this Injury or Condition be Prevented?

Because gait dysfunctions are related to many different types of underlying conditions, they may not be preventable. However, if they are addressed and treated early, many gait dysfunctions can improve and will not result in additional problems, such as falling.

Physical Therapist's Guide to Stroke

Wed, 06 Feb 2019 16:24:20 GMT

If you have 1 or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you:

Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
Sudden confusion or trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

If You Think Someone Might Be Having a Stroke

Act F.A.S.T. ! Emergency treatment with a clot-buster drug called t-PA can help reduce or even eliminate problems from stroke, but it must be given within 3 hours of when symptoms start. Recognizing the symptoms can be easy by remembering to think F.A.S.T.

F =Face. Ask the person to smile . Does one side of the face droop?
A =Arms. Ask the person to raise both arms . Does one arm drift downward?
S =Speech. Ask the person to repeat a simple phrase . Does the speech sound slurred or strange?
T =Time. If you observe any of these signs, call 911 and note the time that you think the stroke began .

Research shows that people with stroke who arrive at the hospital by ambulance receive quicker treatment than those who arrive by their own means.

What Is Stroke?

An ischemic stroke , the most common type, occurs when a blood vessel is blocked. One frequent cause of blockage is a blood clot or a build-up of fatty deposits (arteriosclerosis) in blood vessels that supply the brain.
A hemorrhagic stroke occurs when a blood vessel leaks or ruptures because of a weakened region of a vessel or in an area of the brain with a cluster of abnormally formed vessels.

Ischemic Stroke

Hemorrhagic stroke

Signs and Symptoms

If you are having a stroke, you might:

Feel a sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
Be confused about where you are or what you're doing
Have trouble speaking or understanding what others are saying
Have trouble seeing in one or both of your eyes
Have trouble walking, be dizzy, or lose your balance
Have a sudden, severe headache that seems to come out of nowhere

Stroke can cause a range of long-term problems, such as:

Inability or difficulty moving one side of the body (hemiparesis or hemiplegia)
Severely limited movement or stiffness in the arms and legs (spasticity)
Balance problems
Weakness on one side of the body
Off-and-on numbness
Loss or lack of sensation
Sensitivity to cold temperatures
Memory loss
Slowed or slurred speech
Difficulty remembering words

How Is It Diagnosed?

How Can a Physical Therapist Help?

Later, your physical therapist will:

Help you improve your balance and walking.
Fit you with a wheelchair, if needed.
Provide training to your family and caregivers.
Train you in how to use devices that can help you keep mobile when a stroke has affected your ability to move, walk, or keep your balance: orthoses, prostheses, canes, walkers, wheelchairs, and perhaps even robotics.

Relearning How to Use Your Upper Body, How to Walk, and How to Perform Daily Activities

Constraint-induced movement therapy (CIMT). CIMT is used to strengthen an arm affected by the stroke. Your physical therapist will apply a mitten or a sling on your strong arm to keep you from fully using it. This constraint "forces" you to use your arm or hand affected by the stroke to perform daily tasks, which helps build your strength and control. CIMT requires that the constraint be used for several hours a day, several days a week to be successful.

Functional electrical stimulation (FES). This treatment helps move your muscles if they are very weak. For instance, your physical therapist might use FES to treat a painful or stiff shoulder.

Motor imagery and mental practice. These tools are used to help strengthen the arms, hands, feet, and legs. Working with your physical therapist, you will "rehearse" a movement without actually performing it, which stimulates the part of your brain that controls the movement.

Positioning. Proper positioning helps reduce any muscle pain, spasms, slowness, or stiffness that can result from stroke. Your physical therapist will teach you how to safely move ("transfer") from a sitting to a standing position, and how to support yourself when sitting or lying down, using foam wedges, slings, and other aids.

Virtual reality and interactive video games may be used to provide experiences similar to real life. Using a keyboard and mouse, a special wired glove, or sensors on your body, you can practice daily tasks as your therapist helps you "rewire" your brain and nerve connections. Your therapist may teach you how to continue these activities at home.

Partial body weight support (BWS). BWS is used to help support you as you walk, usually on a treadmill. Your physical therapist will gradually decrease the amount of support as your posture, strength, balance, and coordination improve.

Biofeedback. This treatment helps make you aware of how your muscles work and how you might be able to have better control over them. Your therapist will attach electrodes to your skin to provide measurements of muscle activity that are displayed on a monitor. Your physical therapist will work with you to help you understand and change those readings.

Can this Injury or Condition be Prevented?

The American Stroke Association has estimated that 80% of strokes can be prevented. Some risk factors for stroke can't be changed—such as family history, age, gender, race (stroke death rates are higher for African Americans, even at younger ages), and previous heart attack or stroke. Many causes of stroke can be reduced by lifestyle changes:

Contact a physician if you suspect you have high blood pressure, and take your medication as prescribed. High blood pressure (hypertension) causes approximately one-half of all strokes.
If you are a smoker, join a program to quit smoking. The CDC (see below link) offers resources for quitting.
Reduce high cholesterol by following the recommendations of your health care provider.
Manage diabetes by following recommendations and taking prescribed medication.
Obtain treatment if you have been diagnosed with carotid artery disease.
Engage in daily physical activity for general health and to reduce obesity. Your physical therapist is an expert at designing a health and wellness activity plan specifically for you.
Reduce your alcohol intake.

Physical Therapist's Guide to Ankle Fracture

Mon, 14 Jan 2019 14:41:06 GMT

Physical Therapist's Guide to Ankle Fracture

An ankle fracture occurs when a bone on 1 or both sides of the ankle is partially or completely broken. Most ankle fractures are caused by twisting injuries and falls, or injuries experienced during sports or play. Under the age of 50, most ankle fractures occur in men. Over the age of 50, women experience more ankle fractures. The type of fracture varies from simple to complex, and can involve 1 or all 3 bones that make up the ankle joint. It is important to seek treatment after an ankle injury to determine if you have a fracture. Physical therapy shares an important role in your treatment and recovery from an ankle fracture, for a return to normal activity.

What is an Ankle Fracture?

An ankle fracture is a completely or partially broken bone on 1 or both sides of the ankle joint. There are several types of ankle fractures, and 1, 2, or 3 bones may be fractured. The classifications based on the number of bones broken are:

Lateral malleolus fracture. Only the bone on the outside of the ankle, the fibula, is broken.
Medial malleolus fracture. Only the bone on the inside of the ankle, the tibia, is broken.
Bi-malleolar fracture. Two bones are broken, the fibula and the tibia.
Trimalleolar fracture. Three bones are broken, the fibula, tibia, and the posterior malleolus (the tibia at the back of the foot).

The severity of the fracture is classified as:

Nondisplaced. The pieces of the fractured bone remain lined up.
Displaced. The 2 parts of the fractured bone do not line up.
Comminuted . Splinters or multiple small pieces of bone are found at the fracture site.
Complex Fracture. The soft tissue surrounding the broken bone is severely damaged.
Compound Fracture. Fracture fragments can pierce the skin.

When a fracture involves several broken bones or the bones do not remain lined up, the fracture is considered to be unstable and requires immediate treatment. A compound fracture also involves a risk of infection

Signs and Symptoms

People who fracture their ankles may experience:

Immediate, severe pain after a twisting injury or fall.
A “pop” or “snap” felt or heard at the time of the injury.
Swelling in the ankle.
Tenderness or pain in the ankle area.
Difficulty bearing weight on the ankle when standing, walking.
Not being able to bear weight on the ankle at all.
Bruising.
Pain that increases with activity and improves with rest.
Inability to put a shoe on due to swelling and pain.
A bump or deformity that may be seen or felt at the ankle.

How Is It Diagnosed?

If you see your physical therapist after an ankle injury, the physical therapist will ask about your medical history, and how the injury occurred. Your physical therapist will observe your ability to walk and bear weight on the injured side, and gently examine the area to observe any swelling, deformity, and tenderness. Your physical therapist also will examine your foot and lower leg to identify whether other areas may be injured. If a fracture is suspected, your physical therapist will consult with your physician. An x-ray is needed to confirm or rule out an ankle fracture. You may then be referred to an orthopedic physician or emergency room for further treatment.

It is important to have an ankle injury assessed by your physical therapist or medical provider soon after an ankle injury, to distinguish a severe sprain from a broken bone.

If the bone is piercing the skin, immediately go to a hospital emergency room.

How Can a Physical Therapist Help?

Before Surgery

If you see your physical therapist after your injury and an ankle fracture is suspected, your physical therapist will:

Instruct you in acute injury care using the RICE formula: rest, ice, compression, and elevation.
Immobilize your ankle by wrapping it with an ace wrap, or applying a stirrup brace to limit motion and control swelling.
Apply ice to reduce pain and swelling.
Instruct you to keep the involved ankle elevated to control swelling.
Instruct you to walk without putting weight on the injured ankle, using crutches or a walker.
Make recommendations for additional care with an orthopedic physician or emergency department.

If you have an ankle fracture, treatment will depend on how many bones are broken, and if it is a simple, complex, or compound fracture. Initial treatment involves the realigning and stabilizing of the bones by your physician, and is performed in the hospital emergency room or, if needed, with surgery.

After Surgery

If surgery is required, the affected ankle will be placed in a cast or fracture boot to stabilize it following surgery. A physical therapist will visit your hospital room once you are medically stable, to help you get up and out of bed. Your physical therapist will help you sit up on the bedside, and then stand up. You will not be allowed to put any weight on the involved ankle for about 6 to 10 weeks. Your physical therapist will teach you how to walk with the use of an assistive device, such as crutches or a walker. You will also learn how to go up and down steps and curbs using your assistive device.

When an x-ray confirms that the fracture has healed, your physician will remove your cast. Your physical therapist will work with you to safely put weight on your ankle, and begin treatment to help you return to your normal activity.

If You Do Not Require Surgery

A physical therapist can help treat a broken ankle after it has been treated by a physician and immobilized. After the bone is healed, a physical therapist can help you gain back your strength, motion, balance, and sport skills.

After your injured leg is placed in a cast or a cast boot, your physical therapist will teach you how to walk without bearing weight on the injured ankle, using crutches or a walker. Your physical therapist will teach you how to get in and out of bed, and your car. Your physical therapist will provide you with the equipment that best suits your needs.

When healing of the fracture is seen on an x-ray, your physician will remove your cast, and you will begin bearing weight on that leg again, and continue your physical therapy treatment.

Physical therapy treatment will include:

Walking Instruction. Your physical therapist will help you begin to put some of your weight on the injured leg, gradually progressing to full weight as your physician recommends.
Gait Training. Your physical therapist will offer specific instruction and exercises to restore a normal walking pattern. The focus will be on how your foot and ankle move, and the timing of your steps. You may practice on a treadmill at low speed, on level ground, and on steps.
Reducing Swelling. Swelling is common after an ankle fracture. Treatment may include gentle massage, the use of a compression wrap, ice, or heat, and elevating the affected ankle when at rest.
Exercise. Your physical therapist will design an exercise plan to begin when the cast is removed to help you strengthen and regain motion in your injured ankle. It is important to regain the ability to bend your ankle to restore your full walking ability.
Restoring Ankle Mobility. Your physical therapist may use manual (hands-on) therapy to gently move your foot and ankle joints and surrounding tissues to reduce stiffness, and increase the ankle's bending range of motion.
Return to Work/Play Activity. As you regain strength and flexibility, your physical therapist will provide activity training specific to your job, leisure activity, or sport.

Return to full participation in sports and work activities generally occurs 12 to 16 weeks after an ankle fracture.

Note: Physical therapy treatment is different for each person and depends on your type of injury, how you are healing, and whether you had surgery, as well as your age and physical health.

Can this Injury or Condition be Prevented?

Not all ankle fractures can be prevented. However, some precautions may be taken.

To reduce your risk of ankle injury:

Wear appropriate protective gear when participating in sports.
Train to reach your top strength and fitness levels.
Wear proper shoes, and replace athletic shoes regularly.

To reduce your fall risk:

Remove obstacles and clutter from hallways and rooms in your home.
Work and play in well-lighted areas.
Use night lights in the home.
Install grab bars to tub/shower areas.
Add railings to both sides of stairways.
Maintain strength and fitness throughout your life.

Physical Therapist's Guide to Acromioclavicular (AC) Joint Injuries

Wed, 19 Dec 2018 19:26:50 GMT

Physical Therapist's Guide to Acromioclavicular (AC) Joint Injuries

Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle). It can be caused by a traumatic event, such as a fall directly on the outside of the shoulder, or by repetitive overuse. AC joint injuries are most common in individuals younger than 35 years of age, with males sustaining 5 times more traumatic AC joint injuries than females. Because younger athletes are most likely to participate in high-risk and collision activities, such as football, biking, snow sports, hockey, and rugby traumatic AC joint injuries occur most often in this population. AC joint injuries can be identified and effectively treated by a physical therapist, often avoiding the need for surgery.

What Are Acromicioclavicular (AC) Joint Injuries?

There are 4 ligaments holding the 2 bones of the AC joint (the acromion and the clavicle) together. When an AC joint injury occurs, these ligaments are stressed, resulting in some degree of joint separation. There are 2 types of injuries that can occur at the AC joint: traumatic and overuse injuries.

A traumatic AC joint injury occurs when there is a disruption of the joint due to damaged ligaments holding the 2 bones of the joint together. This injury is called a shoulder separation (in contrast to a shoulder dislocation, it involves the ball-and-socket joint of the shoulder).

Traumatic AC joint injuries are most common in individuals who sustain a fall and land on the outside of the shoulder or onto a hand (eg, a football player who is tackled, a bicyclist who crashes, or a manual laborer who falls off a ladder.

Traumatic AC joint injuries are graded from mild to severe based on the amount of separation of the joint. Treatment of mild cases likely will be provided by a physical therapist; more severe cases may require surgery followed by physical therapy.

An overuse AC joint injury occurs over time as repeated, excessive stress is placed on the joint. Cartilage at the ends of the acromion and clavicle bones protects the joint from daily wear and tear. Over time, the demand placed on this cartilage may be more than it is capable of enduring, resulting in an overuse injury. Significant wearing of the cartilage is known as arthritis. Overuse AC joint injury is most common in individuals who perform tasks, such as heavy weight lifting (bench and military presses), or jobs that require physical labor with the arms stretched over the head.

How Does it Feel?

With an AC joint injury, you may experience:

General shoulder pain and swelling
Swelling and tenderness over the AC joint
Loss of shoulder strength
A visible bump above the shoulder
Pain when lying on the involved side
Loss of shoulder motion
A popping sound or catching sensation with movement of the shoulder
Discomfort with daily activities that stress the AC joint, like lifting objects overhead, reaching across your body, or carrying heavy objects at your side

How Is It Diagnosed?

Diagnosis of an AC joint injury starts with a thorough review of the patient’s medical history, including specific questions regarding when the pain began, and what aggravates and relieves the pain.

Your physical therapist will examine your shoulder and assess different measures, such as sensation, motion, strength, flexibility, tenderness, and swelling. Your physical therapist will perform several tests specific to the shoulder joint to examine the structures located there. The therapist may also ask you to briefly demonstrate the activities or positions that cause your pain. Other nearby areas, such as your neck and upper back will also be examined to determine whether they, too, might be contributing to your shoulder condition.

While an AC joint injury can usually be identified through a shoulder examination, diagnostic imaging, such as ultrasound, x-ray, or MRI is often used to confirm the diagnosis and determine the severity of the injury.

How Can a Physical Therapist Help?

Once other conditions have been ruled out and an injury to the AC joint is diagnosed, your physical therapist will work with you to develop an individualized plan tailored to your specific shoulder condition and your goals. There are many physical therapy treatments that have been shown to be effective in treating this condition. Your physical therapist may focus on:

Range of Motion. An injury to the AC joint, whether traumatic or overuse, causes the joint to be irritated, often resulting in swelling and stiffness, causing loss of normal motion. Motions that are usually most difficult after an AC joint injury are reaching across your body and lifting your arm directly overhead. While it is important to regain your normal shoulder motion, it is also important to allow your injury to heal without placing excessive stress on the healing joint. Your physical therapist will assess your motion and the degree of your injury, and establish a plan that will balance joint protection and motion restoration.

Strength Training. After an injury, the surrounding muscles demonstrate weakness. All of the muscles near the shoulder and elbow as well as those of the upper back, work together to allow for normal, coordinated upper-body motion. Therefore, balancing the strength of all the upper-body muscles is crucial to making sure the shoulder joint is protected and moves efficiently. Your physical therapist will design an individualized exercise program to strengthen the muscles at and around the shoulder, so that each muscle is able to properly perform its job.

Manual Therapy. Physical therapists are trained in manual (hands-on) therapy. If needed, your physical therapist will gently move and mobilize your shoulder joint and surrounding muscles as needed to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.

Pain Management. Your physical therapist may recommend therapeutic modalities, such as ice and heat to aid in pain management.

Functional Training. The AC joint is a relatively small joint that is often asked to bear a significant load. In order to successfully meet this demand, there is a need for functional training, teaching your entire shoulder to work best in different positions. For example, when lifting overhead, poor coordination places undue stress on the shoulder. Physical therapists are experts in assessing movement quality. Your physical therapist will be able to point out and correct your movements to help you maintain a pain-free shoulder.

Education. The first step to addressing your shoulder pain is rest. The amount of rest required varies, and largely depends on the degree of your injury. Your physical therapist will create a personalized plan for your rehabilitation, so you can safely return to your desired daily and recreational activities.

Can this Injury or Condition be Prevented?

It may be difficult to prevent many traumatic AC joint injuries, such as bicycle crashes, falls to the ground, etc. Accidents do happen. Fortunately, however, much can be done to prevent the cascade of events that lead to overuse injuries to the AC joint, including:

Learning about the risks of pushing through pain.
Monitoring work and weight-lifting activities, particularly repetitive overhead lifting.
Avoiding repetitive overhead lifting when possible.
Maintaining adequate general shoulder strength and motion to safely perform desired tasks.
Consulting with a physical therapist if symptoms are persistent or worsening despite rest.

Physical Therapist's Guide to Achilles Tendinopathy

Thu, 13 Dec 2018 16:45:59 GMT

Achilles tendinopathy is an irritation of the Achilles tendon. Achilles tendon pain is one of the most common types of pain felt behind the heel and up the back of the ankle when walking or running. Although Achilles tendinopathy affects both active and inactive individuals, 24% of athletes develop the condition, and an estimated 50% of runners will experience Achilles tendon pain in their running careers. In all individuals, Achilles tendinopathy can result in a limited ability to walk, climb stairs, or participate in recreational activities. Physical therapists help people with Achilles tendinopathy reduce pain in the affected area, and restore strength, flexibility, and mobility to the injured tendon and eliminate swelling when present.

Achilles Tendinopathy

Achilles tendinopathy is an irritation of the Achilles tendon, a thick band of tissue along the back of the lower leg that connects the calf muscles to the heel. The term “tendinopathy” refers to any problem with a tendon, either short- or long-term. The Achilles tendon transmits force from the calf muscles down to the foot when a person pushes the foot off the ground (eg, runs or jumps), and helps control the position of the ankle when the foot touches back down on the ground (eg, lands). Achilles tendinopathy results when the demand placed on the Achilles tendon is greater than its ability to function. The condition can occur after a single incident (acute injury) or after repetitive irritation or "microtrauma" (chronic injury). Most often, Achilles tendon pain is the result of repetitive trauma to the tendon that can result in chronic Achilles tendinopathy—a gradual breakdown of the tissue—and is most often treated with physical therapy.

Achilles tendinopathy is linked to several different factors, including:

Calf muscle tightness
Calf muscle weakness
Abnormal foot structure
Abnormal foot mechanics
Improper footwear
A change in an exercise routine or sport activity
Obesity

Pain can be present at any point along the tendon; the most common area to feel tenderness is just above the heel (known as midportion Achilles tendinopathy), although it may also be present where the tendon meets the heel (known as insertional Achilles tendinopathy).

Achilles Tendon Injury

How Does it Feel?

With Achilles tendinopathy, you may experience:

Tenderness in the heel or higher up in the Achilles tendon with manually applied pressure
Pain and stiffness with walking, at its worst with the first several steps
Tightness in the calf
Swelling in the back of the ankle

How Is It Diagnosed?

Your physical therapist will review your medical history and complete a thorough examination of your heel, ankle, and calf. Your physical therapist will assess your foot posture, strength, flexibility, and movement. This process may include watching you stand in a relaxed stance, walk, squat, step onto a stair, or do a heel raise. The motion and strength in other parts of your leg also will be assessed.

Your physical therapist may also ask questions regarding your daily activities, exercise regimens, and footwear, to identify other contributing factors to your condition.

Imaging techniques, such as X-ray or MRI, are often not needed to diagnose Achilles tendinopathy. Although it is unlikely that your condition will ultimately require surgery, your physical therapist will consult with other medical professionals, such as an orthopedist, to determine the best plan of treatment for your specific condition if it does not respond to conservative care.

How Can a Physical Therapist Help?

Physical therapy promotes recovery from Achilles tendinopathy by addressing issues such as pain or swelling of the affected area, and any lack of strength, flexibility, or body control. You and your physical therapist will work together to develop an individualized treatment program to help you achieve your specific goals in the safest and most effective way possible. Your treatment may include:

Education. Your physical therapist will work with you to identify any possible external factors causing your pain, such as faulty footwear or inappropriate movements or exercises. Your physical therapist will assess your footwear and recommend improvements, and develop a personalized exercise program to help ensure a pain-free return to your desired activities.

Pain management. Many pain-relief strategies may be implemented, such as applying ice to the area, putting the affected leg in a brace, using heel lifts, or using therapies such as iontophoresis (a medicated patch placed on the skin that is electrically charged and used to decrease pain and inflammation), or therapeutic ultrasound. These strategies can reduce the need for pain medication, including opioids.

Manual therapy. Your physical therapist may apply hands-on treatments to gently move your muscles and joints in order to improve their motion and function. These techniques often address areas that are difficult to treat on your own.

Range-of-motion treatments. Your ankle, foot, or knee joint may be moving improperly, causing increased strain on the Achilles tendon. Self-stretching and manual therapy techniques (massage and movement) applied to the lower body to help restore and normalize motion in the foot, ankle, knee, and hip can decrease this tension and restore full range of motion.

Gentle exercise. Loading of the tendon (applying weight or resistance to it) through exercise is beneficial for recovery from Achilles tendinopathy. You may begin by performing gentle strengthening exercises in a seated position (eg, pushing and pulling on a resistive band with your foot). You then may advance to exercises in a standing position (eg, standing heel raises).

Muscle-strengthening exercises. Muscle weakness or imbalance can result in excessive strain on the Achilles tendon. Based on your specific condition, your physical therapist will design an individualized, progressive, lower-extremity resistance program for you to help correct any weakness-associated movement errors that may be contributing to your pain.

Functional training. Once your pain eases and your strength and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension placed on the Achilles tendon and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your goals and movement assessment, your physical therapist will create a series of activities that will help you learn how to use and move your body correctly to safely perform the tasks required to achieve your goals.

If additional interventions are needed , such as injections, minimally invasive tendon procedures, or surgery, your physical therapist will work with you after your procedure to help you regain motion, strength, and function.

MoveForwardPT.com, the official consumer Website of the American Physical Therapy Association,© 2017 MoveForwardPT.com, the official consumer Website of the American Physical Therapy Association,© 2017

Physical Therapist's Guide to Vertigo

Wed, 28 Nov 2018 18:49:28 GMT

Vertigo usually is described as a spinning sensation, whereas dizziness usually is described as "lightheadedness." Often, they have different causes and different treatments.

If you have vertigo accompanied by one or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you:

Double vision
Difficulty speaking
A change in alertness
Arm or leg weakness
Inability to walk

What Is Vertigo?

Vertigo is the sensation of spinning—even when you're perfectly still, you might feel like you're moving or that the room is moving around you. Most causes of vertigo involve the inner ear ("vestibular system"). A number of conditions can produce vertigo, such as:

Inner ear infections or disorders
Migraines
Tumors, such as acoustic neuroma
Surgery that removes or injures the inner ear or its nerves
Head injury that results in injury to the inner ears
A hole in the inner ear
Stroke

You also might have:

Nausea
Vomiting
Sweating
Abnormal eye movements

One of the most common forms of vertigo is benign paroxysmal positional vertigo, an inner-ear problem that causes short periods of a spinning sensation when your head is moved in certain positions.

How Is It Diagnosed?

Your physical therapist will use your answers to the following questions to help identify the cause of your vertigo and to determine the best course of treatment:

When did you first have vertigo (the sensation of spinning)?
What are you doing when you have vertigo (turning your head, bending over, standing perfectly still, rolling in bed)?
How long does the vertigo last(seconds, minutes, hours, days)?
Have you had vertigo before?
Do you have hearing loss, ringing, or fullness in your ears?
Do you have nausea with the spinning?
Have you had any changes in your heart rate or breathing?

Your physical therapist will perform tests to determine the causes of your vertigo and also to assess your risk of falling. Depending on the results of the tests, your therapist may recommend further testing or consultation with your physician.

How Can a Physical Therapist Help?

Based on your physical therapist's evaluation and your goals for recovery, the therapist will customize a treatment plan for you. The specific treatments will depend on the cause of your vertigo. Your therapist's main focus is to help you get moving again and manage the vertigo at the same time. Treatment may include specialized head and neck movements or other exercises to help eliminate your symptoms. Conditions such as benign paroxysmal positional vertigo have very specific tests and treatments.

If you have dizziness and balance problems after your vertigo has stopped, your physical therapist can develop a treatment plan that targets those problems. Your physical therapist will teach you strategies to help you cope with your symptoms :

Do certain activities or chores around the house cause you to become dizzy? Your therapist will show you how to do those activities in a different way to help reduce the dizziness.
Have simple activities become difficult and cause fatigue and more dizziness? Your therapist will help you work through these symptoms right away so you can get moving again and return to your roles at home and at work more quickly.

Physical therapy treatments for dizziness can take many forms. The type of exercise that your therapist designs for you will depend on your unique problems and might include:

Exercises to improve your balance
Exercises to help the brain "correct" differences between your inner ears
Exercises to improve your ability to focus your eyes and vision

In addition, your physical therapist might prescribe exercises to improve your strength, your flexibility, and your heart health—with the goal of improving your overall physical health and well being.

Physical Therapist's Guide to Chronic Pain Syndromes

Wed, 21 Nov 2018 18:50:28 GMT

It is estimated that 116 million Americans have chronic pain each year. The cost in the United States is $560–$635 billion annually for medical treatment, lost work time, and lost wages.

The causes of chronic pain vary widely. While any condition can lead to chronic pain, there are certain medical conditions more likely to cause chronic pain. These include:

Trauma/injury
Diabetes Mellitus
Fibromyalgia
Limb amputation
Reflex Sympathetic Dystrophy

Some diseases, such as cancer and arthritis, cause ongoing pain. With chronic pain, however, pain is created in the nervous system even after physical tissues have healed.

Chronic pain affects each person experiencing it differently. In some cases, chronic pain can lead to decreased activity levels, job loss, or financial difficulties, as well as anxiety, depression, and disability. Physical therapists work together with chronic pain patients to lessen their pain, and restore their activity to the highest possible levels. With treatment, the negative effects of chronic pain can be reduced.

What Is Chronic Pain?

Pain is an unpleasant sensation that we usually associate with injury or tissue damage, but can actually be present in the absence of tissue damage as well. Pain can be acute or chronic.

Acute pain lasts for a short time – up to 12 weeks. It is a warning that tissue damage has occurred or may occur, or to help us prevent injury or disease. For instance, if we touch a hot stove, the body sends a danger message to the brain that there is a threat to tissues in order to prevent further injury. A sore foot can signal a need to change your footwear. In some cases, the danger messages may be due to some disease process, and your brain may interpret those messages as pain. This can cause you to seek medical attention – diagnosis and treatment – for what may be a serious condition. Signaling pain in this manner is the body's way of protecting us and is a good thing.

Chronic pain is any discomfort or unpleasant sensation that lasts for more than 3 months – or beyond an expected normal healing time. Often, those who have chronic pain believe they have an ongoing disease or that their body has not healed, when this may not be the case. Chronic pain is likely not warning you of possible injury or danger; instead, the pain centers in the brain may be causing you to hurt even though there are no new causes of pain occurring in the body. Anyone can develop chronic pain, at any age. The brain changes in chronic pain:

When you are injured or develop a painful disease, nerves send information from the problem area to the brain.
The brain analyzes this information coming from the body to determine if there is a threat to the body and whether action needs to be taken to prevent harm.
When pain is constant or chronic, the brain and nervous system go on "high alert," becoming more sensitive.
Cells that conduct sensation in the nervous system can also become more sensitive when on high alert, making it easier for the brain to interpret these sensations as a threat and thus cause you to have more pain. These changes in the brain and central nervous system induce and maintain chronic pain symptoms.
When pain is chronic: Pain sensations are activated in the brain; The brain continues to interpret all sensations from the problem areas as danger, even when there is no more tissue damage occuring. This makes it easier for the pain centers in the brain to activate; Pain messages come from many different areas of the brain – areas that may control fight or fear reactions, movement, emotions, problem-solving, and learning. In fact, almost any system of the body can be affected by chronic pain.
The brain and nervous system continue reacting by causing you to continue to be in pain. This process increases sensations, emotions, or thoughts about the problem area. At this point, any sensory input can activate the pain centers. Even thinking about it, or reading the word pain can trigger pain sensations. The pain is in the brain: In order to protect you, the brain is making the decision to increase the alert level for sensations you feel.

How Does it Feel?

How chronic pain feels varies with each individual; it is very personal. How often it occurs, how severe it is, or how long it lasts is not predictable from one person to another.

Common complaints related to chronic pain include:

It may seem as if "everything hurts, everywhere."
There may be sudden stabs of pain.
It may seem as if the pain "has a mind of its own."
You feel symptoms even if you are not doing anything to cause them.
It feels worse when you think about it.
It feels worse when you experience upsetting circumstances in your life.
You may feel more anxious and depressed.
You may feel your symptoms spread from one area to another area.
You may feel fatigued, and afraid to do your normal activities.

These complaints are common when you have chronic pain. However, it does not necessarily mean that your physical condition is worsening; it may just mean that your system has become more sensitive.

Signs and Symptoms

Research finds the following signs may be associated with a chronic pain syndrome:

Fearfulness. It is easy to begin to fear increased pain when you have a chronic pain condition. As a result, you may begin to avoid activity. You may find that you rely more on family members to help with daily functions.

Body stiffness when you try to become more active. Stiffness may make you feel as if your body is less able to perform daily activities.

Deconditioning. Not moving your body results in less tolerance when you want to become more active. If you are inactive for a long time, muscles weaken and shrink from not being used. This can also increase your risk of falling.

Decreased circulation. Lack of activity decreases the circulation of much-needed blood to your cells. Tissues in your body may not get as much oxygen as they need. As a result, they may not be as healthy as they can be. This can cause you to feel fatigued, and lack energy.

Weight gain and/or a worsening of other conditions. Decreased activity can lead to unwanted weight gain. Added pounds and inactivity can aggravate symptoms of other conditions such as diabetes and high blood pressure. Chronic pain conditions are also commonly associated with feelings of anxiety or depression.

Increased use of medication. Chronic pain patients can have the tendency to increase their medication over time to seek relief.

Individual behaviors can include:

Seeking out of many different doctors or health care providers and facilities to find relief.
Difficulties with job performance. Some people with chronic pain even seek work disability.
Avoidance of social situations or family members.
When pain is ongoing, you may find you have feelings of bitterness, frustration, or depression. Some people report they have thoughts of suicide. If you are having these feelings, tell your doctor. This is important, so that you can get appropriate medications to help you feel better.

How Is It Diagnosed?

Your physical therapist will perform a thorough evaluation. He or she will:

Ask specific questions about your past and present health and use of medication.
Ask about your symptoms: their location, intensity, how and when the pain occurs, and other questions, to form a clear picture of your individual situation.
Ask you to fill out pain and function questionnaires, to understand how the pain is affecting your daily life.
Perform tests and movements with you. The tests help to identify problems with posture, flexibility, muscle strength, joint mobility, and movement. Special tests help to rule out any serious health problem such as pressure on a nerve or an underlying disease.
Observe how you use your body for home, work, and social/leisure activities. This information helps your therapist prescribe a program that will boost your quality of life, and get you moving your best.

Your physical therapist will work with your physician to provide the best diagnosis and treatment for your chronic pain.

How Can a Physical Therapist Help?

Not all chronic pain is the same. Your therapist will evaluate your clinical examination and test results and design an individualized treatment plan that fits you best.

Physical therapy treatments may include:

Education to improve your knowledge and understanding of chronic pain -- how it occurs, and what you can do about it. Your therapist will teach you how to manage your pain and help you work toward performing your normal daily activities again.

Strengthening and flexibility exercises to help you move more easily with less discomfort. Your therapist will design a program of graded exercises for you -- movements that are gradually increased according to your abilities. Graded exercises help you improve your coordination and movement, reducing the stress and strain on your body, and decreasing your pain. Carefully introducing a graded exercise program will help train your brain to sense the problem area in your body without increasing its danger messages.

Manual therapy , which consists of specific, gentle, hands-on techniques that may be used to manipulate or mobilize tight joint structures and soft tissues. Manual therapy is used to increase movement (range of motion), improve the quality of the tissues, and reduce pain.

Posture awareness and body mechanics instruction to help improve your posture and movement. This training helps you use your body more efficiently while performing activities and even when you are resting. Your therapist will help you adjust your movement at work, or when performing chores or recreational activities, to reduce your pain and increase your ability to function.

Can this Injury or Condition be Prevented?

Research shows that treating pain as soon as possible helps to prevent chronic pain. Don't ignore pain. Serious pain or pain that does not get better as expected should be treated.

Your physical therapist will work with you to develop strategies to prevent chronic pain, such as:

Keeping up with your normal activities as much as possible.
Avoiding bed rest. Long periods of bed rest will not improve your pain and may make it worse. Prolonged bed rest puts you at risk of other complications as well, including increased muscle weakness, bone loss, weight gain, and poor circulation.
Improving posture. Your therapist will help you adjust your posture so your body can work at optimal efficiency to reduce joint stress and help to reduce your symptoms.
Performing exercises to improve and restore your sense of the involved body area. Your therapist will also teach you exercises to restore movement (range of motion), mobilize nervous tissue (main component of nervous system), and rebuild your strength for performing routine daily activities.
Introducing meditation, relaxation, and imagery exercises to help reduce stress and muscle tension.
Learning fully about your condition. This will help you better understand what is occurring in your body, so you don't worry about every new ache, pain, or symptom.
Maintaining healthy activity levels and improving your overall health.

Authored by Mary Kay Zane, PT, OCS . Reviewed by the MoveForwardPT.com editorial board .

Physical Therapist's Guide to Osgood-Schlatter Disease

Wed, 14 Nov 2018 20:11:00 GMT

Physical Therapist's Guide to Osgood-Schlatter Disease

Osgood-Schlatter disease (OS) is an overuse injury causing pain in the knee area and often a visible growth just below the kneecap. The development of OS is most often a consequence of excessive stress to the front of the knee during periods of rapid skeletal growth. Because adolescents typically experience the greatest rate of skeletal growth, this population is most commonly affected by OS. The condition can be effectively treated by a physical therapist.

What is Osgood-Schlatter Disease?

Osgood-Schlatter disease occurs when there is irritation to the top, front portion of the shin bone (tibia) where the tendon attached to the kneecap (patella) meets the shin bone. It occurs when there is an increased amount of stress placed upon the bones where the tendons attach. This is most often the result of increased activity levels by an adolescent athlete.

Our musculoskeletal system is made up of bones and surrounding soft tissue structures, including muscles, ligaments (which connect bone to bone), and tendons (which connect muscle to bone). These structures all play a role in helping us move.

During adolescence our bodies grow at a rapid rate. As our bodies develop, our bones are growing longer. Throughout this phase, our growth plates (epiphyseal plates) are susceptible to injury. A growth plate is the site at the end of a bone where new bone tissue is made and bone growth occurs. Females typically experience the most rapid growth between approximately 11 to 12 years of age, and males typically experience this growth surge between approximately 13 and 14 years of age. Males experience OS more frequently than females, likely due to an increased rate of sports participation.

Structures in our body might become irritated if they are asked to do more than they are capable of doing. Injuries can occur in an isolated event, but OS disease is most likely the cumulative effect of repeated trauma. OS is most frequently experienced in adolescents who regularly participate in running, jumping, and "cutting" (rapid changes in direction) activities.

When too much stress is present (ie, from rapid growth) and when the body is overworked (ie, either too much overall volume of exercise, or too much repetition), the top of the shin can become painful and swollen. As this condition progresses, the body’s response to bone stress can be an increase in bone production; an adolescent may begin to develop a boney growth that feels like a bump on the front of the upper shin.

OS can start as mild soreness, but can progress to long-lasting pain and limited function, if not addressed early and appropriately.

How Does it Feel?

With Osgood-Schlatter, you may experience:

Gradually worsening pain below your knee, at the top of the shin bone.
Pain that worsens with exercise.
Swelling and tenderness at the top of the shin.
A boney growth at the top of the shin.
Loss of strength in the quadriceps muscle (connecting the hip to the knee).
Increased tightness in the quadriceps muscle.
Loss of knee motion.
Discomfort with daily activities that use your knee, like kneeling, squatting, or walking up and down stairs.

How Is It Diagnosed?

Diagnosis of OS begins with a thorough medical history, including specific questions regarding athletic participation (sports played, frequency of practices/games, positions). Your physical therapist will assess different measures, such as sensation, motion, strength, flexibility, tenderness, and swelling. Your physical therapist will perform several tests specific to the knee joint, and may ask you to briefly demonstrate the activities or positions that cause your pain, such as walking, squatting, and stepping up or down stairs.

Because the knee and hip are both involved in these aggravating activities, your physical therapist will likely examine your hip as well. Other nearby areas, such as your feet and core, will also be examined to determine whether they, too, might be contributing to your knee condition.

If your physical therapist suspects there may be a more involved injury than increased stress-related irritation (ie, if there is a recent significant loss of motion or strength, or severe pain when the knee is moved), your therapist will likely recommend a referral to an orthopedic physician for diagnostic imaging, such as ultrasound, x-ray, or MRI.

How Can a Physical Therapist Help?

Once other conditions have been ruled out and OS is diagnosed, your physical therapist will work with you to develop an individualized treatment plan tailored to your specific knee condition and your goals. The goal of physical therapy is to accelerate your recovery and return to pain-free activity. There are many physical therapy treatments that have been shown to be effective in treating OS, and among them are:

Range of Motion Therapy. Your physical therapist will assess the motion of your knee and its surrounding structures, and design gentle exercises to help you work through any stiffness and swelling to return to a normal range of motion.

Strength Training. Your physical therapist will teach you exercises to strengthen the muscles around the knee so that each muscle is able to properly perform its job, and stresses are eased so the knee joint is properly protected.

Manual Therapy. Physical therapists are trained in manual (hands-on) therapy. If needed, your physical therapist will gently move your kneecap or patellar tendon and surrounding muscles as needed to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.

Pain Management. Your physical therapist may recommend therapeutic modalities, such as ice and heat, or a brace to aid in pain management.

Functional Training. Physical therapists are experts at training athletes to function at their best. Your physical therapist will assess your movements and teach you to adjust them to relieve any extra stress on the front of your knee.

Education. The first step to addressing your knee pain is rest. Your physical therapist will explain why this is important and develop a plan for your complete rehabilitation.

Can this Injury or Condition be Prevented?

Fortunately, there is much that can be done to prevent the cascade of events that lead to OS. Physical therapists focus on:

Educating coaches, parents, and athletes on guidelines for sports participation, explaining common causes of overuse injuries, and providing strategies for prevention.
Educating athletes on the risks of playing through pain.
Scheduling adequate rest time to recover between athletic events.
Tracking a young athlete’s growth curves (height, weight, BMI) to identify periods of increased injury risk.
Developing an athlete-specific flexibility and strengthening routine to be followed throughout the athletic season.
Encouraging consultation with a physical therapist whenever symptoms appear.

Authored by Allison Mumbleau, PT, DPT, SCS. Reviewed by the MoveForwardPT.com editorial board .

Physical Therapist's Guide to Total Shoulder Replacement (Arthroplasty)

Mon, 05 Nov 2018 15:58:58 GMT

Physical Therapist's Guide to Total Shoulder Replacement (Arthroplasty)

Total shoulder arthroplasty (TSA), often called a total shoulder replacement, is a surgical procedure in which part or all of the shoulder joint is replaced. It is estimated that 53,000 people in the United States have shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality. That number compares to the more than 900,000 Americans a year who have knee and hip replacement surgery. Physical therapists can help patients who undergo a TSA return to their previous levels of physical activity, including fitness training, or participation in sports like swimming or golf.

What is Total Shoulder Arthoplasty?

Total shoulder arthroplasty is a surgical procedure in which part or all of the shoulder joint is replaced. It is performed on the shoulder when medical interventions, such as other conservative surgeries, medication, and physical therapy no longer provide pain relief. The decision to have a TSA is made following consultation with your orthopedic surgeon and your physical therapist.

A shoulder replacement may be needed if you have any of the following conditions affecting the shoulder, causing severe shoulder pain and limiting your ability to use the affected shoulder:

Osteoarthritis
Rheumatoid arthritis
Severe shoulder fracture
Rotator cuff disease (a muscle tear or soft-tissue breakdown of the rotator cuff)
Osteonecrosis of the shoulder (death of the bone tissue at the head of the humerus)

A TSA involves removing the ends of the bone at the shoulder joint, and replacing them with artificial parts. The upper part of the arm bone (humerus) is shaped like a ball; it is called the "head" of the humerus. During a TSA, the head of the humerus is replaced by a metal ball. The socket that the head of the humerus sits in is called the glenoid fossa. During a TSA, the socket is replaced by a plastic cup.

Due to various physical limitations, your orthopedic surgeon may decide that you are a candidate for another form of TSA, such as:

Shoulder hemiarthroplasty, where only the head of the humerus is replaced with a metal ball.
Reverse TSA, where the metal ball and plastic socket are reversed. This procedure is recommended when the rotator cuff muscles of the shoulder are damaged. The plastic socket is attached to the top of the humerus, and the metal ball is attached to the socket. This procedure allows another shoulder muscle, called the deltoid, to take over for the damaged rotator cuff muscles, improving functional range of motion, strength, and stability of the shoulder

Shoulder Replacement See More Detail

How Can a Physical Therapist Help?

Physical therapy plays a vital role in ensuring a safe recovery by improving shoulder function, and limiting pain following a TSA. Your physical therapist will work with you prior to and following your surgery, to help you safely return to your previous levels of activity, including performing household chores, job duties, and recreational activities.

Before Surgery

The better physical condition your shoulder is in prior to surgery, the better your recovery will be. Your physical therapist will teach you exercises to build shoulder strength, and improve your shoulder and upper back movement to keep the shoulder as strong and mobile as possible up until the time of surgery.

After Surgery

Your physical therapist will educate you about precautions to take after surgery, such as wearing a sling to perform all activities, and gradually beginning to safely move your arm. If you are a smoker, quitting smoking will improve your healing process.

After your TSA, you will likely stay in the hospital for 2 to 3 days. If you have other medical conditions, such as diabetes or heart disease, your hospital stay may be a few days longer. Your shoulder will be placed in a sling for the next 2 to 6 weeks; you will be advised to not move your shoulder on your own.

Your physical therapy will begin within a day or two of your surgery. A hospital physical therapist will visit your room to teach you how to perform simple tasks like brushing your teeth, and tell you what movements (such as pushing, pulling, or reaching with the affected arm) you simply cannot perform. Your physical therapist will teach you how to get in and out of bed safely, how to get the sling on and off, and how to get dressed while keeping your shoulder in a safe position. You will also learn how to minimize pain and swelling in the area by applying an ice pack, and elevating the upper arm.

You may need some help from friends or family members with daily activities for the first few days or weeks after your surgery. You will not be able to drive for the first few weeks after surgery.

As You Recover

When you are discharged from the hospital, continuation of physical therapy is essential. Your surgeon and physical therapist will work as a team to ensure your safe recovery. Your physical therapist will teach you exercises that may include:

Range-of-Motion Exercises. It is important to not move your shoulder suddenly or with any force for the first 2 to 6 weeks following surgery, to allow proper healing. Your physical therapist will passively move your shoulder in different directions to allow you to safely begin regaining movement. Your physical therapist will also teach you gentle exercises to perform at home. You will also learn range-of-motion exercises for the elbow and hand, so these joints do not get stiff from being held in a sling. Squeezing a ball or putty will help keep your grip strong, while your shoulder recovers. You will use ice packs on the shoulder and elevate your arm on pillows to allow gravity to help reduce the swelling in the shoulder, as instructed by your physical therapist.

Strengthening Exercises. As your shoulder mobility returns within a few weeks or months, your physical therapist will guide you through a shoulder strengthening program. You may use resistive bands and weights to perform gentle strengthening exercises.

Functional Training. Your physical therapist will help you regain everyday shoulder movements, such as reaching into a cupboard, reaching behind your body to tuck in your shirt, or reaching across your body to fasten a seat belt.

Job and Sport-Specific Training. Your physical therapist will design a personalized program to enable you to resume your job tasks without pain. These may include reaching, pushing, or carrying movements. You will also receive sport-specific training if you are planning to return to a sport. Your physical therapist will create a specialized home or fitness-center exercise program based on your individual needs, to be continued long after formal physical therapy has been completed.

Can this Injury or Condition be Prevented?

If you begin noticing your shoulder is painful and you are losing the ability to move your shoulder, a physical therapist can help. A properly designed exercise program can delay or even help you avoid surgery. A physical therapist will teach you specific, safe exercises to improve your shoulder flexibility and strength, and teach you how to manage your pain. Proper nutrition and physical activity will keep all of your joints healthy. Avoiding smoking is essential for proper healing and overall recovery from any injury.

Physical Therapist's Guide to Acromioclavicular (AC) Joint Injuries

Thu, 01 Feb 2018 00:00:00 GMT

What Are Acromicioclavicular (AC) Joint Injuries?

A traumatic AC joint injury occurs when there is a disruption of the joint due to damaged ligaments holding the 2 bones of the joint together. This injury is called a shoulder separation (in contrast to a shoulder dislocation , it involves the ball-and-socket joint of the shoulder).

An overuse AC joint injury occurs over time as repeated, excessive stress is placed on the joint. Cartilage at the ends of the acromion and clavicle bones protects the joint from daily wear and tear. Over time, the demand placed on this cartilage may be more than it is capable of enduring, resulting in an overuse injury. Significant wearing of the cartilage is known as arthritis. Overuse AC joint injury is most common in individuals who perform tasks, such as heavy weight lifting (bench and military presses), or jobs that require physical labor with the arms stretched over the head.

How Does it Feel?

With an AC joint injury, you may experience:

General shoulder pain and swelling
Swelling and tenderness over the AC joint
Loss of shoulder strength
A visible bump above the shoulder
Pain when lying on the involved side
Loss of shoulder motion
A popping sound or catching sensation with movement of the shoulder
Discomfort with daily activities that stress the AC joint, like lifting objects overhead, reaching across your body, or carrying heavy objects at your side

How Is It Diagnosed?

How Can a Physical Therapist Help?

Range of Motion. An injury to the AC joint, whether traumatic or overuse, causes the joint to be irritated, often resulting in swelling and stiffness, causing loss of normal motion. Motions that are usually most difficult after an AC joint injury are reaching across your body and lifting your arm directly overhead. While it is important to regain your normal shoulder motion, it is also important to allow your injury to heal without placing excessive stress on the healing joint. Your physical therapist will assess your motion and the degree of your injury, and establish a plan that will balance joint protection and motion restoration.

Strength Training. After an injury, the surrounding muscles demonstrate weakness. All of the muscles near the shoulder and elbow as well as those of the upper back, work together to allow for normal, coordinated upper-body motion. Therefore, balancing the strength of all the upper-body muscles is crucial to making sure the shoulder joint is protected and moves efficiently. Your physical therapist will design an individualized exercise program to strengthen the muscles at and around the shoulder, so that each muscle is able to properly perform its job.

Manual Therapy.Physical therapists are trained in manual (hands-on) therapy. If needed, your physical therapist will gently move and mobilize your shoulder joint and surrounding muscles as needed to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.

Pain Management.Your physical therapist may recommend therapeutic modalities, such as ice and heat to aid in pain management.

Functional Training. The AC joint is a relatively small joint that is often asked to bear a significant load. In order to successfully meet this demand, there is a need for functional training, teaching your entire shoulder to work best in different positions. For example, when lifting overhead, poor coordination places undue stress on the shoulder. Physical therapists are experts in assessing movement quality. Your physical therapist will be able to point out and correct your movements to help you maintain a pain-free shoulder.

Education. The first step to addressing your shoulder pain is rest. The amount of rest required varies, and largely depends on the degree of your injury. Your physical therapist will create a personalized plan for your rehabilitation, so you can safely return to your desired daily and recreational activities.

Can this Injury or Condition be Prevented?

Learning about the risks of pushing through pain.
Monitoring work and weight-lifting activities, particularly repetitive overhead lifting.
Avoiding repetitive overhead lifting when possible.
Maintaining adequate general shoulder strength and motion to safely perform desired tasks.
Consulting with a physical therapist if symptoms are persistent or worsening despite rest.

Real Life Experiences

Noah is a 17-year-old varsity starting quarterback. In his first regular season game, he injured his left, nonthrowing shoulder when he was tackled and landed directly on it. Noah was unable to continue to play during that game. He was immediately evaluated by the team athletic trainer and physician on the sideline, who placed Noah in a sling and ordered an x-ray. Fortunately, Noah's x-rays revealed no fracture had occurred, and Noah was referred to physical therapy.

Noah's physical therapist took his health history and performed a thorough examination. He asked Noah about his goals and specific sport and position demands. The physical examination revealed that Noah’s AC joint was very tender and swollen, and that he had lost significant motion and strength in his shoulder.

Together, Noah, his physical therapist, parents, and coach developed a treatment plan to help get him back on the field in 4 to 6 weeks. Noah's first treatment was to keep wearing the sling to give his damaged shoulder ligaments a chance to heal. During this initial phase, Noah could not participate in any football activities, but did work regularly with his physical therapist on selective, gentle, stretching and strengthening exercises.

After about 2 weeks when his shoulder was less tender and he had met some of the goals set in physical therapy, Noah began some higher-intensity strengthening exercises with his physical therapist, and was allowed to resume conditioning with his team under his coach's watchful eye. The following week, Noah continued to achieve his physical therapy goals and was allowed to participate in noncontact football activities, while continuing to work with his physical therapist on advanced strengthening drills.

After 5 weeks of physical therapy, Noah achieved all of the return-to-sport goals that his physical therapist had established, and was cleared to return to play by his physical therapist, team physician, and athletic trainer. Noah was thrilled that all of his hard work had paid off, and he returned to the field, pain-free, for the all-important homecoming game!
MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Ankle Sprain

Thu, 01 Feb 2018 00:00:00 GMT

Ankle sprains are common injuries that occur when the foot twists or turns beyond its normal range of movement, causing the ligaments of the ankle to overstretch or tear. It is estimated that 23,000 Americans experience ankle sprains daily. Of all sports injuries in the United States, 45% are ankle sprains; basketball players are the athletes most often affected. People who have an increased risk of spraining an ankle include younger athletes, members of the military, and anyone who frequently runs, jumps, and changes direction quickly, while performing an athletic activity (“cutting motion”). Physical therapists help people who have experienced ankle sprains reduce their pain; regain their strength, motion, and balance; return to normal activity levels; and avoid reinjury.

What Is Ankle Sprain?

Sprains are injuries to ligaments (the bands of tissue that hold joints together). Ankle sprains occur when the foot twists or turns beyond its normal range of movement, causing the ligaments connecting the bones of the leg, ankle, and foot to overstretch or tear.

The ligaments on the outer (lateral) side of the ankle are the ones most commonly injured. Ligaments on the inner (medial) side of the ankle, or above the ankle bone, can also be sprained, but are injured less frequently.

An ankle sprain usually takes between 2 weeks to 2 months to heal. The ankle will feel better after a few weeks, and be fully strengthened in a few months. A severely sprained ligament, however, can take 9 months to 1 year to heal.

Recurrent ankle sprains are common; once an ankle ligament is sprained, it is often reinjured. In fact, 73% of people who have sprained an ankle once are likely to do so again. Reinjury is especially likely if muscle strength and balance are not fully restored to, or improved beyond, preinjury levels.

How Does it Feel?

Right after an ankle sprain, you may experience:

Pain
Swelling
Inability to stand or walk on the affected foot
Throbbing
Stiffness
Weakness
A feeling of instability in the ankle joint

After most sprains, you feel pain right away at the site of the ligament stretch or tear. Often, the ankle starts to swell immediately and may bruise. The ankle area usually is tender to the touch, and when you move the ankle, it hurts. In more severe sprains, you may hear or feel something tear, along with a "pop" or "snap."

How Is It Diagnosed?

If you see your physical therapist first, the physical therapist will examine your ankle, take your health history, and ask questions such as:

How did you get injured?
Did you feel a pop, snap, or tear?
What activities are you having trouble doing?
What activities do you want to get back to doing?

Your physical therapist will gently press around your ankle to see if it is painful to the touch, and may use additional tests to determine if other parts of your foot are injured. Your physical therapist will test your strength and flexibility, observe how you can move your foot and leg, and watch how you walk.

Depending on how badly a ligament is damaged, or how many ligaments are injured, your ankle sprain may be classified as:

Grade 1 (mild). The ligament is overstretched.
Grade 2 (moderate). The ligament is overstretched or partially torn.
Grade 3 (severe). The ligament is completely torn.

Your physical therapist also will test and screen for other, more serious conditions that could be causing the pain and swelling. To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an x-ray, to confirm the diagnosis and to rule out other damage to the ankle, including a fracture.

How Can a Physical Therapist Help?

Physical therapists help people with ankle sprains recover more quickly than they would without treatment. The time it takes to heal an ankle sprain varies, but results can often be achieved in 2 to 8 weeks. Your physical therapist will work with you to design a specific treatment program that meets your needs and goals.

During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:

Rest the area by avoiding any activity that causes pain.
Apply ice packs to the area for 15 to 20 minutes every 2 hours.
Consult with a physician for further services, such as medication or diagnostic tests.
Walk on the affected foot as soon, and as much as you are able, without making the pain or swelling worse.
Use crutches or other walking aids to help alleviate pain and support balance.
Wrap your ankle or use an ankle brace for support and to prevent swelling.

These self-treatments will allow you to be as active as possible with the least amount of pain, and will help speed healing.

Your physical therapist will work with you to:

Reduce Pain and Swelling. You will learn how to avoid or modify your daily and sports activities to allow healing to begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, specific exercises, and hands-on therapy, such as specialized massage.

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the ankle. These might begin with "passive" motions that the physical therapist performs for you to gently move your ankle and foot, and progress to “active” exercises and stretches that you do yourself.

Improve Flexibility. Your physical therapist will determine if any foot, ankle, or lower leg muscles are tight, begin to stretch them, and teach you how to stretch them.

Improve Strength. Ankle sprains may be related to weak, injured, or uncoordinated leg muscles. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to use, to steadily and safely restore your strength. These may include using cuff weights, stretch bands, and weight-lifting equipment.

Improve Endurance. Regaining your muscular endurance in the ankle and leg is important after an injury. Your physical therapist will teach you exercises to improve endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as treadmills or stationary bicycles.

Improve Balance. Regaining your sense of balance is important after an injury. Your physical therapist will teach you exercises to improve your balance ability.

Restore Agility. Speed and accuracy of leg movement is important in athletics and in many daily activities. Your physical therapist will help you regain these skills in preparation for a return to sports and to your daily routine.

Return to Activities. Your physical therapist will discuss activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

If Surgery Is Necessary

Surgery is not commonly required for ankle sprains. But if surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.

Can this Injury or Condition be Prevented?

Your physical therapist can recommend a home-exercise program to help prevent ankle sprains. It may include strength, flexibility, and balance exercises. If you have sprained your ankle once, it is at greater risk for reinjury in the future, if the ligaments did not heal properly or if your ankle never returned to its normal strength. And if you return to sports or other activities too soon after injury, your ankle might give you persistent pain or might easily or frequently reinjure.

Possible other factors that may increase someone’s risk of spraining an ankle are body weight, female gender, muscle weakness, balance problems, or foot/ankle problems.

To help prevent an ankle sprain or a reinjury, your physical therapist may recommend that you:

Warm up effectively before athletic activities.
Use footwear that is best for specific activities.
Use ankle wraps or braces as directed.
Perform specific balance and strength exercises several times per week for up to a year.
Maintain a healthy body weight.

Real Life Experiences

Travis is a 13-year-old basketball player who has just made the junior varsity team at his school. Travis is practicing a lot for the upcoming basketball season, shooting for hours at his local playground, and working hard to gain the respect of his new coach and teammates.

During a practice drill this week, while going up for a layup, Travis lands awkwardly on his right foot, and his right ankle rolls outward as he stumbles and falls. He feels a sharp pain on the outer side of the ankle, and when his teammates help him up, he finds that he can’t put weight on the foot or walk on it. His coach has him sit with his right leg up, and applies an ice pack to the ankle. When Travis's parents arrive, his teammates help him to the car. At home, his mom immediately reapplies the ice pack. His father calls his physical therapist.

The next morning, Travis's physical therapist conducts a complete examination, testing his strength, flexibility, walking, and balance. She checks for tenderness and swelling, and asks about his pain level. Travis explains that his first season's basketball games start in 4 weeks, and he doesn’t want to miss any of them.

Travis's physical therapist recommends an x-ray, which his physician orders for him. The results show that, fortunately, there is no fracture. The diagnosis is a moderate (grade 2) sprain of the lateral (outer) ankle. Travis's physical therapist also notes that he has some muscle weakness and tightness in the lower leg, loss of motion, balance problems, and significant swelling.

Travis's physical therapist gently applies specialized massage around the ankle to reduce the swelling, and teaches Travis specific exercises to help regain normal movement in the ankle. She instructs him to stop if he feels any pain. She teaches him some simple exercises that he can do at home. She also gives him crutches, and teaches him how to use them and how to put a little bit of weight on his injured foot, but not enough to increase his pain. She explains that the earlier he can put a bit of weight on his foot and walk on it without increasing his pain, the faster it will heal. To finish his first treatment, she applies electrical stimulation and an ice pack to the ankle. Before Travis leaves the clinic, she wraps his ankle with an elastic wrap to reduce and prevent further swelling.

At his next treatment, Travis is able to add more exercises for stretching and balance. By the end of the second week of treatment, he is able to walk normally and does not need crutches. By the end of the third week, he is able to run for 10 minutes and perform some jumping drills that his physical therapist teaches him. During the fourth week of treatment, Travis performs some cutting drills during his physical therapy session. At the end of the fourth week, wearing an ankle brace that his physical therapist has recommended, he is able to play 1 quarter in his team's first basketball game of the season, without increased pain.

Travis continues with physical therapy treatments to improve his strength and balance, until he does not need to wear the ankle brace to play in his basketball games anymore, and can play a full game pain free.

After he is discharged from physical therapy, Travis continues to use his home program exercises to warm up before games, and to improve his balance to help prevent reinjury. Just this evening, Travis's jump shot at the buzzer wins the first playoff game of the season!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide Cerebral Palsy

Thu, 01 Feb 2018 00:00:00 GMT

Cerebral Palsy (CP) is a general term used to describe a group of disorders that affect the normal development of movement and posture. CP is caused by an injury to the brain—such as infection, stroke, trauma, or the loss of oxygen to the brain—that occur before, during, or after birth or within the first 2 years of life. The injury to the brain is "nonprogressive," meaning that it does not get worse after the initial injury. However, the day-to-day activities that can be affected by the injury during an individual's childhood can worsen throughout the individual's life.

Difficulties from CP can range from mild to severe. Individuals with CP may have trouble seeing, hearing, feeling touch, thinking, or communicating. They may also experience seizures.

CP affects approximately 3.6 infants per each 1,000 born in the United States. The number of children diagnosed with CP has grown in recent years as a result of the increased survival rates of premature babies and those born with low birth weights. The average life expectancy of adults with CP has increased as well. People with CP can benefit from physical therapy throughout all the stages of their lives.

Physical therapists are experts in helping people with CP improve their physical functions. They can help them stay active, and healthy, and perform day-to-day tasks such as walking, operating a wheelchair, and getting in or out of a wheelchair to and from a bathtub, bed, or car.

What is Cerebral Palsy?

Cerebral palsy is a broad term used to describe the effects on the development of motor skills caused by nonprogressive injuries to the developing brain. Types of CP are given different names based on the type of movement problem and the areas of the body affected:

Spastic involves increasing spasm of the muscles as the person moves faster.
Ataxic involves decreased coordination and unsteadiness throughout the body.
Dyskinetic involves unpredictable changes in muscle tone and movement that create unstable posture.
Mixed describes a combination of the movement problems noted above (spastic, dyskinetic, or ataxic).
Quadriplegia describes CP that affects both arms and legs, the neck, and the trunk.
Diplegia affects either both legs (the most common form of the disorder) or both arms (less common).
Hemiplegia affects just one side of the body.

How Is It Diagnosed?

Although a child's pediatrician may identify a delay in movement development and refer the child to a physical therapist, physical therapists are often the first medical professionals to identify signs and symptoms of CP. The therapist will:

- Conduct a medical history, asking questions about the parents' concerns, the pregnancy, birth, and the general health of the child
- Perform a thorough evaluation that includes:
  - observing the child in different positions to assess movement patterns
  - hands-on assessment of the child's muscle tone, strength, flexibility, and reflexes
  - determining developmental milestones (how well he or she can sit, stand, or grasp objects)

Your therapist will collaborate with your child’s physician, who may order further tests—such as blood work, magnetic resonance imaging (MRI), or computerized tomography (a CT Scan)—to reach a final diagnosis.

How Can a Physical Therapist Help?

A physical therapist is an important partner in health care and fitness for anyone diagnosed with CP. Therapists help people with CP gain strength and movement to function at their best throughout all the stages of life.

The physical therapist will provide care at different stages in the individual's development, depending on his or her unique needs. Therapy may be provided in your home or at another location such as a community center, school, or a physical therapy outpatient clinic. The physical therapist will work with other health care professionals, such as speech/language pathologists or occupational therapists, to address all the individual's needs as treatment priorities shift.

Physical Therapy in the Early Years: Birth to Age 4

Physical therapists can help caregivers support their child's movement development by providing hands-on training for positioning, movement, feeding, play, and self-calming. Your therapist will also suggest changes at home to encourage movement development, as well as communication, hearing, vision, and play skills. It is important to remember that it is through play that young children learn many skills. Your therapist will develop an individual program of play activities that match your child's specific needs—to improve strength, movement, and function. At this age, physical therapy is generally provided at home, in a daycare center, or in an outpatient clinic.

Physical Therapy in the School Years: Ages 5 to 12

Physical therapists train caregivers to help the child with CP accomplish functional goals and promote the highest quality of life through all stages of development. The treatment plan and goals will change as your child ages. Pre-school and school bring challenges for your child to navigate new environments each year. At this age, children also experience growth spurts, requiring adjustments to therapy and equipment used to help the child. Care priorities can focus on walking, transfers, personal hygiene, play, socialization, and adaptive equipment needs to meet the social and physical changes that occur during this time period. Physical therapy may be provided in outpatient and/or school settings. School-based therapy focuses on accommodations and modifications to ensure your child has the best possible learning environment.

Physical therapy benefits the adolescent with CP by focusing on prevention of posture problems and joint limitations. This is done by encouraging mobility and fitness, managing muscle and/or joint pain, and recommending braces and other helpful equipment to maintain health and function. The physical therapist will educate parents about self-care, maintaining daily routines, socialization, physical activity, and plans for the child's schooling and future careers.

It is important to note that lifelong health habits are formed at this age—and developing an individual fitness program can improve the person’s health and function for the remainder of his or her life. Children with CP are at a greater risk than the general youth population of not exercising enough and becoming sedentary, which can lead to weight issues and medical complications. These issues progress gradually but can have a significant impact on the quality of life of the child and of the caregivers. Physical therapists are skilled in developing individual exercise programs that use each child's strengths and abilities. For instance, a therapist might recommend adaptive sports such as bowling, swimming, cycling, volleyball, tennis, and basketball to promote physical fitness and socialization with peers.

Physical Therapy in Adulthood: Age 18+

Many individuals with CP live highly functional lives as adults. Many have careers and families. In adulthood, people with CP often focus on pain management, conserving energy, adaptive equipment, and environment modifications to promote independence at work and at home. Physical therapists can help with managing these concerns. Like many adults, individuals with CP have muscle and joint pain in adulthood. Physical therapists can prescribe an exercise routine that enables the individual to stay strong and minimize joint issues.

Physical therapists are skilled in all of these areas, and they partner with people with CP and their caregivers to address their individual goals for realistic, positive outcomes.

MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Cervical Radiculopathy

Thu, 01 Feb 2018 00:00:00 GMT

Cervical radiculopathy is often referred to as a pinched nerve in the neck. It is characterized by radiating pain from the neck to the shoulder, shoulder blade, arm, or hand. Weakness and lack of coordination in the arm and hand can also occur. The condition affects an average of 85 out of 100,000 people—most often individuals in their 50s. Athletes, heavy laborers, and workers who use vibrating machinery are commonly affected. People who sit for long periods of time, or individuals with arthritis in the cervical (neck) region can also be affected. Conservative care, including physical therapy, can help reduce symptoms. A physical therapist can help alleviate the acute neck and arm symptoms that result from the condition, as well as improve general strength and function. Most cases of cervical radiculopathy are resolved with physical therapy and do not require surgery.

What is Cervical Radiculopathy?

Cervical radiculopathy occurs when a nerve root coming off the spinal cord becomes compressed. The compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma. In older individuals, it commonly occurs spontaneously as a result of arthritis or decreased disc height in the neck region.

The cervical spine consists of 7 cervical vertebrae (the bones that form the neck region). Each vertebra is separated by a gel-like disc. The discs provide shock absorption for the spine. The spinal cord travels through a canal in the cervical vertebrae. Spinal nerve roots extend from the spinal cord and branch off going to specific locations in the arm. The spinal nerves send signals to our muscles for movement as well as sensations that we feel in the entire arm. The spinal cord is like a tree trunk, and the spinal nerves are like the tree branches. If an impingement or abnormal pressure is placed on a branch near the trunk, everything along that branch will be affected.

Spinal nerves can be impinged by:

Arthritis or disc wear-and-tear with age
Herniated or bulging discs from trauma or degeneration
Spinal stenosis, which is a narrowing of the spaces in which the nerves travel
Tumor, which can be benign or malignant, impinging the nerve root

When the spinal nerves are impinged, they cannot properly send messages to the muscles from the brain, nor receive proper sensation from the specific arm location the nerve travels. Everywhere the spinal nerve travels will be affected. That is why a pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm, even though the pinch is in the cervical region.

How Does it Feel?

Symptoms of cervical radiculopathy vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:

Pain in the neck, shoulder blade, shoulder, upper chest, or arm, with pain possibly radiating into the fingers following the path of the involved nerve root.
Pain described as "sharp" or "pins-and-needles" or “popping sensation” in cervical region.
General dull ache or numbness anywhere along the pathway of the nerve.
Weakness in the shoulder, arm, or hand.
Pain that worsens with certain neck movements.
Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).

These symptoms may also be specific to the nerve root involved:

C5 nerve root (between cervical vertebrae C4-C5): weakness in the deltoid muscle (front and side of the shoulder) and upper arm; shoulder pain and numbness
C6 nerve root (between cervical vertebrae C5-C6): weakness in the bicep muscle (front of the upper arm) and wrist muscles; numbness on the thumb side of the hand
C7 nerve root (between cervical vertebrae C6-C7): weakness in the triceps muscle (the back of the upper arm and wrist); numbness and tingling in the back of the arm and the middle finger of the affected hand
C8 nerve root (between vertebrae C7-T1): weakness with hand grip; numbness in the little finger

The most common nerve root levels for this condition are C6 and C7.

How Is It Diagnosed?

When you seek the help of a physical therapist, the physical therapist performs a comprehensive evaluation and asks questions about your pain and your daily activities. These may include:

How and when the pain started: Did the pain begin spontaneously or was there any trauma or popping experienced in the cervical region?
Where are the symptoms located, and have they changed location or intensity since the onset?
What makes the symptoms better or worse?
What type of work do you perform?
What hobbies or household activities do you regularly perform?

Your physical therapist will gently test the movement of your neck and arms. The therapist will check your tendon reflexes and strength, and conduct special tests on your neck and upper extremity to determine which spinal nerve root(s) may be involved, and to rule out other conditions. To provide a definitive diagnosis, your therapist may collaborate with an orthopedist or other health care provider. The orthopedist may order further tests, such as magnetic resonance imaging (MRI) or electromyography (EMG). An MRI can show soft tissues, including the spinal cord and nerve roots. This test can determine what is causing the compression on the nerves, including disc bulges or disc herniation. An EMG measures the nerve and muscle function. This test can tell how well your spinal nerves are communicating to your muscles.

How Can a Physical Therapist Help?

Physical therapy is an effective treatment for cervical radiculopathy, and in many cases, it completely resolves symptoms. Your physical therapist will develop an individual treatment plan based on the findings of your initial evaluation. The treatment plan may include:

Pain Management. The first goal is to reduce the pain and inflammation in the area. Ice packs applied to the neck and scapular (shoulder blade) region during the first 24 to 48 hours following the onset of pain, help reduce inflammation. Moist heat can be used after this time period to help the surrounding muscles relax. Your physical therapist may advise you to wear a soft cervical collar at times throughout the day, to allow the neck to relax. A cervical contoured pillow may be recommended to properly support the neck, and allow you to sleep more comfortably.

Manual Therapy. Your physical therapist may use manual therapy techniques, such as manual cervical traction, to relieve pressure in the cervical (neck) region. This procedure can provide immediate relief of pain and numbness radiating into the arm. Gentle massage may also be performed on the muscles of the cervical spine and scapular (shoulder blade) region. This technique helps the muscles relax and improves circulation to the area, promoting healing and pain relief.

Posture Education. Posture education is an important part of rehabilitation. Your physical therapist may suggest adjustments to your workstation and work habits, to promote good posture to protect your neck. In the early stages of recovery this may mean sitting only 15 to 20 minutes at a time. You will also receive instructions on how to bend, reach, and lift throughout the day in safe positions that place minimal pressure on your spinal discs.

Range-of-Motion Exercises. Your physical therapist will teach you gentle cervical mobility exercises to relieve your symptoms, and allow you to return to normal movement. In the beginning stages of recovery, it is important that none of these exercises increase the pain radiating down into your arm. It is important to communicate your symptoms accurately to your physical therapist. If you spend many hours sitting at a desk during your workday, your neck may become stiff. Your therapist will teach you neck stretches to take pressure off of your neck from extended periods of sitting, to help improve your mobility.

Strengthening Exercises. Your physical therapist will help you determine which muscle groups need to be strengthened based on which spinal nerves are involved in your particular case. When pain no longer radiates down your arm, you may begin more aggressive strengthening exercises. Neck stability (strengthening) exercises will also be performed. You will receive a home-exercise program to continue strengthening your neck, shoulder, arm, and upper back long after your formal physical therapy has ended.

Functional Training. As your symptoms improve, your physical therapist will work on functional exercises to help you return to your job, sport, or other daily activities. For example, if your job duties require overhead reaching, pushing, pulling, and long periods of sitting, you will be taught ways to perform these tasks to reduce undue stress to the neck.

Can this Injury or Condition be Prevented?

Your physical therapist will educate you on the best ways to prevent cervical radiculopathy from recurring, including:

Maintaining proper posture. Use a supportive pillow and proper posture when sitting at a desk or in the car.
Setting up your workstation to minimize undue forces on the spine. You may be advised to use a hands-free phone, or adjust your computer monitor to avoid excessive twisting or extending of your neck in repetitive directions during the workday.
Continuing with regular exercise to maintain spinal muscles flexibility and strength, including the upper body, middle back, and core muscles.
Keeping a healthy weight to minimize unnecessary forces on the spine.

Real Life Experiences

William is a 50-year-old man who enjoys coaching his son’s Little League baseball team. At a recent practice session, he joined the team, playing in right field. The third batter hit a ball high to right field. As William stretched his left arm and neck to reach for the ball, he felt a popping in his neck on the left side. Within 3 hours, he began experiencing severe pain radiating from the left shoulder blade, down the back of the upper arm, and into the thumb, index, and middle finger of his left hand. The pain continued to worsen over the next 24 hours. He was unable to sleep at night or lay flat. His pain was somewhat relieved when he stretched his left arm overhead with the elbow bent. The next day, William called his physical therapist.

William's physical therapist performed a full evaluation of his cervical spine and left upper extremity. She measured his cervical range of motion and upper extremity strength, and checked his reflexes in his left arm. She asked William when the pain first started; he told her about the incident on the ball field. She also asked about his job duties; he told her he spends a lot of time at work on a computer.

His physical therapist finds that William has limited mobility in the cervical spine, especially for side-bending to the left. He also has weakness in the left triceps muscle. She uses gentle touch techniques to determine that William has muscle tightness and tenderness in the left side of the neck and shoulder blade region. She performs some special tests, including a gentle cervical compression test called the Spurling’s test. During the test, William's symptoms increase down his left arm, indicating the spinal nerve on that side is involved. Based on her findings, she determines that William has a cervical radiculopathy at the C7 level on the left. She contacts an orthopedic physician, who orders an MRI, which confirms her findings.

William and his physical therapist work together to establish short- and long-term goals for his treatment. She designs a 6-week treatment program of 2 to 3 rehabilitation sessions per week. She prescribes ice for pain management and the use of a cervical collar intermittently throughout the day to alleviate pressure on the cervical spine, allowing it to heal. She instructs William in the use of a cervical pillow to properly support his spine at night, so he can begin sleeping more comfortably. She also educates William in correct posture to limit prolonged positioning (eg, limited sitting with frequent breaks).

William's physical therapist performs light, manual cervical traction and soft-tissue mobilizations to relieve the pain radiating down his arm, and to relieve muscle tightness in the neck and shoulder blade regions. She instructs William in self-care techniques at home, including ice and gentle exercises. As his symptoms improve, they begin working on improving his left-shoulder strength, especially in the triceps region. She teaches him strengthening exercises for the shoulder blade region to promote better posture, and stretching exercises to help him safely return to the ball field. She encourages him to start a walking program to promote general physical fitness and spinal health.

Together they evaluate his workstation, and determine that a square back spinal cushion in his office chair will support his lower back and improve his seated posture. She creates a comprehensive home-exercise program to help him meet his goals, and to continue progressing long after he has completed physical therapy.

After a few weeks of diligent therapy sessions and working with his home-exercise program, William notices he is able to sleep again without pain. He can also resume his regular work, household, and recreational activities, including returning to coaching his son’s baseball team free of pain.

MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Discoid Meniscus

Thu, 01 Feb 2018 00:00:00 GMT

A discoid meniscus is an abnormally shaped meniscus (cartilage that cushions the bones of the knee) present in 1% to 3% of people born in the United States. The condition is the result of abnormal formation of the meniscus during development in the womb. While some people may be unaware of their discoid meniscus and never experience symptoms related to it, they live at a higher risk of injury than those born with a normal meniscus. A discoid meniscus is commonly detected in childhood or adolescence, and often requires surgical intervention. Physical therapists provide treatment prior to and following surgery, and for conditions not requiring surgery.

What is Discoid Meniscus?

Our knees contain 2 cushions between our thigh bone (femur) and shin bone (tibia), made of cartilage called meniscus. The meniscus is normally crescent-shaped. Its role is to provide stability to the knee joint and absorb forces when we stand and move. Both menisci are attached to the shin bone (tibia) by the meniscofemoral ligament.

A discoid meniscus is present at birth. It occurs when the cartilage does not properly develop, resulting in a thicker disc- or oval-shaped meniscus. The defect most often occurs in the meniscus on the outer (lateral) part of the knee joint. Approximately 20% of individuals diagnosed with a discoid meniscus have it in both knees.

There are 3 types of discoid menisci. The classifications are:

Incomplete Discoid Meniscus. The shape of the meniscus is a bit wider and thicker than a normal meniscus.
Complete Discoid Meniscus. The shape of the meniscus is significantly wider than a normal meniscus, covering the shin bone (tibia).
Wrisberg-Ligament Meniscus. The normally present meniscofemoral ligament is absent.

Their abnormal shape and thickness make discoid menisci more prone to injury and tearing. The meniscus tissue is often not capable of healing itself due to its limited blood supply, which is required for tissue healing.

Meniscal injuries most commonly occur in activities that require sudden stopping, pivoting, and "cutting," such as in sports. Pain may also be present, sometimes without a specific injury to, or a tear in, the discoid meniscus.

In some cases, arthroscopic surgery may be required to reshape the abnormal meniscus to make it as normal as possible.

How Does it Feel?

With a discoid meniscus or torn discoid meniscus, you may experience:

Pain in your knee, most often on the outer (lateral) side of the leg.
Sharp pain with running, jumping, cutting, or deep squatting.
Swelling in the knee.
Tenderness on the outer side, or less commonly on the inner side, of the knee.
Catching or locking of the knee while walking or squatting.
Loss of knee motion, particularly getting "stuck," while fully bending or straightening the knee.
Loss of strength in the quadriceps (thigh) muscle.
Discomfort with daily activities, like walking up and down stairs.

How Is It Diagnosed?

Diagnosis of a discoid meniscus begins with a thorough medical history and physical examination. Your physical therapist will assess different measures of the knee area, such as motion, strength, flexibility, tenderness, and swelling. Your physical therapist will perform several tests specific to the knee joint, and may ask you to briefly demonstrate the activities or positions that cause your pain, such as walking, squatting, and stepping up or down stairs.

If your physical therapist suspects there may be an injury inside the knee joint, such as a discoid meniscus, the therapist will likely recommend a referral to an orthopedic physician for diagnostic imaging, such as ultrasound, x-ray, or MRI. An MRI, which looks at bones, muscles, and cartilage, is the best imaging source to identify a discoid meniscus and a tear in the meniscus.

How Can a Physical Therapist Help?

When you have been diagnosed with a discoid meniscus, your physical therapist will work with you to develop a plan to help achieve your specific goals. If surgery is needed, your physical therapist will work with you after surgery. To do so, your physical therapist will select treatment strategies in any or all of the following areas:

Range of Motion . An injury or surgery to the knee joint causes the joint to be irritated, often resulting in swelling and stiffness, resulting in loss of normal motion. While it is important to regain your normal knee motion, it is also important to allow your injury to heal, without placing excessive stress on the healing joint. Your physical therapist will assess your motion, design gentle exercises to help you regain normal range of motion, and establish a plan that will balance joint protection with motion restoration.

Strength Training. Your physical therapist will teach you exercises to strengthen the muscles around the knee, so that each muscle is able to properly perform its job, and stresses are eased, so the knee joint is properly protected.

Manual Therapy. Physical therapists are trained in manual (hands-on) therapy. If needed, your physical therapist will gently move your knee cap (patella) or patellar tendon and surrounding muscles to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.

Pain Management . Many pain-relief strategies may be implemented; the most beneficial with knee pain is to apply ice to the area, and decrease or eliminate specific activities for a certain length of time. Your physical therapist will help to identify specific movements or activities that continue to aggravate your knee joint, and will design an individual treatment plan for you, beginning with a period of rest, and gradually adding a return to certain activities as appropriate.

Functional Training. Physical therapists are experts at training athletes to function at their best. Your physical therapist will assess your movements, and teach you to adjust them to relieve any extra stress in your knee.

Education. Your physical therapist will work with you to identify and change any external factors causing your pain, such as exercise selection, footwear, or the amount of exercises you complete. Your physical therapist will develop a personal exercise program to help you return to your desired activities.

Can this Injury or Condition be Prevented?

A discoid meniscus is present at birth and, therefore, cannot be prevented. Maintaining appropriate lower-extremity mobility and muscular strength are the best methods for preventing any type of knee injury. Unfortunately, the structure of some individuals’ menisci can increase the risk of sustaining an injury. It is imperative to be aware of any knee pain that you experience, particularly with squatting, running, or cutting, as these are signs of a potential knee injury. Identifying and addressing these injuries early is helpful in their treatment.

Real Life Experiences

Ashleigh is a 15-year-old girl who has been playing soccer since she was in the first grade. She plays with her high school team during the week, and competes in tournaments with her club team on the weekends. Last weekend, while she was running and cutting in her soccer game, she felt a sharp pain in her right knee. She was able to finish playing, but after the game, she told her dad her knee was hurting. She said it had begun getting sore during one of the practices that week, but she didn’t want to tell her coach because she was worried she would not be allowed to continue to play. Now she said she felt like her knee was swollen. Her dad immediately called their local physical therapist.

Ashleigh's physical therapist performed a comprehensive health history and examination. The physical examination revealed that Ashleigh’s knee was tender, swollen, and that she had lost leg motion and strength. Because Ashleigh’s knee was so tender, her physical therapist referred her to an orthopedic surgeon. Her MRI results showed that Ashleigh had a discoid meniscus in her right knee that required surgery.

Ashleigh underwent an outpatient arthroscopic surgery, which required 2 small incision holes in the front of her knee. She was able to return home the same day. After her surgery, Ashleigh returned to physical therapy. Ashleigh used crutches for about 2 weeks after her surgery, until her leg was strong enough to walk without support. Together, Ashleigh and her physical therapist, father, and coach developed a treatment plan to help get her back on the soccer field. The treatment process began with exercises to regain motion and strength.

After about 2 months, when her knee was less tender and she had met some of the goals set in physical therapy, Ashleigh began light running, in preparation for her return to soccer. Throughout her rehabilitation, Ashleigh and her physical therapist worked together to improve the ways she moved, including her sqatting, running, and jumping form, in order to decrease the chance of her developing another knee injury. Along with her physical therapist, coach, and parents, Ashleigh developed a gradual reintegration plan for her return to soccer.

A month later, Ashleigh was back playing soccer! In order to minimize her risk of further knee problems, she continued to perform the daily exercises her physical therapist had prescribed. She also changed her routine to allow for adequate warm-up time before and after each practice. At the end of the season, thanks to Ashleigh’s goal scoring, her team won the high-school state championship!

MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Biceps Tendinitis

Thu, 01 Feb 2018 00:00:00 GMT

Biceps tendinitis is a common cause of shoulder pain, often developing in people who perform repetitive, overhead movements. Biceps tendinitis develops over time, with pain located at the front of the shoulder, and usually worsens with continued activity. When treating biceps tendinitis, physical therapists work to determine the exact source of the pain by assessing the entire shoulder, and typically prescribe a program of activity modification, stretching, and strengthening to resolve pain and return individuals to their desired activities.

What is Biceps Tendinitis?

The biceps muscle is made up of 2 parts: the long head and the short head . The long head of the biceps is most commonly implicated with tendinitis, as the tendon from the muscle runs up the length of the arm and attaches into the shoulder joint. It becomes a part of the shoulder joint capsule, which is surrounded by numerous other structures, including the rotator cuff .

Biceps tendinitis result when excessive, abnormal forces are applied across the tendon, including tension (a pulling of the muscle and tendon), compression (pushing or pinching), or shearing (rubbing). When the tendon is subjected to repetitive stresses, it can become irritated, swollen, and painful.

There are many factors that may lead to biceps tendinitis, including:

Activities requiring repetitive overhead movement of the arms
Weakness in the rotator cuff and muscles of the upper back
Shoulder joint and/or muscle tightness
Poor body mechanics (how a person controls his or her body when moving)
An abrupt increase in an exercise routine
Age-related body changes

How Does it Feel?

With biceps tendinitis, you may experience:

Sharp pain in the front of your shoulder when you reach overhead
Tenderness to touch at the front of your shoulder
Pain that may radiate toward the neck or down the front of the arm
Dull, achy pain at the front of the shoulder, especially following activity
Weakness felt around the shoulder joint, usually experienced when lifting or carrying objects or reaching overhead
A sensation of "catching" or "clicking" in the front of the shoulder with movement
Pain when throwing a ball
Difficulty with daily activities, such as reaching behind your back to tuck in your shirt, or putting dishes away in an overhead cabinet

How Is It Diagnosed?

When you first go to see your physical therapist, the therapist will review your medical history, ask you to describe your shoulder condition, and then perform a comprehensive physical exam of your shoulder. Your therapist will assess different measures, such as sensation, motion, strength, and flexibility, and may ask you to briefly perform the activities that cause your pain.

Your physical therapist will likely touch various areas on your shoulder to see which seem to be most consistently painful. Other nearby areas, such as your neck and upper back, will also be examined to determine whether they might be contributing to your shoulder pain.

Imaging techniques, such as x-ray or MRI, are typically not needed to diagnose biceps tendinitis. However, in the event that your physical therapist suspects there are other conditions present in your shoulder, you may be referred to an orthopedist for further investigation.

How Can a Physical Therapist Help?

Once biceps tendinitis has been diagnosed, your physical therapist will work with you to develop an individualized plan tailored to your specific shoulder condition and your goals. There are many physical therapy treatments that have been shown to be very effective in treating this condition:

Range of Motion. Often, abnormal motion of the shoulder joint can lead to biceps tendinitis. Your physical therapist will assess your shoulder motion compared to the expected normal motion and to the motion of your other shoulder.

Strength. The muscles of the shoulder and upper back work together to allow for normal, coordinated upper-body motion. Based on the way the shoulder joint is designed (a ball-and-socket joint, like a golf ball on a golf tee), there are many directions in which the shoulder may move. Therefore, balanced strength of all the upper-body muscles is crucial to make sure the shoulder joint is protected and is moving efficiently. There are many exercises that can be done to strengthen the muscles around the shoulder so that each muscle is able to properly perform its job, and stresses are appropriately dispersed.

Manual therapy. Physical therapists are trained in manual (hands-on) therapy. Your physical therapist will gently move and mobilize your shoulder joint and surrounding muscles as needed to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.

Pain Management. Your physical therapist may recommend therapeutic modalities, such as ice and heat, to aid in pain management.

Functional training. Whether you work in a factory, are a mother of a young child, or play baseball, the ways in which you perform your normal daily activities can affect the health of your muscles, tendons, and joints. Improper movements can, over time, cause pain in the body. Physical therapists are trained to be experts in assessing movement quality, and in training people to function at their best. Your physical therapist will be able to point out and correct faulty movements, so you are able to attain and maintain a pain-free shoulder. Often, the strategies learned through specific education from your physical therapist will allow you to avoid reversing the positive effects of your physical therapy treatment during your normal daily activities, and help make sure your improvements last.

Can this Injury or Condition be Prevented?

Fortunately, there is much that can be done to prevent biceps tendinitis. Some general tips include:

Avoid repetitive overhead activities that cause shoulder pain. If you must move this way for your job or sport, make sure you set aside time to properly rest your shoulder, to avoid overworking it.
Check your posture. The shoulder, neck, and back are all at risk of injury when they are held in a poor posture over a long period of time. Ask your physical therapist to discuss your work environment; describe how you move (or don't move) throughout the day.
Avoid lifting or carrying heavy objects held away from your body. Keep items close to the body and, when possible, use both hands and arms.
Perform rotator-cuff strengthening exercises regularly.
Consult with a physical therapist if your symptoms are worsening despite rest.

Real Life Experiences

Doug is a 45-year-old man who works as his town's lone electrician. He is also the father of 2 children, a 10-year-old son and a newborn daughter. With the addition of the new baby, his wife has decided to take extra time off from work, so Doug has been working extra hours. Over the last month, he has felt pain in his right shoulder when making certain movements. He is still able to work, but not without a lot of discomfort, especially after working long days. He has also started waking up in the middle of the night after having rolled onto his right shoulder, and this is starting to cause disruptions to his wife's sleep—the little that she gets. Doug doesn't remember ever hurting his shoulder; it just seems like the pain came out of nowhere.

One of Doug's friends mentions that he had a similar issue with his shoulder and went to see a physical therapist. At the encouragement of his tired wife, Doug decides to give it a try.

Doug’s physical therapist asks him questions about his activity, work, and prior shoulder conditions. Doug mentions that in addition to putting in extra hours at work, he has also just started coaching his son's Little League team and has been doing a lot of throwing with the boys at practice.

Doug's physical therapist conducts a thorough assessment. She compares the motion and strength of each shoulder, and conducts tests to help determine the source of Doug's pain. She explains that his rapid increase in activity (work and baseball), specifically doing tasks that place his arm overhead for sustained or repetitive motions, has led to his developing biceps tendinitis.

Over the next 4 weeks, Doug works with his physical therapist 2 times a week to decrease his shoulder pain. She uses manual therapy techniques to improve the mobility of his shoulder joint, and prescribes a progressive exercise program to strengthen the muscles of his shoulder and upper back. She adapts the program to meet Doug’s crazy schedule. She even suggests that he make the exercises a fun father-son time!

Within 6 weeks, Doug is amazed by his progress. His shoulder pain has diminished, and he feels stronger and can work longer without developing aches and pains. And best of all, he can rock his baby girl and toss a ball with his son in the backyard as much as he likes!

MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to De Quervain's Tendinitis

Thu, 01 Feb 2018 00:00:00 GMT

What is De Quervain’s Tendinitis?

Risk factors for developing De Quervain's tendinitis include:

Chronic overuse of the hand.
Excessive use of the thumb from texting and gaming.
Being female (women are 8 to 10 times more likely to develop this condition than men).
Pregnancy.
Using the hand or arm in a position that feels awkward.
Participation in sports that stress the hand and wrist, such as golf and tennis.
Age greater than 40 years.
Race; members of the black community may be more likely to experience this problem.

How Does it Feel?

A person who has De Quervain's tendinitis may:

Feel localized tenderness, pain, and, swelling at the wrist near where the thumb is attached to the forearm.
Have difficulty pinching or grasping with the thumb or hand.
Feel pain when moving the wrist from side to side or twisting it.
Experience limited motion and feeling of weakness in the thumb.
Have difficulty flexing the thumb.
Notice a "catching" or "snapping" sensation with movement of the thumb (a less common symptom).

How Is It Diagnosed?

Your physical therapist will also perform other tests to rule out any underlying conditions that may mimic De Quervain's symptoms.

How Can a Physical Therapist Help?

If your physical therapist confirms De Quervain’s Tendinitis from an evaluation, they will work with you to develop an individualized plan with you for this condition.

The therapist may provide a wrist splint to position your wrist and thumb for rest, and to provide compression to help pain and swelling.

Your therapist may also work with you to reduce pain and inflammation.

Iontophoresis is another option to reduce swelling and pain. Iontophoresis is a type of electrical stimulation that is used to administer medication to the problem area through your skin.

Ice or heat may be recommended for short term pain relief. Your therapist will advise you for what is best for your condition.

How Can a Physical Therapist Help Before & After Surgery?

Can this Injury or Condition be Prevented?

It may be possible to prevent De Quervain's tendinitis. Some risk factors cannot be controlled, such as gender, race, or age; however, physical therapists recommend that you :

Avoid chronic overuse of the hand.
Avoid or restrict overly forceful use of the wrist.
Avoid excessive use of the thumbs for texting and gaming.
Avoid putting the wrist and hand in awkward positions while using the hand or arm.
Train and condition in sports, such as golf and tennis to minimize wrist and thumb strain.

Your physical therapist can teach you correct and safe hand and wrist positions to maintain during your daily home, work, and sport activities.

Real Life Experiences

Janet is a mother of a 2-year-old boy, and is expecting her second child in 3 months. Her part-time job as a secretary requires her to spend 90% of her work day typing on a keyboard. Recently, Janet noticed her right wrist near her thumb was starting to feel sore after work. When she got home, she had trouble picking up her child because of the pain she felt on the thumb side of her wrist. On a recent weekend, Janet spent a lot of time painting to get her new nursery ready. On Monday morning she felt a constant pain in her wrist and forearm that was worse with grasping. She could hardly pick up her coffee cup. She was unable to work. She called her physical therapist.

Janet's physical therapist performed an evaluation of her wrist and hand. He found swelling and tenderness of the thumb extensor tendons. Gently bending the wrist to the "pinkie side" and flexing the thumb increased her pain. The Finkelstein test confirmed De Quervain’s tendinitis. He also noticed her hand and wrist movements were limited.

Janet's physical therapist treated the area with ultrasound to reduce the pain and swelling, and fitted her with a wrist-thumb spica splint to limit use of the affected tendons, and to provide compression. He showed her how to perform gentle movements of the thumb for stiffness in a way that did not increase her symptoms. He cautioned her to avoid lifting and typing as much as possible for 2 weeks. He also recommended ice to the area for 10 minutes, 2 to 3 times a day, to reduce pain and swelling.

Janet felt improvement after her first treatment. She returned for treatment 2 times a week for ultrasound, soft-tissue massage, and modified exercises.

Two weeks later, Janet reported that her pain was no longer constant, and when present, it felt 50% better. She still experienced pain when lifting her child and using the keyboard for longer than 30 minutes. At her physical therapist's suggestion, Janet modified her work habits; for example, she began using a voice dictation program to reduce the amount of time she spent typing. She was happy to note that holding her coffee cup, and similar activities of daily living were no longer painful.

Janet kept using her splint daily with activity throughout her rehabilitation, and continued to restrict any activities that created or increased her pain symptoms. She also made changes to her workspace as recommended by her physical therapist, and changed the position of her hands to reduce joint stress at her wrist and hand during work.

Four weeks after her initial visit with the physical therapist, Janet's pain was minimal and only occurred with movements that stressed the thumb side of the wrist, such as holding a gallon of milk. She continues her home exercise program for strengthening her wrist, thumb, and grip. She continues to use her splint intermittently with activity. She feels stronger and more confident lifting her child, and is gradually returning to her full activity levels.

MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Hip Impingement (Femoroacetabular impingement)

Thu, 01 Feb 2018 00:00:00 GMT

Hip impingement involves a change in the shape of the surface of the hip joint that predisposes it to damage, resulting in stiffness and pain. Hip impingement is a process that may precede hip osteoarthritis. It most often occurs in young, active people. A recent study found that 87% of teens and adults with hip pain showed evidence of hip impingement on diagnostic images taken of their hip joints. To treat hip impingement, physical therapists prescribe stretches and strengthening exercises to better balance the muscles around the hip to protect it, and use manual therapies to help restore range of motion and increase comfort.

What is Hip Impingement?

There are 2 types of hip impingement; they may occur alone or together.

Pincer-Type Impingement

In pincer-type impingement, the hip socket (acetabulum), which is usually angled forward, may be angled toward the back, or protruding bone may be present on the pelvis side of the hip joint making the socket a deeper recess that covers more of the ball or head of the femur bone.
The overgrown bone or incorrect angle of the socket causes the labrum, a rim of connective tissue around the edge of the hip socket, to be pinched. Over time, this extra pressure to the labrum when flexing (moving the leg forward) leads to wear and tear that can cause inflammation and could result in a tear. If this condition persists, eventually the cartilage that lines the hip joint can become worn and form holes.
This condition affects men and women equally; symptoms often begin early, appearing at any time between 15 to 50 years of age.

Cam-Type Impingement

In cam-type impingement, the shape of the bone around the head of the femur—the ball at the top of the bone in the thigh—is misshapen. It can vary from the normal round ball shape, or have overgrown bone formed at the top and front. The nickname “pistol grip” deformity is given to the appearance of the bony overgrowth on x-rays.
The overgrown or misshapen bone contacts the cartilage that lines the hip socket, and can cause it to peel away from the bone in the socket. The labrum can become worn, frayed, or torn as well.
This condition affects men to women at a ratio of 3 to 1; symptoms often manifest during the teen years and 20s.

Signs and Symptoms

Hip impingement may cause you to experience:

Stiffness or deep aching pain in the front or side of the hip or front of the upper thigh while resting.
Sharp, stabbing pain when standing up from a chair, squatting, rising from a squat, running, "cutting," jumping, twisting, pivoting, or making lateral motions.
Hip pain described in a specific location by making a "C" with the thumb and hand and placing it on the fold at the front and side of the hip, known as the "C-sign."
Pain that most often starts gradually, but can also remain after another injury resolves.
Pain that increases with prolonged sitting or forward leaning.
Feeling less flexible at the hips, including a decreased ability to turn your thigh inward on the painful side.

How Is It Diagnosed?

Your physical therapist will evaluate the range of motion (movement) of the hip and surrounding joints, and test the strength of the muscles in that area. Your therapist will feel the hip joint and surrounding muscles to evaluate their condition. The examination will include observing how you move, standing from a sitting position, walking, running, or squatting, as appropriate. Your physical therapist may perform special tests to help determine whether the hip is the source of your symptoms. For instance, the therapist may gently roll your leg in and out (the “log roll” test), or bend your hip up and in while turning the lower leg out to the side (the "FADDIR" test) to assess your condition.

If further diagnosis is needed, your doctor may order diagnostic tests to help identify any joint changes, including x-rays, magnetic resonance imaging (MRI), or diagnostic injections. Hip impingement can occur at the same time as low back, buttock, or pelvic pain, or from conditions such as bursitis or groin strain. The final diagnosis of hip impingement may take some time, especially when other conditions are present.

How Can a Physical Therapist Help?

Without Surgery

When an active person develops hip pain, but does not have severe symptoms or joint damage, the recommended treatment is physical therapy. The following interventions can help decrease pain, improve movement, and avoid the progression of hip impingement and the need for surgery:

Improving the strength of your hips and trunk. Strengthening of the hips and trunk can reduce abnormal forces on the already injured joint and help with strategies to compensate.
Improving hip muscle flexibility and joint mobility. Stretching tight muscles can reduce abnormal forces that cause pain with motion. Joint mobilization may help ease pain from the hip joint; however, these treatments do not always help range of motion, especially if the shape of the bone at the hip joint has changed.
Improving tolerance of daily activities. Your physical therapist can consider your job and recreational activities and offer advice regarding maintaining postures that are healthier for your hip and activity modification. Often this involves limiting the amount of bending at the hip to avoid further hip damage.

Following Surgery

Surgery for hip impingement is performed with arthroscopy. This is a minimally invasive type of surgery, where the surgeon makes small incisions in the skin and inserts pencil-sized instruments into the joint to repair damage. The surgeon may perform 1 or several techniques during your procedure as needed. The surgeon may remove or reshape the bone on the pelvis or femur side of the joint, and repair or remove the damaged labrum or cartilage of the hip joint.

Postsurgical physical therapy varies based on the procedure performed. It may include:

Ensuring your safety as you heal. Your physical therapist may recommend that you limit the amount of weight you put on the operated leg if there was a repair of the labrum. You may wear a brace to help limit the amount of bending at the hip. You might also use crutches to avoid overloading the leg if the bone on the femur was reshaped.
Improving your range of motion, strength, and balance. Your physical therapist will guide you through safe range-of-motion, strengthening, and balance activities to improve your movement as quickly as possible while allowing the surgical site to heal properly.
Instructions on returning to an active lifestyle. Most people return to normal daily activities about 3 months after surgery, and to high-level activities and sports 4 to 6 months after surgery. Your physical therapist will recommend a gradual return to activity based on your condition—research shows that 60% to 90% of athletes return to their previous playing ability depending on the surgical procedure performed and the sport.

Can this Injury or Condition be Prevented?

Currently there are no recommendations to prevent hip impingement. Despite a major increase in research to learn more about hip impingement, there is a great deal that is unknown. For instance, many active young people whose x-rays show hips as being abnormal do not have pain despite continuing to live active lives and participate in sports.

However, there is evidence that physical therapy interventions along with anti-inflammatory drugs can decrease pain, slow joint damage, and improve function. This is particularly important in those with mild hip impingement, those who are attempting to avoid surgery, and those who are not candidates for surgery.

Real Life Experiences

Lindsay is an active high school senior who plays shortstop for her school's softball team. Over the last several months, she has had progressively worsening pain on the front and side of her left hip. It started as an occasional sharp pain when she fielded ground balls at practice, and it eventually developed into aching and stiffness of the hip while resting. Lindsay occasionally develops hip pain while sitting in class or at the movies. In the past couple of weeks, she has found it hard to lean forward to tie her shoes. Her mom has been worrying about her pain and takes Lindsay to her physical therapist.

At the evaluation, the physical therapist finds that Lindsay has weakness around her hip and trunk muscles, decreased hip mobility, pain when flexing the hip, pain returning to a standing position after squatting, and decreased balance when standing on her affected leg. Her physical therapist diagnoses mild hip impingement in her left hip. Lindsay sees her physical therapist 1-2 times a week for the next 6 weeks.

Her treatments focus on developing a home program for strengthening her hips and trunk, and the therapist uses manual therapy for the hip to improve her comfort and allow her to perform more activities. The therapist works with Lindsay to change how she moves when standing from a seated position, and also to modify how she moves when playing the infield in softball. Lindsay also spends less time in the positions that bother her hip in the weight room and on the practice field, following recommendations from her physical therapist. After 3 weeks, the majority of her pain has subsided, and by 6 weeks, she is playing in games pain-free.

Lindsay meets her goal of finishing her senior year with the softball team. However, she is considering other ways to stay active after she graduates that don’t involve bending forward as much.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Iliotibial Band Syndrome (ITBS or It Band Syndrome)

Thu, 01 Feb 2018 00:00:00 GMT

Iliotibial band syndrome (ITBS) is one of the most common causes of knee pain, particularly in individuals involved in endurance sports. It accounts for up to 12% of running injuries and up to 24% of cycling injuries. ITBS is typically managed conservatively through physical therapy and temporary activity modification.

What is Iliotibial Band Syndrome (ITBS)?

Iliotibial band syndrome (ITBS) occurs when excessive irritation causes pain at the outside (or lateral) part of the knee. The iliotibial band (ITB), often referred to as the "IT band" is a type of soft tissue that runs along the side of the thigh from the pelvis to the knee. As it approaches the knee, its shape thickens as it crosses a prominent area of the thigh (femur) bone, called the lateral femoral condyle. Near the pelvis, it attaches to 2 important hip muscles, the tensor fascia latae (TFL) and the gluteus maximus.

ITBS involves many lower extremity structures, including muscles, bones, and other soft tissues. Usually discomfort arises from:Irritation and inflammation arise from friction between the ITB and underlying structures when an individual moves through repetitive straightening (extension) and bending (flexion) of the knee. Typically, ITBS pain occurs with overuse during activities such as running and cycling.

Abnormal contact between the ITB and thigh (femur) bone
Poor alignment and/or muscular control of the lower body
Prolonged pinching (compression) or rubbing (shearing) forces during repetitive activities

The common structures involved in ITBS are:

Iliotibial band
Bursa (fluid-filled sack that sits between bones and soft tissues to limit friction)
Hip muscles

ITBS can occur in:

Athletes performing repetitive activities, such as squatting, and endurance sports such as running and cycling
Individuals who spend long periods of time in prolonged positions, such as sitting or standing for a long workday, climbing or squatting, or kneeling
Individuals who quickly start a new exercise regimen without proper warm-up or preparation

Signs and Symptoms

With ITBS, you may experience:

Stabbing or stinging pain along the outside of the knee
A feeling of the ITB “snapping” over the knee as it bends and straightens
Swelling near the outside of your knee
Occasionally, tightness and pain at the outside of the hip
Continuous pain following activity, particularly with walking, climbing, or descending stairs, or moving from a sitting to standing position

Pain is usually most intense when the knee is in a slightly bent position, either right before or right after the foot strikes the ground. This is the point where the ITB rubs the most over the femur.

How Is It Diagnosed?

Your physical therapist will ask you questions about your medical history and activity regimen. A physical examination will be performed so that your physical therapist can collect movement (range of motion), strength, and flexibility measurements at the hip, knee, and ankle.

When dealing with ITBS, it is also common for a physical therapist to use special tests and complete a movement analysis, which will provide information on the way that you move and how it might contribute to your injury. This could include assessment of walking/running mechanics, foot structure, and balance. Your therapist may have you repeat the activity that causes your pain to see firsthand how your body moves when you feel pain. If you are an athlete, your therapist might also ask you about your chosen sport, shoes, training routes, and exercise routine.

Typically, medical imaging tests, such as x-ray and MRI, are not needed to diagnosis ITBS.

How Can a Physical Therapist Help?

Your physical therapist will use treatment strategies to focus on:

Range of motion

Often, abnormal motion of the hip and knee and foot joint can cause ITBS because of how the band attaches to hip muscles. Your therapist will assess the motion of your injury leg compared with expected normal motion and the motion of the hip on your uninvolved leg.

Muscle strength

Hip and core weakness can contribute to ITBS. The "core" refers to the muscles of the abdomen, low back, and pelvis. Core strength is important, as a strong midsection will allow greater stability through the body as the arms and legs go through various motions. For athletes performing endurance sports, it is important to have a strong core to stabilize the hip and knee joints during repetitive leg motions. Your physical therapist will be able to determine which muscles are weak and provide specific exercises to target these areas.

Manual therapy

Many physical therapists are trained in manual therapy, which means they use their hands to move and manipulate muscles and joints to improve motion and strength. These techniques can target areas that are difficult to treat on your own.

Functional training

Even when an individual has normal motion and strength, it is important to teach the body how to perform controlled and coordinated movements so there is no longer excessive stress at the previously injured structures. Your physical therapist will develop a functional training program specific to your desired activity. This means creating exercises that will replicate your activities and challenge your body to learn the correct way to move.

Your physical therapist will also work with you to develop an individualized treatment program specific to your personal goals. He or she will offer tips to help you prevent your injury from reoccurring.

Can this Injury or Condition be Prevented?

Maintaining core and lower extremity strength and flexibility and monitoring your activity best prevents ITBS. It is important to modify your activity and contact your physical therapist soon after first feeling pain. Research indicates that when soft tissues are irritated and the offending activity is continued, the body does not have time to repair the injured area. This often leads to persistent pain, and the condition becomes more difficult to resolve.

Once you are involved in a rehabilitation program, your physical therapist will help you determine when you are ready to progress back to your previous activity level. He or she will make sure that your body is ready to handle the demands of your activities so that your injury does not return. You will also receive a program to perform at home that will help you maintain the improvements that you gained during rehabilitation.

Real Life Experiences

Sarah is a 31-year-old mother training for her first triathlon. With a young child at home, she has to squeeze in her training sessions early in the morning. She rarely has time to cool down or stretch after riding her bike or running because she has to get home before her child wakes up.

Sarah signs up for her first race and begins to increase her cycling and running in preparation. One day during the middle of a long run, she feels a sharp pain at the outside of her knee. It starts hurting with every step, and doesn't go away, even after she stops and stretches. Far from home, she has to finish her run despite the nagging pain. When she gets home, she puts ice on it, but for the rest of the day she has trouble going up and down stairs, or squatting to pick up her son, and feels pain when standing up after driving the car. The next day, she tries to ride her bike, but the knee pain is still there and feels worse.

Wisely, Sarah stops running and cycling and contacts her physical therapist.

Sarah's physical therapist conducts a comprehensive evaluation of her hip and knee motion, strength, balance, and running mechanics. She uses special tests and measures to determine if Sarah’s pain is related to her iliotibial band or if there are other problems occurring simultaneously. She talks with Sarah about her training routine, including equipment (shoes, position on the bike, etc), the routes she runs and their surfaces, and her stretching program. The therapist diagnoses Sarah with iliotibial band syndrome. She guides Sarah through specific exercises in the clinic, including manual stretching of the hip joint by the therapist, sidelying leg raises for hip strengthening, and single leg squats to promote integrated core, hip, knee, and ankle function. Sarah will also perform these exercises at home as a part of her daily exercise routine to maximize improvement and help ensure her sustainable success.

Sarah's physical therapist helps her develop strategies for training, taking into consideration her lifestyle as a busy mother, to help her stay injury-free. Together, they outline a 6-week rehabilitation program for iliotibial band syndrome. Sarah will come to the clinic 1-2 times each week, where her therapist will assess her progress, perform manual therapy techniques, and advance her exercise program as appropriate. Sarah will also have a daily exercise routine to perform independently at home, including stretching and strengthening activities.

In 6 weeks, Sarah has met all of her physical therapy goals and completes her rehabilitation in the clinic. After building her training gradually over the next month, she is able to train and successfully crosses the finish line just as planned!

ardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Tennis Elbow (Lateral Epicondylitis)

Thu, 01 Feb 2018 00:00:00 GMT

Most people who get tennis elbow don't play tennis! In fact, less than 5% of all cases of tennis elbow occur in people who play tennis. Tennis elbow can happen to anyone who repeatedly uses their elbow, wrist, and hand for their job, sport, or hobby.

What Is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow is a painful condition caused by overuse of the "extensor" muscles in your arm and forearm, particularly where the tendons attach to rounded projections of bone (epicondyles) on the outside or lateral aspect of the elbow. The muscles you use to grip, twist, and carry objects with your hand all attach to the "lateral epicondyle" at the elbow. That's why a movement of the wrist or hand can actually cause pain in the elbow.

Prolonged use of the wrist and hand, such as when using a computer or operating machinery —and, of course, playing tennis with an improper grip or technique—can lead to tennis elbow. It can happen to athletes, non-athletes, children, and adults. It occurs more often in men than women, and most commonly affects people between the ages of 30 and 50.

Signs and Symptoms

Symptoms of tennis elbow can occur suddenly as a result of excessive use of the wrist and hand for activities that require force, such as lifting, twisting, or pulling. Forceful activities—like pulling strongly on a lawn mower starter cord—can injure the extensor muscle fibers and lead to a sudden onset of tennis elbow.

More commonly, though, symptoms of tennis elbow develop gradually over a period of weeks or months as a result of repeated or forceful use of the wrist, hand, and elbow. If you work as a grocery store cashier, you might have symptoms of tennis elbow as a result of repetitive (and often too forceful) typing—combined with continuous lifting of grocery bags.

Your symptoms may include:

Pain that radiates into your forearm and wrist
Difficulty doing common tasks, such as turning a doorknob or holding a coffee cup
Difficulty with gripping activities
Increased pain when you use your wrist and hand for lifting objects, opening a jar, or gripping something tightly, such as a knife and fork
Stiffness in the elbow
Weakness in the forearm, wrist, or hand

How Is It Diagnosed?

Tennis elbow usually occurs due to repeated movements. As a result, other muscles and joints in this region of the body may be affected as well. Your physical therapist will perform a careful examination not only of your elbow but of other areas of your body that might be affected and might be contributing to your pain. Your therapist will perform special manual tests that help diagnose the problem and help detect conditions such as muscle weakness that might have led to the problem in the first place. For instance, the therapist might ask you to gently tense or stretch the sore muscles to identify the exact location of the problem. Rarely is an x-ray required to diagnose this condition.

How Can a Physical Therapist Help?

The First 24 to 48 Hours

For the first 24 to 48 hours after acute onset of your pain, treatment includes:

Resting the arm by avoiding certain activities and modifying the way you do others
Using 10-20 minute ice treatments
Using elastic bandages or supports to take the pressure off of the painful muscles

Your physical therapist will decide if you should use a brace or support to protect your muscles while the area is healing. Depending on severity, your therapist may recommend that you consult with another health care provider for further testing or for consideration of additional treatment such as medication. In rare cases, treatments such as cortisone injection or surgery might be needed. Your physical therapist can help you determine whether you need a referral to another health care provider.

Your physical therapist can design a specific treatment program to speed your recovery. There will very likely be exercises and other treatments that you will be expected to do at home. Your physical therapist also might use special physical therapy treatments to help relieve pain, such as manual therapy, special exercises, and ice or heat treatments or both.

For an "acute" case of tennis elbow—one that has occurred within the past few weeks— it's important to treat as early as possible. Left untreated, tennis elbow may become chronic and last for months and sometimes even years . This is especially true if treatment is focused only on relieving pain and not on correcting the muscle weakness and bad habits that might have led to your condition in the first place.

Improve Your Ability to Move

Your physical therapist may use manual therapy to enable your joints and muscles to move more freely with less pain.

Improve Your Strength

Insufficient muscle strength can lead to tennis elbow. Sometimes the weakness is in the muscles of the wrist and forearm. In many cases, the problem stems from weakness of the supporting postural, or "core," muscles. In fact, you might find that it is necessary to improve your overall level of fitness to help manage your elbow condition. Based on the evaluation, your physical therapist can determine the type and amount of exercises that are right for you.

Physical therapists prescribe several types of exercises during recovery from tennis elbow:

Early in the treatment, when the pain is most intense, your therapist may recommend passive exercises in which your wrist and elbow are moved without the use of your muscles.
As your symptoms improve, you can move the wrist and elbow actively without assistance.
As the muscles become stronger and the symptoms have lessened, you will be able to begin using weights or resistance bands to further increase your strength. The amount of weight will need to be carefully monitored to make sure you continue to progress and avoid re-injuring your muscles.

Use Your Muscles the Right Way

Your physical therapist can help you retrain your muscles so that you use them properly. For example, when you lift a heavy grocery bag, you should contract the muscles around your shoulder blade and trunk to provide support for your arm muscles. This simple movement can be easily taught to you by a physical therapist can lessen the stress to the injured muscles and help you return to your normal activities while avoiding re-injury.

Return to Your Activities

Your physical therapist will help you remain active by teaching you how to modify your daily activities to avoid pain and further injury. Sometimes it's necessary to make changes at work, on the playing field, or in the home. Your physical therapist can help you make simple modifications to your work site, your computer set-up, your kitchen devices, your sports equipment, and even your gardening tools to lessen the strain to your hand, wrist, and forearm. Your therapist will emphasize the importance of taking stretch breaks so that your muscles get frequent rest from repetitive movements and standing or sitting in the same position.

Tennis may be a contributing factor to tennis elbow for several reasons. Sometimes the problem results from over-training. In other cases, the weight of the racquet or its grip may need to be adjusted. For others, the problem may stem from improper form, poor overall fitness, or a lack of strength in the supporting or "core" muscles of the trunk and shoulder blades. A physical therapist can help analyze the source of the problem and help find a solution.

Real Life Experiences

You work as a computer graphics engineer. Yesterday, you spent the day gardening with an electric lawn trimmer. This morning you woke up with pain and a feeling of stiffness on the outside of your elbow. The pain increases the more you move your elbow, forearm, and wrist. It also hurts to use your computer mouse or to pick up your coffee cup. You immediately schedule an appointment for an evaluation with a physical therapist. A physical therapist performs a full examination of your elbow and surrounding muscles and joints and can determine whether additional tests or referral to another health care provider is necessary. In most cases of tennis elbow, the therapist will manage your care through your full recovery.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Lumbar Radiculopathy and Sciatica

Thu, 01 Feb 2018 00:00:00 GMT

Lumbar radiculopathy (also known as sciatica or radiculitis) is a condition that occurs when a nerve in your low back is injured, pinched, or compressed, causing pain or other symptoms that can extend from the low back to the hip, leg, or foot. Lumbar radiculopathy can be caused by sudden trauma or by long-term stress affecting structures in the back. It most often affects people aged 30 to 50 years. Risk factors for lumbar radiculopathy include repeated lifting, participating in weight-bearing sports, obesity, smoking, sedentary lifestyles, and poor posture. The majority of lumbar radiculopathy and sciatica cases recover without surgery, and respond well to physical therapy. Physical therapists design individualized treatment programs to help people with lumbar radiculopathy reduce their pain, regain normal movement, and get back to their normal activities.

Lumbar Radiculopathy and Sciatica

The spine is made up of 33 vertebrae (bones) stacked on top of each other. On the side of each vertebra are openings in the bone through which nerve roots and nerves exit the spinal canal and travel out to the hips, legs, and feet. Between each vertebra is a piece of cartilage called an "intervertebral disc" that acts like a cushion between the vertebrae.

Injuries close to the spine can cause pressure or injury to the nerves and nerve roots. These injuries may include:

Bulging intervertebral discs (“ herniated disc ”)
Overstretching of a nerve or nerve root
Tight piriformis muscle

Conditions that can cause lumbar radiculopathy to develop over time include:

Bone spurs
Arthritis
Inflammation

Sudden injury can occur with a fall, when a person lifts an object awkwardly, or through trauma such as a car accident. Structures surrounding the spine, such as ligaments or nerves, can also be injured.

A slow onset of lumbar radiculopathy can occur from sitting or standing with poor posture (slumped forward) for weeks, months, or years. Poor posture can slowly overstretch ligaments in the back, allowing pressure to occur on a spinal nerve. As that pressure increases, the pain can travel farther out along the path of the nerve, causing discomfort in the hip, leg, or foot.

How Does it Feel?

Lumbar radiculopathy can cause pain, muscle tightness and weakness, or other symptoms. The pain usually starts in the low back, and can travel to the hip, leg, or foot. The location of the pain can vary depending on which nerve in the back is affected and how much it is irritated. Greater irritation causes the pain to spread farther. Spreading pain usually affects 1 leg, but may affect both legs. Pain and other symptoms can be constant or come and go, and can vary in intensity.

If a nerve or nerve root is severely pinched or compressed it can cause severe pain, muscle weakness, or extreme movement problems. Surgery may be recommended in more severe cases. On rare occasions, nerve compression can cause bladder control or bowel function problems, in which case immediate surgery is recommended .

Your physical therapist can help determine the details of your condition and whether consultation with a surgeon is necessary. Your physical therapist will work with your physician or surgeon to determine your best treatment.

Signs and Symptoms

Lumbar radiculopathy can cause a variety of symptoms. The type and location of your symptoms will depend on the amount of pressure being placed on the affected nerve(s). Symptoms may include:

Pain and/or pressure in the back, hip, leg(s), foot/feet
Pain that can be throbbing, aching, shooting, sharp, dull, or burning
Inability to bend or rotate the back
Numbness or tingling in the back, hip(s), leg(s), or feet
Weakness in the leg(s)
Increased pain when coughing, sneezing, reaching, or sitting
Inability to stand up straight; being "stuck" in a position such as stooped forward
Difficulty getting up from a chair
Inability to remain in 1 position for a long period of time, such as sitting or standing, due to pain
Pain that is worse in the morning
Limping when walking

The pain or other symptoms can occur in 1 limb or both. They can be in different locations at different times, and can change depending on your activity or body positioning. For example, pain can lessen or worsen when walking versus sitting, or lying down versus standing up.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist also will ask you detailed questions about your injury, such as:

Do you have loss of control of your bladder or bowel? CAUTION: Contact a medical professional immediately if you experience this condition.
How and when did the pain start?
At what time of day is it worse?
What type of discomfort do you feel, and where do you feel it?
What are you unable to do right now in your daily life due to the pain?

Your physical therapist will perform tests on your body to identify problems, such as:

Difficulty moving
Muscle weakness or tightness
Changes in skin sensation (numbness)
Changes in reflexes
Joint stiffness
Changes in posture
Difficulty walking or balancing

If your physical therapist finds any of the above problems, physical therapy treatment may begin right away, to help get you on the road to recovery and back to your normal activities.

If testing indicates any concerns, your physical therapist will consult your physician or surgeon regarding the need for special diagnostic testing, such as magnetic resonance imaging (MRI). Physical therapists work closely with physicians and other health care providers to ensure you receive an accurate diagnosis, treatment, and the care you need.

How Can a Physical Therapist Help?

In all but the most extreme cases of lumbar radiculopathy, conservative care (such as physical therapy) often results in better and faster results than surgery or pain medication (such as opioid medication).

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but improvement may be achieved in 4 to 8 weeks, when a proper posture, pain reduction, stretching, and strengthening program is implemented.

During the first 24 to 48 hours following your diagnosis of lumbar radiculopathy, your physical therapist may advise you to:

Protect the area by avoiding activity that causes worsening symptoms, such as heavy lifting.
Avoid too much bed rest.
Stay active around the house, and go on short walks several times per day. Movement will decrease your pain and stiffness, and help you feel better.
Apply ice packs to the affected area for 15 to 20 minutes every 2 hours.
Sit in firm chairs. Soft couches and easy chairs may make your problems worse.
Consult with a physician for further services, such as medication or diagnostic tests.

Some exercises are better for individuals with lumbar radiculopathy. Your physical therapist will educate you about them. For example:

Water exercises can be a great way to stay physically active when other forms of exercise are painful.
Exercises prescribed for you because your physical therapist found that they reduce your leg pain are important for you to do.
Exercises that involve lots of twisting and bending may or may not benefit you. Your physical therapist will design an individualized exercise program to meet your specific needs.
Weight-training exercises, though very important, need to be done with proper form to avoid stress to the back.

Your physical therapist will work with you to:

Reduce pain and other symptoms. Your physical therapist will help you understand how to avoid or modify the activities that caused the injury, so healing can begin. Your therapist may use different types of treatments and technologies to control and reduce your pain and symptoms. Your treatment, based on your condition, may include specific motion exercises, mechanical traction, the application of cold or heat packs, and gentle electrotherapy such as transcutaneous electrical nerve stimulation (TENS).

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with "passive" motions that the physical therapist performs for you to move your spine, and progress to active exercises and stretches that you do yourself. You can perform these motions at home and in your workplace to help hasten healing and pain relief.

Improve flexibility. Your physical therapist will determine if any of the involved muscles are tight, start helping you to stretch them, and teach you how to stretch them at home.

Improve strength. If your physical therapist finds any weak or injured muscles, the therapist will teach you the correct exercises to steadily restore your strength and agility. “Core strengthening” exercises are commonly used to restore the strength and coordination of muscles around your back, hips, abdomen, and pelvis.

Improve posture. Your physical therapist will teach you how to improve your posture so that pressure is reduced in the injured area, and healing can begin and progress as rapidly as possible.

Learn a home program. Your physical therapist will teach you strengthening, stretching, and pain reduction exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.

Return to activities. Your physical therapist will discuss your activity levels with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. For spine and leg pain from lumbar radiculopathy, your physical therapist may teach you correct ways to lift objects (called “body mechanics”) that will help protect your spine from aggravating symptoms.

Once your pain is under control or gone, it will be important for you to continue your new posture and movement habits to keep your back healthy and pain free.

Following Surgery

In some cases, surgery is necessary to prevent further damage. If you undergo surgery for your lumbar radiculopathy, your physical therapist will work closely with you and your surgeon to help you regain motion and strength more quickly than you could on your own, and help you get back to your normal lifestyle as quickly as possible.

Can this Injury or Condition be Prevented?

Lumbar radiculopathy may be preventable. To reduce the likelihood of developing this condition:

Practice good posture when sitting and standing, including when driving a car.
Use proper body mechanics when lifting, pushing, pulling, or performing any action that puts extra stress on your spine.
Maintain a healthy weight. This will reduce the stress on your spine.
Stop smoking.
Discuss your occupation with a physical therapist, who can provide an analysis of your job tasks and offer suggestions for reducing your risk of injury.
Keep your muscles strong and flexible. Participate in a consistent program of physical activity to maintain a healthy fitness level.

To help prevent recurrence of lumbar radiculopathy, follow the above advice, and:

Continue the new posture and movement habits that you learned from your physical therapist to keep your back healthy.
Continue to do the home-exercise program your physical therapist taught you to help maintain your improvements.
Continue to be physically active and stay fit.

Real Life Experiences

Dana is a 40-year-old new mom. She is delighted with her new baby Amy and loves to play games with her, pick her up, carry her, and hold her.

Recently, after playing with Amy during some tummy time on a blanket on the floor, Dana stood up, and then reached back down to the floor to pick Amy up. She felt a sudden, sharp pain in the left side of her low back. She was able to lift Amy and move her safely to a playpen, but found that she couldn’t stand up straight for a few minutes. As she tried to complete some light housework, the pain traveled from her back, down her left hip, and into her left calf. She had to limp slightly when she walked, and the pain got even worse when she bent forward.

When her husband returned from work, he could see how much pain Dana was in; he said she should seek medical help. But Dana was reluctant to do so, because she didn’t want to take medicine while breast feeding, and she was afraid of ever having to take opioids because of the severe side effects and risk of addiction. Dana’s husband remembered that his brother had chosen physical therapy to help his back pain, and suggested that she contact a physical therapist. Dana scheduled an appointment right away.

At Dana’s first visit, her physical therapist notes her health history, and asks her to describe her pain. Dana tells him when she first felt the pain, how it extends down her leg, and how difficult her daily activities have become because of it. Her physical therapist performs a full physical examination. Dana explains that she now also feels some tingling in her left leg and foot, and that the pain is worse in the morning. She notes that sitting in the car to get to her appointment was quite uncomfortable.

Dana’s physical therapist performs a series of physical tests to determine the severity of her injury, her muscle strength, the movement of the joints in her back, and the skin sensation in her legs. He finds that a specific movement of the spine almost entirely relieves Dana’s leg and hip pain. He concludes that Dana has lumbar radiculopathy. He explains to Dana that physical therapy over the next few weeks will help to reduce her pain and help healing occur faster.

To begin her treatment, Dana’s physical therapist applies a manual (hands-on) technique that almost completely relieves her leg pain and greatly reduces her back pain. He teaches Dana how to do a specific movement that reduces her leg pain after a few repetitions, in just a few minutes. He tells Dana to perform this simple movement throughout the day at home to reduce her pain and prevent it from returning. Dana is excited to learn the movement, because she can easily do it while caring for Amy, and it really eases her pain.

During her next few physical therapy sessions, Dana reports great relief from her pain, and says she now experiences time during the day when she feels no pain at all. Her physical therapist shows Dana how to prevent her pain from returning by improving her posture and changing the way she reaches forward, so there is less stress on her back. Dana also learns strength exercises for her core muscles to better support her back when she reaches for and lifts her baby. Dana realizes that her core muscles (abdominal and back muscles) became weak during pregnancy; she is happy to have the chance to strengthen them, knowing that it will also reduce her back and leg pain.

After 2 weeks, Dana’s physical therapist adds hip strengthening exercises to her treatment program. After performing them for about a week, along with her other exercises, Dana finds she is able to walk normally again, without a limp. He encourages her to stay as active as possible, and to resume her daily walks and workouts. Dana is relieved to find that staying active reduces her pain even more!

After 3 weeks, Dana’s leg and hip pain is gone, and her back hurts only occasionally. Whenever her back starts to hurt, she repeats the specific movement her physical therapist taught her, and the pain goes away. She finds the pain doesn’t occur if she maintains good posture when she sits, stands, and reaches. She is amazed how quickly her pain dissolved in just a few weeks—and she never took any pain medicine!

Dana follows the advice of her physical therapist, and after 7 weeks, she is pain free and walking with renewed strength. She is able to complete all the childcare and housework activities she used to do, with only rare moments of discomfort, which she deals with by using the skills her physical therapist taught her.

These days, Dana is a happy, busy, new mom, feeling stronger and fitter than she has in years!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

MoveFowardPT.com, the official consumer Web site of the American Physical Therapy Association, ©[2018]

Physical Therapist's Guide to Medial Collateral Ligament (MCL) Injury

Thu, 01 Feb 2018 00:00:00 GMT

The medial collateral ligament (MCL) is the most commonly damaged ligament in the knee. The MCL can be sprained or torn as a result of a blow to the outer side of the knee, by twisting the knee, or by quickly changing directions while walking or running. MCL injury most often occurs in athletes, although nonathletes can also be affected. A physical therapist treats an MCL sprain or tear to reduce pain, swelling, stiffness, and any associated weakness in the knee or lower extremity.

What is an MCL Injury?

The MCL is a small, thick band of tissue on the inner side of the knee joint. It connects two bones—the thighbone and the shin bone—preventing the knee from bending inward toward the other knee. When the knee is hit on the outer side of the leg (eg, the left side of the left leg), or if the knee is twisted violently, the MCL can overstretch resulting in a partial or complete tear. MCL injuries commonly occur in football players who get "clipped" or hit on the outer side of the knee. Other causes may include twisting and turning while skiing, blows received on the soccer field, trauma experienced in a car accident, or simply turning the knee sharply while the foot is planted on the ground. Healing times vary from a couple of weeks to a couple of months, depending on the severity of the injury.

How Does it Feel?

When you experience an MCL injury, you may feel:

Pain on the inner side of the knee
Swelling and bruising at the inner side of the knee
Swelling that spreads to the rest of the knee joint in 1 or 2 days following injury
Stiffness in the knee
Difficulty or pain when trying to bend or straighten the knee
An unstable feeling, as though the knee may give out or buckle
Pain or difficulty walking, sitting down, rising from a chair, or climbing stairs

Signs and Symptoms

With an MCL injury, you may experience

A "popping" sound as the injury occurs
Pain and swelling in your knee
Difficulty moving your knee
Difficulty bearing weight on your leg for walking or getting up from a chair

How Is It Diagnosed?

If you see your physical therapist first, the therapist will conduct a thorough evaluation that includes taking your health history. Your therapist will also ask you detailed questions about your injury, such as:

Did you feel pain or hear a "pop" when you injured your leg?
Did you turn your leg with your foot planted on the ground?
Did you change direction quickly while running?
Did you receive a direct hit to the leg while your foot was planted on the ground?
Did you see swelling around the knee in the first 2 to 3 hours following the injury?
Does your knee feel like buckling or giving way when you try to use it?

Your physical therapist also will perform special tests to help determine the likelihood that you have an MCL injury. Your therapist will gently press on the outside of your knee while it is slightly bent as well as when it is fully straight to test the strength of the ligament. The therapist will also check the inner side of your knee for tenderness and swelling and measure for swelling with a tape measure. The therapist may use additional tests to determine if other parts of your knee are injured, and will also observe how you are walking.

To provide a definitive diagnosis, your therapist may collaborate with an orthopedic physician or other health care provider. The orthopedic physician may order further tests, such as magnetic resonance imaging (MRI), to confirm the diagnosis and to rule out other damage to the knee. It also helps to determine whether surgery is required. MRI is not required in all cases but may be ordered. Your therapist or doctor may recommend a knee brace, a knee immobilizer, or crutches to reduce pain if the MCL injury is severe.

How Can a Physical Therapist Help?

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments you can do at home. Physical therapy will help you return to your normal lifestyle and activities.

The First 24-48 Hours

Your physical therapist may advise you to:

Rest the area by avoiding walking or any activity that causes pain. Crutches and a knee brace may be recommended to reduce further strain on the MCL when walking.
Apply ice packs to the area for 15-20 minutes every 2 hours.
Compress the area with an elastic bandage wrap.
Consult with a physician for further services such as medication or diagnostic tests.

Reduce Pain

Your physical therapist may use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and hands-on therapy such as massage.

Improve Motion

Your physical therapist will choose specific activities and treatments to help restore normal movement in the knee and leg. These might begin with passive motions that the therapist performs for you to gently move your leg and knee joint, and progress to active exercises and stretches that you do yourself.

Improve Strength

Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to steadily restore your strength and agility. These may include using cuff weights, stretchy bands, weight-lifting equipment, and cardio-exercise equipment such as treadmills or stationary bicycles.

Improve Balance

Regaining your sense of balance is important after an injury. Your physical therapist will teach you exercises to improve your balance skills.

Speed Recovery Time

Normal healing of time is a few weeks to a few months, depending on which tissues are injured and how severely they are injured. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

Return to Activities

Your physical therapist will discuss your goals with you and use them to set your work, sport, and homelife recovery goals. The therapist will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will apply hands-on therapy, such as massage, and teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Prevent Future Injury

Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your knee, upper leg, and abdomen to help prevent future injury. These may include strength and flexibility exercises for the leg, knee, and core muscles.

If Surgery Is Necessary

Surgery is rarely necessary in the case of an MCL injury. If surgery is needed, you will follow a recovery program over several weeks guided by your physical therapist, who will help you minimize pain, regain motion, strength, and return to normal activities as quickly as possible after surgery.

Can this Injury or Condition be Prevented?

To help prevent a recurrence of the injury, your physical therapist may advise you to:

Learn how to not let your knees collapse in toward each other when jumping, running, or turning quickly
Practice balance and agility exercises and drills
Always warm up before starting a sport or heavy physical activity
Follow a consistent strength and flexibility exercise program to maintain good physical conditioning, even in a sport's off-season
Wear shoes that are in good condition and fit well

Real Life Experiences

Mark is a 35-year-old accountant who is an avid bowler on the weekends. He lives with his 100-lb Rottweiler dog. One morning, as Mark was quickly turning a corner into the kitchen to grab a ringing phone, his dog ran the other way and accidentally hit Mark’s knee on the outer side of his right leg. Mark lost his balance and fell sideways. His right foot got caught underneath the dog as his body fell to the right, forcing the outer side of the knee to buckle and the inner side of the knee to overstretch. Mark felt a sharp pain on the inner side of his knee, and fell to the ground. Mark felt immediate tenderness on the inner side of his knee, and he could not straighten or bend it.

Mark was able to see his physical therapist that day. The physical therapist performed special tests on the ligaments and cartilage in the knee. She found that just the MCL was injured, and that it was a mild sprain. She immediately applied ice and electrical stimulation to the area for 20 minutes. She wrapped Mark’s knee with a compressive wrap and instructed him to keep it elevated when he was sitting or lying down. She gave Mark crutches and taught him how to use them.

When Mark returned for his next visit, the physical therapist began gently moving the knee to reduce the stiffness. She taught Mark some exercises he could do at home to start improving his muscle strength. She helped him use equipment in the clinic to gently move, stretch, and strengthen his knee and leg.

Mark received physical therapy treatments for 2 weeks, after which he was able to walk and climb stairs with only a little discomfort. His therapist taught him a variety of balance and endurance exercises. By the third week, he was able to return to bowling, and walk around sharp corners in his house, while keeping a watchful eye on his energetic dog!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

Physical Therapist's Guide to Multiple Sclerosis (MS)

Thu, 01 Feb 2018 00:00:00 GMT

Multiple Sclerosis (MS) is a chronic, usually progressive, disease that primarily affects young adults. More than 350,000 people in the United States and 2.5 million worldwide have been diagnosed with MS. Its effects vary widely. Although there is no known cure for the disease, it can be successfully controlled with medical management and rehabilitation.

What is Multiple Sclerosis?

Multiple Sclerosis is a disease that involves the loss of myelin, a material that covers and protects the nerves in the body's central nervous system. Without myelin, nerves cannot properly communicate with each other. Multiple Sclerosis symptoms vary from person to person, depending on what part of the nervous system is affected, including structures that control movement, sensation, and mental processes. However, more than 91% of all persons with MS report difficulty walking, and difficulty with body movements.

Although MS is rarely fatal, its complications can be severe, including difficulty with breathing, injury due to falls, and a general lack of mobility. With appropriate medical support and physical therapy, the disease process can be controlled, and movement can be improved and maintained.

How Does it Feel?

MS leads to multiple signs and symptoms, which may include:

Fatigue that does not go away with rest
Difficulty walking, and problems with balance
Stiffness and spasms or a feeling of heaviness in your legs or arms
Bladder and/or bowel problems such as urgency or leaking
Memory and thinking problems
Pain and other unpleasant sensations
Emotional or mood problems, including depression
Vision problems, although vision itself may be good
Dizziness or vertigo
Speech problems

Medical management of the disease can improve many, but not all of the signs and symptoms. Because MS affects each person differently, individuals may experience different signs and symptoms than another person with the same type of MS.

Fluctuating symptoms

Symptoms of MS can come and go, and the disease can go into remission. When a relapse is experienced, the symptoms can vary in duration and strength. A severe relapse can require hospitalization, but milder symptoms may be managed with medication at home. After a relapse occurs, the symptoms will again settle down, but may cause a slight loss of function. Some individuals will recover well from a relapse, but others may experience a higher level of disability.

When MS goes into remission, you feel stable and may be able to gain some improvement in your ability to perform daily activities. Your physical therapist can help you gain strength and endurance during a remission.

Depression

Depression affects 25% of individuals with MS. It can complicate the initial adjustment period following diagnosis. Facing the ongoing challenges of MS can be overwhelming at times, and depression can significantly affect a person's quality of life. For these reasons, depression should be medically managed along with control of the disease itself. Your health care team, including your physician and your physical therapist, will work with you to reach and maintain your goals for living an active, productive life.

How Is It Diagnosed?

A diagnosis of MS is made if all of the following criteria have been met:

Evidence of 2 symptoms occurring at least 6 months apart and occurring in 2 different parts of the body (ie, arms and legs, sensation and motor skills, vision and speech).
MRI evidence of recent attacks in the brain or spinal cord.
Abnormal findings in the cerebral spinal fluid obtained via a lumbar puncture.
Ruling out of conditions that may have similar symptoms such as stroke, tumor, or other progressive neurologic disease.

How Can a Physical Therapist Help?

Physical therapy for people with MS focuses on helping them return to the roles performed at home, work, and in the community. Your first visit to physical therapy will consist of a complete examination to determine your areas of strength and weakness. Following the examination, your physical therapist will develop a specific exercise program for you based on your condition and goals, including a home-exercise program.

Research studies have found that people in the early stages of MS may experience changes in their walking ability, balance, and breathing. If ignored, these early signs can lead to further disability. When someone receives a diagnosis of MS, the best option is to begin physical therapy right away to help improve any mild challenges, and possibly slow down the progression of the symptoms of the disease.

Exercise programs

Types of exercises beneficial for someone with early MS are aerobic training using a treadmill, rowing machine, or any type of stationary bike, strengthening, balance training, and stretching. In general, the program should be based on the individual’s ability and progressed at that person’s tolerance level. The goal of physical therapy in the early stages of MS is to help you perform all your normal activities.

As MS progresses, further disability can occur. Research in physical therapy has identified benefits for people with MS in many areas after completing different types of exercise programs. Aerobic exercise, using equipment, such as an elliptical machine, a treadmill, or a stationary bike can improve your leg strength, walking and exercise endurance, balance, and mood.

General strengthening

Other types of exercise therapy include general strengthening for arms and legs, balance training, stretching activities, and relaxation techniques. These types of exercise have been found to improve walking ability, leg strength, and general balance during normal activities.

Aquatic therapy

People with MS may find aquatic exercise a beneficial way to increase their activity. Pool temperature can help maintain a normal core body temperature during exercise to support your general strength. The buoyancy of the water can offer support for people who cannot walk on solid ground, and provide gentle resistance to exercise movements. The Multiple Sclerosis Association of America strongly supports the use of aquatic therapies for people with MS. A list of MS aquatic programs can be found at mymsaa.org.

Tai Chi and yoga

Programs that include Tai Chi and yoga may also be beneficial for people with MS. Tai Chi is a low-intensity, movement-based form of exercise that can be performed in standing or sitting positions. Deep breathing is included in the technique. Yoga includes breath work, exercises for strengthening and flexibility, and meditation or relaxation techniques. A physical therapist trained in these programs will modify these exercises specifically for each individual's needs and goals.

All adults should complete at least 150 minutes of moderate exercise a week (30 minute sessions, 5 days a week), per the Physical Activity Guidelines for Americans developed by the Office of Disease Prevention and Health Promotion in partnership with the President's Council on Fitness, Sports, and Nutrition.

Can this Injury or Condition be Prevented?

Scientists have yet to determine a specific cause of MS. The best measure of prevention is the maintenance of a healthy lifestyle. Performing at least 150 minutes of moderate physical activity per week (30 minutes per day, 5 days a week), eating a healthy diet, getting an appropriate amount of sleep, and managing daily stress are all aspects of a healthy lifestyle. Early diagnosis and appropriate treatment for MS can lead to a more successful and active life.

Real Life Experiences

Annie is a 34-year-old woman who began to notice her legs felt weak and unsteady when she climbed stairs, and that her left foot began to drag after she took a long walk. She also noted that she felt extremely tired after taking a hot bath and that her feet felt "numb and tingling" for 30 minutes after the bath. Given the fact that she had always been athletic and had kept in shape, these findings concerned her; she contacted her family physician, who referred her to a neurologist.

The neurologist ordered an MRI and a lumbar puncture. The results of both tests, along with Annie's medical history, confirmed a diagnosis of early-stage multiple sclerosis. Annie was quite overwhelmed with the diagnosis. Her physician reassured her, noting that she was diagnosed when the disease was still quite mild, and that with medical management and physical therapy, the odds were that her MS would be managed successfully over her lifetime. He prescribed some medications, and referred her to a physical therapist who specialized in MS.

Annie's physical therapist performed a full evaluation, examining her strength, flexibility, sensation, coordination, gait, and balance. Based on the specific findings of the evaluation, he developed a detailed program for her to follow. The program was carried out in the physical therapy clinic, under his supervision. He also designed a home-exercise program for Annie to follow. He arranged to see her 1 to 2 times a week for the next 4 weeks.

On successive visits, Annie's physical therapist re-examined her and found that many of the difficulties she originally noticed had decreased. She was able to walk longer distances with less fatigue, and her foot dragged less. She was having far less difficulty on stairs and her balance improved. She still noticed that her feet became a little numb after a hot bath, and that if she was very tired or very hot, her symptoms became worse. Most importantly, though, she realized that, despite some of the limitations caused by MS, she was still able to live her life much like she did before her symptoms appeared. Annie and her physical therapist formed an effective team—determined to work together to ensure her active and productive lifestyle for years to come.

Physical Therapist's Guide to Below-Knee Amputation

Thu, 01 Feb 2018 00:00:00 GMT

Lower-limb amputation is a surgical procedure performed to remove a limb that has been damaged due to trauma or disease. Below-knee or "trans-tibial" amputation comprises 23% of lower-limb amputations. Amputation is possible in any age group, but the prevalence is highest among people aged 65 years and older.

What is a Below-Knee Amputation?

Below-knee amputation (BKA) is a surgical procedure performed to remove the lower limb below the knee when that limb has been severely damaged or is diseased. Most BKAs (60%–70%) are performed due to peripheral vascular disease, or disease of the circulation in the lower limb. Poor circulation limits healing and immune responses to injury, and foot or leg ulcers may form and not heal. They may develop an infection, and it could spread to the bone becoming severe enough to be life-threatening. Amputation is performed to remove the diseased tissue and prevent the further spread of infection.

If BKA surgery is necessary, it is usually performed by a vascular or orthopedic surgeon. The diseased or severely injured part of the limb will be removed, keeping as much of the healthy tissue and bone as possible. The surgeon shapes the remaining limb to allow the best use of a prosthetic leg after recovery.

The need for BKA is caused by conditions including:

Peripheral vascular disease
Diabetes
Infection
Foot ulcer
Trauma, causing the lower leg to be crushed or severed
Tumor/cancer (see link references at the bottom of the page for more information)

How Can a Physical Therapist Help?

Prior to BKA surgery

Before your surgery, your physical therapist may:

Prescribe exercises for preoperative conditioning, and to improve the strength and flexibility of the hip and knee
Teach you how to walk with a walker or crutches
Educate you about what to expect after the procedure

Immediately after surgery

Your hospital stay will be approximately 5 to 14 days. Your wound will be bandaged, and you may also have a drain at the surgery site, a tube that is inserted into the area to help remove excess fluid. Pain will be managed with medication.

Physical therapy will begin soon after surgery when your condition is stable and the doctor clears you. A physical therapist will review your medical and surgical history, and visit you at your bedside. Your first 2 to 3 days of treatment may include:

Gentle stretching and range-of-motion exercises
Learning to roll in bed, sit on the side of the bed, and move safely to a chair
Learning how to position your surgical limb to prevent contractures (the inability to straighten the knee joint fully, which results from keeping the limb bent too much)

When you are medically stable, the physical therapist will help you learn to move about in a wheelchair, and stand and walk with an assistive device.

Prevention of contractures

A contracture is the development of soft-tissue tightness that limits joint motion. The condition occurs when muscles and soft tissues become stiff and fibrous from lack of movement. The most common contracture following BKA occurs at the knee when it becomes flexed and unable to straighten. The hip may also become stiff. It is important to prevent contractures early.

Contractures can become permanent if not addressed following surgery, throughout recovery, and after rehabilitation is completed. Contractures can make it difficult to wear your prosthesis, and make walking more difficult, increasing the need for an assistive device like a walker.

Your physical therapist will help you maintain normal posture and range of motion at your knee and hip. The therapist will teach you how to position your limb to avoid development of a contracture, and show you stretching and positioning exercises to maintain normal range of motion.

Swelling and compression

It is normal to experience post-operative swelling. Your therapist will help you maintain compression on your residual limb to protect it, reduce and control swelling, and help it heal. Compression can be accomplished by:

Wrapping the limb with elastic bandages
Wearing an elastic shrinker sock

These methods also help shape the limb to prepare it for fitting the prosthetic leg.

In some cases a rigid dressing, or plaster cast, may be used instead of elastic bandages. An immediate post-operative prosthesis made with plaster or plastic may also be applied. The method chosen depends on each person’s situation. Your physical therapist will help monitor the fit of these devices and instruct you in their use.

Pain management

Your physical therapist will help with pain management in a variety of ways, including:

Electrical stimulation and TENS (transcutaneous electrical nerve stimulation) for pain modification. (Gentle electrical stimulation of the skin to relieve pain by blocking nerve signals from underlying pain receptors.)
Manual therapy, including massage and joint manipulation to improve circulation and joint motion.
Stump management, including skin care and stump sock use.
Desensitization to help modify how sensitive an area is to clothing pressure or touch. Desensitization involves stroking the skin with different types of touch to help reduce or eliminate the sensitivity reaction to the stimulus.

See the guide on Phantom Pain for more details on pain after amputation .

Your physical therapist will work with a prosthetist to prescribe the best prosthesis for your life situation and activity goals. You will receive a temporary prosthesis at first while your residual limb continues to heal and shrink/shape over the first 6 to 9 months of healing. The prosthesis will be modified to fit as needed over this time.

After you move from acute care to rehabilitation, you will learn to function more independently. Your physical therapist will help you master wheelchair mobility and walking with an assistive device like crutches or a walker. Your therapist will also teach you the skills you need for successful use of your new prosthetic limb. You will learn how to care for your residual limb with skin checks and hygiene, and continue contracture prevention with exercise and positioning.

Your physical therapist will teach you how to put your new prosthesis on and take it off, and how to manage a good fit with the socket type you receive. The therapist will help you to gradually build up tolerance for wearing your prosthesis for increasingly longer times, while protecting the skin integrity of your residual limb. You will continue to use a wheelchair for getting around, even after you get your permanent prosthesis, for times when you are not wearing the limb.

Prosthetic training is a process that can last up to a full year. You will begin when the physician clears you for weight bearing on the prosthesis. Your physical therapist will help you learn to stand, balance, and walk with the prosthetic limb. Most likely you will begin walking in parallel bars, then progress to a walker, and later as you get stronger, you may progress to using a cane before walking independently without any assistance. You will also need to continue strengthening and stretching exercises to achieve your fullest potential as you return to many of the activities you performed before your amputation.

Can this Injury or Condition be Prevented?

It is believed that 60% of amputations are preventable. The leading cause of BKA is complications from diabetes, such as peripheral vascular disease, open wounds, and infection. Prevention and management of diabetes and lower-extremity circulation problems can greatly reduce the risk of developing conditions that lead to the need for lower-extremity amputation. Make sure you protect your feet by wearing adequate foot wear. It is also important to examine your lower extremities and feet daily for signs of skin problems, such as redness or discoloration, swelling, blisters, scratches, or open wounds. It is important to promptly consult your primary health care provider should you notice a problem. Prevention of infection is a primary way to prevent below-knee amputation.

It is also important to stop smoking. Smoking cigarettes can interfere with healing, and it is associated with reamputation risk 25 times greater than nonsmokers.

Real Life Experiences

Ed is a 75-year-old gentleman who has diabetes and peripheral artery disease of the right lower leg. Due to the lack of circulation in his lower leg, Ed has developed an open wound that has become infected. Despite the best efforts of medical care, the infection has continued to spread. Because the infection is now threatening Ed’s health and well-being, the decision is made to amputate the diseased part of his lower leg. Ed is referred to physical therapy for preoperative exercise instruction, and to learn how to walk with a walker before his scheduled surgery.

The day after Ed’s surgery, a hospital physical therapist comes to Ed's room to begin treatment. She teaches him to perform some gentle exercises for the affected limb, and exercise his uninvolved leg and arms. She helps him safely roll in bed, and teaches him about keeping his knee straight on the amputated side, and how to support his leg to reduce swelling.

As Ed's residual limb heals, his physical therapist helps him get out of bed and sit in a chair. He learns to stand on 1 leg with a walker next to his bed. As he gets stronger, he advances to 1-leg walking with a walker, with close assistance from the physical therapist.

When Ed is medically stable, he transfers to a rehabilitation facility. There, he works closely with the rehabilitation physical therapist to learn how to care for the skin on his residual limb, how to position and stretch his leg to prevent contractures, and how to wrap the stump and use shrinker socks to reduce swelling and shape his residual limb. Soon, he is able to get around by propelling his wheelchair. He also works hard doing strengthening and stretching exercises as directed by his physical therapist. He gains strength and balance, allowing him to walk farther without becoming tired.

Ed receives a temporary, or preparatory, prosthesis. The prosthetist fabricated a socket from a cast of his residual limb. It was connected to a pylon and prosthetic foot. Ed is now ready to begin his gait training in physical therapy with full weight bearing on his amputated leg. Ed and his physical therapist will monitor the fit of the socket several times a day to avoid pressure points on his residual limb.

Ed is now able to function with minimal assistance and is discharged home. His family has been trained to help keep him safe and assist him. Ed continues physical therapy as an outpatient, and continues to build his strength and improve his walking ability. He is guided in the use of his temporary prosthesis as his stump continues to reshape. Adjustments to the prosthesis will be made as he continues rehabilitation and progresses over the next 1 to 2 months, prior to receiving his permanent prosthesis.

When Ed’s residual limb stops shrinking, about 8 months after his surgery, he receives his permanent prosthesis. He works with his physical therapist and prosthetist to ensure a good fit, and to learn to improve his walking pattern. After much hard work, Ed is discharged from physical therapy, having achieved his goal of walking independently without an assistive device.

Physical Therapist's Guide to Patellofemoral Pain

Thu, 01 Feb 2018 00:00:00 GMT

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap (patella). PFPS is one of the most common types of knee pain experienced in the United States, particularly among athletes, active teenagers, older adults, and people who perform physical labor. Patellofemoral pain affects more women than men and accounts for 20% to 25% of all reported knee pain. Physical therapists design exercise and treatment programs for people experiencing PFPS to help them reduce their pain, restore normal movement, and avoid future injury.

What is Patellofemoral Pain?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint.) Pain occurs when friction is created between the undersurface of the kneecap and the thigh bone (femur). The pain also is usually accompanied by tenderness along the edges of the kneecap.

Current research indicates that PFPS is an "overuse syndrome," which means that it may result from repetitive or excessive use of the knee. Other contributing factors may include:

Weakness, tightness, or stiffness in the muscles around the knee and hip
An abnormality in the way the lower leg lines up with the hip, knee, and foot
Improper tracking of the kneecap

These conditions can interfere with the ability of the kneecap to glide smoothly on the femur (the bone that connects the knee to the thigh) in the femoral groove (situated along the thigh bone) during movement. The friction between the undersurface of the kneecap and the femur causes the pain and irritation commonly seen in PFPS. The kneecap also may fail to track properly in the femoral groove when the quadriceps muscle on the inside front of the thigh is weak, and the hip muscles on the outside of the thigh are tight. The kneecap gets pulled in the direction of the tight hip muscles and can track or tilt to the side, which irritates the tissues around the kneecap.

PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, such as running, stair climbing, squatting, or repeated carrying of heavy loads. Older adults may experience age-related changes that cause the cartilage on the undersurface of the kneecap to wear out, resulting in pain and difficulty completing daily tasks without pain.

How Does it Feel?

People with PFPS may experience:

Pain when walking up or down stairs or hills
Pain when walking on uneven surfaces
Pain that increases with activity and improves with rest
Pain that develops after sitting for long periods of time with the knee bent
A "crack" or "pop" when bending or straightening the knee

How Is It Diagnosed?

Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Your physical therapist also will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee.

Generally, X-rays are not needed to diagnose PFPS. Your physical therapist may consult with an orthopedic physician who may order an X-ray to rule out other conditions.

How Can a Physical Therapist Help?

After a comprehensive evaluation, your physical therapist will analyze the findings and, if PFPS is present, your therapist will prescribe an exercise and rehabilitation program just for you. Your program may include:

Strengthening exercises. Your physical therapist will teach you exercises targeted at the hip (specifically, the muscles of the buttock and thigh), the knee (specifically, the quadriceps muscle located on the front of your thigh that straightens your knee), and the ankle. Strengthening these muscles will help relieve pressure on the knee, as you perform your daily activities.

Stretching exercises. Your physical therapist also will choose exercises to gently stretch the muscles of the hip, knee, and ankle. Increasing the flexibility of these muscles will help reduce any abnormal forces on the knee and kneecap.

Positional training. Based on your activity level, your physical therapist may teach you proper form and positioning when performing activities, such as rising from a chair to a standing position, stair climbing, squatting, or lunging, to minimize excessive forces on the kneecap. This type of training is particularly effective for athletes.

Cross-training guidance. PFPS is often caused by overuse and repetitive activities. Athletes and active individuals can benefit from a physical therapist’s guidance about proper cross-training techniques to minimize stress on the knees.

Taping or bracing. Your physical therapist may choose to tape the kneecap to reduce your pain and retrain your muscles to work efficiently. There are many forms of knee taping, including some types of tape that help align the kneecap and some that just provide mild support to irritated tissues around it. In some cases, a brace may be required to hold the knee in the best position to ensure proper healing.

Electrical stimulation. Your physical therapist may prescribe treatments with gentle electrical stimulation to reduce pain and support the healing process.

Activity-based exercises. If you are having difficulty performing specific daily activities, or are an athlete who wants to return to a specific sport, your physical therapist will design individualized exercises to rebuild your strength and performance levels.

Fitting for an orthosis. If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by low or high arches.

Can this Injury or Condition be Prevented?

PFPS is much easier to treat if it is caught early. Timely treatment by a physical therapist may help stop any underlying problems before they become worse. If you are experiencing knee pain, contact a physical therapist immediately.

Your physical therapist can show you how to adjust your daily activities to safeguard your knees, and teach you exercises to do at home to strengthen your muscles and bones—and help prevent PFPS.

Physical therapists can assess athletic footwear and recommend proper choices for runners and daily walkers alike. Wearing the correct type of shoes for your activity and changing them when they are no longer supportive is essential to injury prevention.

Real Life Experiences

Amelia is a 25-year-old office assistant who loves to start her day with a 5-mile run. Over the past 6 months, she has been training for her first marathon. She began by training on very flat ground and has just moved to a hilly area.

Last week, Amelia began feeling pain in the front of her left knee when running downhill. Today, she had to stop running after 3 miles because of her knee pain. She called her physical therapist.

Amelia's physical therapist completes a comprehensive evaluation, including a screening for other possible conditions that might be causing her pain. He uses special tests to measure her strength and finds that she has weak hip muscles and tenderness around the kneecap. He determines that she has developed PFPS. Amelia is shocked to learn that she also has flat feet, and she’s not wearing the right supportive running shoes.

To begin her treatments, Amelia’s physical therapist applies special tape to the front of her knee to help reduce her pain, and instructs her in the use of ice to decrease her symptoms. He performs gentle movements of her kneecap and the surrounding tissues to help increase mobility and decrease pain. He teaches her special exercises to gently strengthen the weak muscles that support the knee.

He also designs a specific home-exercise program for Amelia to perform between sessions. He provides information about proper shoe choices for her foot and body type, and advises her to purchase shoes that will give her feet the right type of support. He also recommends that she try deep-water running or swimming for a week instead of her regular running program, until her condition improves.

After her first week of physical therapy, Amelia notices a decrease in her pain and an increased ability to walk up and down stairs without pain. Her physical therapist approves her new footwear, and adds more challenging exercises to her session and her home program. He gives her the go-ahead to race-walk. She applies ice only when she has pain.

After 2 weeks, Amelia reports she is feeling even less pain. Her physical therapist continues to increase the intensity of her exercises, and she starts to run again—but only on flat surfaces and short distances combined with longer walk intervals.

After a few more weeks of therapy, Amelia occasionally feels only slight twinges of pain and gradually resumes her prior level of training. Her physical therapist recommends continuation of her stretching and strengthening exercises, and discharges her from physical therapy.

A few months later, Amelia completes her first marathon pain free. She is thrilled to learn that her time was a personal best!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

Physical Therapist's Guide to Sacroiliac Joint Dysfunction

Thu, 01 Feb 2018 00:00:00 GMT

Sacroiliac joint (SIJ) dysfunction is a lower back/pelvic condition that can result from joint stiffness (hypomobility) or slackness (hypermobility) at the sacroiliac joints in the pelvis. The condition can affect both men and women of all ages, but is more common in females. Symptoms typically are present on 1 side of the back, and affect 10% to 25% of patients with complaints of low back pain. Physical therapists design individualized treatment programs to address SIJ dysfunction based on the specific cause of each person's condition, and treatment goals.

What is Sacroiliac Joint Dysfunction?

The sacroiliac joint is a joint between the sacrum and the ilium, or pelvic bone. The 2 sides of the sacroiliac joint normally work together. If 1 side becomes stiff, they will not move together and this causes pain or muscle stiffness in the area. Pain is often made worse with walking and bending activities. It is also possible that 1 side may become too loose (lax) as well, resulting in SIJ dysfunction. This may occur during the menstrual cycle or pregnancy due to hormonal changes that cause the ligaments to become more lax. SIJ dysfunction can occur with injury, such as when a person falls and lands on 1 side of the body and alters the position of the joint, or when an athlete overtrains. Muscle imbalances and hip problems, such as hypermobility or dysplasia, may also lead to SIJ dysfunction. Sacroiliac pain is also related to some types of arthritis, such as ankylosingspondylitis, an inflammatory process most often affecting the lower back, which may cause the vertebrae to fuse.

How Does it Feel?

People with SIJ dysfunction may experience:

Pain that may be sharp, stabbing or dull, localized to 1 side of the pelvis/low back, groin, or tailbone.
Pain that may radiate down to the knee.
Pain with movements, such as standing up from a sitting position, turning in bed, or bending/twisting.
Muscle tightness and tenderness in the hip/buttock region.
Pain with walking, standing, and prolonged sitting.
Pain that is worse when standing and walking, and eases when sitting or lying down.

How Is It Diagnosed?

When you see your physical therapist, the therapist will ask you questions about your current condition, such as:

When did the pain start?
What happened to cause the pain to start?
Did you experience a fall or injury?
Have you experienced similar symptoms in the past?
Where is the pain located?
What specific movements/activities cause your pain?
Are you pregnant, or have you recently given birth?

Your physical therapist will then conduct a physical evaluation. Your therapist may examine the position of your spine, conduct strength tests of the hip, pelvic, and lower extremity muscles, and gently perform movement tests to assess your mobility and flexibility. Specialized tests will be performed to rule out any problems that may require other medical intervention. If further medical intervention is required, your physical therapist may refer you to a physician who specializes in SIJ dysfunction or other conditions that may be causing your symptoms.

Once SIJ dysfunction has been confirmed, your physical therapist will work with you to determine your personalized treatment program.

How Can a Physical Therapist Help?

Your physical therapist will design a targeted treatment program based on your evaluation and your goals for a safe return to sport or daily activities. Treatment may include:

Manual therapy. Often, manual therapy for SIJ dysfunction includes soft tissue release or massage for tight and sore muscle groups. Manual therapy and muscle energy techniques (MET) are used to correct pelvic/SIJ alignment. MET uses your own muscle contractions to realign the position of the pelvis, and can be a source of pain relief. Joint mobilizations/manual therapy uses gentle movements to improve mobility of the hip, SIJ, and low back.
Flexibility exercises. Stretching exercises may be prescribed to improve the flexibility of tight muscles. They may also help to improve movement in the spine and lower extremities, and help decrease stress at the sacroiliac joint during daily activities.
Strengthening exercises. Strengthening helps to improve the stability of the sacroiliac and spinal joints, which helps to reduce ligament strain and pain.These exercises are focused on weak muscles, including the lower abdominal, pelvic floor, and buttocks muscles.
Body mechanics. How you move and use your body for daily work and other activities can contribute to your SIJ dysfunction and pain. Your physical therapist will teach you how to improve your movements or body mechanics based on your specific daily activities. The physical therapist may also make recommendations to improve activities, such as sitting, or lifting and carrying objects.
Modalities. Hot and cold treatments are often prescribed to loosen up tight muscles prior to treatment, or to alleviate pain following exercise. Electrical stimulation uses electricity to target nerve fibers that send pain signals to the brain, and may also be used in conjunction with ice to provide pain relief.
Braces. Your physical therapist may also recommend wearing a sacroiliac belt, designed to provide support to the sacroiliac joints. It is used to provide stability during daily activities as your strength returns, and flexibility improves. This modality is especially helpful for pregnant women.

All treatments prescribed by the physical therapist will be based on your specific case.

Can this Injury or Condition be Prevented?

Fall prevention, the use of proper body mechanics (such as correcting your posture), and maintaining healthy activity levels are all ways that SIJ dysfunction may be prevented. Adhering to appropriate strength and flexibility programs can maintain muscle mobility and strength to keep the area stable when joint hypermobility is present. Your physical therapist can work with you to strengthen and stretch your joints and muscles to prevent conditions like SIJ dysfunction from occurring.

To prevent a recurrence of SIJ dysfunction after physical therapy treatment is completed, you will need to continue performing your home-exercise program. It is imperative that you do this to maintain your strength and flexibility. Improving and maintaining muscle strength will continue to provide stability for the sacroiliac joint and low-back ligaments after an injury.

Real Life Experiences

Jessica is a 29-year-old marathon runner who began experiencing low back pain a few months ago when training for a marathon. However, once she finished the training and the race, her pain subsided.

She is now 30 weeks pregnant, and her low back pain has returned. Jessica does not recall a particular instance that started the pain, but remembers waking up one morning feeling stiff after a 3-mile run the day before. She has now stopped running because of the pain.

She presents with complaints of a sharp pain in her right low back, which is worsened with sitting for greater than 10 minutes as well as standing after sitting. She is not able to run because of her pain, and she has difficulty walking for more than 20 minutes. She also reports pain with any rotating movements, such as when rolling over in bed. Her inability to sit is limiting her job tolerance as a sales manager, and she is frustrated that she is not able to exercise as she would like to. She is not sleeping through the night, as she wakes every time she rolls over.

After listening to Jessica's history, her physical therapist performs a thorough evaluation. She assesses her posture and notices the right SIJ is rotated forward, causing the right leg to be slightly longer than the left. He asks Jessica to bend forward, backwards, and rotate her spine. She reports a lot of stiffness with the movements, and her pain increases with bending and twisting. She also feels tightness in her lower back, gluteal muscles, and right hip. Strength testing shows that Jessica is experiencing muscle weakness of her abdominal, pelvic floor, and buttocks muscles.

Her physical therapist performs some special tests for the sacroiliac joints. The tests reproduce her symptoms indicating SIJ dysfunction.

Jessica receives physical therapy treatment over the next 5 weeks. Treatment includes education for positioning and body mechanics to help with her sleeping, sitting, and driving positions to minimize her low back pain. Her physical therapist performs soft-tissue massage to improve Jessica's flexibility and movement and provide pain relief, as well as METs to correct her pelvic alignment. She designs a home-exercise program for her to build up her weak muscles and gently stretch her tight muscles, including heat and ice treatments before and after she exercises.

After 5 weeks of therapy, Jessica can sit through work meetings and serve customers with improved ease. She is also sleeping better at night, and is no longer waking up during the night due to back pain. She has not yet returned to running; however, she is able to walk for exercise now without any pain. She is happy with this ability, and has decided to return to running after her delivery.

Jessica returns to the clinic 2 months after giving birth for a reassessment, as she is ready to resume running and wants to prevent reinjury. She has continued to do strengthening exercises that focus on the lower abdominals as well as the gluteals, to maintain the strength she gained from physical therapy. She also has incorporated stretching for the legs and low back. Her strength and flexibility are normal. At this time, she was issued a return to run program. The program she was issued was a combination of a walk/run, which gradually decreased the walk time and increased the run time. She was educated to run every other day, allowing enough time for her body to recover in between each session. She was instructed to call with any questions or concerns as she progressed through the program.

She calls her physical therapist after the 4 weeks have been completed to report she has safely returned to pain-free running. Jessica has met all of her set goals, and is pain-free with all activity.

Physical Therapist's Guide to Rheumatoid Arthritis

Thu, 01 Feb 2018 00:00:00 GMT

Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects approximately 1% of the United States population. RA often results in pain and inflammation in joints on both sides of the body, and can become disabling due to its effect on the immune system. A physical therapist can help manage the symptoms of RA, enhancing an individual's quality of life.

What is Rheumatoid Arthritis?

RA is classified as an autoimmune disease—a condition where the body’s immune system attacks its own tissues. Although the exact cause of RA is not known, multiple theories have been proposed to identify who is most likely to develop it. The cause may be related to a combination of genetics and environmental or hormonal factors. Women are more likely to develop the disease; women are diagnosed with RA 3 times more than men. Although RA may begin at any age, most research suggests it often begins in midlife.

How Does it Feel?

RA symptoms can flare up and then quiet down (go into remission). Research shows that early diagnosis and treatment is important for easing symptoms and flare-ups.

People with RA may experience:

Stiff joints that feel worse in the morning.
Painful and swollen joints on both sides of the body.
Bouts of fatigue and general discomfort.
Fever.
Loss of joint function.
Redness, warmth, and tenderness in the joint areas.

How Is It Diagnosed?

RA is generally diagnosed by a rheumatologist. Diagnosis is based upon factors, such as inflammation of the tissues that line the joints, the number of joints involved, and blood-test results. A physical therapist may be the first practitioner to recognize the onset of RA; the physical therapist will refer an individual with suspected symptoms to an appropriate clinician for further tests.

How Can a Physical Therapist Help?

Physical therapists play a vital role in improving and maintaining function that may be limited by RA. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals.

Because the signs and symptoms of RA can vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:

Aerobic Activities. Studies have shown that group-based exercise and educational programs for people with RA have beneficial effects on individual strength and function.

Goal-Oriented Exercise. Studies also show that achievement of personal physical activity goals helps reduce pain and increase the general quality of life in people diagnosed with RA.

Modalities. Your physical therapist may use modalities, such as gentle heat and electrical stimulation to help manage your RA symptoms.

Can this Injury or Condition be Prevented?

Unfortunately, the actual mechanisms that cause RA are not completely understood. There currently is no sure way to predict or prevent the onset of RA. However, the early detection of the signs and symptoms will help you and your medical providers begin early management of RA, which may enhance your long-term well-being.

Upon diagnosis, your physical therapist will work with you to develop strategies to better understand and manage your symptoms.

As with many conditions, education is key. Understanding the underlying mechanisms of RA, so you can recognize early signs and symptoms (eg, morning stiffness, painful and swollen joints), may help you better manage the condition.

Above all, it is important to keep moving. Maintaining or increasing your activity levels will help improve your function and maintain a better quality of life.

Real Life Experiences

Regina is a 40-year-old teacher whose primary exercise is walking her dog. One morning 3 weeks ago, Regina noticed that both of her knees looked swollen and red, and felt achy and stiff. She took some ibuprofen, but the pain got worse after school. She tried icing her knees at home, but got little relief. She called her physical therapist.

Regina's physical therapist asked her several questions about her current condition. She reported that she first noted her symptoms the morning after she had spent the day cleaning out her attic. She said she had climbed up and down the ladder to the attic, and moved a lot of heavy objects all day long. She mentioned how she had tried to manage her symptoms with ibuprofen and ice, but had gotten little relief.

Her physical therapist asked about her family's medical history, and learned that Regina’s mom was diagnosed with RA 20 years ago.

Upon examination, Regina's physical therapist noted joint swelling, redness, and tenderness within both knees. Using further tests, he was able to rule out other possible conditions. Based on Regina's symptoms and her family history of RA, he referred her to a local rheumatologist for a final diagnosis.

Regina reported back to her physical therapist 2 weeks later that she had been diagnosed with RA. She said she was determined that RA wasn’t going to "take over her life."

Her physical therapist helped her learn all she could about RA and her particular condition. He designed a comprehensive exercise program just for her, focusing on aerobic conditioning and joint mobility to get her moving—and keep her moving well.

Today, Regina attends a local aerobics class 3 times a week, performs exercises at home, and has joined a dog-walking club, making a new set of friends in the process. Due to her increased level of fitness, she feels "in charge" of her RA—and actually feels more upbeat than she has in years.

This story highlights an individualized experience of RA. Your case may be different. Your physical therapist will tailor a treatment program to your specific needs.

Physical Therapist's Guide to Parkinson Disease

Thu, 01 Feb 2018 00:00:00 GMT

Parkinson disease (PD) is the second most common degenerative brain disorder affecting adults. (Alzheimer disease is the most common.) People of all ethnic groups can develop PD, but it occurs less among African American and Asian populations. Parkinson disease was first defined as only a “motor” (movement) disease, but research has shown that it also causes “nonmotor” symptoms (such as lightheadedness when standing up) in other systems of the body. People with PD are at risk of falling and sustaining other injuries due to their movement and balance challenges. Treatment includes a combination of medication and physical therapy—and in some cases surgery. Physical therapists partner with people with PD and their families to manage their symptoms, maintain their fitness levels, and help them stay as active as possible.

What is Parkinson's Disease?

Parkinson disease is related to a loss of nerve cells in the brain that produce a chemical called dopamine. Dopamine and other brain chemicals are normally in balance and are important for the control of body movements, thought processes, decision making, moods, and other behaviors.

The exact cause of PD is not yet known. Family history, aging, or exposure to certain environmental toxins may contribute to the onset of PD. It is a chronic degenerative disease, which means that it gets worse over time; however, people usually do not die from it.

The severity and symptoms of PD can vary widely. Some people have the disease for 20 to 30 years and experience a slower decline in mobility and thinking over a longer period of time. Others may experience difficulty with physical movements and thought processes within 5 to 10 years, as the disease progresses more rapidly.

Signs and Symptoms

Nonmotor symptoms of PD, such as a decreased sense of smell, sleep problems, and lightheadedness when first standing up, can begin many years before motor (movement) symptoms develop. Motor symptoms of PD, which typically include muscle and joint stiffness (rigidity), shaking (tremors) in the hands and limbs, slowed movement, and balance problems, most often begin at or around age 60. However, early-onset PD can affect people at a younger age.

The motor symptoms of PD can be very mild at first. A common early symptom is a tremor in 1 hand, most often when you are at rest. It might look like you are rolling a pill between your thumb and forefinger. Tremors also can occur in your legs or jaw when you are at rest. Since the tremors are most apparent during rest, they usually go away when moving and typically don't interfere substantially with daily functions.

As the condition progresses, people with PD may notice other motor symptoms, such as:

Movements that become smaller, possibly resulting in:
- shuffling when walking
- the arms swinging less when walking
- the voice becoming quieter

Muscle stiffness or rigidity, causing discomfort in the neck, trunk, or shoulders

Pain due to muscle stiffness

Postural instability, resulting in poor balance and a greater risk of falling
Movements that become slower during daily activities such as dressing, showering, or moving in bed
A feeling of the feet being "frozen" to the floor, making it hard to take a first step, or to turn around when walking
Stooped posture
Difficulty speaking at a normal voice level
Difficulty swallowing
Difficulty performing tasks that were once easy to do, such as gardening or swinging a tennis racquet or golf club
Difficulty making facial expressions

Difficulty holding and releasing urine (bladder urgency and incontinence)

Nonmotor symptoms might include:

Difficulty paying attention to a task for a long period of time or dividing attention between 2 or more tasks
Fatigue
Lack of motivation
Lightheadedness
Depression
Anxiety
Disturbed sleep

How Is It Diagnosed?

Because there is not one definitive test for PD, it can be difficult to diagnose. A diagnosis is usually made based on a person’s medical history and a neurological examination. If your physical therapist suspects that you have symptoms of PD, you may be referred to a neurologist for further examination.

A diagnosis of PD may be made if a person is found to have:

Slowing of motion and
Tremor when resting, or muscle rigidity
A significant improvement in symptoms when taking a medication to treat PD
Initial symptoms on 1 side of the body only

How Can a Physical Therapist Help?

Because PD affects each person differently, your physical therapist will partner with you to manage your specific situation—now and as your condition changes. You are not alone!

Following a diagnosis of PD, your physical therapist will conduct a comprehensive evaluation, including tests to examine your posture, strength, flexibility, walking, endurance, balance, coordination, and attention with movement. Based on your test results, your physical therapist will develop an individualized treatment plan to help you stay as active and as independent as possible. Your program will include exercises and techniques to combat the symptoms of PD.

Depending on the nature and severity of your condition, your treatment program may focus on activities and education to help you:

Improve your fitness level, strength, and flexibility
Develop more effective strategies to get in and out of bed, chairs, and cars
Turn over in bed more easily
Stand and turn to change directions more efficiently
Improve the smoothness and coordination of your walking
Improve your ability to perform hand movements
Decrease your risk of falling
Improve your ability to climb and descend stairs and curbs
Perform more than 1 task at a time more efficiently
Participate in activities that are important to you

Some of the medications designed to manage PD symptoms may have an immediate positive effect. For example, movement is typically much easier shortly after you begin taking certain PD medications. Your physical therapist will know how to time treatments, exercise, and activity based on both the schedule and the effects of your medications to get the best results.

Parkinson’s disease can make daily activities seem frustrating and time-consuming. Your physical therapist will become a partner with you and your family to help you combat and manage the symptoms of PD. As your condition changes, your treatment program will be adjusted to help you be as independent and as active as possible.

Some people with PD benefit from using a cane or a walker. Your physical therapist can work with you to determine if any of these devices may be helpful to you. If you need physical assistance to help you with moving in bed or getting out of a chair, your physical therapist can team with you and your family to develop strategies to make moving easier and help prevent injury. In addition, your physical therapist can make suggestions on changes to your home environment to optimize safe and efficient daily function at home.

Can this Injury or Condition be Prevented?

To date, there is no known way to prevent PD. Studies have shown improved walking, balance, strength, flexibility, and fitness in people with PD, who participate in a regular exercise program. However, these studies also indicate that people with PD gradually lose the gains they make when their supervised exercise program ends. It’s important to work with your physical therapist to help develop good long-term exercise habits.

Real Life Experiences

Bob is a 58-year-old store manager who was diagnosed with PD 6 months ago. Bob works full-time and does not currently exercise. His physician has recommended a course of physical therapy treatments. Bob has heard that exercise may be helpful for people with PD, but he doesn’t know which exercises are best for him and how much he should exercise. He calls a local physical therapy clinic for help.

At his first visit to the clinic, Bob reports slowness with walking, a tendency to drag his left leg, and a limited ability to swing his left arm when he’s walking. He notes that his neurologist has prescribed a drug for him that helps relieve tremors early in the course of the disease.

Bob's physical therapist conducts a full physical examination that includes an evaluation of his balance, and his ability to walk, turn, and rise from a chair. She tests his strength, flexibility, and cardiovascular (heart) responses to exercise. She also administers standardized tests that measure Bob’s quality of life, and his walking, balance, and neurological signs, to determine Bob's baseline status and to help set his treatment goals.

Bob’s physical therapist develops an individualized exercise program to help him improve his walking and prevent the onset of weakness and deconditioning. She teaches him specific exercises to help increase his strength and flexibility. She recommends that Bob start a brisk walking program using a metronome for 30 minutes, 3 times per week. A metronome is a device that produces regular “clicks.” Bob walks to the "beat" of the metronome, resulting in faster walking with less leg dragging and better arm swings.

Bob’s physical therapist also recommends he join a fitness center or other community exercise class. Once Bob chooses a facility and a program, she meets with the fitness staff to instruct them about Bob’s particular exercising needs related to his PD.

After 1 month of exercising, Bob's walking is faster, his leg is dragging less, and his arm is swinging better. Bob is carrying out his exercise program successfully. He thinks the exercises are helping, and he is more confident in his ability to exercise on a regular basis.

Bob agrees to consult with his physical therapist every 6 months to monitor his progress and to adjust his exercises, so he can maintain his highest possible levels of fitness and activity.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

Physical Therapist's Guide to Shoulder Impingement

Wed, 31 Jan 2018 00:00:00 GMT

Shoulder impingement syndrome occurs as the result of chronic and repetitive compression or "impingement" of the rotator-cuff tendons in the shoulder, causing pain and movement problems. It can also be caused by an injury to the shoulder. People who perform repetitive or overhead arm movements, such as manual laborers or athletes who raise their arms repeatedly overhead (ie, weightlifters and baseball pitchers), are most at risk for developing a shoulder impingement. Poor posture can also contribute to its development. If left untreated, a shoulder impingement can lead to more serious conditions, such as a rotator cuff tear. Physical therapists can help decrease pain, and improve shoulder motion and strength in people with shoulder impingements.

What is Shoulder Impingement?

Shoulder impingement syndrome is a condition that develops when the rotator-cuff tendons in the shoulder are overused or injured, causing pain and movement impairments. Shoulder impingement syndrome may also be referred to as "subacromial" impingement syndrome because the tendons, ligaments, and bursa under the "acromion" can become pinched or compressed. The shoulder is made up of 3 bones called the humerus, the scapula, and the clavicle. The acromion is a bony prominence on the top of the scapula, which can be felt as a bump at the tip of the shoulder.

The rotator cuff tendon and the bursa sit beneath the acromion. The bursa is a fluid-filled sac that provides a cushion between the bony acromion and the rotator cuff tendon, and it can become compressed underneath the acromion. Impingement symptoms can occur when compression and microtrauma harm the tendons. There are several causes to shoulder impingement syndrome including:

Repetitive overhead movements, such as golfing, throwing, racquet sports, and swimming, or frequent overhead reaching or lifting.
Injury, such as a fall, where the shoulder gets compressed.
Bony abnormalities of the acromion, which narrow the subacromial space.
Osteoarthritis in the shoulder region.
Poor rotator cuff and shoulder blade muscle strength, causing the humeral head to move abnormally.
Thickening of the bursa.
Thickening of the ligaments in the area.
Tightness of the soft tissue around the shoulder joint called the joint capsule.

How Does it Feel?

Individuals with shoulder impingement may experience:

Restriction in shoulder motion with associated weakness in movement patterns, such as reaching overhead, behind the body, or out to the side.
Pain in the shoulder when moving the arm overhead, out to the side, and beside the body.
Pain and discomfort when attempting to sleep on the involved side.
Pain with throwing motions and other dynamic movement patterns.

How Is It Diagnosed?

A physical therapist will perform an evaluation and ask you questions about the pain you are feeling, and other symptoms. Your physical therapist may perform strength and motion tests on your shoulder, ask about your job duties and hobbies, evaluate your posture, and check for any muscle imbalances and weakness that can occur between the shoulder and the scapular muscles.

Special tests involving gentle movements of your arm and shoulder may be performed to determine exactly which tendons are involved. X-rays may also be taken to identify other conditions that could be contributing to your discomfort, such as bony spurs or abnormalities, or arthritis.

How Can a Physical Therapist Help?

It is important to get proper treatment for shoulder impingement as soon as it occurs. Secondary conditions can result from the impingement of the tissues in the shoulder, including irritation of the bursa and rotator-cuff tendinitis or tears.

Physical therapy can be very successful in treating shoulder impingement syndrome. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

Pain Management. Your physical therapist will help you identify and avoid painful movements, as well as correct abnormal postures to reduce impingement compression. Therapeutic modalities, like iontophoresis (medication delivered through an electrically charged patch) and ultrasound may be applied. Ice may also be helpful to reduce pain.

Manual Therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches to get your shoulder moving properly, so that the tendons and bursa avoid impingement.

Range-of-Motion Exercises. You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.

Strengthening Exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific condition. Often with shoulder impingement syndrome, the head of the humerus tends to drift forward and upward due to the rotator-cuff muscles becoming weak. Strengthening the rotator-cuff and scapular muscles helps position the head of the humerus bone down and back to ease the impingement. You may also perform resistance training exercises to strengthen your weaker muscles. You will receive a home-exercise program to continue your strengthening long after you have completed your formal physical therapy.

Patient Education. Learning proper posture is an important part of rehabilitation. For example, when your shoulders roll forward as you lean over a computer, the tendons in the front of the shoulder can become impinged. Your physical therapist will work with you to help improve your posture, and may suggest adjustments to your work station and work habits.

Functional Training. As your symptoms improve, your physical therapist will teach you how to correctly perform a range of functions using proper shoulder mechanics, such as lifting an object onto a shelf or throwing a ball. This training will help you return to pain-free function on the job, at home, and when playing sports.

Can this Injury or Condition be Prevented?

Shoulder impingement syndrome can be prevented by:

Maintaining proper strength in the shoulder and shoulder-blade muscles.
Regularly stretching the shoulders, neck, and middle-back region.
Maintaining proper posture and shoulder alignment when performing reaching and throwing motions.
Avoiding forward-head and rounded-shoulder postures (being hunched over) when spending long periods of time sitting at a desk or computer.

Real Life Experiences

Bob is a 33-year-old engineer who spends many hours drafting, creating spreadsheets, and writing reports on his computer at work. He enjoys playing tennis after work a few times a week.

Recently, Bob began feeling pain in his right shoulder when he reached overhead to serve a tennis ball. He felt the same kind of pain when he tried to throw a softball during his daughter's softball practice.

After a few weeks, the shoulder pain worsened and Bob began to have difficulty just reaching into a cupboard to get a glass at home. Last night, the pain in his shoulder woke him up every time he rolled onto it. He decided to call his physical therapist.

Bob's physical therapist performed a full evaluation of his shoulder. She noted he felt pain with certain shoulder movements, and had difficulty performing them due to weakness in the rotator-cuff and scapular muscles. She also saw that he had a rounded posture when sitting. She performed range-of-motion and other special tests on his shoulder. Based on her findings, she diagnosed shoulder impingement syndrome.

Bob and his physical therapist worked together to establish short- and long-term goals for his treatment. She prescribed ice to help decrease his pain, and taught him some gentle movement and strengthening exercises. She performed manual (hands-on) therapy on his shoulder to gently mobilize the joints and tissues.

Bob's physical therapist showed him how to improve his posture when sitting at his desk at work, and taught him a home-exercise program of stretching, strengthening, and postural exercises, which she modified throughout the course of his therapy as his condition improved.

After a few weeks of diligent physical therapy sessions and performing his home-exercise program, Bob reported he was able to raise his shoulder completely overhead without pain or limitation, and sleep on his side comfortably at night.

Today, Bob is back playing tennis pain-free, and is able to "throw long" for his daughter during softball practice.

Physical Therapist's Guide to Shin Splints (Medial Tibial Stress Syndrome)

Wed, 31 Jan 2018 00:00:00 GMT

Medial tibial stress syndrome (MTSS) is a condition that causes pain on the inside of the shin (the front part of the leg between the knee and ankle). MTSS is commonly referred to as shin splits due to the location of pain over the shin bone. MTSS is one of the most common athletic injuries. It affects both the muscle on the inside of the shin and the bone to which it attaches. MTSS may affect up to 35% of athletes who run and jump, such as distance runners, sprinters, basketball or tennis players, or gymnasts. Military personnel, dancers, and other active people can also develop MTSS. A physical therapist can help you recover from MTSS and teach you exercises and tactics to prevent reinjury.

What is Shin Splints (Medial Tibial Stress Syndrome)?

Medial tibial stress syndrome develops when too much stress is placed on the tibia (main shin bone). The muscles that attach to the tibia can cause an overload of stress on the bone. These muscles include the posterior tibialis muscle, the soleus muscle, and the flexor digitorum longus muscle.

The most common risk factors of MTSS include:

Flattening of the arch of the foot while standing (over-pronation)
Being an athlete who participates in repetitive jumping and/or running
Being female
Excessive hip range of motion
Smaller calf girth in males
A high body mass index (>20.2)

How Does it Feel?

You may have MTSS if you feel pain in the middle or bottom third of the inside of the shin. The pain may be sharp when you touch the tender area, or occur as an ache during or after exercise. When MTSS is developing, the pain may be present during the beginning of exercise and less noticeable as exercise progresses. Over time the condition can worsen and pain may be felt throughout any exercise regimen, and it also may continue after exercise.

How Is It Diagnosed?

Your physical therapist will perform a thorough evaluation and take your health history. Your therapist will assess your overall strength, mobility, flexibility, and your walking and running movements. Your physical therapist will apply gentle pressure to the shin, ankle, and foot areas to diagnose MTSS. The most reliable symptom of MTSS is pain felt when pressure is applied to certain parts of the shin.

How Can a Physical Therapist Help?

Your physical therapist will determine what risk factors have caused your MTSS and will teach you how to address those causes. A treatment plan will be developed that is specific to you and what your body needs to recover and to prevent reinjury.

To relieve pain, your physical therapist may prescribe:

Rest from the aggravating activity or exercise
Icing the tender area for 5-10 minutes, 1-3 times a day
Exercises to gently stretch the muscles around the shin
Taping the arch of the foot or the affected leg muscles
Hands-on massage of the injured tissue

To help strengthen weak muscles, your physical therapist may prescribe:

Exercises that increase hip rotation, abduction (lifting the leg away from the other leg), and extension (lifting the leg behind your body) to decrease stress to the lower leg
Exercises that increase your arch and shin muscle strength to decrease the overpronation (flattening out) of the arch of the foot

Your physical therapist may also prescribe:

Calf and foot muscle stretches
Single-leg exercises including squats, reaching exercises, or heel raises
Modified take off and landing techniques for jumping athletes
Modified leg and foot control during walking and running
New footwear to provide better support when walking or exercising

Your physical therapist may also prescribe orthotics or shoe inserts that support the arch of the foot if your feet flatten out too much, or if your foot muscles are weak.

Can this Injury or Condition be Prevented?

Physical therapists recommend that to prevent MTSS you should:

Get an annual functional fitness examination, including strength, flexibility, mobility, and sport-specific analyses
Perform dynamic stretches before exercising and static stretches after exercise
Perform strength and endurance exercises for the foot, hip, and pelvic muscles
Perform balance exercises on each leg
Follow a recommended training program when starting or progressing your exercise program

Your physical therapist can teach you all of these exercises to ensure maximum strength and health, and prevent MTSS.

Real Life Experiences

John is a 35-year-old recreational runner who is training for his third half-marathon. John begins to feel shin pain in both legs during the first mile of his runs, which goes away during the remaining miles. Over the next few days, the pain lasts longer during his run. Concerned that he might be injuring himself, John contacts his physical therapist.

John's physical therapist conducts a thorough examination to assess his pelvic, trunk, hip, leg, foot, and ankle strength. She asks him to try to hold test positions as she applies pressure to different areas. John can't hold his position when she applies pressure to the hip area. During further tests, John demonstrates excessive flattening of each of his feet, and his knees show weakness. John’s physical therapist applies pressure to the muscles surrounding the shins and reproduces pain over the muscles on the lower one-third of the inside of the shin on each leg. She diagnoses MTSS in both legs.

She prescribes massage for the painful area in both shins, and teaches John strengthening exercises for the hip and foot muscles. She shows him how to apply ice to the painful areas for 5-10 minutes, 1-3 times a day. She recommends that he modify his training program to run fewer overall miles, and prescribes a change in footwear for better support and cushioning.

Since John sought help when his symptoms began, after two weeks of treatment his pain is much less, and he is slowly rebuilding his training program back to its former level. He continues his prescribed exercise regimen and his physical therapy treatments. The following month, John competes pain free in the half-marathon, and is proud of his finishing time!

Physical Therapist's Guide to Hamstring Injuries

Wed, 31 Jan 2018 00:00:00 GMT

A hamstring injury occurs when 1 or more of the 3 hamstring muscles or tendons (a type of soft tissue connecting the muscle to the bone) tear. It is 1 of the most common injuries of the lower body, particularly affecting athletes participating in sports such as football, soccer, or track. After tearing a hamstring muscle, a person is 2 to 6 times more likely to suffer a subsequent injury. Surgery is required to treat the most severe cases. However, in most cases, hamstring injuries are managed with physical therapy.

What are Hamstring Injuries?

The hamstrings make up the primary muscle group responsible for straightening (extending) the hip and bending (flexing) the knee. It includes a group of 3 muscles along the back of the thigh that connect the pelvis to the leg. The three muscles are the:

Semitendinosus
Semimembranosus
Biceps femoris

Hamstring injuries occur when excessive force is placed across the muscles. This typically happens during sudden starts or stops when running, a rapid change of direction with "cutting" or jumping maneuvers, or when the muscle is overstretched by activities such as sprinting, hurdling, kicking, or heavy lifting.

The common structures involved in hamstring injuries are:

Hamstring muscle(s) and/or tendon (a type of soft tissue that connects muscle to bone)
Bursa (a fluid-filled sack that sits between bones and soft tissues to limit friction), usually irritated with recurring hamstring injuries
Ischial tuberosity (the "sit-bone"), which in rare cases can be fractured by traumatic injury

Risk factors for hamstring injuries include:

A history of prior hamstring injury
Muscle imbalances (particularly hamstring weakness)
Poor flexibility (muscle tightness)
Inadequate warm-up before activity
Muscle fatigue

How Does it Feel?

When a person injures a hamstring muscle, the symptoms are related to the severity of the injury. Mild hamstring strains often just feel like a pulled or cramping muscle; you might not even realize you have pulled your hamstring until you stop performing the activity, or until the next day, when you might have soreness, tightness, or bruising. However, more involved injuries can be painful, and your symptoms might include:

A sudden, sharp pain in the buttocks or back of the thigh
A feeling of a "pop" or tearing in the muscle
Bruising within hours or days after the injury
Swelling
Tenderness to touch
Difficulty sitting comfortably, lifting the leg when lying down, or straightening the knee
Difficulty walking, resulting in a limp

How Is It Diagnosed?

Diagnosis of hamstring injuries starts with a thorough understanding of your health history and the cause of the injury. The questions your therapist may ask include:

If you have had a similar injury before
What you were doing when you first felt the pain
Where you felt the pain, and if you felt a "pop"
If you noticed any swelling or bruising in the first 24 hours after the injury
What you were able to do immediately following the injury, and how you have been functioning since the injury (walking, sleeping, lifting your leg, etc.)

Your physical therapist will also perform a clinical evaluation, including some of the following observations and tests to determine the nature of your injury:

Observation: To note any discoloration or bruising
Pain: To identify your current pain level, and the activities that make your pain better or worse
Palpation: To pinpoint the location and size of the tender area through touch, which will help determine the severity of the injury
Range of motion: To compare the motion of your injured leg with your healthy leg
Muscle strength: To determine the strength of the hamstring muscles when bending or straightening your knee and hip
Gait analysis: To note any limping or pain when walking

Typically, hamstring injuries are classified as Grade I – III depending on the severity of the injury.

Grade I: Mild strain with minimal tearing; usually feels like a pulled or cramping muscle
Grade II: Moderate strain with partial tearing; may cause a stinging or burning sensation at the back of the thigh
Grade III: A severe, complete muscle tear; may result in a “lump” on the back of the thigh where the muscle has torn

If your physical therapist suspects a severe injury, you will likely be referred to an orthopedic physician for medical diagnostic imaging, including x-ray and MRI, to evaluate the extent of the injury. In the event of a fracture of the ischial tuberosity (sit-bone) and/or a complete rupture of the muscle, surgery might be recommended.

How Can a Physical Therapist Help?

Your physical therapist will design an individualized treatment program specific to the exact nature of your injury and your goals.

The First 24-48 hours

Physical therapy may include:

Resting the injured area by avoiding aggravating activities, such as walking or working out. If you are having notable difficulty walking, crutches may be recommended.
Applying ice to the injured area 3-4x/day for 15-20 minutes (with a towel placed between your skin and the ice).
Applying a compression wrap to the area to aid in decreasing swelling and pain.
Referral to another health care provider for further diagnostic testing (if needed).

Range of motion

It is common for muscles and joints to become stiff after an injury. As your pain decreases, your physical therapist will begin gentle flexibility exercises, such as stretching your hamstring muscles.

Muscle strength

Hamstring strengthening will be an essential part of your rehabilitation program. Your physical therapist will compare the strength of the muscle groups in each leg, and prescribe specific exercises to target areas of weakness.

Manual therapy

Many physical therapists are trained in hands-on "manual" therapy to move and manipulate muscles and joints to improve motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.

Functional training

As you regain the flexibility and strength in your hamstrings, it will be important to teach your body how to move so you no longer put excessive stress on the previously injured area. Your physical therapist will develop a functional training program specific to your desired activity.

In the event that the severity of your hamstring injury requires surgical treatment, a physical therapist will guide your postoperative rehabilitation. Your physical therapist will communicate with your surgeon to ensure complete and consistent postoperative care.

Can this Injury or Condition be Prevented?

You can decrease your risk of a hamstring injury in the following ways:

Always warm up before participating in athletic activities.
Avoid starting a new activity too quickly; gradually increase the frequency and intensity of the activity so that your body may adapt to the new movement patterns.
Listen to your body after you work out (and stretch, apply ice, rest as needed) prior to engaging in the same routine again.
Use proper lifting and squatting techniques, particularly when maneuvering heavy objects.

Real Life Experiences

John is a 28-year-old former collegiate football player. Since graduating from college, his workout routine typically involves several days of weightlifting and the occasional pick-up basketball game. John is an engineer working 40 hours a week, primarily seated at his desk. Recently, work has been very busy, as his company has been assigned a new project. John hasn't made it to the gym in several weeks.

One Friday afternoon as he is leaving the office, John runs into a colleague on his way to the gym for a game of pick-up basketball. John decides to join him. When he gets to the gym, the game has already started, so he has to rush and doesn't have time to warm up.

During the first game, John runs down the court on a fast break but doesn’t see a defender step into his path until the last second. To avoid colliding, he stops suddenly. When his foot hits the ground, he feels a sudden, sharp pain in the back of his thigh, like a very bad cramp, and he has to limp off the court. Even after 20 minutes of resting and trying to stretch, John is unable to walk normally without pain.

When John wakes up the next morning, he is very sore, still unable to walk properly, and sees a bruise forming on the back of his thigh. He contacts his local physical therapist.

During his initial evaluation, John's physical therapist assesses his signs and symptoms and indicates that he has suffered a grade II hamstring strain. That day, John is given a compression wrap for his thigh, is instructed in gentle stretching exercises, and educated on applying ice to the injury and on modifying his activity level. He discusses his goals with his physical therapist, indicating that, following his recovery, he would like to be more consistent with his workout routine and participate in a recreational basketball league.

Over the next 4 weeks, John attends physical therapy 2 times a week. As his pain improves, he is guided through a progressive exercise program to strengthen his hamstrings and improve his body control when running, jumping, and "cutting." His therapist also uses manual therapy techniques to improve the mobility and flexibility of his hamstring muscle. When he is reevaluated, his therapist is happy with his progress and offers recommendations for a gradual rebuilding of his workout routine.

A month later, John calls his physical therapist and states that he is feeling great! He is going to the gym 3 times each week, using the therapist's recommendations for exercise as his guide. John says he has started shooting baskets without any trouble, and he's planning to sign up for the basketball league.

Physical Therapist's Guide to Carpal Tunnel Syndrome

Wed, 31 Jan 2018 00:00:00 GMT

Carpal tunnel syndrome (CTS) is a common condition of the wrist and hand that can affect the use of the whole arm. It is caused by pressure on the nerve at the base of the palm (median nerve). Because of the demands that people place on their hands and wrists, CTS is a common condition affecting 1 out of 20 Americans. Surgery for this condition is commonly performed on the wrist and hand. Fortunately for most people who develop CTS, physical therapy treatment can often relieve pain and numbness and restore normal use of the hand, wrist, and arm without the need for surgery.

What is Carpal Tunnel Syndrome?

About the width of your thumb, the carpal tunnel is a narrow channel on the palm side of your wrist. The tunnel protects the median nerve and the tendons that bend your fingers. Pressure on the nerve can cause pain and weakness in your wrist and hand and numbness or tingling in some of your fingers. This pressure is caused by crowding or irritation of the median nerve in the carpal tunnel and can lead to CTS.

Extreme wrist positions, as well as a lot of finger use, especially with a lot of force or vibration (such as holding the steering wheel when driving heavy machinery), can all contribute to CTS.

CTS is common in professions such as assembly-line work, particularly meat packing; and jobs requiring the use of hand tools, especially tools that vibrate. Although excessive keyboard and computer use is often associated with CTS, those performing assembly line work are 3 times more likely to develop CTS than those who perform data entry work. Some leisure activities can also create CTS, such as sewing, sports such as racquetball and handball, and playing string instruments such as the violin.

The following health conditions can also lead to CTS in some individuals:

Inflammation and swelling of the tendons of the wrist
Injuries to the wrist (strain, sprain, dislocation, fracture)
Hormone or metabolic changes (pregnancy, menopause, thyroid imbalance)
Fluid retention (eg, during pregnancy)
Diabetes
Certain medicine use (eg, steroids)
Degenerative and rheumatoid arthritis

How Is It Diagnosed?

Physical therapists work closely with other health care professionals to accurately diagnose and treat CTS. Symptoms of CTS are typical, and it is often possible to diagnose it without extensive testing. Physical therapists are experts in the movement and function of the body and will conduct an evaluation to determine all of the factors that may be contributing to your condition.

These are several tests that may be used to help diagnose CTS:

Examination of your neck and entire upper extremity to rule out other conditions. Many patients have been told they have CTS, only to find out that the pain is coming from another body area.
Grip strength of fingers and thumb
Sensory tests
Wrist and hand range-of-motion
Wrist flexion (Phalen) test: Your physical therapist will have you push the backs of your hands together for 1 minute. Tingling or numbness in your fingers that occurs within 60 seconds may be an indication of CTS.
Tinel's Sign: Your physical therapist will use a reflex hammer or finger to tap over the median nerve at your wrist. Tingling in the thumb and index and middle fingers may indicate CTS.
Electrical studies (electromyogram/EMG) and nerve conduction velocity (NCV): These tests determine the transmission of the nerve and the severity of the CTS.
X-rays: When trauma has occurred or if there is reason to suspect anatomical abnormality, x-rays may be ordered.

In some cases, your physical therapist may refer you to a physician or other health care professional for additional testing or treatment.

How Can a Physical Therapist Help?

After the evaluation, your physical therapist will prescribe your treatment plan based on your specific case.

Conservative Care

If your evaluation confirms early-stage CTS, conservative care will be recommended as a first step. Physical therapy treatment can be effective in reducing your symptoms and getting you back to performing normal activities. During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Depending upon the causes of your CTS, your therapy program may include:

Education regarding:
- changing wrist positions (ie, avoiding prolonged bent wrist positions)
- proper neck and upper back posture (ie, avoiding forward head or slouching)
- safe use of sharp utensils, tools, or other implements, if sensory changes are identified
- "stretch breaks" during your work or daily routine
Exercises to increase the strength of the muscles in your hand, fingers, and forearm—and in some cases, the trunk and postural back muscles
Stretching exercises to improve the flexibility of the wrist, hand, and fingers
Use of heat/cold treatments to relieve pain
Use of a night splint to reduce discomfort
A worksite visit to assess your work area. For example, if you sit at a desk and work on a computer, it's important for the keyboard to be in proper alignment to help avoid working in a bent wrist position.
Increasing the size of tool and utensil handles by adding extra material for a more comfortable grip
Anti-vibration gloves or anti-vibration wraps around tool handles, if vibration is a factor at your workplace

Your physical therapist will also consider your home and leisure activities, with recommendations such as wearing gloves to keep the wrist/hands warm and limiting sports that aggravate the condition, such as racquet sports, until symptoms resolve.

The goals of physical therapy are to reduce your symptoms without the need for surgery, to enable you to be as active and functional as possible, and to help you resume your normal work, home, and leisure activities.

Physical Therapy Following Surgery

If the evaluation reveals that your CTS is more severe, or if your symptoms persist, your physical therapist may refer you to a physician for a surgical consultation. If necessary, surgery will be performed to release the band of tissue that is causing pressure on the median nerve. Physical therapy treatment is important after surgery to help restore strength to the wrist and to learn to modify habits that may have led to symptoms in the first place. Your physical therapy treatment may include:

Exercises to improve the strength of the wrist/hand muscles and improve function
Stretching to improve mobility of the wrist/fingers and improve function
Scar management to keep the skin supple and flexible
Education regarding appropriate posture and wrist position to avoid carpal tunnel compression in home/leisure activities
A worksite visit or simulation to optimize postures and positions

Can this Injury or Condition be Prevented?

There are no proven strategies for preventing CTS, but there are ways to minimize stress to your hands and wrists. Since there are contributing factors to developing CTS, one single solution may not be effective.

The following strategies are effective ways to minimize stress to your hands and wrists:

Reduce force . Most people use more force than needed when performing work with their hands. Relax your grip to avoid muscle fatigue and strain. For prolonged handwriting, use a larger-handle pen or soft gel grip.
Take frequent breaks . When doing repeated activities, give your hands a break by performing stretching exercises once in a while. If possible, alternate your hands when completing some tasks.
Neutral wrist position . Avoid bending your wrists by keeping them in a straight or “neutral” position. This means your wrist should not be bent up (extended) or down (flexed).
Work area adjustment . Have a physical therapist examine your work area to make sure it fits your height, posture, and the tasks required. Simple adjustments can help avoid unnecessary strain.
Improve your posture . Make sure your posture is appropriate to the task you are performing. Believe it or not, proper alignment of your trunk, neck, and shoulders can prevent excessive strain and improper positioning of the wrists and hands.
Keep your hands warm . You are more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature, be sure to wear gloves to keep your hands and wrists warm.
Maintain good health . Paying attention to your general health is an important step in preventing CTS. Staying physically fit and maintaining a healthy weight may help control diseases and conditions that may contribute to the onset of CTS.

Real Life Experiences

Claudia is a 42-year-old woman who works in a meat packing plant. Her job involves taking meat off of the vibrating conveyor belt, and packing it into containers. Claudia had worked for the company for just over a year when she began to experience numbness and pain in her right thumb and index and middle finger. Her pain is worse at night and interrupts her sleep. Her hand feels weak and swollen, and she has begun to drop things. Claudia has read about potential causes of pain and numbness in the hand on the Internet and is afraid she will need surgery. It took her months to find this job after being laid off from her last job. She is afraid of losing her job if she mentions her symptoms and can't afford to miss work.

Her neighbor suggests she see someone for her problem. She then makes an appointment to see a physical therapist.

The therapist asks about Claudia's health history, which includes diabetes, inquires about her current job demands, and performs a thorough evaluation. The therapist evaluates the mobility and strength in Claudia’s right hand, wrist, and arm. Her strength is slightly decreased in the affected hand and wrist. The results of the Tinel and Phalen tests bring on her symptoms.

Claudia's physical therapist recommends:

Strengthening exercises using small foam balls and exercise putty to increase the strength of hand muscles. Exercise putty is a material, similar to children’s putty, used to strengthen the fingers and hand.
Use of a night splint to decrease symptoms
Education about proper neck and upper back posture
Education regarding proper wrist position for activities at home and work
Interrupting activities, as well as alternating the right and left hand when possible at home and work

Claudia's employer agrees to a worksite visit by the physical therapist. Although the packer station allows both the right and left hand to be used, Claudia had only been using her right hand. The therapist recommends Claudia alternate hands to give the right hand a rest. She also shows Claudia how to position her body to avoid the need for excessive reaching and pulling, and how to keep her wrist in a neutral position when pulling. Last, she instructs Claudia in stretches to use between work activities.

This story is based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program for your specific case.

Physical Therapist's Guide to Medial Epicondylitis (Golfers Elbow)

Wed, 31 Jan 2018 00:00:00 GMT

What is Medial Epicondylitis (Golfer's Elbow)?

How Does it Feel?

Persons with medial epicondylitis may experience:

Pain along the inside of the forearm with wrist, hand, or elbow movements.
Pain or numbness and tingling that radiates from the inside of the elbow down into the hand and fingers, with gripping or squeezing movements.
Tenderness to touch and swelling along the inside of the forearm.
Weakness in the hand and forearm when attempting to grip objects.
Elbow stiffness.

How Is It Diagnosed?

How Can a Physical Therapist Help?

Range-of-Motion Exercises. You will learn mobility exercises and self-stretches to help your elbow and wrist maintain proper movement.

Can this Injury or Condition be Prevented?

Understanding the risk of injury and being aware of your daily movements can help prevent the development of medial epicondylitis. Individuals should:

Maintain proper form and technique when performing repetitive work tasks or sports movements, like golf swings.
Maintain shoulder, forearm, and wrist muscle strength.
Perform gentle forearm muscle stretches before and after performing tasks.
Use proper posture and body mechanics when lifting heavy objects to reduce joint strain.

Real Life Experiences

Lauren is a 47-year-old woman who has built a successful career as a cake decorator. During the spring and summer wedding seasons, she can hardly keep up with the demand for her award-winning designs.

Recently, Lauren has begun experiencing pain along the inside of her forearm near her elbow, when squeezing the icing bag she uses all day long to create her designs. The pain has continued to worsen and has begun to radiate down into her forearm. Because the pain is affecting her work performance as she attempts to fill her many orders, Lauren calls her physical therapist.

Lauren's physical therapist performs a comprehensive evaluation, asking several questions about her job duties, household activities, and hobbies. He also measures Lauren's elbow and wrist motion and strength, gently feels the tendons around the elbow, and performs some special tests to determine the source of her symptoms. Lauren's grip strength is weaker than usual, and she feels pain when she bends her right wrist. Her tendon is tender to touch along the inside of the elbow. Based on these findings, Lauren is diagnosed with medial epicondylitis.

Lauren and her physical therapist work together to establish short- and long-term goals for her treatment. He prescribes ice to help decrease her pain, and teaches her some gentle movement and strengthening exercises. He also recommends an elbow brace to help alleviate pressure on the tendons in the elbow, which allows her to return to her important work tasks. He also shows Lauren how to better position her wrist when squeezing the icing bag, and teaches her a stretching and strengthening home-exercise program, which he modifies throughout the course of her therapy as her condition improves.

Lauren and her physical therapist work together in a 6-week program of 2 to 3 rehabilitation sessions per week. After a few weeks of therapy sessions and working with her home-exercise program, Lauren notices she is able to resume her job duties without elbow pain. This wedding season proves to be her best one yet!

Physical Therapist's Guide to Achilles Tendon Injuries (Tendinopathy)

Wed, 31 Jan 2018 00:00:00 GMT

An Achilles tendon injury (tendinopathy) is one of the most common causes of pain felt behind the heel and up the back of the ankle when walking or running. While Achilles tendinopathy affects both active and inactive individuals, it is most common in active individuals; 24% of athletes develop the condition. Males experience 89% of all Achilles tendon injuries, and an estimated 50% of runners will experience Achilles pain in their running careers. In all individuals, Achilles tendinopathy can result in a limited ability to walk, climb stairs, or participate in recreational activities.

Achilles Tendon Injuries (Tendinopathy)

Achilles tendinopathy is an irritation of the Achilles tendon, a thick band of tissue along the back of the lower leg that connects the calf muscles to the heel. The term tendinopathy refers to any problem with a tendon, either short or long term. The Achilles tendon helps to balance forces in the leg and assists with movement of the leg and the ankle joint. Achilles tendinopathy results when the demand placed on the Achilles tendon is greater than its ability to function. This can occur after 1 episode (acute injury) or after repetitive irritation or "microtrauma" (chronic injury).

The severity of acute injuries is graded based on the amount of damage to the tendon:

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.

Most often, Achilles tendon pain is the result of repetitive trauma to the tendon. This repetitive strain can result in chronic Achilles tendinopathy, which is a gradual breakdown of the tissue and is most often treated with physical therapy.

Achilles tendinopathy may result from a combination of several different variables, including:

Ankle stiffness
Calf tightness
Calf weakness
Abnormal foot structure
Abnormal foot mechanics
Improper footwear
A change in an exercise routine or sport activity

Pain can be present at any point along the tendon; the most common area to feel tenderness is just above the heel, although it may also be present where the tendon meets the heel.

How Does it Feel?

With Achilles tendinopathy, you may experience:

Tenderness in the heel or higher up in the Achilles tendon
Tightness in the ankle
Tightness in the calf
Swelling in the back of the ankle
Pain in the back of the heel
Pain and stiffness with walking, worst with the first several steps

How Is It Diagnosed?

Your physical therapist will review your medical history and complete a thorough examination of your heel. The goals of the initial examination are to assess the degree of the injury and determine the cause and contributing factors to your injury.

It is common for your physical therapist to perform a movement assessment. This may include watching you walk, squat, step onto a stair, or balance on 1 leg. The motion and strength in your leg will also be assessed.

Your physical therapist may also ask questions regarding your daily activities, exercise regimens, and footwear to identify other contributing factors.

Imaging techniques, such as x-ray or MRI, are often not needed to diagnose Achilles tendinopathy.

How Can a Physical Therapist Help?

You and your physical therapist will work together to develop a plan to help you achieve your specific goals. To do so, your physical therapist will select treatment strategies including any or all of the following areas:

Pain. Many pain-relief strategies may be implemented, such as applying ice to the area, putting the affected leg in a brace, or using therapies such as iontophoresis (a medicated patch placed on the skin that is electrically charged and used to decrease pain and inflammation) or therapeutic ultrasound.
Range of motion. Your ankle, foot, or knee joint may be moving improperly, causing increased strain on the Achilles tendon. Self-stretching and manual therapy techniques (massage and movement) applied to the lower body to help restore and normalize motion in the foot, ankle, knee, and hip can decrease this tension.
Muscular strength. Muscular weaknesses or imbalances can result in excessive strain on the Achilles tendon. Based on your specific condition, your physical therapist will design an individualized, progressive, lower-extremity resistance program for you. You may begin by performing strengthening exercises in a seated position -- for example, pushing and pulling on a resistive band with your foot. You then may advance to exercises in a standing position -- for example, standing heel raises.
Manual therapy. Your therapist may treat your condition by applying hands-on treatments to move your muscles and joints in order to improve their motion and strength. These techniques often address areas that are difficult to treat on your own.
Functional training. Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension on the Achilles tendon and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your goals and movement assessment, your physical therapist will create a series of activities that will help you learn how to use and move your body correctly to safely perform the tasks required to achieve your goals.
Patient education. Your therapist will work with you to identify, and establish plans to address, any possible external factors causing your pain, such as faulty footwear or inappropriate exercises. He or she will assess your footwear and recommend improvements, and develop a personal exercise program to help ensure a pain-free return to your desired activities.

Physical therapy promotes recovery from Achilles tendon injuries by addressing issues such as pain or swelling of the affected area, and any lack of strength, flexibility, or body control. When the condition remains untreated, pain will persist and may result in a complete tear of the Achilles tendon, which often requires surgery to repair.

If your surgeon decides that surgery is needed, physical therapy will be necessary after surgery for several months. Immediately after surgery, your ankle will be placed in a splint or cast with crutches to allow the repaired tissue to heal. Once sufficient healing has occurred, you will work with your physical therapist to progressively regain your ankle mobility and leg strength. He or she will also help you regain your ability to walk without assistance—and carefully guide your return over time to your desired recreational activities.

Can this Injury or Condition be Prevented?

Maintaining appropriate lower extremity mobility and muscular strength, and paying particular attention to your exercise routine—especially changes in an exercise surface, the volume of exercises performed, or your footwear are the best methods for preventing Achilles injuries.

Your physical therapist will help guide you through a process that will progressively reintegrate more demanding activities into your routine without overstraining your Achilles tendon. Keep in mind that returning to activities too soon after injury often leads to persistent pain, and the condition becomes more difficult to fix.

Real Life Experiences

Kevin is a 45-year-old recreational distance runner training for his second 5K road race. He runs 3 to 4 days each week. Over the past 2 months, he has begun to experience pain in the back of his right heel. His pain is worst at the beginning of his training runs; he also experiences pain and stiffness when taking his first steps in the morning and after standing up from his desk at work. He typically performs stretches for 5 minutes before or after his runs and is wearing running shoes that he purchased 10 months ago.

Kevin is becoming impatient as his pain is not improving, despite the fact that he has decreased the length of his runs. He is worried about his ability to train for and compete in an upcoming race, and consults his physical therapist.

The physical therapist conducts a comprehensive examination of Kevin's motion, strength, balance, movement, and running mechanics. Kevin describes his typical daily running routine, including distance, pace, and running surface; his stretching routine; and his footwear. Based on these findings, the physical therapist diagnoses Achilles tendinopathy.

Kevin and his physical therapist work together to establish short- and long-term goals and identify immediate treatment priorities, including icing and stretching to decrease his pain, as well as gentle foot and ankle strengthening exercises. They also discuss temporary alternative methods for Kevin to maintain his fitness without continuing to aggravate his injury and prolong his recovery, including swimming, biking, and aqua jogging. Kevin is also prescribed a home exercise program consisting of a series of activities to perform daily to help his recovery.

Together, they outline an 8-week rehabilitation program for Achilles tendinopathy. Kevin visits his physical therapist 1-2 times each week; she assesses his progress, performs manual therapy techniques, and advances his exercise program as appropriate. She also advises him when it is appropriate to resume running, and establishes a day-by-day plan to help him safely build back up to his desired mileage. They also discuss the appropriate running footwear, given Kevin’s foot shape, movement patterns, and injury history. Kevin also performs an independent daily exercise routine at home, including stretching and strengthening activities. After 8 weeks of patience and diligence, Kevin no longer experiences pain or stiffness in the affected leg and resumes his desired training program without pain in preparation for his upcoming 5K race.

Physical Therapist's Guide to Chronic Obstructive Pulmonary Disease (COPD)

Wed, 31 Jan 2018 00:00:00 GMT

Chronic obstructive pulmonary disease (COPD) causes breathing difficulty and leads to other systemic problems. COPD is the tenth most prevalent disease worldwide. It's estimated that by 2050, COPD will be the fifth leading cause of death in the world. Although COPD used to be more common among men, it now affects women nearly as equally in developed countries.

Physical therapists can work with your pulmonary rehabilitation team or with you individually to help improve:

Your exercise capacity
Your overall strength
Your health and quality of life

What Is Chronic Obstructive Pulmonary Disease (COPD)?

In chronic obstructive pulmonary disease, the airways in your lung lose their normal shape and elasticity, and can become inflamed. The result is that the airways are less efficient at moving air in and out of your lungs. Primary risk factors for developing COPD include:

Smoking
Inhaling toxic substances
Indoor and outdoor pollutants
Genetic/environment interactions
Respiratory insult to the developing lungs during prenatal or early childhood stages of life

Current research indicates that COPD is no longer considered a “smoker’s” or “older person’s” disease.

The most common types of COPD are:

Chronic bronchitis —a chronic inflammation of the medium-size airways, or "bronchi" in the lungs, causing a persistent cough that produces sputum (phlegm) and mucus for at least 3 months per year, in 2 consecutive years.

Emphysema —a condition in which small air sacs in the lungs called "alveoli" are damaged. The body has difficulty getting all of the oxygen it needs, resulting in shortness of breath ("dyspnea") and a chronic cough.

In addition to causing breathing difficulty, COPD results in cough, sputum production, and other symptoms. The disease can affect the whole body and lead to:

Weakness in the arms and legs
Balance problems and increased risk of falls
Nutritional problems (weight loss or gain)

People with COPD are likely to have other health problems that can occur at the same time or be related to COPD, such as:

Reduced blood supply to the heart (ischemic heart disease)
High blood pressure(hypertension)
Depression
Lung cancer
Osteoporosis
Diabetes
Congestive heart failure
Coronary artery disease
Atrial fibrillation
Asthma

Over time, COPD leads to a progressive decline in physical function because of increased shortness of breath (dyspnea) and loss of muscle strength. There are 4 stages of COPD—mild, moderate, severe, and very severe—based on measurements of the amount or flow of air as you inhale and exhale. People with COPD may need to take medications, or may require supplemental oxygen.

How Can a Physical Therapist Help?

Your physical therapist will perform an evaluation that includes:

A review of your history, including smoking history, exposure to toxic chemicals or dust, your medical history, and any hospitalizations related to your breathing problems
A review of your medications
Assessment of what makes your symptoms worse, and what relieves them
Review of lung function test results that may have been performed by your physician
Muscle strength tests of your arms, legs, and core
Walk tests to measure your exercise capacity
Tests of your balance and your risk of falling

Pulmonary rehabilitation, including exercise training for at least 4 weeks, has been shown to improve shortness of breath, quality of life, and strategies for coping with COPD. Your physical therapist will serve as an important member of your health care team, and will work closely with you to design a program that takes into account your goals for treatment. Your physical therapist's overall goal is to help you continue to do your roles in the home, at work, and in the community.

Improve Your Ability to Be Physically Active

Your physical therapist will design special exercises that train the muscles you use in walking and the muscles of your arms, so you can increase your aerobic capacity and reduce your shortness of breath. You may also use equipment, such as a recumbent bike, treadmill, or recumbent stepper to improve cardiovascular endurance.

Research has shown that strength training in people with moderate to severe COPD increases muscle mass and overall strength. Your physical therapist will provide strengthening exercises for your arms and legs using resistance bands, weights, and weighted medicine balls.

Improve Your Breathing During Activity

People with COPD often have shortness of breath and reduced strength in their "inspiratory muscles" (the muscles used to breathe in). Your physical therapist can help you with inspiratory muscle training, which has been shown to help reduce shortness of breath and increase exercise capacity. Your physical therapist can instruct you in pursed lip and diaphragmatic breathing, which can help make each breath more efficient, and helps to reduce shortness of breath during your physical activities.

Improve Your Balance

The decrease in function and mobility that occurs with individuals who have COPD can cause balance problems and risk of falls. People who require supplemental oxygen can be at a greater risk for a fall. If balance testing indicates that you are at risk for falling, your physical therapist can help by designing exercises aimed at improving your balance, and helping you feel steadier on your feet.

Can this Injury or Condition be Prevented?

One of the most important ways to prevent COPD is to stop smoking, which also can delay the onset of COPD, or delay the worsening of breathing difficulty. If you are a smoker who has a cough or shortness of breath but whose tests don't yet show a decline in lung function, you may be able to avoid a diagnosis of COPD, if you stop smoking now! The American Lung Association offers an online Freedom From Smoking® program for adult smokers. Your physical therapist also can help you get in touch with local smoking cessation programs.

If you already have COPD, your physical therapist can guide you to help slow the progression. The therapist will show you how to continue an exercise program at home or at a fitness center, after you've completed your physical therapy treatment. Regular exercise that is continued after pulmonary rehabilitation for COPD helps slow the decline in quality of life and shortness of breath during activities of daily living. It has been found that patients who continue exercising after completing a pulmonary rehabilitation program, maintained the gains that had been made, whereas those who stopped their exercise program had a major decline in their exercise endurance and physical functioning.

When COPD is accompanied by excessive body weight, breathing can be more difficult. Excessive weight can also inhibit the ability to exercise and decrease overall quality of life. Your physical therapist can help you manage your weight, or prevent unnecessary weight gain by designing an exercise program specifically targeted to your current abilities. Your physical therapist also can also refer you to a dietician for help with proper nutrition to support a healthy lifestyle.

Real Life Experiences

Thomas is a 68-year-old man who recently was diagnosed with COPD. He smoked 1.5 packs of cigarettes for 40 years before quitting 2 years ago. He is referred to a cardiopulmonary physical therapist after telling his physician that he is having more difficulty climbing up and down stairs, as well as trouble golfing. He notes that he is having increased shortness of breath and now has to ride the golf course in a cart, rather than walking. He reports that his other main problem is leg fatigue with walking, which further contributes to his movement limitations.

The physical therapist performs an evaluation and notes that Thomas has a reduced exercise capacity based on a test called the "6-minute walk test." Based on other tests, the therapist finds that Thomas has decreased leg strength and decreased endurance. Thomas says that he feels like he doesn't have much control over his breathing, which is affecting his quality of life.

Over the course of his physical therapy treatment, the physical therapist teaches him how to use the treadmill, stationary bicycle, and upper-body ergometer (a kind of bicycle that's pedaled using only the arms), and strengthening exercises with weights. The therapist instructs him in how to do pursed lip breathing and diaphragmatic breathing, how to pace himself during his activities, and how to best conserve his energy.

At the end of his physical therapy, Thomas is able to walk 200 feet farther on the 6-minute walk test with reduced shortness of breath and leg fatigue. He resumes golfing, and is able to walk half of the course before requiring a cart. He reports that he also feels much more at ease on the stairs, and has an improved overall sense of control of his breathing. He joins a local gym, where he plans on continuing his walking program 3 times per week.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

Physical Therapist's Guide to Balance Problems

Wed, 31 Jan 2018 00:00:00 GMT

Balance problems make it difficult for people to maintain stable and upright positions when standing, walking, and even sitting. Older people are at a higher risk of having balance problems; 75% of Americans older than 70 years are diagnosed as having "abnormal" balance. Older women are more likely than older men to develop balance problems, although the difference between the genders is small. Balance problems increase by almost 30% in people aged 80 years or more. Mexican-Americans have the highest rate of balance problems among all Americans. Physical therapists develop individualized physical activity plans to help improve the strength, stability, and mobility of people with balance problems.

What are Balance Problems?

A balance problem exists when an individual has difficulty maintaining a stable and upright position. A range of factors can cause balance problems, including:

Muscle weakness
Joint stiffness
Inner ear problems
Certain medications (such as those prescribed for depression and high blood pressure)
Lack of activity or a sedentary lifestyle
Simple aging

Balance problems can also be caused by medical conditions, such as:

Stroke
Parkinson’s disease
Multiple sclerosis
Brain injury
Arthritis
Spinal cord injury
Cognitive diseases
Diabetes

Balance problems occur when 1 or more of 4 systems in the body are not working properly:

Vision
Inner ear
Muscular system
Awareness of one's own body position (called “proprioception”)

Poor vision can result from age, eye tracking problems, or eye diseases. Inner ear problems, also called vestibular problems, can develop from trauma, aging, poor nutrition, or disease. Body-position sense can become abnormal as a result of trauma or a disease, such as diabetes. Muscle strength and flexibility can decline due to lack of exercise, a sedentary lifestyle, or disease.

The brain coordinates impulses from the eye, inner ear, and body-position senses, and sends signals to the muscular system to move or make adjustments to maintain balance. If one or more of the senses is not sending correct signals to the brain, or if the muscular system cannot carry out the necessary movements, a person may not be able to maintain or correct their balance.

How Does it Feel?

A person with balance problems may experience tripping, swaying, stumbling, dizziness, vertigo, and falling. Although a person’s "static" balance may be fine when standing still or only performing a single task at a time, “dynamic” balance problems may become apparent when the person is moving about or trying to do more than 1 thing at a time (ie, walking, while turning the head to talk to another person), or when there is not much light (at night, or in a darkened room). If someone’s dynamic balance is abnormal, it can cause a fall and possible injury.

Balance problems can make a person fearful of performing simple daily activities. As a result, they may lose muscle strength and become frail because they avoid strenuous or challenging movements. A person who has balance problems may start to feel frustration about the condition, and become depressed.

How Is It Diagnosed?

If you see your physical therapist first, the physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your condition, such as:

How often do you experience problems with your balance?
What are you doing when you experience balance problems?
Is your balance worse at nighttime or in dark rooms?
Does the room spin, or do you feel off-balance?
How many times have you fallen in the past year?
Have you suffered injuries from falling?
Have you changed or limited your daily activities because of your balance problems?
What medications do you take?
Have you had a vision or ear checkup recently?
Do you have difficulty with any daily activities?
How much, and what kind of daily exercise do you get?
Do you have any other medical conditions or problems?
Are you under the care of a physician?
What are your goals?

Your physical therapist will perform tests, such as motion, strength, coordination, visual tracking, and balance tests, to help assess your overall physical ability. Your physical therapist may collaborate with your physician or other health care providers, who may order further tests to rule out any underlying conditions that may exist.

How Can a Physical Therapist Help?

Physical therapists offer numerous options for treating balance problems, based on each person’s needs. They are trained to evaluate multiple systems of the body, including the muscles, joints, inner ear, eye tracking ability, skin sensation, and position awareness in the joints (proprioception). Physical therapists are experts in prescribing active movement techniques and physical exercise to improve these systems, including strengthening, stretching, proprioception exercises, visual tracking, and inner ear retraining.

Your physical therapist can help treat your balance problems by identifying their causes, and designing an individual treatment program to address your specific needs, including exercises you can do at home. Your physical therapist can help you:

Reduce Fall Risk. Your physical therapist will assess problem footwear and hazards in your home that increase your risk of balance problems or falling. Household hazards include loose rugs, poor lighting, unrestrained pets, or other possible obstacles.

Reduce Fear of Falling. By addressing specific problems that are found during the examination, your physical therapist will help you regain confidence in your balance and your ability to move freely, and perform daily activities. As you build confidence in your balance and physical ability, you will be better able to enjoy your normal daily activities.

Improve Mobility. Your physical therapist will help you regain the ability to move around with more ease, coordination, and confidence. Your physical therapist will develop an individualized treatment and exercise program to gradually build your strength and movement skills.

Improve Balance. Your physical therapist will teach you exercises for both static balance (sitting or standing still) and dynamic balance (keeping your balance while moving). Your physical therapist will progressively increase these exercises as your skills improve.

Improve Strength. Your physical therapist will teach you exercises to address muscle weakness, or to improve your overall muscle strength. Strengthening muscles in the trunk, hip, and stomach (ie, “core”) can be especially helpful in improving balance. Various forms of weight training can be performed with exercise bands, which help avoid joint stress.

Improve Movement. Your physical therapist will choose specific activities and treatments to help restore normal movement in any of your joints that are stiff. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises that you do yourself.

Improve Flexibility and Posture. Your physical therapist will determine if any of your major muscles are tight, and teach you how to gently stretch them. The physical therapist will also assess your posture, and teach you exercises to improve your ability to maintain proper posture. Good posture can improve your balance.

Increase Activity Levels. Your physical therapist will discuss activity goals with you, and design an exercise program to address your individual needs and goals. Your physical therapist will help you reach those goals in the safest, fastest, and most effective way possible.

Once your treatment course is completed, your physical therapist may recommend that you transition to a community group to continue your balance exercises, and maintain a fall-proof home environment. Many such community groups exist, hosted by hospitals, senior centers, or volunteer groups.

Your physical therapist may recommend that you consult with other medical providers, including:

An eye doctor, to check your current vision needs.
An ear doctor, to check your outer and inner ear status.
Your personal physician, to review your current medications to see if any of them may be affecting your balance.

Can this Injury or Condition be Prevented?

To help prevent balance problems, your physical therapist will likely advise you to:

Keep moving. Avoid a sedentary lifestyle. Perform a challenging physical activity each day to keep your muscles strong and flexible, and your heart and lungs strong. Use your body as much as you can to walk, climb stairs, garden, wash dishes by hand, and other daily activities that keep you moving. If you work out or follow a fitness program, keep it up!
Have yearly checkups for vision and hearing. Make sure your vision prescription is up-to-date.
Carefully manage chronic diseases like diabetes, whose long-term side effects can include balance problems. These side effects can be greatly reduced by following the recommended diet and medication guidelines given to you by your physician.
Monitor your medications. Make note of any medications that you think may be affecting your sense of balance, and talk to your physician about them.
Report any falls to your physician and physical therapist immediately. They will evaluate and address the possible causes.

Your physical therapist will also prescribe a home exercise program specific to your needs to prevent future problems or injuries. This program can include strength and flexibility exercises, posture retraining, eye-tracking and vestibular exercises, and balance exercises.

Real Life Experiences

Margaret is a 70-year-old retiree. She and her husband have lived in the same house for 30 years. Margaret is as active around the house as ever, taking care of all the household cleaning and maintenance, growing vegetables in her garden, cooking, and tackling light landscaping.

One night recently, Margaret tried to close the bathroom window when it turned chilly outside. She didn't bother to switch on the bathroom light. In order to reach the window, she had to step into the tub with her right foot. She found that she had to push harder on the stubborn window, and lifted her left leg to place it in the tub. The next thing she recalled was explosive pain in her ribs. She realized that she was on her side, sprawled half in and half out of the tub. She did not recall falling. Her husband got her to the doctor.

Margaret's doctor x-rayed her ribs, shoulder, and toe, and found no broken bones. He instructed Margaret on how to care for her many bruises. He bandaged a torn toenail on her right foot, and told Margaret that she would not be able to wear a closed-toe shoe for awhile.

When her doctor asked Margaret if she had fallen before, she admitted that she had lost her balance while going upstairs recently. She admitted that she felt more off-balance in the dark. Margaret also mentioned that she and her husband attended ballroom dancing sessions each week, and joked that she never could learn to “spot a turn.” The physician, knowing that the dancer technique of “spotting a turn” requires inner ear and vision function, recommended that Margaret consult with her eye doctor, and her physical therapist.

Margaret met with her eye doctor and got her vision prescription updated; she noted that she felt somewhat more balanced with proper eyeglasses. She then met with her physical therapist.

Margaret's physical therapist took her medical history and performed a full battery of tests, assessing Margaret's muscle strength, balance, body-position sense (proprioception), eye-tracking ability, and inner ear (vestibular) function.

She noted Margaret's bruises from her fall. In addition, she found that Margaret lacked the ability to keep her eyes focused on an object while turning her head, and that her balance was severely affected when her eyes were closed. She asked what Margaret's personal goals were for therapy; Margaret said she wanted to avoid falling, return to her normal vigorous household activities, and attend her ballroom dance sessions 3 times per week.

Margaret's treatment began with simple eye-tracking exercises, and moved on to standing and walking balance exercises. Her physical therapist then added specific strengthening exercises to the routine. She also performed hands-on therapy, somewhat like massage, to increase the healing speed of the shoulder and rib muscles that were bruised and strained. She also applied electrical stimulation and cold packs to those areas to reduce swelling and pain.

Margaret continued her physical therapy sessions for 4 weeks, increasing her exercises as her strength returned. She learned about fall-proofing her home, including installing night lights in the bathrooms, and about wearing proper footwear.

At the end of her treatment program, Margaret was able to return to all her household tasks, and maintain a home-based exercise program designed by her physical therapist. She reported that she felt much more confident about maintaining her balance, even at night. She and her husband returned to ballroom dancing—and she was able to gently “spot a turn” for the first time in her life!

Physical Therapist's Guide to Frozen Shoulder (Adhesive Capsulitis)

Wed, 31 Jan 2018 00:00:00 GMT

Often called a stiff or “frozen shoulder,” adhesive capsulitis occurs in about 2% to 5% of the American population. It affects women more than men and is typically diagnosed in people over the age of 45. Of the people who have had adhesive capsulitis in 1 shoulder, it is estimated that 20% to 30% will get it in the other shoulder as well. Physical therapists help people with adhesive capsulitis address pain and stiffness, and restore shoulder movement in the safest and most effective way possible.

What is Frozen Shoulder (Adhesive Capsulitis)?

Adhesive capsulitis is the stiffening of the shoulder due to scar tissue, which results in painful movement and loss of motion. The actual cause of adhesive capsulitis is a matter for debate. Some believe it is caused by inflammation, such as when the lining of a joint becomes inflamed (synovitis), or by autoimmune reactions, where the body launches an "attack" against its own substances and tissues. Other possible causes include:

Reactions after an injury or surgery
Pain from other conditions, such as arthritis, a rotator cuff tear, bursitis, or tendinitis, that has caused a person to stop moving the shoulder
Immobilization of the arm, such as in a sling, after surgery or fracture

Often, however, there is no clear reason why adhesive capsulitis develops.

How Does it Feel?

Most people with adhesive capsulitis have worsening pain and a loss of movement. Adhesive capsulitis can be broken down into 4 stages; your physical therapist can help determine what stage you are in.

Stage 1: "Prefreezing"

During stage 1 of its development, it may be difficult to identify your problem as adhesive capsulitis. You've had symptoms for 1 to 3 months, and they're getting worse. Movement of the shoulder causes pain. It usually aches when you're not using it, but the pain increases and becomes "sharp" with movement. You'll begin to limit shoulder motion during this period and protect the shoulder by using it less. The movement loss is most noticeable in "external rotation" (this is when you rotate your arm away from your body), but you might start to lose motion when you raise your arm or reach behind your back. Pain is the hallmark feature of this stage; you may experience pain during the day and at night.

Stage 2: "Freezing"

By this stage, you've had symptoms for 3 to 9 months, most likely with a progressive loss of shoulder movement and an increase in pain (especially at night). The shoulder still has some range of movement, but it is limited by both pain and stiffness.

Stage 3: "Frozen"

Your symptoms have persisted for 9 to 14 months, and you have a greatly decreased range of shoulder movement. During the early part of this stage, there is still a substantial amount of pain. Toward the end of this stage, however, pain decreases, with the pain usually occurring only when you move your shoulder as far you can move it.

Stage 4: "Thawing"

You've had symptoms for 12 to 15 months, and there is a big decrease in pain, especially at night. You still have a limited range of movement, but your ability to complete your daily activities involving overhead motion is improving at a rapid rate.

How Is It Diagnosed?

Often, physical therapists don't see patients with adhesive capsulitis until well into the freezing phase or early in the frozen phase. Sometimes, people are being treated for other shoulder conditions when their physical therapist notices the signs and symptoms of adhesive capsulitis. Your physical therapist will perform a thorough evaluation, including an extensive health history, to rule out other diagnoses. Your physical therapist will look for a specific pattern in your decreased range of motion called a "capsular pattern" that is typical with adhesive capsulitis. In addition, your physical therapist will consider other conditions you might have, such as diabetes, thyroid disorders, and autoimmune disorders, that are associated with adhesive capsulitis.

How Can a Physical Therapist Help?

Your physical therapist's overall goal is to restore your movement, so you can perform your daily activities. Once the evaluation process has identified the stage of your condition, your physical therapist will create an individualized exercise program tailored to your specific needs. Exercise has been found to be most effective for those who are in stage 2 or higher. Your treatment may include:

Stages 1 and 2

Exercises and manual therapy. Your physical therapist will help you maintain as much range of motion as possible and will help reduce your pain. Your therapist may use a combination of range-of-motion exercises and manual therapy (hands-on) techniques to maintain shoulder movement.

Modalities. Your physical therapist may use heat and ice treatments (modalities) to help relax the muscles prior to other forms of treatment.

Home-exercise program. Your physical therapist will give you a gentle home-exercise program designed to help reduce your loss of motion. Your therapist will warn you that being overly aggressive with stretching in this stage may make your shoulder pain worse.

Your physical therapist will match your treatment activities and intensity to your symptoms, and educate you on appropriate use of the affected arm. Your therapist will carefully monitor your progress to ensure a safe healing procedure is followed.

Pain medication . Sometimes, conservative care cannot reduce the pain of adhesive capsulitis. In that case, your physical therapist may refer you for an injection of a safe anti-inflammatory and pain-relieving medication. Research has shown that although these injections don’t provide longer-term benefits for range of motion and don’t shorten the duration of the condition, they do offer short-term pain reduction.

Stage 3

The focus of treatment during phase 3 is on the return of motion. Treatment may include:

Stretching techniques. Your physical therapist may introduce more intense stretching techniques to encourage greater movement and flexibility.

Manual therapy. Your physical therapist may take your manual therapy to a higher level, encouraging the muscles and tissues to loosen up.

Strengthening exercises. You may begin strengthening exercises targeting the shoulder area as well as your core muscles. Your home-exercise program will change to include these exercises.

Stage 4

In the final stage, your physical therapist will focus on the return of "normal" shoulder body mechanics and your return to normal, everyday, pain-free activities. Your treatment may include:

Stretching techniques. The stretching techniques in this stage will be similar to previous ones you’ve learned, but will focus on the specific directions and positions that are limited for you.

Manual therapy. Your physical therapist may perform manual therapy techniques in very specific positions and ranges that are problematic for you. They will focus on eliminating the last of your limitations.

Strength training. Your physical therapist will prescribe specific strengthening exercises related to any weakness that you may have to help you perform your work or recreational tasks.

Return to work or sport. Your physical therapist will address movements and tasks that are required in your daily and recreational life.

Can this Injury or Condition be Prevented?

The cause of adhesive capsulitis is debatable, with no definitive cause. Therefore, to date, there is no known method of prevention. The onset of the condition is usually gradual, with the disease process needing to "run its course." However, the sooner you contact your physical therapist, the sooner you will receive appropriate information on how to most effectively address your symptoms.

Real Life Experiences

Cheryl is 47-year-old office manager who swims and hikes on the weekends. A few months ago, Cheryl began having pain in her left shoulder when she reached up to file archived reports at work. At first she ignored it, but then noticed her shoulder was aching after work and sometimes at night. She began to limit her movement due to pain. Just this week, she chose not to visit her local pool for her regular swim. She decided to contact a physical therapist.

Cheryl’s physical therapist took her health history, and asked her to describe when the pain began, and how her current symptoms are affecting her. Cheryl reports no accident or trauma, and that the pain has slowly increased over the past few months. She notes that she has to make adjustments at work because she can’t lift her arm above shoulder level, and that the pain is now affecting her sleep. Her physical therapist conducts a thorough physical examination and diagnoses stage 2 frozen shoulder (adhesive capsulitis).

He begins Cheryl’s rehabilitation with heat treatments to relax her muscles, and designs an individualized home-exercise program to address her symptoms and help stall any loss of motion. He encourages Cheryl to perform her home exercises every day.

Cheryl’s treatments during this phase consist of gentle movements performed by her physical therapist (manual therapy), to help maintain the shoulder joint’s current range of motion. At this point, he focuses treatment not on increasing the shoulder’s range of motion, but on mobilizing the joint to reduce pain and reduce the amount of movement that is lost.

When Cheryl progresses into stage 3 ("frozen") adhesive capsulitis, her visits to the physical therapist are increased. He uses stretching and manual therapy techniques to improve her range of motion. He updates Cheryl’s home-exercise program to match her current limitations and function.

After a few more weeks of treatment, Cheryl reports minimal pain, and her range of motion is beginning to increase. Her treatment is reduced to weekly visits, and then to twice monthly visits. She begins to slowly return to swimming; her physical therapist prescribes a safe and appropriate program to follow, as she resumes her activities.

After 2 more months of treatment, Cheryl’s range of motion is normal, and her pain has stopped. She has happily returned to her regular swimming schedule, and feels stronger than she has in years! Cheryl's physical therapist credits her excellent recovery to her full participation in her treatment and home-exercise programs.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

Physical Therapist's Guide to Plantar Fasciitis

Thu, 16 Nov 2017 00:00:00 GMT

Plantar fasciitis is a condition causing heel pain. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear. You experience pain when you put weight on your foot—particularly when taking your first steps in the morning. The pain can be felt at the heel, or along the arch and the ball of the foot.

Plantar fasciitis is a common foot condition. It occurs in as many as 2 million Americans per year and 10% of the population over their lifetimes.

Factors that contribute to the development of plantar fasciitis include:

Age (over 40 years)
A job, sport, or hobby that involves prolonged standing or other weight-bearing activity
Rapid increases in length or levels of activity, such as beginning a new running program or changing to a job that requires a lot more standing or walking than you are accustomed to
Decreased calf muscle flexibility
Increased body weight (Body Mass Index greater than 30)
Tendency to have a flat foot (pronation)

Plantar fasciitis affects people of all ages, both athletes and non-athletes. Men and women have an equal chance of developing the condition.

Treatment generally reduces pain and restores your ability to put weight on your foot again.

What is Plantar Fasciitis?

Plantar fasciitis is a condition causing heel pain. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear. The condition develops when repeated weight-bearing activities put a strain on the plantar fascia. People who are diagnosed with plantar fasciitis also may have heel spurs, a bony growth that forms on the heel bone. However, people with heel spurs may not experience pain.

Plantar fasciitis occurs most frequently in people in their 40s but can occur in all age groups.

The condition can develop in athletes who run a great deal and in non-athletes who are on their feet most of the day, such as police officers, cashiers, or restaurant workers.

Signs and Symptoms

The onset of symptoms of plantar fasciitis frequently occurs with a sudden increase in activity. You might feel a stabbing pain on the underside of your heel, and a sensation of tightness and/or tenderness along your arch.

People with plantar fasciitis may experience pain:

In the morning, when stepping out of bed and taking the first steps of the day
With prolonged standing
When standing up after sitting for awhile
After an intense weight-bearing activity such as running
When climbing stairs
When walking barefoot or in shoes with poor support

As your body warms up, your pain may actually decrease during the day but then worsen again toward the end of the day because of extended walking. Severe symptoms may cause you to limp.

How Is It Diagnosed?

The physical therapist’s diagnosis is based on your health and activity history and a clinical evaluation. Your therapist also will take a medical history to make sure that you do not have other possible conditions that may be causing the pain. Sharing information about the relationship of your symptoms to your work and recreation, and reporting any lifestyle changes, will help the physical therapist diagnose your condition and tailor a treatment program for your specific needs.

To diagnose plantar fasciitis, your therapist may conduct the following physical tests to see if symptoms occur:

Massaging and pressing on the heel area (palpation)
Gently stretching the ankle to bend the top of the foot toward the leg (dorsiflexion)
Gently pressing the toes toward the ankle

How Can a Physical Therapist Help?

Physical therapists are trained to evaluate and treat plantar fasciitis.

When you are diagnosed with plantar fasciitis, your physical therapist will work with you to develop a program to decrease your symptoms that may include:

Stretching exercises to improve the flexibility of your ankle and the plantar fascia
Use of a night splint to maintain correct ankle and toe positions
Selection of supportive footwear and/or shoe inserts that minimize foot pronation and reduce stress to the plantar fascia
Application of ice to decrease pain and inflammation
Iontophoresis (a gentle way to deliver medication through the skin)
Taping of the foot to provide short-term relief

Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely required.

Can this Injury or Condition be Prevented?

Guidelines for the prevention or management of plantar fasciitis include:

Choosing shoes with good arch support
Replacing your shoes regularly, so that they offer arch support and provide shock absorption to your feet
Using a thick mat if you must stand in one place for much of the day
Applying good principles to your exercise program, such as including a warm-up and gradually building up the intensity and duration of your exercises to avoid straining the plantar fascia
Stretching your calves and feet before and after running or walking
Maintaining a healthy body weight

Real Life Experiences

Jason has worked as a cook in a restaurant kitchen for 5 years. He has gradually gained about 25 pounds over those years. He began to develop pain in both his heels about 2 months ago. He does not exercise.

Jason asks a friend who has received physical therapy for advice. His friend suggests he see a physical therapist to find the cause of his heel pain.

Jason's physical therapist conducts a detailed history, asking questions about his health, lifestyle, and work, and performs a thorough evaluation. Jason says that his heel pain is worst when he gets up in the morning. After a shower and walking around for a while, his pain diminishes. However, when he is cooking at the restaurant during the evening shift, his heel pain returns, extending to the balls of his feet. Due to food debris in the restaurant kitchen, Jason says he wears old beat-up sneakers to work.

After conducting a physical examination, Jason's therapist diagnoses plantar fasciitis. She teaches Jason several stretches to perform twice a day and designs a home exercise program that will fit his goals and lifestyle. The therapist recommends he choose a shoe with a good arch support and replace them when they are worn out. She also suggests an orthotic (shoe insert) to place into his new shoes. She instructs him to apply ice to the bottom of his feet several times throughout the day. The therapist does not prescribe a night splint at this time, because Jason has had symptoms for less than 3 months. The therapist recommends that for his general health, Jason begin a low-impact exercise program, including swimming and using an exercise bike. This will help him lose the excess weight he has gained without further aggravating his plantar fasciitis.

Jason follows the advice of his physical therapist. He purchases new footwear for work and performs the stretching exercises and icing as instructed. After 2 weeks, he is 90% pain-free. Jason keeps his follow-up visit with his physical therapist 1 month later to review his condition and adjust his home program.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat plantar fasciitis. However, you may want to consider:

A physical therapist who is experienced in treating people with orthopedic and sports injuries, particularly those with experience working with the ankle and foot
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy, meaning that this therapist has advanced knowledge, experience, and skills that may apply to your condition

You can find physical therapists who have these and other credentials by using Find a PT , the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have heel pain.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Physical Therapist's Guide to Headaches

Thu, 05 Oct 2017 00:00:00 GMT

Pain of any type that occurs in any part of the head is called a headache. There are many different types of headaches, with just as many causes. The International Headache Society describes several different categories of headache:

Tension-type
Migraine and cluster
Secondary headaches from an underlying condition, such as fever, infectious disease, sinus disorder, or in rare cases, a tumor or more serious illness
Cranial neuralgias, facial pain, and other headaches

Most headaches are harmless and resolve on their own, although severe headaches that recur frequently can affect your ability to do your daily activities and can reduce your quality of life.

There is effective treatment for almost every type of headache. The challenge lies in determining the type of headache, its cause, and in developing an appropriate treatment plan that will reduce both its frequency and intensity. Physical therapists can help determine the type of headache you have and are experts in managing pain from tension-type headaches.

What are Headaches?

Headaches, like back pain, are one of the most common of all physical complaints and can be one of the most frustrating to manage. Pain of any type that occurs in any part of the head is called a headache.

Tension-type headaches (also called muscle-spasm headaches) are the most common types of headaches in adults. They may be the result of a neck or jaw problem, poor posture, fatigue, or stress.

A problem in the neck, head, or jaw--such as an injury or arthritis--can lead to tension in the muscles at the back of the head and to increased pressure on the nerves to the face and head. Poor posture can cause these muscles to become overworked, which can trigger a headache.

How Does it Feel?

A tension-type headache typically begins at the back of the head and spreads to the top of the head and the eyes. You might feel an increase in facial pain along the cheeks near the jaw bone ( temporomandibular joint dysfunction ). People often describe a tightness, a sensation of someone tugging on their hair, or a feeling of wearing a tight cap. These headaches can worsen with specific positions--such as sitting at a desk--and may ease with rest. Back to Top

How Can a Physical Therapist Help?

Your physical therapist will conduct a thorough examination that includes a review of your health history. Your therapist will ask you questions and will perform tests to determine the most likely cause of your headaches. For example, your therapist might:

Ask you:
- to recall any previous injuries to your neck, head, or jaw
- the location, nature, and behavior of your pain and other symptoms
- to draw your areas of pain on a body diagram
- Perform tests of muscle strength and sensation
- Examine your posture when sitting, standing, and performing various activities
- Measure the range of motion of your neck, shoulders, and other relevant parts of your body
- Use manual therapy to evaluate the mobility of the joints and muscles in your neck
If it appears that you do have tension-type headaches, your physical therapist will work with you to design a plan of care to meet your goals. If the evaluation indicates that you may have a different type of headache--such as sinus, migraine, or cluster headache--your physical therapist likely will refer you to another health care professional for additional diagnostic tests and treatment.

Your physical therapist will work with you to correct the problems that are causing your pain and will help you learn to prevent headaches through simple changes in your posture and lifestyle:

Improve neck mobility. Physical therapists use a specialized technique called manual therapy to increase movement and relieve pain and to stretch the muscles of the back of the neck.

Improve your strength. Your physical therapist will teach you exercises to increase the strength of the muscles that help stabilize your upper back and neck to improve your posture and endurance and make it easier for you to sit or stand for longer periods of time without discomfort.

Improve your posture. Physical therapistswill teach you to ways to improve your posture. Whether it is simply pushing your chest out or pulling your shoulder blades backward and together, slight modifications to everyday living can make a vast improvement in posture.

Modify your workstation or home office. Tips may include:
- using a headset instead of a regular phone
- adjusting your computer screen so that it is no lower than the level of your eyes
- finding an appropriate desk chair
- adjusting the position of your computer mouse

Real Life Experiences

Sarah has noticed over the past 2 weeks that she has experienced a "pressure sensation" starting at the base of her head that travels to the front of her forehead when she is sitting at her computer for more than an hour. Her discomfort increases as the day goes on, but is less on weekends.

She decides to consult her physical therapist to see if physical therapy can help. Her therapist discusses her symptoms with her, examines her, and determines that her headache is a tension-type headache resulting from tightness in the muscles of the neck. The therapist works with Sarah to treat her pain, increase her flexibility and strength, and improve her posture.

The physical therapist also offers suggestions for making changes to her workspace. For instance, Sarah makes sure that her computer monitor is directly in front of her and at eye level; she buys a new desk chair; and she now uses a headset for her phone. She quickly notices that her headaches are much less severe and that she can work at the computer for longer periods of time. Soon, Sarah is headache-free.

Physical Therapist's Guide to Temporomandibular Joint Disorder

Mon, 18 Sep 2017 00:00:00 GMT

Temporomandibular joint disorder, or dysfunction, (TMD) is a common condition that limits the natural functions of the jaw, such as opening the mouth and chewing. It currently affects more than 10 million people in the United States. It is sometimes incorrectly referred to as simply “TMJ,” which represents the name of the joint itself. TMD affects more women than men and is most often diagnosed in individuals aged 20 to 40 years. Its causes range from poor posture, chronic jaw clenching, and poor teeth alignment, to fracture or conditions such as lockjaw, where the muscles around the jaw spasm and reduce the opening of the mouth. Physical therapists help people with TMD ease pain, regain normal jaw movement, and lessen daily stress on the jaw.

What Is Temporomandibular Joint Disorder?

Temporomandibular joint disorder (TMD) is a common condition that limits the natural function of the jaw, such as opening the mouth and chewing, and can cause pain. The temporomandibular joint (TMJ) is a hinge joint that connects your jaw to your skull in front of your ear. The TMJ guides jaw movement and allows you to open and close your mouth and move it from side to side to talk, yawn, or chew. TMD can be caused by:

Bad posture habits. One of the reasons TMD is so common is because many of us spend a great deal of time sitting at a desk, where we often hold our heads too far forward as we work. But there are many other kinds of bad posture. Sitting in the car for a long commute, working at a checkout station, always carrying your child on the same hip—all can place the head in an awkward position and cause jaw problems. The "forward head position" puts a strain on the muscles, disk, and ligaments of the TMJ. The jaw is forced to "rest" in an opened position, and the chewing muscles become overused.
Chronic jaw clenching ("bruxism"). Many people clench their jaws at night while they sleep, usually because of stress. Some clench their teeth throughout the day as well, especially when dealing with stressful situations. This puts a strain on the TMJ and its surrounding muscles.
Problems with teeth alignment ("malocclusion" ). If your teeth are positioned in an unusual way, greater stress is placed on the TMJ when performing everyday jaw motions, such as chewing.
Fracture . In a traumatic accident involving the face or head, a fracture to the lower jaw may result and cause TMD. Even when the fracture is fully healed, TMJ stiffness and pain may remain.
Surgery . Individuals may experience a loss of TMJ mobility and function following certain kinds of surgery to the face and jaw.
Trismus ("lockjaw"). This condition—where the jaw muscles spasm and the jaw cannot be fully opened—can be both a cause and a symptom of TMD. Other causes of trismus include trauma to the jaw, tetanus, and radiation therapy to the face and neck.
Displacement of the disc or soft-tissue cushion located between the ball and socket of the TMJ, which causes popping or clicking of the jaw and, frequently, pain.
Arthritis in the TMJ.

How Does it Feel?

The symptoms of TMD can be temporary or last for years. Jaw pain is the most common symptom.

CAUTION: Jaw pain also can be a symptom of heart attack. Seek medical care immediately if jaw pain is accompanied by:

Chest pain
Shortness of breath
Dizziness
Left arm pain
Numbness in the left arm
Nausea

TMD can cause the jaw to lock or get stuck in a certain position. You may experience headaches, feel pain when chewing certain foods, or have difficulty fully opening your mouth.

TMD symptoms include:

Jaw pain
Jaw fatigue
Difficulty opening your mouth to eat or talk
Ringing in your ears
Dizziness
Headache
Popping sounds in your jaw
Neck pain
Locking jaw

How Is It Diagnosed?

To identify the cause of your symptoms, your physical therapist may:

Review your medical history, and discuss any previous surgery, fractures, or other injuries to your head, neck, or jaw.
Ask you to describe your pain, including headaches, and observe any pain patterns in the neck and TMJ.
Conduct a physical examination of your jaw and neck, including the soft tissue and muscles in the area.

Your physical therapist will evaluate your posture and observe how your cervical spine—the upper portion of your spine, situated in your neck—moves. Your physical therapist will examine your TMJ to find out how well it functions and whether there are any abnormalities in your jaw motion.

If, after the examination, your physical therapist suspects that your pain is a result of the position ("alignment") of your teeth, the therapist will refer you to your dentist for further examination.

How Can a Physical Therapist Help?

Your physical therapist can help you restore the natural movement of your jaw and decrease your pain. Based on your condition, your therapist will select treatments that will work best for you. Your treatments may include:

Posture Education. If you sit with your head in an increased forward position, you are placing greater strain on the muscles beneath your chin, causing the lower jaw to pull back and the mouth to be in an open position even when resting, increasing stress on the TMJ. You also might be overworking the jaw muscles to force the jaw closed so your mouth isn't open all the time. Your physical therapist will teach you to be aware of your posture so that you can improve the resting position of your jaw, head, neck, breastbone, and shoulder blades when you're sitting and walking.

Improving Jaw Movement. Physical therapists use skilled hands-on techniques (manual therapy) to gently increase movement and relieve pain in tissues and joints. Your physical therapist may use manual therapy to stretch the jaw in order to restore normal joint and muscle flexibility or break up scar tissues ("adhesions") that sometimes develop when there is constant injury.

Your physical therapist will teach you special "low-load" exercises that don't exert a lot of pressure on your TMJ, but can strengthen the muscles of the jaw and restore a more natural, pain-free motion.

Special Pain Treatments. If your pain is severe, your physical therapist may provide treatments, such as electrical stimulation or ultrasound to reduce it.

Referral to a Dentist. If your TMD is caused by teeth alignment problems, your physical therapist can refer you to a dentist who specializes in TMD, who can correct the alignment with special appliances, such as "bite guards" that create a natural resting position to relax the TMJ, relieve pain, and improve jaw function.

Can this Injury or Condition be Prevented?

Maintaining good sitting posture is key to preventing TMJ problems. Your physical therapist will show you how to maintain better posture to prevent future episodes of TMD.

General Tips:

Place any work you are focusing on (written documents, computer screens) directly in front of you and not off to the side where you are forced to look in one direction for long periods of time.
Place your computer monitor at eye level so you don’t have to look up, down, or to the side throughout your day.
If you are on the phone at work for long periods of time, use a headset that allows the neck and jaw to remain in a restful ("neutral") position.
Avoid repetitive chewing, such as chewing gum.
Avoid smoking.
Avoid opening the jaw too wide.
Avoid eating hard or chewy foods.
Maintain good oral hygiene and tooth health.
Avoid sleeping on your stomach, which forces the neck to rotate to one direction in order to maintain an open airway, increasing stress on the TMJ.

Real Life Experiences

Eleanor is a paralegal with a busy workload. She spends long hours at her desk, reviewing documents and filing lengthy reports to meet multiple deadlines. She clenches her teeth when feeling stressed, and often complains to her coworkers about her stiff neck.

Eleanor is extremely proud of her daughter Rebecca, who is a star athlete. Last night, Eleanor attended Rebecca's state championship volleyball match. All season long, Eleanor has been cheering when Rebecca's team was winning, and grinding her teeth when the score was close. She's also been sitting on bleachers without any back support. Last night, Rebecca's team was ahead by 1 point; Rebecca set up for the winning point, and scored.

The next morning, Eleanor noticed her jaw was really sore, and it hurt to chew. Over the next week, the pain got worse. She called her physical therapist.

Eleanor's physical therapist conducted a thorough examination of her jaw and neck, and listened carefully as she described her recent experiences at her daughter's games and her high-stress job. He diagnosed TMD, and determined that her pain was related to postural habits and stress, not to the alignment of her teeth.

Eleanor's physical therapist began her treatment by teaching her how to maintain proper posture at work. He helped her achieve a proper resting position of the jaw to minimize pressure on the muscles around the jaw, and explained that this was the position she needed to maintain throughout her day. He asked her to focus on returning her jaw to this position whenever she began to feel tense.

He then applied specialized manual therapy techniques to her TMJ and surrounding muscles, and guided her through a few neck and middle-back strengthening exercises. He designed an individualized home-exercise program for Eleanor that included postural exercises, gentle stretches, and strengthening exercises for the neck and middle back. Finally, he taught her some gentle relaxation techniques to help her manage her stress.

After a month of receiving physical therapy treatments and sticking to her home-exercise program, Eleanor felt much less pain in the TMJ, and was able to fully open and close her mouth and chew normally.

This week, Eleanor attended Rebecca's first tennis match of the season. She brought her own stadium chair with back support. And, as she had promised her daughter and her physical therapist, she cheered less and was careful to not grind her teeth at the big points.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

Physical Therapist's Guide to Concussion

Fri, 08 Sep 2017 00:00:00 GMT

The Centers for Disease Control (CDC) estimates that 1.6 million to 3.8 million people experience concussions during sports and recreational activities annually in the United States. These numbers may be underestimated, as many cases are likely never reported. A physical therapist can assess symptoms to determine if a concussion is present, and treat the injury by guiding the patient through a safe and individualized recovery program.Concussion is a traumatic brain injury that can cause lasting effects on brain tissue and change the chemical balance of the brain. Concussion may cause physical, cognitive, and behavioral symptoms and problems, both short-term and long-term. Every concussion is considered a serious injury by health care providers. If you have experienced a head injury, seek medical help immediately.

What Is Concussion?

Concussion is a brain injury that occurs when the brain is violently shaken. The injury can happen during rapid movement changes (such as whiplash) or when the head is directly hit. This shaking or hitting of the head causes unpredictable injury to any area of the brain, resulting in immediate or delayed changes in the brain's chemistry and function. Less than 10% of concussions involve a loss of consciousness. Depending on which area of the brain suffers injury, many different temporary or permanent problems with brain function can occur.

Motor vehicle collisions (ie, head impact, whiplash)Concussions can occur at any age, from a variety of causes, including:

Work accidents (ie, falls, head trauma)
Playground accidents (ie, falling from a slide or swing)
Sports injury to the head or neck
Falls (which are the leading cause of concussions)
Violent events, such as:
- Physical abuse during which the head is shaken
- Being too close to a blast or explosion
- Direct blow to the head, face, or neck
- Assaults, domestic violence

Recovery from a concussion can take several weeks to several months and sometimes years, depending on many factors, including severity of the injury and the age of the person affected.

Concussion may occur along with other injuries, such as those to the neck and surrounding tissues, which should be managed by a licensed physical therapist. More serious brain injuries, such as bruising, bleeding, or tearing, may also occur and require the immediate care of a medical doctor, such as a neurosurgeon.

CAUTION: Concussions can be fatal or can result in permanent brain damage. S eek medical help from a licensed health care provider following any suspected head injury.

How Does it Feel?

A concussion is a brain injury; patients living with a brain injury often don’t have the language to express how they feel after injury. Therefore, it is important to work with a physical therapist who gets to know you, your family, teammates, and/or coworkers who may notice any changes in you.

Signs and Symptoms

There are many symptoms related to concussion, and they can affect your physical, emotional, and mental well-being. Some symptoms occur immediately, some a few hours after the injury, and some show up months or years after a concussion.

It is important to seek medical treatment immediately following any head injury. The risk of death or permanent brain damage from a concussion can be minimized by immediate and appropriate treatment from health care providers, like a physical therapist. Only health care providers have the knowledge and training to identify concussion in the maze of symptoms that can occur following a head injury.

Immediate and short-term symptoms

Physical symptoms of a concussion can include:

Headache
Dizziness
Difficulty with balance and coordination
Nausea/vomiting
Fatigue
Difficulty sleeping
Increased sleepiness
Double or blurred vision
Sensitivity to light and sound
Slurred speech
Glassy-eyed stare
Seizures

Cognitive (thinking) symptoms can include:

Difficulty with short-term or long-term memory
Confusion
Slowed "processing" (eg, a decreased ability to think through problems)
"Fogginess"
Difficulty concentrating
Worsening grades in school

Emotional symptoms can include:

Irritability
Restlessness
Anxiety
Depression
Mood swings
Aggression
Decreased tolerance of stress
Change in personality or behavior

Longer-term symptoms

Loss of libido
Loss of menses/menstruation
Growth problems (children)
Fatigue
Weight gain
Low blood pressure
Muscle weakness
Chronic headaches or dizziness
Muscle spasticity
Early dementia/chronic traumatic encephalopathy (brain disorder)

Some concussion symptoms do not go away in the expected time frame. These symptoms may need further testing and treatment by a team of health care providers, including a physical therapist.

Postconcussion syndrome is the term applied to symptoms such as headaches or dizziness that persist for weeks or months after the initial injury.

Second-impact syndrome is a serious, although preventable, complication that can occur after a concussion. If a person who has suffered a recent concussion experiences another concussion, permanent brain damage or death can occur. Permanent brain damage can include learning disabilities, personality changes, walking disability, or other brain or nerve disabilities. Research suggests that a person who suffers a second concussion before the initial concussion has healed, has a 100% chance of permanent brain damage, and a 50% chance of dying.

An example of second-impact syndrome would be a football player who suffers a concussion in a game, keeps playing, and is hit again; or a person who suffers a concussion from whiplash in a car accident, and then falls at home and endures another concussion very soon after the initial injury.

Extreme care should be taken after a concussion to prevent a second injury.

Athletes who suffer a concussion during practice or competition must be removed immediately from play, in order to prevent subsequent concussions and second-impact syndrome. A physical therapist will work to develop safe guidelines for return to play, return to work, and return to life’s daily requirements.

A longer recovery time may be required for those with a history of prior concussions, eye tracking/movement issues from childhood, migraines, attention deficit hyperactivity disorder, or a learning disability. It's important to disclose your entire medical health history to your physical therapist.

How Is It Diagnosed?

Concussion is most often diagnosed through careful testing by your health care provider, such as a physical therapist. Unfortunately, no single test or tool exists to diagnose a concussion. The diagnosis usually does not rely on hi-tech testing, such as an MRI or CT scan, because brain scans often do not show any brain abnormality, even when the person has symptoms of a concussion.

Your physical therapist will ask you many questions to understand all of the symptoms that you are experiencing. He or she also will perform numerous tests to identify problems caused by a concussion, including muscle strength, coordination, balance, sight, smell, hearing, and memory tests.

During treatment, your physical therapist will repeat the same questions and tests frequently to gauge your progress and help judge when you can return to work, school, sport, or recreational activities.

If you are an athlete who underwent preseason memory (neuropsychological) testing, your physical therapist may collaborate with the health care provider who performed that testing to help determine if you have a concussion.

Your physical therapist may also examine your neck for problems following a concussion. Neck injuries can occur at the same time as concussions, and can cause or increase headaches and dizziness.

How Can a Physical Therapist Help?

Physical therapists can evaluate and treat many problems related to concussion. Because no 2 concussions are the same, a physical therapist will examine your neurological, orthopedic, and cardiovascular systems in order to best prescribe a routine to address your particular symptoms and your needs in all of your daily environments.

Treatment may include:

Rest and recovery. Your physical therapist will help you and your family understand why you should limit any kind of activity (daily tasks, work, school, sports, recreation, the use of electronics) after a concussion, until it is safe to return to these activities. A period of rest helps the brain heal and helps symptoms clear up as quickly as possible. Your physical therapist will prescribe the rest and recovery program most appropriate for your condition.

Restoring strength and endurance. The physical and mental rest required after a concussion can result in muscle weakness, and a decrease in physical endurance. Your physical therapist can help you regain your strength and endurance when the right time comes, without making your concussion symptoms worse. It is common for elite-level athletes and fit “weekend warriors” to experience exercise intolerance with concussion and brain injury. Your physical therapist will work with you to identify and treat your particular concussion symptoms.

Your physical therapist will design a therapeutic exercise program just for you, and closely monitor your symptoms as you participate in the program.

Stopping dizziness and improving balance. If you have dizziness or difficulty with your balance following a concussion, a type of physical therapy called vestibular physical therapy may help. The vestibular system, which includes the inner ear and its connections with the brain, helps you keep your balance and prevent dizziness. A qualified vestibular physical therapist may be able to help reduce or stop your dizziness or balance problems after a concussion by applying special treatments or teaching you specific exercises, some of which you may be able to do at home.

Reducing headaches. Your physical therapist will assess the different possible causes of your headaches, and use specific treatments and exercises to reduce and eliminate them. Treatment may include stretches, strength and motion exercises, eye exercises, hands-on techniques like specialized massage, and the use of technologies such as electrical stimulation.

Returning to normal activity or sport. As symptoms ease and you are able to regain your normal strength and endurance without symptoms returning, your physical therapist will help you gradually add normal activities back into your daily routine. Your physical therapist will help you avoid overloading the brain and nervous system as you increase your activity level. Overloading the brain during activity after a concussion interferes with the healing of the brain tissue, and can make your symptoms return. Your physical therapist will help you return to your normal life and sport activities in the quickest and safest way possible, while allowing your brain to properly heal.

Can this Injury or Condition be Prevented?

While initial injuries can’t always be prevented, it is very important to prevent further injuries to those with concussion. The injured person should be closely protected until all symptoms have cleared, and normal activity can resume.

The risk of concussion can be greatly reduced by taking the following precautions:

Avoid motor vehicle collisions:
- Drive defensively, not aggressively.
- Eliminate distractions while driving, such as eating, talking on a cell phone, or texting.
- Choose cars with airbags.
- Make sure the airbags in your car are in good working order.
- Avoid risky behavior in sports:
Absolutely avoid football techniques that increase the risk of concussion, such as "spearing" and headbutting.
Avoid or limit "heading" the ball in soccer.
Don’t ignore or hide signs of concussion, even in an important game or competition. Report them immediately to your coach.
Stay current with state and federal guidelines.
- Remember that neither helmets nor mouth guards prevent concussions.
- Clear your walking areas at home of any objects that might increase the risk of falling, such as loose throw rugs, dropped objects, loose flooring, torn or rumpled carpets, and pet toys or dishes.
- Make sure that all traffic areas in your home are well-lit.
- Avoid exposure to blast explosions and violent events.
- Do not shake babies, or anyone of any age!

It is imperative to prevent second-impact syndrome after an initial concussion. The injured person should be closely protected until all symptoms have cleared, and normal activity can resume.

Real Life Experiences

Sara is a 15-year-old star soccer player. After today's game, she admits to her parents that she is feeling a bit dizzy after "heading" the ball a number of times. She says a little dizziness is “common” for her, but now she has a headache and the bright headlights of oncoming cars are hurting her eyes. Sara has trouble concentrating at home as she tries to do her homework. She also has trouble falling asleep. Her dizziness gets worse when she changes her head position. Her parents worry that she may have a concussion, and check on her throughout the night. They call their physical therapist the next morning, and take her to see him right away.

Sara's physical therapist asks her all about her symptoms. He tests her eye motion, balance, strength, coordination, memory, and face and neck motion. He gently touches her neck and upper shoulder muscles to check for tightness. He also assesses her heart rate’s response to exercise. After a thorough examination, he determines that Sara has indeed suffered a concussion and needs to begin treatment immediately.

First, he explains to Sara and her parents that she will need to "rest her brain" for a few days. That means that she will avoid school, homework, sports, exercise, reading, and TV, cell phone, tablet and computer use, plus anything else that makes her symptoms worse. He encourages Sara to sleep as much as she wants. He explains the importance of avoiding second-impact syndrome. He learns from Sara that her coach had all the athletes take a preseason memory test, so he arranges for her to be retested by the same health care provider.

Sara's physical therapist then begins to address her dizziness by performing some special techniques for the inner ear. After a few minutes, Sara notes that her dizziness is much less. He then gently treats Sara’s tight neck by applying electrical stimulation and specialized massage techniques. He teaches her some easy stretches that she can do at home, and reminds Sara to “rest her brain” for the rest of the day. He gives her parents a handout of directions for symptoms to watch for in Sara while at home, and when to call him or their family physician.

When Sara returns for her next physical therapy treatment, she reports that she has slept much better. She says bright lights are not hurting her eyes as much, and her dizziness is almost gone. Her physical therapist rechecks all the tests he performed before, and notes that she has better neck motion. At the end of her treatment session, Sara says that her headache seems to be less as well.

Sara returns for physical therapy treatment several more times over the next week, and her symptoms rapidly improve.

In the second week, Sara is free of symptoms for 48 hours; her physical therapist determines that she is ready to try a gradual return to activity. He develops a “return to activity” plan, using Sara’s goals and input. She starts performing a little bit of aerobic exercise and low-level strength training during her physical therapy treatments. Her physical therapist watches her closely to see if any symptoms and problems return during the exercises. Sara is able to gradually increase her exercise each day, without the symptoms returning. She also goes back to school for half-days.

During the third week of treatment, Sara's physical therapist determines that she is ready to try easy soccer drills. She is able to remain at school for full days, now, and to complete her homework, with no return of symptoms.

In the fourth week of treatment, Sara is able to perform vigorous soccer drills during her physical therapy treatments, without the concussion symptoms returning at all—even within the following 24 hours. Her physical therapist determines that Sara is ready to attend a short soccer practice; he collaborates with her soccer coach to plan a gradual return to practice and games. Her physical therapist advises her to avoid "heading" the soccer ball for several weeks, and to limit all use of that technique in the future.

Six weeks after the concussion, Sara plays her first game back with her team, is symptom-free, and helps set up a winning goal!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

Physical Therapist's Guide to Anterior Cruciate Ligament (ACL) Tear

Mon, 03 Apr 2017 00:00:00 GMT

An anterior cruciate ligament (ACL) tear is an injury to the knee commonly affecting athletes, such as soccer players, basketball players, skiers, and gymnasts. Nonathletes can also experience an ACL tear due to injury or accident. Approximately 200,000 ACL injuries are diagnosed in the United States each year. It is estimated that there are 95,000 ruptures of the ACL and 100,000 ACL reconstructions performed per year in the United States. Approximately 70% of ACL tears in sports are the result of noncontact injuries, and 30% are the result of direct contact (player-to-player, player-to-object). Women are more likely than men to experience an ACL tear. Physical therapists are trained to help individuals with ACL tears reduce pain and swelling, regain strength and movement, and return to desired activities.

What is an ACL Tear?

The ACL is one of the major bands of tissue (ligaments) connecting the thigh bone (femur) to the shin bone (tibia) at the knee joint. It can tear if you:

Twist your knee while keeping your foot planted on the ground.
Stop suddenly while running.
Suddenly shift your weight from one leg to the other.
Jump and land on an extended (straightened) knee.
Stretch the knee farther than its usual range of movement.
Experience a direct hit to the knee.

How Does it Feel?

When you tear the ACL, you may feel a sharp, intense pain or hear a loud "pop" or snap. You might not be able to walk on the injured leg because you can’t support your weight through your knee joint. Usually, the knee will swell immediately (within minutes to a few hours), and you might feel that your knee "gives way" when you walk or put weight on it.

How Is It Diagnosed?

Immediately following an injury, you may be examined by a physical therapist, athletic trainer, or orthopedic surgeon. If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes reviewing your health history. Your physical therapist will ask:

What you were doing when the injury occurred.
If you felt pain or heard a "pop" when the injury occurred.
If you experienced swelling around the knee in the first 2 to 3 hours following the injury.
If you felt your knee buckle or give out when you tried to get up from a chair, walk up or down stairs, or change direction while walking.

Your physical therapist may perform gentle "hands-on" tests to determine the likelihood that you have an ACL tear, and may use additional tests to assess possible damage to other parts of your knee.

An orthopedic surgeon may order further tests, including magnetic resonance imaging (MRI), to confirm the diagnosis and rule out other possible damage to the knee.

Surgery

Most people who sustain an ACL tear will undergo surgery to repair the tear; however, some people may avoid surgery by modifying their physical activity to relieve stress on the knee. A select group can actually return to vigorous physical activity following rehabilitation without having surgery.

Your physical therapist, together with your surgeon, can help you determine if nonoperative treatment (rehabilitation without surgery) is a reasonable option for you. If you elect to have surgery, your physical therapist will help you prepare both for surgery and to recover your strength and movement following surgery.

How Can a Physical Therapist Help?

Once an ACL tear has been diagnosed, you will work with your surgeon and physical therapist to decide if you should have surgery, or if you can recover without surgery. If you don’t have surgery, your physical therapist will work with you to restore your muscle strength, agility, and balance, so you can return to your regular activities. Your physical therapist may teach you ways to modify your physical activity in order to put less stress on your knee. If you decide to have surgery your physical therapist can help you before and after the procedure.

Treatment Without Surgery

Current research has identified a specific group of patients (called "copers") who have the potential for healing without surgery following an ACL tear. These patients have injured only the ACL, and have experienced no episodes of the knee "giving out" following the initial injury. If you fall into this category, based on the specific tests your physical therapist will conduct, your therapist will design an individualized physical therapy treatment program for you. It may include treatments such as gentle electrical stimulation applied to the quadriceps muscle, muscle strengthening, and balance training.

Treatment Before Surgery

If your orthopedic surgeon determines that surgery is necessary, your physical therapist can work with you before and after your surgery. Some surgeons refer their patients to a physical therapist for a short course of rehabilitation before surgery. Your physical therapist will help you decrease your swelling, increase the range of movement of your knee, and strengthen your thigh muscles (quadriceps).

Treatment After Surgery

Your orthopedic surgeon will provide postsurgery instructions to your physical therapist, who will design an individualized treatment program based on your specific needs and goals. Your treatment program may include:

Bearing weight . Following surgery, you will use crutches to walk. The amount of weight you are allowed to put on your leg and how long you use the crutches will depend on the type of reconstructive surgery you have received. Your physical therapist will design a treatment program to meet your needs and gently guide you toward full weight bearing.

Icing and compression. Immediately following surgery, your physical therapist will control your swelling with a cold application, such as an ice sleeve, that fits around your knee and compresses it.

Bracing. Some surgeons will give you a brace to limit your knee movement (range of motion) following surgery. Your physical therapist will fit you with the brace and teach you how to use it safely. Some athletes will be fitted for braces as they recover and begin to return to their sports activities.

Movement exercises. During your first week following surgery, your physical therapist will help you begin to regain motion in the knee area, and teach you gentle exercises you can do at home. The focus will be on regaining full movement of your knee. The early exercises help with increasing blood flow, which also helps reduce swelling.

Electrical stimulation. Your physical therapist may use electrical stimulation to help restore your thigh muscle strength, and help you achieve those last few degrees of knee motion.

Strengthening exercises. In the first 4 weeks after surgery, your physical therapist will help you increase your ability to put weight on your knee, using a combination of weight-bearing and non-weight-bearing exercises. The exercises will focus on your thigh muscles (quadriceps and hamstrings) and might be limited to a specific range of motion to protect the new ACL. During subsequent weeks, your physical therapist may increase the intensity of your exercises and add balance exercises to your program.

Balance exercises. Your physical therapist will guide you through exercises on varied surfaces to help restore your balance. Initially, the exercises will help you gently shift your weight on to the surgery leg. These activities will progress to standing on the surgery leg, while on firm and unsteady surfaces to challenge your balance.

Return to sport or activities. As athletes regain strength and balance, they may begin running, jumping, hopping, and other exercises specific to their individual sport. This phase varies greatly from person-to-person. Physical therapists design return-to-sport treatment programs to fit individual needs and goals.

Can this Injury or Condition be Prevented?

Much of the research on ACL tears has been conducted with female collegiate athletes, because women are 4 to 6 times more likely to experience the injury. Preventive physical therapy programs have proven to lower ACL injury rates by 41% for female soccer players. Researchers have made the following recommendations for a preventive exercise program:

The program should be designed to improve balance, strength, and sports performance. Strengthening your core (abdominal) muscles is key to preventing injury, in addition to strengthening your thigh and leg muscles.
Exercises should be performed 2 or 3 times per week and should include sport-specific exercises.
The program should last no fewer than 6 weeks.

Although most exercise studies have been conducted with female athletes, the findings may benefit male athletes as well.

Real Life Experiences

Anita is a 20-year-old student at a local university, and a star basketball player. Her team is off to a great start this year; the buzz around campus is that this could be a dream team!

But tonight, when Anita goes up for a rebound and lands off-balance, she hears a "pop" in her left knee and feels a sharp pain. When she tries to walk, she realizes that she can't put weight on her left leg. She's led back to the training room, where the school physical therapist conducts an evaluation. The test results indicate injury, and the physical therapist notices an increase in swelling around the knee just 30 minutes after the incident. She suspects an ACL tear, and refers Anita to an orthopedic surgeon. The next day, the surgeon confirms the diagnosis of an ACL tear, and tells Anita that her injury requires surgery.

After a short course of treatment by her new local physical therapist, including pain and swelling management, manual (hands-on) therapy, and knee range-of-motion and strengthening exercises, Anita has surgery the following month. Her surgeon schedules her to receive physical therapy 3 days after her surgery. She is advised to ice and elevate the knee several times per day.

Three days after surgery, Anita returns to her local physical therapist to begin her rehabilitation. He shows her how to use her crutches properly to gently begin to put weight on the operative knee. He guides her to contract/tighten the quadriceps muscle, and gently performs manual (hands-on) stretches for her to straighten the knee.

Over the next few weeks, Anita is able to gradually stop using her crutches, and begins to put her full weight on her left leg. She can also fully straighten her knee and tighten her quadriceps muscle without help from her physical therapist. She learns exercises she can safely perform at home.

After 5 weeks, Anita is able to walk normally, fully extending her knee with no pain or feelings of instability. During the next 2 months, she and her physical therapist work on her strength and balance. She finds the hardest exercises are the balance exercises, which require her to balance on a piece of foam or a rocker board while throwing a ball.

About 4 months after surgery, Anita's physical therapist designs a gentle jogging program for her. At 5 months, he allows her to begin a running program. He also adds exercises during Anita's physical therapy sessions that mimic basketball activities such as rebounding or taking a jump shot. During these activities, Anita’s physical therapist teaches her proper landing techniques to lessen the chance of reinjuring her knee when she returns to play.

After 8 months, Anita is allowed to practice with her team. They are thrilled and excited to see their star player is back. Last year was a good year for the team, but it ended in the first round of the playoffs.

Anita and her team begin a new year of full competition 11 months after her surgery. With Anita back in top form, they make the playoffs, blast through to the finals – and bring home the trophy!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of ACL tears. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are listed by year and are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.

Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DN. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med. 2016;7:21–32. Free Article.

Anderson MJ, Browning WM III, Urband CE, Kluczynski MA, Bisson LJ. A systematic summary of the systematic reviews on the topic of the anterior cruciate ligament. Orthop J Sports Med. 2016;4:2325967116634074. Free Article.

Anterior cruciate ligament injury. Medscape website. Accessed June 16, 2016 .

Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Godges JJ; Orthopaedic Section of the American Physical Therapy Association. Knee stability and movement coordination impairments: knee ligament sprain. J Orthop Sports Phys Ther. 2010;40:A1–A37. Free Article.

Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. J Orthop Sports Phys Ther. 2010;40:705-721. Free Article .

Nyland J, Brand E, Fisher B. Update on rehabilitation following ACL reconstruction. Open Access J Sports Med. 2010;1:151–166. Free Article.

Risberg MA, Holm I. The long-term effect of 2 postoperative rehabilitation programs after anterior cruciate ligament reconstruction: a randomized controlled clinical trial with 2 years of follow-up. Am J Sports Med. 2009;37:1958–1966. Free Article .

Gilchrist J, Mandelbaum BR, Melancon H, et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med. 2008;36:1476–1483. Article Summary on PubMed .

Hurd WJ, Axe MJ, Snyder-Mackler L. A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury: Part 1, outcomes. Am J Sports Med. 2008;36:40-47. Free Article .

Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006;36:267–288. Article Summary on PubMed .

Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med. 2006;34:490–498. Article Summary on PubMed .

Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichol CE. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med. 2005;33:1751–1767. Article Summary on PubMed .

Fitzgerald GK, Piva SR, Irrgang JJ. A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2003;33:492–501. Article Summary on PubMed .

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Physical Therapist's Guide to Degenerative Disk Disease

Wed, 22 Feb 2017 00:00:00 GMT

It's estimated that as many as 75% of us will have some form of back or neck pain at some point in our lifetime. The good news is that most of us will recover without the need for surgery—and conservative care such as physical therapy usually gets better results than surgery. Degenerative disk disease (DDD) is one cause of back and neck pain. Usually the result of the natural aging process, degenerative disk disease (DDD) is a type of osteoarthritis of the spine.

What Is Degenerative Disk Disease?

Your spine is made up of 33 vertebrae that are stacked on top of one another. Between each of these vertebrae is a rubbery piece of cartilage called an "intervertebral disk." ( See images: Degenerative Disk Disease - Cervical | Lumbar ) Imagine the disk as a tire, with gelatin filling the hole in the tire. The tire is called the "annulus," and the gelatin is called the "nucleus." When we're young—under 30 years of age—the disk is made mostly of gelatin. As we age, and sometimes with injury or excessive wear and tear, we start to lose some of that gelatin, and the volume of the disk decreases, resulting in less space between the vertebrae. The disk becomes flatter and less flexible, leaving less space between each set of vertebrae. Sometimes bone spurs form in response to this degeneration of the disk, making the spine stiff. When the rough surfaces of the vertebral joints rub together, pain and inflammation may result. Nerves may become irritated or compressed.

Disk degeneration might occur throughout several regions of the spine, or it might be limited to one disk. When it's part of the natural aging process, the degeneration does not always lead to pain. For some people, however, it can cause a great deal of pain and disability.

You are more likely to develop DDD if you:

Smoke
Are obese
Do heavy physical work
Don't get very much exercise

How Does it Feel?

You might have mild to intense neck and back pain—or no pain at all:

A degenerative disk in the neck can cause pain in the arm, shoulder,or neck
A degenerative disk in the low back might cause pain in the back, buttocks, or legs

The pain is often made worse by sitting, bending, and reaching. It may be worse first thing in the morning and after staying in any one position for a long time.

In severe cases, when DDD results in pressure on the nerves, it can lead to numbness, tingling, and even weakness in the arms or legs.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes a review of your medical history and will use screening tools to determine the likelihood of DDD. For example, the therapist may:

Ask you very specific questions about the location and behavior of your pain, weakness, and other symptoms
Ask you to fill out a body diagram to indicate specific areas of pain, numbness, and tingling
Perform tests of muscle strength and sensation to determine the severity of the pressure on your nerves
Examine your posture and observe how you walk and perform other activities
Measure the range of motion of your spine and your arms and legs
Use manual therapy to evaluate the mobility of the joints and muscles in your spine
Test the strength of important muscle groups

If you have muscle weakness and loss of sensation or very severe pain, special diagnostic tests, such as x-rays, may be needed. Physical therapists work closely with physicians and other health care providers to make certain that an accurate diagnosis is made and the appropriate treatment is provided.

Research shows that in all but the most extreme cases (usually involving muscle weakness or high levels of pain), conservative care, such as physical therapy, has better results than surgery.

After the evaluation, if your therapist suspects you have DDD and there are no major medical problems, treatment can begin right away.

How Can a Physical Therapist Help?

Your physical therapist's overall purpose is to help you continue to participate in your daily activities and life roles. The therapist will design a treatment program based on both the findings of the evaluation and your personal goals. The treatment program likely will be a combination of exercises.

Relieve Pain and Increase Movement

Your therapist will design:

Stretching and flexibility exercises to improve mobility in the joints and muscles of your spine and your extremities—improving motion in a joint is often the key to pain relief
Strengthening exercises—strong trunk muscles provide support for your spinal joints, and strong arm and leg muscles help take some of the workload off your spinal joints
Aerobic exercise, which has been shown to be helpful in relieving pain, promoting a healthy body weight, and improving overall strength and mobility—all important factors in managing DDD

This might sound like a lot of exercise, but don't worry: research shows that the more exercise you can handle, the quicker you'll get rid of your pain and other symptoms.

Your physical therapist also might decide to use a combination of treatments:

Manual therapy to improve the mobility of stiff joints and tight muscles that may be contributing to your symptoms
Posture and movement education to show you how to make small changes in how you sit, stand, bend, and lift—even in how you sleep—to help relieve your pain and help you manage your condition on your own
Special pain treatments—such as ice, electrical stimulation, or a short course of traction—for pain that is severe and not relieved by exercise or manual therapy

Once your pain is gone, it will be important for you to continue your new posture and movement habits to keep your back healthy.

Can this Injury or Condition be Prevented?

DDD usually is a natural result of aging. Research has not yet shown how to prevent it—but you can make choices that lessen its impact on your life and slow its progression. Many physical therapy clinics conduct regular educational seminars to help people in the community learn to take care of their backs and necks. These seminars often are free and provide demonstrations along with written information about exercises for the back and neck, instruction on proper lifting and sitting postures, and other tips to keep your back healthy.

Your physical therapist can help you develop a fitness program that takes into account your DDD. There are some exercises that are better than others for people with DDD, and your therapist will educate you about them. For instance:

Exercising in water can often be a great way to stay physically active when other forms of exercise are painful.
Exercises involving lots of twisting and bending need to be avoided in some individuals.
Weight training exercises, though very important, need to be done with proper form to avoid stress to the back and neck.

Physical Therapist's Guide to Osteoporosis

Wed, 22 Feb 2017 00:00:00 GMT

Osteoporosis is a common disease that causes a thinning and weakening of the bones. It can affect people of any age. Women have the greatest risk of developing the disease, although it also occurs in men. Osteoporosis affects 55% of Americans aged 50 or older; one-half of women and a quarter of men will fracture a bone.

Thin bones are the cause of 1.5 million fractures per year in the United States— hip fractures alone result in 300,000 hospitalizations. It is important to diagnosis osteoporosis early so that steps can be taken to lessen the risk of fracture.

What is Osteoporosis?

Osteoporosis is a bone disease characterized by low-bone density (thickness of the bone), decreased bone strength, and a change in the bone structure, which can lead to an increased risk of fracture. The normal bone structure becomes thinned out and porous, lessening the ability of the bone to withstand the typical forces that are applied in everyday living. Fractures from osteoporosis and low-bone density can be serious, causing pain and affecting your quality of life.

Bone is living tissue. Normally, one type of cell removes bone and another type of cell adds bone in a balanced, ongoing process. In osteoporosis, bones weaken when not enough new bone is formed and/or too much bone is lost. This imbalance commonly begins in women during the first 5 years of menopause. However, it can also occur in men and in children, often due to diseases that affect bone development, such as Celiac disease, inflammatory bowel disease, rheumatoid arthritis, spina bifida, cystic fibrosis, or kidney disease. Some medicines, such as steroids, may increase your risk for developing osteoporosis. Athletes who are underweight during the time of peak bone development are also susceptible.

There are many factors that can cause a person to be at risk for developing the disease. It is important to know your risks so that you can be diagnosed and proactive in your treatment.

Risk Factors for Osteoporosis

Noncontrollable Risks

Female gender
Small frame
Advanced age
Hormone levels
Genetics
Predisposing medical conditions

Controllable Risks

Cigarette smoking
Excessive alcohol intake
Inactive lifestyle
Excessive caffeine intake
Lack of weight-bearing exercise
Drugs (eg, steroids, heparin)
Poor health
Low weight
Calcium-poor diet
Low vitamin D levels

How Does it Feel?

Osteoporosis is a disease that can be "silent," and there may be no outward symptoms until a fracture occurs. If you are middle-aged or older, you may notice a loss of height or the appearance of a humpback, although this is not a diagnosis for osteoporosis in and of itself. Fractures may occur in situations that would not occur in persons with healthy bones, such as breaking an ankle after stepping off a curb, breaking a hip with a fall, or breaking a rib when opening a window. These are called fragility fractures and are a red flag for bone disease. Spinal compression fractures, particularly those in the upper back or thoracic spine (area between the neck and the lower back), are the most common fractures, followed by hip and wrist fractures.

How Is It Diagnosed?

If you are seeing a physical therapist for back pain or other rehabilitation issues, he or she will review your medical, family, medication, exercise, dietary, and hormonal history, conduct a complete physical examination, and determine your risk factors for osteoporosis. The assessment may lead the therapist to recommend further testing.

Osteoporosis is best diagnosed through a quick and painless specialized x-ray called the DXA, which measures bone density. The results are reported using T-scores and Z-scores.

The T-score compares your score to that of healthy 30-year-old adults. If you have a T-score of -1 or less, you have a greater risk of having a fracture.
The Z-score compares your bone mineral density to those of the same sex, weight, and age. It is used for those whose bone mass has not yet peaked, premenopausal women, and men older than 50.

Other methods of measuring bone density include x-ray, ultrasound, and CT scan.

How Can a Physical Therapist Help?

Your physical therapist can develop a specific program based on your individual needs to help improve your overall bone health, keep your bones healthy, and help you avoid fracture. Your physical therapist may teach you:

Specific exercises to build bone or decrease the amount of bone loss
Proper posture
How to improve your balance so as to reduce your risk of falling
How to adjust your environment to protect your bone health

Healthy bone is built and maintained through a healthy lifestyle. Your physical therapist will teach specific exercises to meet your particular needs.

The exercise component for bone building or slowing bone loss is very specific and similar for all ages. Bone grows when it is sufficiently and properly stressed, just as muscle grows when challenged by more than usual weight. Two types of exercise are optimal for bone health, weight-bearing and resistance.

It is best for a physical therapist to provide your individual bone-building prescription to ensure that you are neither over- or under-exercising. Typically, exercises are performed 2 to 3 times a week as part of an overall fitness program.

Weight-bearing exercises

Dancing
Jogging
Racquet sports
Heel drops
Stomping

Resistance exercises

Weight lifting
Use of exercise bands
Water resistance
Gravity resistance (eg,push-ups, sustained yoga poses)

If you are diagnosed with osteoporosis or low-bone density , your physical therapist will work with you to:

Build bone or lessen the amount of bone loss at areas most vulnerable to fracture through exercise—hip, spine, shoulder, arms
Improve your dynamic balance to avoid falls
Improve your posture and your work and living environments
Help you avoid exercises and movements that may contribute to spinal fracture, including any type of sit-up or crunch, and excessive spinal or hip twisting

Conservative treatment of a fracture includes bed rest and appropriate pain medication. Your physical therapist will work with you to:

Decrease your pain through positioning and other pain-relieving modalities
Provide appropriate external devices, such as bracing, to promote healing and improve posture
Decrease your risk of a fall, strengthen your muscles, and improve your postural alignment

If your pain lasts longer than 6 weeks following a fracture, you can discuss surgical options with the physical therapist, primary care physician, and surgeon.

For children and adolescents , physical therapists can educate families and youth groups on proper exercise, posture, and the need to move daily. Children with health issues such as spina bifida, diabetes, Crohn's disease, and cerebral palsy are at a greater risk for bone disease and can particularly benefit from the guidance of a physical therapist. The majority of bone is built during adolescence and peaks by the third decade of life.

If you are middle-aged and older , youmay begin to notice postural, balance, and strength changes. Your physical therapist will work with you to:

Optimize your exercise program to promote bone growth or lessen bone loss
Improve your dynamic balance to avoid falls
Improve your posture
Improve the strength of your back muscles
Improve your hip strength and mobility

Can this Injury or Condition be Prevented?

Osteoporosis can be prevented by building adequate bone density through childhood, adolescence, and early adulthood. Building strong bones requires an adequate intake of calcium and vitamin D, and regular exercise.

There are steps to take to improve bone health at any age. An active lifestyle that includes resistance and weight-bearing exercise is important to maintain healthy bone. It is also important to avoid habits that promote bone loss, such as smoking, excessive alcohol consumption, and an inadequate intake of calcium in your diet. Maintaining good body mechanics and posture also contribute to good bone health. We have no control over the genetic tendencies we have inherited, but we can choose to manage osteoporosis through proper medication, diet, and appropriate exercise

As with any health issue, an overall healthy lifestyle is important for staying well.

Real Life Experiences

Anna is 69 years old and has a history of breast and ovarian cancer. She has had a total knee replacement due to arthritis. She walks with a cane because of chronic knee and ankle pain, and she has experienced a loss of balance. She has a very rounded upper back, and low back pain. She is seeking the help of a physical therapist.

Anna's physical therapist performs an assessment that includes a medical review for other health issues and osteoporosis risk factors. He evaluates her range of motion and strength, testing her arms, legs, and trunk, especially her upper back. He tests the flexibility of her spine and her balance, walking ability, and risk of falling. Anna's walking style is uneven and she leans heavily on her cane. A DXA scan reveals that Anna has lost bone density in her spine and both hips. An x-ray shows that she has painless compression fractures of her spine. Her physical therapist diagnoses osteoporosis of the spine, and he photographs her posture for future comparison.

Anna first works with her physical therapist to improve her posture and knee function through flexibility and strengthening exercises, so she can walk more normally while working on her balance to lower her fall risk. He teaches her safe trunk movement to avoid spinal fracture. Anna agrees to wear a dynamic trunk brace 2 hours a day to help make her posture more upright. She practices weight-bearing exercises with considerations for her arthritis, and she is also given resistive strengthening exercises for her spine and hip. Anna's physical therapist designs a gentle home exercise program for her as well.

By her last visit, the flexibility and strength of Anna’s trunk and legs and her tolerance of physical activity has improved. The quality of her walking and dynamic balance is measurably improved, and her risk of falling has decreased. Anna feels more confident about managing her condition, and she looks forward to new life experiences.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat those with osteoporosis. However, if you have a diagnosis of osteoporosis or low-bone density, you may want to consider:

A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy (OCS) or geriatric physical therapy (GCS). This therapist has advanced knowledge, experience, and skills that may apply to your condition.
A physical therapist that specializes in the treatment of osteoporosis.

You can find physical therapists with these and other credentials by using Find a PT, the online tool by the American Physical Therapy Association that can help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have osteoporosis.

Physical Therapist's Guide to Osteoarthritis

Wed, 22 Feb 2017 00:00:00 GMT

"Arthritis" is a term used to describe inflammation of the joints. Osteoarthritis (OA) is the most common form of arthritis and usually is caused by the deterioration of a joint. Typically, the weight-bearing joints are affected, with the knee and the hip being the most common.

An estimated 27 million Americans have some form of OA. According to the Centers for Disease Control and Prevention, 1 in 2 people in the United States may develop knee OA by age 85, and 1 in 4 may develop hip OA in their lifetime. Until age 50, men and women are equally affected by OA; after age 50, women are affected more than men. Over their lifetimes, 21% of overweight and 31% of obese adults are diagnosed with arthritis.

OA affects daily activity and is the most common cause of disability in the US adult population. Although OA does not always require surgery, such as a joint replacement, it has been estimated that the use of total joint replacement in the United States will increase 174% for hips and 673% for knees by 2030.

Physical therapists can help patients understand OA and its complications, and provide treatments to lessen pain and improve movement. Additionally, physical therapists can provide information about healthy lifestyle choices and obesity education. This is important because some research shows that weight loss can reduce the chance of getting OA. One study showed that an 11-pound weight loss reduced the risk of OA in women.

What is Osteoarthritis?

Your bones are connected at joints such as the hip and knee. A rubbery substance called cartilage coats the bones at these joints and helps reduce friction when you move. A protective oily substance called synovial fluid is also contained within the joint, helping to ease movement. When these protective coverings break down, the bones begin to rub together during movement. This can cause pain, and the process itself can lead to more damage in the remaining cartilage and the bones themselves.

The cause of OA is unknown. Current research points to aging as the main cause. Factors that may increase your risk for OA include:

Age. Growing older increases your risk for developing OA because of the amount of time you’ve used your joints.
Genetics. Research indicates that some people's bodies have difficulty forming cartilage. Individuals can pass this problem on to their children.
Past Injury. Individuals with prior injury to a specific joint, especially a weight-bearing joint (such as the hip or knee), are at increased risk for developing OA.
Occupation. Jobs that require repetitive squatting, bending, and twisting are risk factors for OA. People who perform jobs that require prolonged kneeling (miners, flooring specialists) are at high risk for developing OA.
Sports. Athletes who repeatedly use a specific joint in extreme ways (pitchers, football linemen, ballet dancers) may increase their risk for developing OA later in life.
Obesity. Being overweight causes increased stress to the weight-bearing joints (such as knees), increasing the risk for development of OA.

How Does it Feel?

Typically, OA causes pain and stiffness in the joint. Common symptoms include:

Stiffness in the joint, especially in the morning, which eases in less than 30 minutes
Stiffness in the joint after sitting or lying down for long periods
Pain during activity that is relieved by rest
Cracking, creaking, crunching, or other types of joint noise
Pain when you press on the joint
Increased bone growth around the joint that you may be able to feel

Caution: Swelling and warmth around the joint is not usually seen with OA and may indicate a different condition or signs of an inflammation. Please consult with your doctor if you have swelling, redness, and warmth in the joint.

How Is It Diagnosed?

Osteoarthritis is typically diagnosed by your doctor using an x-ray, but there are signs that may lead your physical therapist to suspect you have OA. Joint stiffness, difficulty moving, joint creaking or cracking, and pain that is relieved with rest are typical symptoms.

How Can a Physical Therapist Help?

Your physical therapist can effectively treat OA. Depending on how severe the OA is, physical therapy may help you avoid surgery. Although the symptoms and progression of OA are different for each person, starting an individualized exercise program and addressing risk factors can help relieve your symptoms and slow the condition's advance. Here are a few ways your physical therapist can help:

Your therapist will do a thorough examination to determine your symptoms and what activities are difficult for you. He or she will design an exercise program to address those activities and improve your movement.
Your therapist may use manual (hands-on) therapy to improve movement of the affected joint.
Your physical therapist may offer suggestions for adjusting your work area to lessen the strain on your joints.
Your physical therapist can teach you an aerobic exercise program to improve your movement and overall health, and offer instructions for continuing the program at home.
If you are overweight, your physical therapist can teach you an exercise program for safe weight loss, and recommend simple lifestyle changes that will help keep the weight off.

In cases of severe OA that are not helped by physical therapy alone, surgery, such as a knee or hip replacement, may be necessary. Your physical therapist will refer you to an orthopedic surgeon to discuss the possibility of surgery.

Can this Injury or Condition be Prevented?

The best way to prevent or slow the onset of OA is to choose a healthy lifestyle, avoid obesity, and participate in regular exercise.

Physical Therapist's Guide to Herniated Disc

Wed, 22 Feb 2017 00:00:00 GMT

A herniated disc occurs when the cushion-like cartilage (the disc) between the bones of the spine is torn, and the gelatin-like core of the disc leaks. Often mistakenly called a slipped disc, a herniated disc can be caused by sudden trauma or by long-term pressure on the spine. This condition most often affects people aged 30 to 50 years; men are twice as likely to be diagnosed as women. Repeated lifting, participating in weight-bearing sports, obesity, smoking, and poor posture are all risk factors for a herniated disc. The majority of herniated discs do not require surgery, and respond best to physical therapy. Physical therapists design individualized treatment programs to help people with herniated discs regain normal movement, reduce pain, and get back to their regular activities.

What is a Herniated Disc?

The spine is made up of 33 vertebrae (bones) stacked on top of each other. Between each vertebra is a cushion-like piece of cartilage called an "intervertebral disc." Imagine the disc as a jelly donut:

The outer portion of the donut is a rubbery substance (the "annulus fibrosus" or AF).
A gelatin-like substance fills the "hole" in the donut (the "nucleus pulposus" or NP).

In people younger than 30 years of age, the disc is soft, flexible, and absorbs shock extremely well. As individuals age, however, the disc can lose some flexibility. If stress is applied to the spine, the outer part of the disc (AF) can tear, and the gelatin-like core (NP) leaks through the tear. This leaking, or bulging, of the gelatin is called a herniated disc. In more severe cases, the leaked NP can seep outside the spinal column.

Injuries that cause herniation can occur rapidly, or develop slowly over time.

A sudden injury can occur when an individual lifts something while in a poor position. This action strains the spine, and causes the outer part of a disc to suddenly tear.
A slow injury can occur as the result of sitting or standing with poor posture (slumped forward) for hours, weeks, or years, slowly overstretching or tearing the outer part of a disc.

The most common area of the spine to experience a herniated disc is the low back, just below waist level. Herniated discs also commonly occur in the neck.

How Does it Feel?

A herniated disc can cause pain, tightness, numbness, weakness, or tingling in the neck, back, arms, or legs. If the bulging or leaking disc pushes on a nearby nerve, pain or muscle weakness may result. If the bulging or leaking disc does not push on a nerve, pain or disability may not occur. Although back or neck pain can be caused by a herniated disc, other factors may be involved. Your physical therapist can test for and rule out other possible conditions.

If a herniated disc is severely pressing on a nerve, or is pressing on the spinal cord, surgery may be needed to immediately relieve that pressure. Your physical therapist can help determine whether either of these conditions is occurring, and will work closely with your physician and surgeon to determine the correct treatment.

Signs and Symptoms

The type and location of your symptoms depend on the location and direction of the herniated disc, and the amount of pressure on nearby nerves.

A herniated disc may cause no pain at all. Or, it can cause any of the following symptoms:

Pain in the neck, back, low back, arms, or legs
Inability to bend or rotate the neck or back
Numbness or tingling in the neck, shoulders, arms, hands, hips, legs, or feet
Weakness in the arms or legs
Limping when walking
Increased pain when coughing, sneezing, reaching, or sitting
Inability to stand up straight; being "stuck" in a position, such as stooped forward or leaning to the side
Difficulty getting up from a chair
Inability to remain in 1 position for a long period of time, such as sitting or standing, due to pain
Pain that is worse in the morning

In individuals older than 50 years, the gelatin-like core of the disc (NP) can become dry and less soft, making it less likely to leak, or herniate. This deterioration, however, can lead to other conditions that cause pain, such as degenerative disc disease, and degenerative joint disease. Your physical therapist will work with other health care professionals to determine your correct diagnosis.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your injury, such as:

How and when did the pain start?
At what time of day is it worse?
What type of discomfort do you feel, and where do you feel it?
What can’t you do right now, in your daily life, due to the pain?

Your physical therapist will perform tests on your body to find physical problems, such as:

Difficulty moving
Weakness or tightness in the muscles
Loss of skin sensation in some areas (numbness)
Loss of reflexes
Joint stiffness
Poor posture
Difficulty walking

If your physical therapist finds any of the above problems, physical therapy treatment may begin right away, to help get you on the road to recovery and back to your normal activities.

If more severe problems are found with any of the testing, your physical therapist may collaborate with a physician or surgeon to obtain special diagnostic testing, such as an MRI. Physical therapists work closely with physicians and other health care providers to ensure that you receive an accurate diagnosis and the treatment and care you need.

How Can a Physical Therapist Help?

In all but the most extreme cases, conservative care (such as physical therapy) often produces better results in treating a herniated disc than surgery or pain medications, such as opioids.

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but results can be achieved in 2 to 8 weeks or less, when a proper posture, pain-reduction, stretching, and strengthening program is implemented.

During the first 24 to 48 hours following your diagnosis of a herniated disc, your physical therapist may advise you to:

Rest the area by avoiding any activity that causes worsening symptoms in the arms or legs.
Avoid bed rest.
Stay active around the house, and go on short walks several times per day. Movement will decrease pain and stiffness, and help you feel better.
Apply ice packs to the affected area for 15 to 20 minutes every 2 hours.
Sit in firm chairs. Soft couches and easy chairs may make your problems worse.
Consult with a physician for further services, such as medications or diagnostic tests.

Some exercises are better for individuals with herniated discs. Your physical therapist will educate you about them. For example:

Exercising in water can be a great way to stay physically active when other forms of exercise are painful.
Exercises that involve lots of twisting and bending may or may not benefit you. Your physical therapist will design an individualized exercise program to meet your specific needs.
Weight-training exercises, though very important, need to be done with proper form to avoid stress to the back and neck.

Your physical therapist will work with you to:

Improve posture . If your physical therapist finds that poor posture has contributed to your herniated disc, the therapist will teach you how to improve your posture so that pressure is reduced in the injured area, and healing can begin and progress as rapidly as possible.

Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with "passive" motions that the physical therapist performs for you to move your spine, and progress to “active” exercises and stretches that you do yourself. You can perform these motions at home and in your workplace to help hasten healing and pain relief.

Improve flexibility. Your physical therapist will determine if any of the involved muscles are tight, start helping you to stretch them, and teach you how to stretch them at home.

Improve strength. If your physical therapist finds any weak or injured muscles, your physical therapist will choose, and teach you, the correct exercises to steadily restore your strength and agility. For neck and back disc herniations, “core strengthening” is commonly used to restore the strength and coordination of muscles around your back, hips, abdomen, and pelvis.

Return to activities. Your physical therapist will discuss your activity levels with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. For spine injuries like a herniated disc, your physical therapist may teach you proper “body mechanics”—correct ways to perform tasks and lift heavy objects—that will help protect your spine from further injury.

Once your pain is gone, it will be important for you to continue your new posture and movement habits to keep your back healthy and pain free.

Following Surgery

In rare cases, surgery is necessary to prevent permanent damage to a nerve or the spinal cord. If you undergo surgery for your herniated disc, your physical therapist will work closely with you and your surgeon to help you regain motion and strength more quickly than you could on your own, and help you get back to your normal lifestyle as quickly as possible.

Physical Therapist's Guide to Osteoarthritis of the Knee

Wed, 22 Feb 2017 00:00:00 GMT

Osteoarthritis of the knee (knee OA) is the inflammation and degeneration of the bones that form the knee joint (osteo=bone, arthro=joint, itis=inflammation). The diagnosis of knee OA is based on 2 primary findings: radiographic evidence of changes in bone health (through medical images such as x-ray and MRI) and an individual’s symptoms (how you feel). Approximately 14% of adults aged 25+ and 34% of adults aged 65+ are diagnosed with radiographic osteoarthritis. Specifically, about 16% of adults aged 45+ have knee OA.

What is Osteoarthritis of Knee?

Osteoarthritis of the knee (knee OA) is a progressive disease causing inflammation and degeneration of the knee joint that worsens over time. It affects the entire joint, including bone, cartilage, ligament, and muscle. Its progression is influenced by age, body mass index (BMI), bone structure, genetics, strength, and activity level. Knee OA also may develop as a secondary condition following a traumatic knee injury. Depending on the stage of the disease and whether there are associated injuries or conditions, knee OA can be managed with physical therapy. More severe or advanced cases may require surgery.

How Does it Feel?

Individuals who develop knee OA experience a wide range of symptoms based on the progression of the disease. Pain occurs when the cartilage covering the bones of the knee joint wears down. This narrows the space between the bones and causes friction. Because the knee is a weight-bearing joint, your activity level, and the type and duration of your activities usually have a direct impact on your symptoms.

Symptoms of knee OA may include:

Worsening pain during or following activity, particularly with walking, climbing, or descending stairs, or moving from a sitting to standing position
Pain or stiffness after sitting with the knee bent or straight for a prolonged period of time
A feeling of popping, cracking, or grinding when moving the knee
Swelling following activity
Tenderness to touch along the knee joint

Typically these symptoms do not occur suddenly or all at once, but instead they develop gradually over time. Sometimes individuals do not recognize they have osteoarthritis because they cannot remember a specific time or injury that caused their symptoms. If you have had worsening knee pain for several months that is not responding to rest, it is best to seek the advice of a medical provider.

How Is It Diagnosed?

Knee OA is diagnosed by 2 primary methods. The first is based on your symptoms and a clinical examination. Your physical therapist will ask you questions about your medical history and activity routine. He or she will perform a physical exam to measure your knee's movement (range of motion), strength, mobility, and flexibility. You might also be asked to perform various movements to provoke the pain you are experiencing.

The second tool used to diagnose knee OA is diagnostic imaging. Your physical therapist may refer you to a physician, who will order x-rays of the knee in a variety of positions to assess the effect of weight-bearing (walking, standing, etc) on your knee joint. If more severe joint damage is suspected, an MRI may be ordered to look more closely at the overall status of the joint and surrounding tissues.

How Can a Physical Therapist Help?

Your physical therapist will design an individualized treatment program specific to the exact nature of your condition and your goals.

Range of Motion

Often, abnormal motion of the knee joint can lead to a progression of OA when there is more contact between, and wear on, the bones. Your therapist will assess your motion compared with expected normal motion and the motion of the knee on your uninvolved leg.

Muscle Strength

Strengthening the muscles around your knee will be an essential part of your rehabilitation program. Individuals with OA who adhere to strengthening programs have been shown to have less pain and an improved overall quality of life. There are several factors that influence the health of a joint: the quality of the cartilage that lines the bones, the tissue within and around the joints, and the associated muscles. Due to the wear and tear on cartilage associated with knee OA, maintaining strength in the muscles near the joint is crucial to preserve joint health. For example, as the muscles along the front and back of your thigh (quadriceps and hamstrings), cross the knee joint, they help control the motion and forces that are applied to the bones.

Strengthening the hip and core muscles also can help balance the amount of force on the knee joint, particularly during walking or running. The “core” refers to the muscles of the abdomen, low back, and pelvis. A strong core will increase stability through your body as you move your arms and legs. Your physical therapist will assess these different muscle groups, compare the strength in each limb, and prescribe specific exercises to target your areas of weakness.

Manual Therapy

Physical therapists are trained in manual (hands-on) therapy. Your physical therapist will gently move and mobilize your muscles and joints to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own. In patients with knee OA, the addition of manual therapy techniques to exercise has been shown to decrease pain and increase function.

Modalities

Your physical therapist may recommend therapeutic modalities, such as ice and heat, to aid in pain management.

Bracing

Compressive sleeves placed around the knee may help reduce pain and swelling. Devices such as realignment braces are used to modify the forces placed on the knee. These braces can help "unload" certain areas of your knee and move contact to less painful areas of the joint during weight-bearing activities.

Activity Recommendations

Physical therapists are trained to understand how to prescribe exercises to individuals with injuries or pain. Since OA is a progressive disease, it is important to develop a specific plan to perform enough activity to address the problem while avoiding increases in stress on the knee joint. Activity must be prescribed and monitored based on type, frequency, duration, and intensity, with adequate time allotted for rest and recovery. Your physical therapist will consider the stage and extent of your arthritis and prescribe an individualized exercise program to address your needs and maximize the function of your knee.

What if I Need Surgery?

In some cases of knee OA, the meniscus (shock absorber of the knee) may be involved. In the past, surgery to repair or remove parts or all of this cartilage was common. Current research, however, has shown in a group of patients who were deemed surgical candidates, 60-70% of those who participated in a physical therapy program, instead of surgery, did not go on to have surgery. Further, after 1 year those outcomes were unchanged. This study suggests that physical therapy may be an effective alternative for those patients who would like to avoid surgery.

Sometimes conservative management strategies are not successful. When these strategies fail surgical intervention such as arthroscopy or a total knee replacement, may be recommended. There are many factors to consider when determining the appropriate surgical treatment, including the nature of your condition, and your age, activity level, and overall health. Your physical therapist will refer you to an orthopedic surgeon to discuss your surgical options.

Real Life Experiences

Luke is a 50-year-old businessman who has just moved his family to the city so he can start a new job. For the last 2 months, Luke has been working hard carrying heavy boxes and moving furniture up and down stairs. He has also worked late into the night installing appliances.

After starting his new job last week, sitting through numerous orientation sessions and meetings, Luke notices that his right knee is really hurting. He is used to occasional knee discomfort, but this is the worst it has felt in a long time. During his junior year at college, he suffered a significant knee injury while playing basketball, which required surgery.

These days, Luke coaches his son’s Little League team, works out several times each week, and plays pick-up basketball with his friends. But occasionally, particularly after long road trips, his knee pain flares up, and he has to resort to medication, icing, and rest. These bouts are starting to occur more regularly. Luke decides it's time to find a physical therapist.

During his first appointment, Luke’s physical therapist asks him questions regarding his medical history, prior injuries, current symptoms and complaints, and goals for physical therapy. She examines his knee motion, strength, balance, and walking mechanics. She also uses special tests and measures to determine the nature of Luke’s pain, ruling out any other possible conditions.

Based on her findings, Luke's physical therapist determines his current knee pain is a result of post-traumatic osteoarthritis. She explains that his history of significant knee injury in college puts him at risk of developing OA at a young age. The recent increased demand on his knee joint during his move is likely responsible for the current flare-up of pain and swelling.

Over the next 6 weeks, Luke works with his physical therapist 2 times a week to decrease his joint pain and improve his knee motion and full-body flexibility. She uses manual therapy techniques to improve the mobility of his knee joint. She prescribes a progressive exercise program to strengthen the muscles of his hip, knee, and core. She tailors this program so that Luke can complete it daily based on the equipment available at his office gym facility.

Six weeks later, Luke is able to climb and descend stairs, squat, and jog without pain. He can sit through a full day of meetings without noticing stiffness or swelling in his knee. On his last day of therapy, Luke’s physical therapist provides him with a detailed home program and suggestions for maintaining the improvements he has made. With the summer approaching, he's preparing to coach his son's baseball tournaments--and take his family to the beach!

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:

A physical therapist who is experienced in treating people with knee osteoarthritis and after knee replacement surgery. Some physical therapists have a practice with an orthopedic focus.
A physical therapist who is a board-certified orthopedic clinical specialist. This therapist will have advanced knowledge, experience, and skills that may apply to your condition.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with arthritis.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and report activities that makes your symptoms worse.

Physical Therapist's Guide to Low Back Pain

Wed, 22 Feb 2017 00:00:00 GMT

If you have low back pain, you are not alone. At any given time, about 25% of people in the United States report having low back pain within the past 3 months. In most cases, low back pain is mild and disappears on its own. For some people, back pain can return or hang on, leading to a decrease in quality of life or even to disability.

If your low back pain is accompanied by the following symptoms, you should visit your local emergency department immediately:

Loss of bowel or bladder control
Numbness in the groin or inner thigh

These symptoms might indicate a condition called "cauda equina syndrome," in which nerves at the end of the spinal cord that control bowel and bladder function are being squeezed.

For more resources on low back pain, visit our Health Center for Low Back Pain .

Signs and Symptoms

The symptoms of low back pain vary a great deal. Your pain might be dull, burning, or sharp. You might feel it at a single point or over a broad area. It might be accompanied by muscle spasms or stiffness. Sometimes, it might spread into 1 or both legs.

There are 3 different types of low back pain:

Acute – pain lasting less than 3 months
Recurrent – acute symptoms come back
Chronic – pain lasting longer than 3 months

Most people who have an episode of acute pain will have at least 1 recurrence. While the actual cause of low back pain isn't often known, symptoms usually resolve on their own. Psychosocial factors, such as self-confidence and a perceived ability to cope with disability, have been shown to be predictors of who might not recover from low back pain as expected. We used to believe the cause of low back pain was related directly to the tissues of our body, but are now understanding the condition to be more complex.

Although low back pain is rarely serious or life threatening, there are several conditions that may be related to your low back pain, such as:

Degenerative disk disease
Lumbar spinal stenosis
Fractures
Herniated disk
Osteoarthritis
Osteoporosis
Tumors of the spine

While we used to believe the above list contributed directly to low back pain, research has shown these conditions are also present in people without any pain (asymptomatic).

How Is It Diagnosed?

Your physical therapist will perform a thorough evaluation that includes:

A review of your health history.
Questions about your specific symptoms.
A thorough examination that includes assessing the quality and quantity of your movements, and any movement behaviors that might put you at risk for delayed recovery.
Tests to identify signs or symptoms that could indicate a serious health problem, such as broken bones or cancer.
Assessment of how you use your body at work, at home, during sports, and at leisure.

For most cases of low back pain imaging tests, such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are not helpful for recovery. For example, in a recently published article comparing patients who received an MRI first vs physical therapy first for low back pain, the patients who received an MRI first spent on average $4,793 more (with similar outcomes in each group). If your physical therapist suspects that your low back pain might be caused by a serious health condition, the therapist will refer you to other health care professionals for further evaluation.

How Can a Physical Therapist Help?

Your physical therapist can help you improve or restore mobility and reduce low back pain—in many cases, without expensive surgery or the side effects of medications.

If you are having low back pain right now:

Stay active, and do as much of your normal routine as possible ( bed rest for longer than a day can actually slow down your recovery .)
If your pain lasts more than a few days or gets worse, schedule an appointment to see your physical therapist.

Not all low back pain is the same, so your treatment should be tailored to for your specific symptoms and condition. Once the examination is complete, your physical therapist will evaluate the results, identify the factors that have contributed to your specific back problem, and design an individualized treatment plan for your specific back problem. Treatments may include:

Manual therapy, including spinal manipulation, to improve the mobility of joints and soft tissues
Specific strengthening and flexibility exercises
Education about how you can take better care of your back
Training for proper lifting, bending, and sitting; for doing chores both at work and in the home; and for proper sleeping positions
Assistance in creating a safe and effective physical activity program to improve your overall health
Use of ice or heat treatments or electrical stimulation to help relieve pain

Can this Injury or Condition be Prevented?

As experts in restoring and improving mobility and movement in people’s lives, physical therapists play an important role not only in treating persistent or recurrent low back pain, but also in preventing it and reducing your risk of having it come back.

Physical therapists can teach you how to use the following strategies to prevent back pain:

Use good body positioning at work, home, or during leisure activities.
Keep the load close to your body during lifting.
Ask for help before lifting heavy objects.
Maintain a regular physical fitness regimen—staying active can help to prevent injuries.

There is evolving evidence suggesting that the best strategy in preventing disability and care-seeking for low back pain is simply understanding what we are learning about the topic of pain. To learn more, read more about Pain .