Progressive Physical Therapy, Inc.

Frozen Shoulder

2012-03-05T08:33:00.000-08:00

Physical Therapist's Guide to Frozen Shoulder (Adhesive Capsulitis)

Often called a stiff or “frozen shoulder,” adhesive capsulitis occurs in about 2% to 5% of the general population. It affects women more than men and typically occurs in people who are over the age of 45. Of the people who have had adhesive capsulitis in one shoulder, 20% to 30% will get it in the other shoulder.

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 you to stop moving your shoulder
Immobilization of your arm, such as in a sling, after surgery or fracture

Often, however, there is no known reason why adhesive capsulitis starts.

Frozen Shoulder:

How Does it Feel?

Most people with adhesive capsulitis have worsening pain and then a loss of range of movement. Adhesive capsulitis can be broken down into 4 stages, and your physical therapist can help determine what stage you are in:

Stage 1 - "Pre-Freezing"

During this stage, 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. There is pain with active movement and passive motion (movements that a physical therapist does for you). The shoulder usually aches when you're not using it, but pain increases and becomes "sharp" with movement. You'll have a mild reduction in motion during this period, and you'll 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 (called "flexion and abduction")or reach behind your back (called "internal rotation"). You'll have 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 this is limited by both pain and stiffness.

Stage 3 – "Frozen"

Your symptoms have persisted for 9 to 14 months, and you have 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. Your physical therapist will perform a thorough evaluation, including an extensive health history, to rule out other diagnoses. Your therapist will look for a specific pattern in your decreased range of motion; it's called a "capsular pattern" and is typical with adhesive capsulitis. In addition, your 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 that you can perform your activities and life roles. Once the evaluation process has identified the stage of your condition, your therapist will create an exercise program tailored to your needs. Exercise has been found to be most effective for those who are in stage 2 or higher.

Stages 1 and 2

Your physical therapist will help you maintain as much range of motion as possible and will help reduce the pain. Your therapist may use a combination of stretching and manual therapy techniques to increase your range of motion. The therapist also may decide to use treatments such as heat and ice to help relax the muscles prior to other forms of treatment. The therapist will give you a home exercise program designed to help reduce the loss of motion.

Stage 3

The focus of treatment will be on the return of motion, with your therapist using more aggressive stretching and manual therapy techniques. You may begin some strengthening exercises as well, and your home exercise program will change to include these exercises.

Stage 4

In the final stage, your therapist will focus on the return of "normal" shoulder body mechanics and your return to normal, everyday, pain-free activities. The therapist will continue to use stretching, strength training, and a variety of manual therapy techniques.

Sometimes, conservative care cannot reduce the pain. If this happens to you, your physical therapist may refer you for an injection of anti-inflammatory and pain-relieving medication into the joint space. Research has shown that although these injections don’t provide longer-term benefit for range of motion and don’t shorten the duration of the condition, they do offer short-term benefit in reducing pain.

Can this Injury or Condition be Prevented?

The cause of adhesive capsulitis is debatable, with no definitive cause, so there is no known method of prevention. The onset is usually gradual, with the disease process needing to "run its course."

Real Life Experiences

Cheryl L. is 47-year-old woman whose physical therapist has diagnosed her with adhesive capsulitis. She has no history of trauma and reports a slow onset of pain that increased over the past 6 months. She says that it significantly affects her sleep.

Her pain is accompanied by a loss of range of movement that has now progressed to the point where she can’t lift her arm to shoulder level. Her therapist provides heat treatments to relax her muscles and designs a home exercise program to help stall the loss of motion. He monitors Cheryl periodically, encouraging her to continue with the home exercises despite the pain. Treatment in the physical therapy clinic consists of stretches performed by the therapist, who also mobilizes the joint to help maintain its current range of motion. At this stage, the therapist focuses the manual therapy not on increasing range of motion but on mobilizing the joint to reduce pain and reduce the amount of range of motion that is lost.

When Cheryl progresses into stage 3 ("frozen"), her visits to the physical therapist are increased. The therapist uses stretching and manual therapy techniques to improve her range of motion. After 4 weeks of treatment, Cheryl reports minimal pain, and her range of motion is beginning to increase rapidly. Her therapy is reduced to weekly visits and then to twice monthly visits. Fourteen months after the onset of her condition, her range of motion returns to normal, and her pain has stopped. Cheryl's progress is rapid, and the therapist credits this to her full participation in her exercise program.

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.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have frozen shoulder, or adhesive capsulitis. You may want to consider:

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 frozen shoulder.
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 Low Back Pain

2012-02-22T06:00:00.001-08:00

Physical Therapist's Guide to Low Back Pain

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 are being squeezed.

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 one 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 one recurrence.

Often, low back pain occurs due to overuse, strain, or injury. It could be caused by too much bending, twisting, lifting—or even too much sitting. But just as often, the actual cause of low back pain isn't known, and symptoms usually resolve on their own.

Although low back pain is rarely serious or life threatening, there are several conditions that may contribute to low back pain, such as:

Degenerative disk disease
Lumbar spinal stenosis
Fractures
Herniated disk
Osteoarthritis
Osteoporosis
Tumors of the spine

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
Tests to identify any problems with posture, flexibility, muscle strength, joint mobility, and movement
Tests to identify signs or symptoms that could indicate a serious health problem, such as a herniated disk, broken bone, 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 diagnosing the cause. However, 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 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:

Participate in regular strengthening and stretching exercises to keep your back, stomach, and leg muscles strong and flexible
Keep your body in alignment, so that it can be more efficient when you move
Keep good posture – don’t slouch!
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
Use an assistive device, such as a dolly or wheelbarrow, to transport heavy objects
Maintain a regular physical fitness regimen—staying active can help to prevent injuries

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have low back pain. You may want to consider:

A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This therapist has 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 low back 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.

Article originally appeared on www.apta.org. Click the following link to view original article: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=d0456c65-7906-4453-b334-d9780612bdd3

Physical Therapist's Guide to Labral Tear

2012-02-15T07:20:00.000-08:00

Physical Therapist's Guide to Labral Tear

An unstable shoulder joint can be the cause or the result of a labral tear. "Labral" refers to the glenoid labrum—a ring of cartilage that surrounds the base of the shoulder joint. Injuries to the labrum are common, can cause a great deal of pain, and may make it hard to move your arm. A labral tear can occur from a fall or from repetitive activities or sports that require you to use your arms raised above your head. Some labral tears can be managed with physical therapy; in severe cases, surgery may be required to repair the torn labrum.

What is a Labral Tear?

The glenoid labrum provides extra support for the shoulder joint, helping to keep it in place. A labral tear occurs when part of this ring is disrupted, frayed, or torn. Tears may lead to shoulder pain, an unstable shoulder joint, and, in severe cases, dislocation of the shoulder. Likewise, a shoulder dislocation can result in labral tears.
When you think of the shoulder joint, picture a golf ball (the head of the upper-arm bone, or humerus) resting on a golf tee (the glenoid fossa, a shallow cavity or socket located on the shoulder blade, or scapula). The labrum provides a rim for the socket (golf tee) so that the humerus (golf ball) does not easily fall off. If the labrum is torn, it is harder for the humerus to stay in the socket. The end result is that the shoulder joint becomes unstable and prone to injury.
Because the biceps tendon attaches to the shoulder blade through the labrum, labral tears can occur when you put extra strain on the biceps muscle, such as when you throw a ball. Tears also can result from pinching or compressing the shoulder joint when the arm is raised overhead. There are 2 types of tears:

Traumatic labral tears usually happen because of a single incident, such as a shoulder dislocation or an injury from heavy lifting. People who use their arms raised over their heads—such as weight lifters, gymnasts, and construction workers—are more likely to have traumatic labral tears. Activities the force is at a distance from the shoulder, such as striking a hammer or swinging a racquet, also can create shoulder joint problems.
Nontraumatic labral tears most often occur because of muscle weakness or shoulder joint instability. When the muscles that stabilize the shoulder joint are weak, more stress is put on the labrum, leading to a tear. People with nontraumatic tears tend to have more "looseness" or greater mobility throughout all their joints, which might be a factor in the development of a tear.

Labral Tear: See More Detail

How Does it Feel?

With a labral tear, you might have:

Pain over the top of your shoulder
"Popping," "clunking," or "catching" with shoulder movement, because the torn labrum has "loose ends" that are flipped or rolled within the shoulder joint during arm movement and that may even become trapped between the upper arm and shoulder blade
Shoulder weakness, often on one side
A feeling that your shoulder joint will pop out

How Is It Diagnosed?

Not all labral tears cause symptoms. In fact, when tears are small, many people are able to function without pain. In some instances, the labrum might even heal on its own, if care is taken not to stress the injured tissues. Due to the lack of blood supply available at the labrum, complete healing may be difficult. The shoulder with a labral tear may pop or click without being painful; however, if a tear progresses, it is likely to lead to pain and weakness.
If your physical therapist suspects that you may have a labral tear, the therapist will review your health history and perform an examination that is designed to test the condition of the glenoid labrum (the ring of cartilage at the base of the shoulder). The tests will place your shoulder in positions that may recreate some of your symptoms, such as "popping," "clicking," or mild pain. Using this examination, your physical therapist will determine whether your shoulder joint is unstable. Magnetic resonance imaging (MRI) also may be used. Labral tears may be difficult to diagnose with certainty without arthroscopic surgery, where a tube-like instrument called an arthroscope is inserted into the joint through a small incision to view or repair an injury.

How Can a Physical Therapist Help?

When labral tears cause minor symptoms but don’t cause shoulder instability, they usually are treated with physical therapy. Your physical therapist will:

Educate you about positions or activities to avoid
Tailor a treatment plan for your recovery
Design specific shoulder strengthening exercises, such as external rotation and internal rotation exercises, to help support the joint and decrease strain on the glenoid labrum
Design stretching exercises, such as the cross-body stretch or the doorway stretch, to help improve the function of the muscles surrounding the shoulder
Perform a special technique called manual therapy to decrease pain and improve movement

In more severe cases, when conservative treatments are unable to completely relieve the symptoms of a labral tear, surgery may be required to re-attach the torn labrum. Following surgery, your physical therapist will show you how to slowly and safely return to your daily activities.
A surgically repaired labrum takes 9 to 12 months to completely heal. Immediately following the repair, you should avoid putting excessive stress or strain on the repaired labrum and should increase stress to your shoulder slowly over time. Your physical therapist is trained to gradually introduce activity in a safe manner to allow you to return to your usual activities without re-injuring the repaired tissues.

Can this Injury or Condition be Prevented?

Forceful activities with the arms raised overhead may increase the likelihood of developing a labral tear. To avoid putting excessive stress on the labrum, you need to develop strength in the muscles that surround the shoulder and scapula. Your therapist will:

Design exercises to help you strengthen your shoulder
Show you how to avoid potentially harmful positions
Determine when it is appropriate for you to return to your normal activities
Train you to properly control your shoulder movement and modify your activities to reduce your risk of sustaining a labral injury

Real Life Experiences

After a day of heavy upper-body lifting at the gym, Jill notices that her shoulder is aching. She ignores the discomfort, thinking that it’s just post-workout soreness, and she continues with her normal routine. But when Jill returns to the gym the following week, she is unable to exercise as aggressively as she usually does because of right shoulder pain. Almost every time she raises her arm overhead, she feels a “clicking” in the shoulder that was never there before. What should she do?

Rest.Jill should avoid overhead activities, to allow the irritated tissues to heal.
Ice. Ice applied to the shoulder may help decrease her pain and any swelling.

Rest and ice do not completely get rid of her symptoms, so Jill decides to visit a physical therapist. The therapist conducts an examination designed to detect the amount of injury and how it is affecting her shoulder’s function. Based on the findings of the physical exam, Jill’s physical therapist determines her diagnosis is consistent with a labral injury and recommends the following treatments:

Strengthening exercises. Improving the strength of the muscles of the shoulder will help Jill decrease the stresses placed on the torn labrum and allow for better healing. The therapist designs external rotation and internal rotation exercises that target the muscles of the shoulder blade and the shoulder joint.;
Stretching exercises. An imbalance in the muscles or a decrease in flexibility can result in poor posture or excessive stress within the shoulder joint. Jill's therapist prescribes stretching exercises to restore the normal balance of the muscles surrounding the shoulder to help them work better together.
Education. Education is an important part of any physical therapy treatment plan. If Jill understands the injury, the reasons for modifying her activities, and the importance of doing the exercises provided by the physical therapist, she can help decrease her risk of future injury.
Home exercise program. A home exercise program is an important companion to treatment in the physical therapy clinic. The physical therapist identifies the stretching and strengthening exercises that will help her continue to make improvements and meet her goals.

Following 6 weeks of physical therapy, Jill begins a progressive return to her weight-lifting activities. Her physical therapist gives her instruction in proper lifting techniques and training intensity, and Jill is able to make a safe and effective transition back to her lifting program. If Jill's pain and other symptoms return, her physical therapist will work with her and with an orthopedist to help determine whether she needs surgery to repair her labrum.
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

2012-02-01T07:35:00.000-08:00

· Physical Therapist's Guide to Anterior Cruciate Ligament (ACL) Tear

An anterior cruciate ligament (ACL) tear is an injury to the knee commonly affecting soccer players, basketball players, skiers, gymnasts, and other athletes. About 70% of ACL tears are the result of non-contact injuries; 30% are the result of direct contact (player-to-player, player-to-object). Women are 4-6 times more likely than men to experience an ACL tear.

Usually, you will be examined by a physical therapist or an orthopedic surgeon immediately following injury. 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 so that they don't put a lot of 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 non-operative treatment (rehabilitation without surgery) is a reasonable option for you. If you elect to have surgery, your physical therapist will help you both prepare for surgery and recover your strength and movement following surgery.

What is an ACL Tear?

The ACL is one of the major ligaments (bands of tissue) connecting the thigh bone to the shin bone. It can tear if you:

o Twist your knee while keeping your foot planted on the ground

o Stop suddenly while running

o Suddenly shift your weight from one leg to the other

o Jump and land on an extended (straightened) knee

o Stretch the knee farther than you should

o 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?

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

o Felt pain or heard a pop when you jumped, stopped quickly when running, turned your leg with your foot on the ground, or stretched your knee farther than usual

o Had a direct hit to the leg while your foot was planted on the ground

o Saw severe swelling around the knee in the first 2-3 hours following the injury

o Felt your knee buckling or giving way when you tried to get up from a chair, walk up and down stairs, or turn while walking

Your physical therapist also will perform special tests to help determine the likelihood that you have an ACL tear. For instance, the therapist may bend your knee and gently pull on the lower leg (called the "anterior drawer" test or the "Lachman" test). The therapist also might use the "pivot shift" test, gently bending and twisting your knee at the same time. (You might feel some discomfort or instability during these tests, which is normal.) Your therapist may use additional tests to assess possible damage to other parts of your knee.

The orthopedic surgeon may order further tests, including magnetic resonance imaging (MRI), to confirm the diagnosis and also to rule out other possible damage to the knee.

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 try to manage your recovery without surgery. If you don’t have surgery, your therapist will work with you to restore your muscle strength, endurance, and coordination so that you can return to your regular activities. In some cases, the therapist may help you to learn to modify your physical activity so that you put less stress on your knee. If you decide to have surgery, your therapist can help you both before and after the procedure.

Treatment Without Surgery

Current research evidence has identified a specific group of patients (called "copers") who have the potential for success without surgery. These patients have injury only to the ACL, and no episodes of "giving way" since the initial injury. There are specific functional tests—such as the Knee Outcomes Survey, the Global Rating of Knee Function, and the timed hop test—that can help the physical therapist identify this group of patients. If you fall into this category, your physical therapist will design a specific physical therapy treatment program for you, most likely including electrical stimulation to the quadriceps muscle, cardiovascular strengthening, traditional muscle strengthening, and balance training.

Treatment Before Surgery

Some orthopedic surgeons refer their patients to a physical therapist for a short course of rehabilitation before surgery. Your therapist will help you decrease your swelling, increase the range of movement of your knee, and strengthen your thigh muscles (quadriceps).

You might have what is known as a "quadriceps lag." This is when you try to raise your leg straight in the air, but you can't control the knee, and your leg bends slightly. Research shows that improving this condition before surgery leads to better outcomes after surgery. Your therapist might use electrical stimulation to help you straighten your leg.

Treatment After Surgery

Your orthopedic surgeon will provide postsurgery instructions. Physical therapists have developed and published guidelines on knee stability and movement problems, which recommend the following actions.

Bearing weight. Immediately after 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 had. Your physical therapist will guide you through this part of your rehabilitation.

Icing and compression. Immediately after your 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. Almost all surgeons will give you a brace to limit your knee movement (range of motion) after your surgery. Some will give you a brace to use during sports a little further along during your recovery. Your physical therapist will fit you with the brace and teach you how to use it safely.

Exercises to increase your ability to move. You will begin some exercises almost immediately following surgery. In the first week, your physical therapist will help you with your range of motion and teach you gentle exercises that you can do at home. The focus will be on regaining full movement of your knee. If you're like most people, this will take some time.

You will do exercises without pressure on your leg (called "non-weight-bearing exercises") and ones that have you placing weight on your leg ("weight-bearing exercises"). These exercises might be limited to a specific range of motion to protect your newly healing ACL graft. Your therapist might use electrical stimulation to help restore your quadriceps (thigh) muscle strength and help you achieve those last few degrees of straightening the knee.

Exercises to increase your strength. 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 quadriceps and hamstrings (thigh muscles) and might be limited to a specific range of motion to protect the new ACL. Your therapist might use electrical stimulation to help restore your quadriceps strength.

During weeks 5 through 12, you can expect to begin to walk without crutches and regain a normal walking pattern. Your therapist will increase the intensity of your exercises and add balance exercises to your program. After 3-4 months, your thigh muscles should have about 75% of the strength of the muscles on your uninjured side. During this time, you and your therapist will be planning your return to higher-level activity.

Return to your sport or physical activity. You may begin balance exercises, running, jumping, hopping, and other exercises specific to your sport. This phase varies greatly from person to person. One study found that the return to moderate and strenuous sports varied between 6 and 12 months after surgery. You might be ready to return to your sport if:

o You no longer have pain and swelling

o You have no feelings of instability during sport-specific activities, such as cutting, jumping, and landing

o Your quadriceps strength is 90% of that on your uninjured side

o Your performance of the 1-legged hop test is at 90% of that on the uninjured side

Remember, each surgeon might have a specific plan for you; these are only broad guidelines describing what you might expect for your recovery.

Can this Injury or Condition be Prevented?

Current research shows that the percentage of ACL tears has been reduced in certain populations. Much of the research on ACL tears has been conducted with female collegiate athletes, because women are 4-6 times more likely to have this injury. Researchers have made the following recommendations for a preventive exercise program:

o 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.

o Exercises should be done 2 or 3 times per week and should include sport-specific exercises.

o 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 star college basketball player—until she comes down from a rebound and feels a pop in her knee and can no longer stand on it. She's taken to the training room, where the physical therapist conducts an evaluation, including the Lachman and anterior drawer tests. The results of both tests are positive, and the therapist notices an increase in her swelling just in the 30 minutes that she spends in the training room. He suspects an ACL tear and refers her to an orthopedic surgeon. As the physical therapist suspected, Anita is diagnosed with an ACL tear.

After a short course of treatment by a physical therapist, Anita has surgery the following month. After surgery, she returns to her physical therapist and begins her rehabilitation. After 5 weeks, she is able to walk normally, fully extending her knee with no pain or feelings of instability. During the next 2 months, she visits her physical therapist 2 times a week and works on her strength and balance. She finds that 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 is allowed to begin jogging, then running; at 5 months, she starts exercises that involve jumping up and down or that mimic basketball activities such as rebounding. During these activities, the therapist has Anita concentrate on proper landing techniques so that she lessens the chance of reinjuring her knee when she returns to play.

After 8 months, Anita is allowed to practice with her team. She has no problems with her knee following surgery and returns to competition 11 months after her surgery.

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.

What Kind of Physical Therapist Do I Need?

Although all physical therapists are prepared through education and experience to treat a variety of conditions or injuries, you may want to consider:

o A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.

o A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic physical therapy has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists with 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:

o Get recommendations from family and friends or from other health care providers.

o When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with ACL tears.

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.

Further Reading

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.

Ritter RC, Axe MJ, Godges JJ, Logerstedt DS, Snyder-Mackler L. 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.

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. Epub 2009 Jun 25. Free Article.

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. Epub 2007 Oct 16. 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.

Acknowledgement: Christopher Bise, PT, MS, DPT

Article originally appeared on http://www.apta.org/ (http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=d8e73ca8-71f4-48a7-92f8-675bca38232c)

Physical Therapist's Guide to TMJ

2012-01-25T05:14:00.000-08:00

Physical Therapist's Guide to Temporomandibular Joint Disorder

Temporomandibular joint disorder (or "dysfunction") (TMD) is very common; more than 10 million people in the United States have it.

Jaw pain is one of the symptoms of TMD. It's important for you to know that jaw pain also can be a symptom of heart attack. Seek medical care immediately if jaw pain is accompanied by:

o Chest pain

o Shortness of breath

o Dizziness

o Left arm pain

o Numbness in your left arm

o Nausea.

What Is Temporomandibular Joint Disorder?

The temporomandibular joint (TMJ) guides jaw movement. Problems with the TMJ are known as temporomandibular joint disorder or dysfunction (TMD). TMD is very common; more than 10 million people in the United States have it. TMD can be caused by:

o 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 head 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, cradling a telephone receiver against the same shoulder for long periods of time, 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.

o Chronic jaw clenching at night("bruxism"). Many people clench their jaws at night while they sleep, usually because of stress. This puts a strain on the TMJ because of the constant strain on the joint and surrounding muscles.

o Problems with teeth alignment("malocclusion"). If your teeth come together in an unusual way, greater stress is placed on your TMJ.

o Fracture. In a traumatic accident involving the face or head, a fracture to the lower jaw may result, and even when the fracture is fully healed, TMJ stiffness and pain may remain.

o Surgery. Following surgery to the face and jaw, there may be a loss in mobility and function of the TMJ.

o Trismus ("lockjaw"). This condition—where 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.

How Does it Feel?

TMD symptoms include:

o Jaw pain

o Jaw fatigue

o Difficulty opening your mouth to eat or talk

o Ringing in your ears

o Dizziness

o Headache

o Popping sounds in your jaw

o Neck pain

o Locking jaw

How Is It Diagnosed?

To identify the cause of the symptoms, your physical therapist will first:

o Review your medical history, and discuss any previous surgery, fractures, or other injuries to your head, neck, or jaw.

o Conduct a physical examination of your jaw and neck.

The physical therapist will evaluate your posture and how your cervical spine—your neck—moves. The therapist will examine the TMJ to find out how well it can open and whether there are any abnormalities in jaw motion. The therapist might place his or her hand in your mouth in order to examine your jaw movement.

If, after the examination, the 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 restore the natural movement of your jaw and decrease your pain. If the therapist determines that your jaw pain is not related to teeth alignment, the therapist will select treatments that will work best for you. Treatments used by physical therapists for TMD include:

Posture education. If your therapist finds that you sit with your head in an increased forward position, this means that 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, and 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 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.

Improve jaw movement. Physical therapists use skilled hand movements called manual therapy to increase movement and relieve pain in tissues and joints. Your therapist also might use manual therapy to stretch the jaw in order to restore normal joint and muscle flexibility (how supple your muscles are) or break up scar tissues ("adhesions") that sometimes develop when there is constant injury.

Your physical therapist will teach you special "low-load" exercises—exercises that don't exert a lot of pressure on your TMJ but that can strengthen the muscles of the jaw and restore a more natural, pain-free motion.

Special pain treatments. In addition to manual therapy, if your pain is severe, your physical therapist may decide to use treatments such as electrical stimulation or ultrasound to reduce pain.

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 your teeth alignment with special appliances, such as "bit guards," that create a natural resting position of the jaw 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 good sitting posture to prevent future episodes of TMD.

General Tips:

o Avoid repetitive chewing, such as gum chewing

o Avoid smoking

o Avoid opening the jaw too wide

o Avoid eating hard or chewy foods

o Maintain good oral hygiene and tooth health

o 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

At work:

o Your work should be 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.

o Are you on the phone for long periods of time? Use a headset that allows the neck and jaw to remain in a restful("neutral") position.

Real Life Experiences

You're attending your daughter's state championship volleyball match. Her team is ahead by one point, she sets up for the winning point, and she scores! Her team wins the state title, but after the celebration, you realize that your jaw is sore—and over the next week, it keeps getting worse.

You make an appointment with your physical therapist, who examines you and determines that your pain is related to postural habits and not to the alignment of your teeth. All season long, you've been cheering and yelling hard when her team was winning and nervously grinding your teeth when her team was trailing. You've also been sitting on bleachers without back support. Your physical therapist will provide a thorough examination of your neck and jaw to determine the true cause of your pain complaints and select treatments that will relieve your pain and help you use good posture so that you don't have more episodes of jaw pain.

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.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

o A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with a craniofacial focus, meaning that they focus on movement disorders related to the skull and facial structures.

o A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedics physical therapy. This therapist has 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):

o Get recommendations from family and friends or from other health care providers.

o When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with TMD.

o 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.

A Guide to Understanding Knee Pain...How PT can help!

2012-01-18T06:50:00.000-08:00

Physical Therapist's Guide to Knee Pain

Knee pain can be caused by disease or injury. The most common disease affecting the knee is osteoarthritis. Knee injuries can occur as the result of a direct blow or sudden movement that strains the knee beyond its normal range of movement. Knee pain caused by an injury is most often associated with knee cartilage tears, such as meniscal tears, or ligament tears, such as anterior cruciate ligament tears.

What is Knee Pain?

Knee pain can be caused by disease or injury. Knee pain can restrict movement, affect muscle control in the sore leg, and reduce the strength and endurance of the muscles that support the knee.

The most common disease affecting the knee is osteoarthritis, which is caused by the cartilage in the knee gradually wearing away, resulting in pain and swelling.

Knee injuries can occur as the result of a direct blow or sudden movement that strains the knee beyond its normal range of motion, as can happen in sports, recreational activities, a fall, or a motor vehicle accident. Knee pain caused by an injury often is associated with tears in the knee cartilage or ligaments. Knee pain also can be the result of repeated stress, as often occurs with the kneecap, also known as patellofemoral pain syndrome. Very rarely, with extreme trauma, a bone may break at the knee.

How Does it Feel?

You may feel knee pain in different parts of your knee joint, depending on the problem affecting you. Identifying the location of your pain can help your physical therapist determine its cause.

How Is It Diagnosed?

Your physical therapist will make a diagnosis based on your symptoms, medical history, and a thorough examination. X-ray and magnetic resonance imaging (MRI) results may also be used to complete the diagnosis.

To help diagnose your condition, your physical therapist may ask you questions like these:

o Where exactly on your knee is the pain?

o Did you twist your knee?

o Did you feel a "tearing" sensation at the time of injury?

o Do you notice swelling?

o Have you ever felt like your knee joint is "catching," or "locking," or will give way?

o Do you have difficulty walking up and down stairs?

o Do you have difficulty sitting with your knee bent for long periods, as on an airplane or at the movies?

o Does your pain increase when you straighten or bend your knee?

o Does your knee hurt if you have to twist or turn quickly?

The physical therapist will perform tests to find out whether you have:

o Pain or discomfort with bending or straightening your knee

o Tenderness at the knee joint

o Limited motion in your knee

o Weakness in the muscles around your knee

o Difficulty putting weight on your knee when standing or walking

The physical therapist also is concerned about how well you are able to use your injured knee in daily life. To assess this, the therapist may use such tests as a single-limb hop test, a 6-minute walk test, or a timed up and go test.

How Can a Physical Therapist Help?

Based on the evaluation, your physical therapist will develop a customized rehabilitation program, including a specific set of knee exercises, for you.

If you already have knee problems, your physical therapist can help with a plan of exercise that will strengthen your knee without increasing the risk of injury or further damage. As a general rule, you should choose gentle exercises such as swimming, aquatic exercise, or walking rather than jarring exercises such as jogging or high-impact aerobics.

Consult your physical therapist about specific ways to maintain your knee health following injury or surgery. Your physical therapist has the relevant educational background and expertise to evaluate your knee health and to refer you to another health care provider if necessary.

Depending on the severity of your knee problem, your age, and your lifestyle, the therapist may select such treatments as:

Strength training and functional exercises, which are designed to increase strength, endurance, and function of your leg muscles (quadriceps and hamstrings). This in turn helps support the knee and reduce stress to the knee joint.

Electrical stimulation of the knee, which further increases leg muscle strength and can help reduce knee pain. To increase strength, electrical impulses are generated by a device and delivered through electrodes to stimulate the primary muscle that supports the knee, the quadriceps femoris. To reduce your knee pain, the electrodes are placed on the skin to gently stimulate the nerves around the knee.

Your physical therapist can determine just how much you may need to limit physical activity involving the affected knee. He or she also can gauge your knee’s progress in function during your rehabilitation.

How Can a Physical Therapist Help Before & After Surgery?

Your physical therapist, in consultation with your surgeon, will be able to tell you how much activity you can do depending on the type of knee surgery (such as total knee replacement) you undergo. Your therapist and surgeon also might have you participate in physical therapy prior to surgery to increase your strength and motion. This can sometimes help with recovery after surgery.

Following surgery, your physical therapist will design a personalized rehabilitation program for you and help you gain the strength, movement, and endurance you need to return to performing the daily activities you did before.

Can this Injury or Condition be Prevented?

Ideally, everyone should regularly get 3 types of exercise to prevent injury to all parts of the body, including the knees:

o Range-of-motion exercises to help maintain normal joint movement and relieve stiffness.

o Strengthening exercises to keep or increase muscle strength.

o Aerobic or endurance exercises (such as walking or swimming) to improve function of the heart and circulation and to help control weight. Weight control can be important to people who have arthritis because extra weight puts pressure on many joints, including the knee.

To keep knee pain and other musculoskeletal pain at bay, it’s important to maintain an overall healthy lifestyle, exercise, get adequate rest, and eat healthy foods. It’s also important for runners and other athletes to perform physical therapist-approved stretching and warm-up exercises on a daily basis—especially before beginning physical activity.

Real Life Experiences

At age 56, Monica was in very good health—eating right, maintaining her weight, and exercising daily at home. One day she fell off her exercise equipment and twisted her knee. The pain was excruciating. Even though she could walk short distances, using her sore leg during her daily activities soon became impossible. Monica made an appointment with her physical therapist. The therapist reviewed her medical history, conducted a thorough examination, and consulted with Monica’s physician regarding the need for a series of X-rays to ensure no bones were broken in the fall.

Consultation with an orthopedic surgeon confirmed that there were no broken bones and no need for surgery. Monica's physical therapist developed a program of strength training and functional exercises to increase her hip, knee, and ankle muscle strength and endurance. The physical therapist also recommended electrical stimulation of the knee to increase her quadriceps (thigh) muscle strength.

By following the physical therapist's regimen, Monica decreased her knee pain, and her mobility improved dramatically. Regular ongoing strength-training knee exercises—and more careful use of her exercise equipment—have helped Monica remain free of knee pain.

What Kind of Physical Therapist Do I Need?

Although all physical therapists are prepared through education and experience to treat people with knee pain, you may want to consider:

o A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems

o A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic physical therapy, giving the therapist advanced knowledge, experience, and skills that may apply to your condition

General tips when you're looking for a physical therapist:

o Get recommendations from family and friends or from other health care providers.

o When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with TKR.

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.

Article originally appeared on http://www.apta.org/, click the following link to read the original article: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=b92021cb-a1ec-4f20-8b7e-37d62bc1a52e

Physical Therapists Help You Get Fit!

2012-01-11T07:06:00.000-08:00

This was a news release from last year by the American Physical Therapy Association (APTA) but is very applicable in the beginning of this new year with everyone's resolutions to get fit. Read more to learn how to stay safe in your new endeavors of physical fitness...

New to the Gym? Physical Therapists Help You Get Fit – Safely – in 2011

ALEXANDRIA, VA, January 7, 2011 — New Years’ resolutions have an 80 percent rate of failure

by Valentine’s Day, but Americans can increase their success by sharing their commitment with

others. The American Physical Therapy Association’s (APTA’s) Move Forward campaign is

helping individuals keep commitments by starting the conversation online and providing fitness

tips for those who are heading to the gym.

For new, potential, and even returning gym members, APTA launched 12 instructional videos

featuring physical therapist and APTA member Robert Gillanders, PT, DPT. Dr. Gillanders

demonstrates correct posture and form for selected core, leg, shoulder and arm exercises. These

exercises, in conjunction with a regular cardiovascular routine, will help individuals strengthen

target areas. Gillanders’ advice will also help individuals exercise with less risk of injury.

“One of the most important things to remember is the overall form of the exercise,” Gillanders

said. “It’s going to help you be less vulnerable to injury. Physical therapists have extensive

knowledge of the way the body moves and are also able to adjust workouts for pre-existing

conditions, and these videos will help get Americans off to a good start in 2011.”

To help individuals stick to their New Years’ fitness resolutions, @MoveForwardPT invites people

to share their progress every Friday in January on Facebook and on Twitter via #MovePT. Join

the Move Forward PT community on Facebook, YouTube and Twitter via @MoveForwardPT. For

more information on how a physical therapist can help individuals achieve their fitness goals, visit

MoveForwardPT.com and read more about the benefits of physical activity.

About APTA

The American Physical Therapy Association (APTA) represents more than 74,000 physical

therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more

about conditions physical therapists can treat and find a physical therapist in your area.

Consumers are encouraged to follow us on Twitter (@moveforwardpt) and Facebook.

Physical and Occupational Therapy for Arthritis

2012-01-04T06:49:00.000-08:00

Physical and Occupational Therapy for Arthritis

Arthritis treatment may include physical therapy and/or occupational therapy.

People with arthritis often have stiff joints -- largely because they avoid movements that can increase pain. By not moving arthritic joints, however, the stiffness and pain only get worse. Therefore, people with arthritis often benefit from physical therapy. A physical therapist can teach you how to work out stiffness without further damaging your joint. Physical therapy also is useful after an injury, such as from a fall, and after joint surgery, especially for artificial joint replacement.

Occupational therapy can teach you how to reduce strain on your joints during daily activities. Occupational therapists can show you how to modify your home and workplace environments to reduce motions that may aggravate arthritis. They also may provide splints for your hands or wrists, and recommend assistive devices to aid in tasks such as driving, bathing, dressing, housekeeping, and certain work activities.

What Is the Goal of Physical Therapy?

The goal of physical therapy is to get a person back to the point where he or she can perform normal, everyday activities without difficulty.

Preserving good range of motion is key to maintain the ability to perform daily activities. Therefore, increasing the range of motion of a joint is the primary focus of physical therapy. Building strength in the involved muscles surrounding the joint also is extremely important, since stronger muscles can better stabilize a weakened joint.

Physical therapists provide exercises designed to preserve the strength and use of your joints. They can show you the best way to move from one position to another and can also teach you how to use walking aids such as crutches, a walker or a cane, if necessary.

What Are Some Benefits of Occupational and Physical Therapy?

If you have arthritis, there are many benefits to participating in a physical and occupational therapy program, including:

· You gain education about your type of arthritis, so that you can be well informed.

· If you are overweight, a dietary plan can be created to reduce the stress of excess weight on supporting joints of the back, legs, and feet. As yet, no specific diet -- other than a diet designed for weight loss -- has proved helpful for arthritis.

· You gain foot-care advice, including choice of well-fitting shoes with shock-absorbing outer soles and sculptured (orthotic) insoles molded exactly to the contour of each foot.

· You will learn therapeutic methods to relieve discomfort and improve performance through various physical techniques and activity modifications.

What Techniques Will I Learn?

You'll learn several techniques, including:

· Rest. Bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem. Individual joint rest is most helpful when arthritis involves one or only a few joints. Custom splints can be made to rest and support inflamed joints and a soft collar can support the neck while you are sitting or standing.

· Thermal modalities. Applying ice packs or heating pads, as well as deep heat provided by ultrasound and hot packs, can help relieve local pain. Heat also relaxes muscle spasm around inflamed joints. Heating joints and muscles with a warm bath or shower before exercising may help you exercise more easily.

· Exercise . Exercise is an important part of arthritis treatment that is most effective when done properly every day. Your doctor and therapist will prescribe a program for you that may vary as your needs change.

What Therapy Is Offered for People Recovering From Joint Replacement?

Preoperative programs of education and exercise, started before joint replacement surgery, are continued at home. They may be changed in the hospital after surgery to fit new needs during the rehabilitation period. These exercises may be added to your usual exercise regimen, and you may find your ability to exercise has improved after surgery.

What Joint Protection Techniques Are Offered?

There are ways to reduce the stress on joints affected by arthritis while participating in daily activities. Some of these include:

· Controlling your weight to avoid putting extra stress on weight-bearing joints such as the back, hips, knees, and feet.

· Being aware of body position, using good posture to protect your back and the joints of your legs and feet. When possible, sit down to do a job instead of standing. Change position often since staying in one position for a long time tends to increase stiffness and pain.

· Conserving energy by allowing for rest periods, both during the workday and during an activity.

· Respecting pain. It is your body's way of telling you something is wrong. Don't try an activity that puts strain on joints that are already painful or stiff.

An occupational therapist can show you ways to do everyday tasks without worsening pain or causing joint damage. Some joint protection techniques include:

· Using proper body mechanics for getting in and out of a car, chair or tub, as well as for lifting objects.

· Using your strongest joints and muscles to reduce the stress on smaller joints. For example, carrying a purse or briefcase with a shoulder strap rather than with your hand.

· Distributing pressure to minimize stress on any one joint. Lifting dishes with both palms rather than with your fingers and carrying heavy loads in your arms instead of with your hands.

· If your hands are affected by arthritis, avoid tight gripping, pinching, squeezing, and twisting. Ways to accomplish the same tasks with alternate methods or tools can usually be found.

What Are Assistive Devices for Arthritis?

If you have arthritis, many assistive devices have been developed to make activities easier and less stressful for the joints and muscles. Your therapist can suggest devices that will be helpful for tasks you may find difficult at home or at work.

A few examples of helpful devices include a bath stool for use in the shower or tub, grab bars around the toilet or tub, and long-handled shoehorns or sock grippers. Your therapist can show you catalogs that have a wide variety of assistive devices

Call us today to schedule an appointment if you or someone you love suffers from arthritis pain and are looking for relief!
1-386-898-0443

Physical Therapy and the Camaraderie of Healing

2011-12-14T09:26:00.000-08:00

I found this wonderful article written by an author about her experiences as a physical therapy patient. It really speaks to the bond and relationship patients and Physical Therapists develop during the course of treatment...

Physical Therapy and the Camaraderie of Healing

Brian Stauffer

I first had physical therapy at 27, after I slipped on an icy Montreal sidewalk and tore the ligaments in my left ankle. I had it again at 42 and 43, after surgery on my right and left knees, and most recently I’ve had it on both shoulders.

My orthopedist likes to say surgery is half the battle. If so, it’s the easy half.

The slow and repetitive work of physical therapy often starts the next day, and for an injury like a tear in an anterior cruciate ligament, it can take up to six months. Before you’ve done it, it’s hard to imagine anything is going to take so long and hurt so much.

Part of the challenge is the nature of arthroscopic surgery, whose multiple incisions are often so tiny they barely leave a trace. I’ve had torn meniscus (cartilage) removed from both my knees, and I have to look really hard to find my scars. Removal of bone spurs from my shoulder through four incisions left my skin almost smooth. Surely this is a good thing.

But those minuscule entry points make it difficult to comprehend what has been done in there. After only 45 minutes under general anesthetic and with no huge incision or bloody wound, why am I in so much pain? And why do I have to keep doing these silly exercises?

Surgeons have little time, and sometimes less appetite, to discuss the minutiae of a procedure’s aftereffects. Often it’s the physical therapists who patiently explain what the physician did and why we now have to relinquish huge chunks of our time to rehabilitation.

Physical therapy, or P.T., demands the month-after-month tedium of spending hours in a room filled with strangers stretching colored rubber bands or spinning their arms in circles.

The rituals are oddly and intimately public. Patients of every age, race and income level share a large, sunny room. We do our leg-raises side by side on wide beds. We wait in line for the pulley, the elliptical and the arm bike. We learn a new language and its tools: the strap, the stick, shrugs and pinches.

Everyone ends up in P.T. — lithe teenage athletes, construction workers and police officers with job-related strains, C.E.O.’s with skiing injuries, older people with replaced knees and hips. I’ve commiserated there with an Episcopal minister, an Ivy League economics professor and a firefighter.

The rituals become routine, starting with a heating pad and nerve stimulation, ending with the soothing benediction of a black rubber ice pack. We learn to bend our lives around the inexorable, unfashionable truth — healing takes work and it takes time.

Camaraderie grows as patients compare notes on the frustration of needing help for tasks as simple as pulling up your trousers or opening a can of soup. Women commiserate with the new knowledge that a bra strap can pinch a healing shoulder like steel cable. Struggling to complete even the simplest of tasks in a room full of fellow adults is humbling. When I see someone’s jaw clench with effort, I remember that lifting a one-pound weight can be tough.

I never expected to forge a multiyear relationship with my physical therapists, but I have. I like Helen and Matt and Stephanie and Richard. Really. I just hope I never see them again.

I don’t envy them their job, stretching and shaking and manipulating our joints to loosen them and keep them flexible. It has left me gasping in pain, sometimes even tears. I can’t imagine having to intentionally inflict pain, but that, one quickly learns, is an inevitable part of healing.

It must be difficult for our physical therapists to cheer us on for what are, in other circumstances, a toddler’s proud achievements — when we have regained the ability to tie our shoelaces or walk steadily across a room or throw a ball.

There is an upside. Because we see them so frequently for months, we get to know our physical therapists, and they us, in ways we’ll never know our doctors. We learn where they live and go on vacation, who has a new puppy, whose husband changed careers.

It’s not an intimacy we would choose. But, shoved out of our private, busy lives, whether reluctantly or gratefully, we fall into their strong, skilled, waiting hands.

Caitlin Kelly is the author of “Blown Away: American Women and Guns.”

New Study Proves PT is the Best Choice in Tendon Injuries....

2011-12-07T07:24:00.000-08:00

For Tendon Pain, Think Beyond the Needle

By JANE E. BRODY Published: February 28, 2011

Two time-honored remedies for injured tendons seem to be falling on their faces in well-designed clinical trials.

Enlarge This Image

The first, corticosteroid injections into the injured tendon, has been shown to provide only short-term relief, sometimes with poorer long-term results than doing nothing at all.

The second, resting the injured joint, is supposed to prevent matters from getting worse. But it may also fail to make them any better.

Rather, working the joint in a way that doesn’t aggravate the injury but strengthens supporting tissues and stimulates blood flow to the painful area may promote healing faster than “a tincture of time.”
And researchers (supported by my own experience with an injured tendon, as well as that of a friend) suggest that some counterintuitive remedies may work just as well or better.

A review of 41 “high-quality” studies involving 2,672 patients, published in November in The Lancet, revealed only short-lived benefit from corticosteroid injections. For the very common problem of tennis elbow, injections of platelet-rich plasma derived from patients’ own blood had better long-term results.
Still, the authors, from the University of Queensland and Griffith University in Australia, emphasized the need for more and better clinical research to determine which among the many suggested remedies works best for treating different tendons.

My own problem was precipitated one autumn by eight days of pulling a heavy suitcase through six airports. My shoulder hurt nearly all the time (not a happy circumstance for a daily swimmer), and trying to retrieve something even slightly behind me produced a stabbing pain. Diagnosis: tendinitis and arthritis. Treatment: rest and physical therapy.

Two months of physical therapy did help somewhat, as did avoiding motions that caused acute pain. The therapist had some useful tips on adjusting my swimming stroke to minimize stress on the tendon while the injury gradually began to heal.

The following spring, although I still had some pain and feared a relapse, I attacked my garden with a vengeance. Much to my surprise, I was able to do heavy-duty digging and lugging without shoulder pain.
Could the intense workout and perhaps the increased blood flow to my shoulder have enhanced my recovery? A friend, Richard Erde, had an instructive experience.

An avid tennis player at 70, he began having twinges in his right shoulder while playing. Soon, simple motions like slipping out of a shirt sleeve caused serious pain. The diagnosis, based on a physical exam, was injury of the tendon that attaches the biceps muscle of his upper arm to the bones of the shoulder’s rotator cuff.
He was advised to see a rheumatologist, who declined to do a corticosteroid injection and instead recommended physical therapy and rest.

“I stopped playing tennis for a month, and it didn’t help at all,” Mr. Erde told me. “The physical therapist found I had very poor range of motion and had me do a variety of exercises, which improved my flexibility and reduced the pain somewhat.” After two months, he stopped the therapy.

Then several weeks ago, after watching the Australian Open, he thought he should do more to strengthen his arm and shoulder muscles and decided to try playing tennis more vigorously. “The pain started to drop off dramatically,” he said, “and in just 10 days the pain had eased more than 90 percent.”

A Frustrating Injury

Tendinopathies, as these injuries are called, are particularly vexing orthopedic problems that remain poorly understood despite their frequency. “Tendinitis” is a misnomer: rarely are there signs of inflammation, which no doubt accounts for the lack of lasting improvement with steroid shots and anti-inflammatory drugs. They may relieve pain temporarily, but don’t cure the problem.

The underlying pathology of tendinopathies is still a mystery. Even when patients recover, their tendons may continue to look awful, say therapists who do imaging studies. Without a better understanding of the actual causes of tendon pain, it’s hard to develop rational treatments, and even the best specialists may be reduced to trial and error. What works best for one tendon — or one patient — may do little or nothing for another.

Most tendinopathies are precipitated by overuse and commonly afflict overzealous athletes, amateur and professional alike. With or without treatment, they usually take a long time to heal — many months, even a year or more. They can be frustrating and often costly, especially for professional athletes and physically active people like me and Mr. Erde.

In a commentary accompanying the Lancet report, Alexander Scott and Karim M. Khan of the University of British Columbia noted that although “corticosteroid injection does not impair recovery of shoulder tendinopathy, patients should be advised that evidence for even short-term benefits at the shoulder is limited.” Like the Australian reviewers, the commentators concluded that “specific exercise therapy might produce more cures at 6 and 12 months than one or more corticosteroid injections.”

Treatments to Try

Now the question is: What kind of physical therapy gives the best results? Most therapists prescribe eccentric exercises, which involve muscle contractions as the muscle fibers lengthen (for example, when a hand-held weight is lowered from the waist to the thigh). Eccentric exercises must be performed in a controlled manner; uncontrolled eccentric contractions are a common cause of injuries like groin pulls or hamstring strains.

Marilyn Moffat, professor of physical therapy at New York University and president of the World Confederation for Physical Therapy, prefers “very protective” isometric exercises, at least at the outset of treatment until the tendon injury begins to heal. These exercises involve no movement at all, allowing muscles to contract without producing pain. For example, in treating shoulder tendinopathy, she said in an interview, the patient would push the fists against a wall with upper arms against the body and elbows bent at 90 degrees.

In another exercise, the patient sits holding one end of a dense elastic Thera-Band in each hand and, with thumbs up, upper arms at the sides and elbows bent at 90 degrees, tries to pull the hands apart.
“The stronger the shoulder muscles are when the tendinopathy calms down, the better shape the shoulder is in to take over movement without further injury,” Dr. Moffat said. “You don’t want the muscles to weaken, which is what happens when you rest and do nothing. That leaves you vulnerable to further injury.”

(article originally appeared in the NY Times. http://www.nytimes.com/2011/03/01/health/01brody.html?_r=1&ref=physicaltherapy)

Teaching our Children the True Meaning of Christmas...very inspirational

2011-11-30T07:23:00.000-08:00

Instead of our usual blog, and in consideration of the wonderful season that is now upon us, I've decided to make this week's entry be more about teaching the true meaning of Christmas. I found this story online and I hope you enjoy it as much as I did. It really helps put the season into perspective and gives us the opportunity to teach our own children about the true meaning of Christmas while they are still young. Enjoy!

Teach the children...

Late one Christmas Eve, I sank back, tired but content, into my easy chair. The kids were in bed, the gifts were wrapped, the milk and cookies waited by the fireplace for Santa. As I sat back admiring the tree with its decorations, I couldn't help feeling that something important was missing. It wasn't long before the tiny twinkling tree lights lulled me to sleep.

I don't know how long I slept, but all of a sudden I knew that I wasn't alone. I opened my eyes, and you can imagine my surprise when I saw Santa Claus himself standing next to my Christmas tree. He was dressed all in fur from his head to his foot just as the poem described him, but he was not the "jolly old elf" of Christmas legend. The man who stood before me looked sad and disappointed, and there were tears in his eyes.

"Santa, what's wrong?" I asked, "Why are you crying?"

"It's the children," Santa replied sadly.

"But Santa, the children love you," I said.

"Oh, I know they love me, and they love the gifts I bring them," Santa said, "but the children of today seem to have somehow missed out on the true spirit of Christmas. It's not their fault. It's just that the adults, many of them not having been taught themselves, have forgotten to teach the children."

"Teach them what?" I asked.

Santa's kind old face became soft, more gentle. His eyes began to shine with something more than tears. He spoke softly. "Teach the children the true meaning of Christmas. Teach them that the part of Christmas we can see, hear, and touch is much more than meets the eye. Teach them the symbolism behind the customs and traditions of Christmas which we now observe. Teach them what it is they truly represent."

Santa reached into his bag and pulled out a tiny Christmas tree and set it on my mantle. "Teach them about the Christmas tree. Green is the second color of Christmas. The stately evergreen, with its unchanging color, represents the hope of eternal life in Jesus. Its needles point heavenward as a reminder that mankind's thoughts should turn heavenward as well."

Santa reached into his bag again and pulled out a shiny star and placed it at the top of the small tree. "The star was the heavenly sign of promise. God promised a Savior for the world and the star was the sign of the fulfillment of that promise on the night that Jesus Christ was born. Teach the children that God always fulfills His promises, and that wise men still seek Him."

"Red," said Santa, "is the first color of Christmas." He pulled forth a red ornament for the tiny tree. "Red is deep, intense, vivid. It is the color of the life-giving blood that flows through our veins. It is the symbol of God's greatest gift. Teach the children that Christ gave His life and shed His blood for them that they might have eternal life. When they see the color red, it should remind them of that most wonderful Gift."

Santa found a silver bell in his pack and placed it on the tree. "Just as lost sheep are guided to safety by the sound of the bell, it continues to ring today for all to be guided to the fold. Teach the children to follow the true Shepherd, who gave His life for the sheep."

Santa placed a candle on the mantle and lit it. The soft glow from its one tiny flame brightened the room. "The glow of the candle represents how people can show their thanks for the gift of God's Son that Christmas Eve long ago. Teach the children to follow in Christ's foot steps... to go about doing good. Teach them to let their light so shine before people that all may see it and glorify God. This is what is symbolized when the twinkling lights shine on the tree like hundreds of bright, shining candles, each of them representing one of God's precious children, their light shining for all to see."

Again Santa reached into his bag and this time he brought forth a tiny red and white striped cane. As he hung it on the tree he spoke softly. "The candy cane is a stick of hard white candy: white to symbolize the virgin birth and sinless nature of Jesus, and hard to symbolize the Solid Rock the foundation of the church, and the firmness of God's promises. The candy cane is in the form of a 'J' to represent the precious name of Jesus, who came to earth. It also represents the Good Shepherd's crook, which He uses to reach down into the ditches of the world to lift out the fallen lambs who, like all sheep, have gone astray. The original candy cane had three small red stripes, which are the stripes of the scourging Jesus received by which we are healed, and a large red stripe that represents the shed blood of Jesus, so that we can have the promise of eternal life."

"Teach these things to the children."

Santa brought out a beautiful wreath made of fresh, fragrant greenery tied with a bright red bow. "The bow reminds us of the bond of perfection, which is love. The wreath embodies all the good things about Christmas for those with eyes to see and hearts to understand. It contains the colors of red and green and the heaven-turned needles of the evergreen. The bow tells the story of good will towards all and its color reminds us of Christ's sacrifice. Even its very shape is symbolic, representing eternity and the eternal nature of Christ's love. It is a circle, without beginning and without end. These are the things you must teach the children."

I asked, "But where does that leave you, Santa?"

The tears gone now from his eyes, a smile broke over Santa's face. "Why bless you, my dear," he laughed, "I'm only a symbol myself. I represent the spirit of family fun and the joy of giving and receiving. If the children are taught these other things, there is no danger that I'll ever be forgotten."

"I think I'm beginning to understand."

"That's why I came," said Santa. "You're an adult. If you don't teach the children these things, then who will?"

(author unknown)

Carpal Tunnel Syndrome and How Our Certified Hand Therapists Can Help You!

2011-11-16T09:03:00.000-08:00

What is it?

• Carpal tunnel syndrome is the effect of pressure on the median nerve, one of the main nerves of the hand. It can result in a variety of problems, including pain, tingling, numbness, swelling, weakness or clumsiness of the thumb, index, middle and ring fingers.

What caused it?

• Carpal tunnel syndrome develops in people who have a tendency toward swelling or inflammation in their hands.
• Like a telephone cable, the median nerve is a connection between the fingers and the spinal cord. It passes a through a protective conduit (tunnel) deep in the wrist (carpus), along with the nine tendons which bend the fingers. The nerve and each of the tendons are each nearly as wide as a pencil. The tunnel is only a little over an inch wide - just big enough to hold the nerve and tendons. When the tendons are irritated, the lining around the tendons (synovium) swells up and puts pressure on the nerve. This pressure cuts off the blood supply to the nerve.
• Tendon swelling (tendinitis) results from a person's own tendency to collect fluid around their tendons and joints. This may be aggravated by repetitive or strenuous activities.
• Swelling from adjacent problems, such as trigger finger, basal joint arthritis, rheumatoid arthritis or effects of a wrist fracture may aggravate or bring on carpal tunnel syndrome.
• Early on, symptoms occur during sleeping hours. This is because the swelling is relieved by normal use of the hand which pumps extra fluid out of the carpal tunnel. The fluid pressure builds up only when the hand is at rest - especially during sleep. Bending the wrist may also increase pressure on the nerve.
• In more advanced cases, symptoms occur during waking hours. At this stage, scar tissue may form around the nerve from repeated episodes of pressure. Nerve damage is suspected when any symptoms occur regularly during the day.

What can you do to help?

• As many as two out of three people with mild carpal tunnel syndrome will have some improvement with Stretching Exercises designed to relieve pressure within the carpal tunnel as outlined here.
• "Over the counter" non-steroidal anti-inflammatory medication (NSAID), such as aspirin, ibuprofen, naprosyn, or ketoprofen. Check with your pharmacist regarding possible side effects and drug interactions.
• Take Vitamin B6 100 mg daily (not more) - controversial, but can't hurt, and might help. If you are pregnant or receiving vitamin therapy already, first check with your doctor.
• A splint or brace which supports the wrist, to use while sleeping.
• Wait and watch.

What can a therapist do to help?

• Provide a hand splints to support the wrist.
• Help identify aggravating activities and suggest alternative postures.

What can a doctor do to help?

• Confirm that this actually is the problem. This may require special nerve tests done by a neurologist.
• Prescribe stronger NSAID medication or cortisone-type medication.
• Prescribe hand therapy and/or a custom prescription splint.
• The most effective treatment without surgery is a cortisone shot into the carpal tunnel. Depending on several factors, these measures can provide provide long-term relief in 5 to 60 per cent of patients. Conservative treatment is usually not recommended for patients who have evidence of nerve damage.
• Surgery for carpal tunnel syndrome is intended to provide more space for the nerve and tendons, so that swelling will not put dangerous amounts of pressure on the nerve. It is usually done through an incision on the palm or the front of the wrist. An incision is made to open the carpal tunnel. The tunnel opens up. It heals with more space inside for the nerve and tendons - like letting out a pair of pants.
• Carpal tunnel syndrome associated with other medical conditions, such as rheumatoid arthritis, may require a more extensive cleaning out of the tissue around the tendons, referred to as a synovectomy.

There are many different techniques used for the surgery - whether it involves a cut in the palm, the wrist, smaller or longer cuts or different instruments, the one thing in common is that the thick layer of ligament in front of the nerve is cut.

After surgery, the healing edges of the ligament beneath the skin are usually tender for at least four to six weeks after the procedure. Temporary tenderness on each side of the palm where the ligament is attached to the bones on each side of the palm these bones is common after surgery and is called "pillar pain". This generally resolves gradually. Hand therapy is often helpful during recovery.

How successful is treatment?

• Swelling, stiffness, aches and pains in the hand may well be due to other problems, and may persist to some extent following any form of treatment.
• Nerve damage existing before treatment may lead to incomplete recovery.
• With this in mind, the great majority of patients are improved with appropriate treatment. Most reports indicate that if carpal tunnel syndrome is the only problem, over 95% of patients have a satisfactory outcome from surgery.

What happens if you have no treatment?

• It depends most importantly on whether or not the problem actually is carpal tunnel syndrome and whether or not there are other medical conditions contributing to the overall picture.
• Mild carpal tunnel syndrome can improve without treatment in as many as one in three people.
• The chances of getting better without surgery are less when
o both hands are involved.
o the longer the problem has been going on.
o the older the person is.
o the more severe the symptoms of numbness and tingling are.
• The longer the nerve is irritated, the longer numbness or tingling are constant, the harder it is to have a full recovery - even with surgery. If the problem is severe, however, surgery is a reasonable step to prevent further nerve damage even if full recovery cannot be guaranteed.

If you are suffering from Carpal Tunnel Syndrome and are looking for relief, call us today to schedule an appointment and one of our Certified Hand Therapists can discuss therapy options with you. We take most major insurances. 1-386-898-0443.

Online resource: http://www.eatonhand.com/hw/hw006.htm

Search the web for carpal tunnel syndrome, or go to these on line brochures:
American Association of Orthopedic Surgeons: CTS Patient Education Brochure.
American Society for Surgery of the Hand: CTS Patient Education Brochure.

Top 5 Repetitive Strain Injuries in Runners and Ways to Treat Them

2011-11-09T05:47:00.000-08:00

Running is a popular sport enjoyed by many people of all ages. While running is great exercise for the muscles, joints, heart and lungs, it may also cause repetitive strain on body parts and be a source of injury.

While not all running injuries can be avoided, many repetitive strain injuries from running can. By maintaining adequate flexibility and strength, you can limit your chances of suffering from the top five running injuries.

1. Iliotibial Band Syndrome: Iliotibial band syndrome (ITBS) occurs when there is repetitive friction of the iliotibial band, a thick mass of tissue that courses down the outside of the thigh from the hip to the front of the knee. Irritation of the ITB usually causes intense burning pain in the outside portion of the kneecap. Treatment of ITBS involves rest and ice during the initial phase of injury. This can help limit the inflammatory response.

After a short period of rest, gentle stretching of the ITB can be started. Occasionally hip and abdominal strength limitations can have an effect on knee position during running, which can place stress on the ITB. Therefore, hip and core strengthening may be required to fully recover from ITBS. Your doctor and physical therapist can help you determine which specific muscles groups you should focus on.

2. Piriformis Syndrome: The piriformis is a muscle that resides deep in the hip and serves to rotate and stabilize the hip. Irritation of the piriformis muscle can cause hip and buttock pain. The piriformis muscle courses over the sciatic nerve, and tightness in the piriformis muscle can cause pain that runs down the leg, much likesciatica. If you have piriformis syndrome, your doctor and physical therapist should evaluate you to determine the biomechanical cause of the pain. Since low back pain is sometimes felt in the hip, examination of your low back and spine should occur. Initial treatment of piriformis syndrome involves a period of rest. Once the acute pain has subsided, stretching and strengthening the muscles of the hips and legs should occur.

3. Patellofemoral Stress Syndrome (PFSS): This common knee problem occurs with improper tracking of the kneecap in the groove of the femur and causes pain around the kneecap. It can be caused by tightness in the iliotibial band, weakness in the thigh muscles, or weakness in the hip muscles. Treatment of PFSS involves rest and ice to control initial inflammation. After a short period of rest, gentle stretching and strengthening can be done. Your physical therapist should also evaluate your gait and running stride to assess if other mechanical faults are causing your problem.

4. Shin Splints: Shin splints are caused by inflammation of the anterior tibialis tendon in the front of the shin. Symptoms of shin splints include pain, numbness and burning in the front of the shin. Occasionally poor foot position can cause shin splints, so your physical therapist should evaluate the position of your feet while you are standing and lying down. Orthotics are sometimes necessary to correct foot position.

5. Plantar Fasciitis: The plantar fascia is a thick band of tissue on the bottom of the foot that helps form the arch of the foot. Irritation of the plantar fascia can cause pain on the bottom of the foot near the heel bone. You should initially treat plantar fasciitis with a period of rest and ice. Gentle stretching of the calf and leg muscles should be started. As with shin splints, a foot evaluation may be necessary to see if the position of your feet may be a mechanical cause of plantar fasciitis.

If you are a runner experiencing any repetitive strain injuries, you should speak with your doctor and physical therapist to decide on the best treatment for you. A thorough evaluation of your specific biomechanics while running can help you treat the current problem and prevent future episodes of pain.

This article originally appeared on:

http://physicaltherapy.about.com/od/sportsinjuries/a/The-Top-Five-Running-Injuries.htm

Early Therapy Can Help Knee Surgery Patients

2011-11-02T08:08:00.000-07:00

Beginning physical therapy within 24 hours of knee arthroplasty surgery can improve pain, range of joint motion and muscle strength as well as cut hospital stays, according to new research in Clinical Rehabilitation.

Physical therapy and public health researchers from Almeria, Malaga and Granada in Spain compared patients who began treatment within 24 hours of surgery with those who began 48 to 72 hours after their operation in a random, controlled clinical trial. Each group had more than 150 patients, ages 50 to 75.

The post-operative treatment began with a series of leg exercises, breathing exercises, and tips on posture. By the second day, walking short distances with walking aids was added. In subsequent days the regimen built up to adapting to daily life activities, such as beginning to climb stairs on the fourth day.

On average, those beginning treatment earlier stayed in hospital two days less than the control group and had five fewer rehabilitation sessions before discharge. An early start also led to less pain, greater range of joint motion both in leg flexion and extension, improved muscle strength and higher scores in tests for gait and balance.

Other benefits of early mobilization after this surgery are fewer complications, such as deep vein thrombosis, pulmonary embolism, chest infection and urinary retention. With hospital-acquired infections, such as MRSA, also a serious concern, a shorter hospital stay also might lower the risk to patients of contracting this type of secondary infection.
source: todayinpt.com

Prevention is Key with Recurrent Ankle Injuries

2011-10-26T07:09:00.000-07:00

Key To Avoiding Ankle Re-Injury May Be In The Hips And Knees Suggests UGA Study

Nearly all active people suffer ankle sprains at some point in their lives, and a new University of Georgia study suggests that the different ways people move their hip and knee joints may influence the risk of re-injury.

In the past, sports medicine therapists prescribed strengthening and stretching exercises that targeted only ankle joints after a sprain. The study by UGA kinesiology researchers, published in the early online edition of the journal Clinical Biomechanics, suggests that movements at the knee and hip joints may play a role in ankle sprains as well.

"If you have ankle sprains, you may have a problem with the way you move, and we think we can change movement through rehabilitation," said Cathleen Brown, lead author of the study and assistant professor in the department of kinesiology in the College of Education.

Past studies on ankle sprains have shown that some people are able to return to sports or physical activities without a problem. Brown and her team, which includes associate professor Kathy J. Simpson, also in the kinesiology department, want to know why some recover completely.

"One theory for explaining those divergent paths is that a person comes up with good strategies to move, land, balance and not get re-injured," Brown said.

For the study, 88 participants were divided into three groups: an uninjured control group, active people who still experienced problems after an ankle sprain and "copers," or people who had been injured but no longer felt pain or weakness in their ankle. Participants dressed in an Avatar-like body suit that sent data to cameras and computers detailing the exact position of ankle, knee and hip joints. Each person stood 27.5 inches away from an in-ground metal platform and jumped to reach a target, then landed on one foot without assistance.

Of the three groups, the uninjured group bent their knees and swayed their hips side-to-side more often than either of the other groups. However, the "copers" also showed differences in those joint movements. The injured group with lingering ankle pain appeared unable to use their knee and hip joints as well when landing on the metal surface.

"Maybe the injured people don't use the same landing strategies, or their strategies aren't as effective," Brown said, adding that the study was a snapshot in time, not a long-term follow-up. By the time subjects were included in the research study, they have usually already injured themselves. "We don't know if they are this way because of the injury, or if they got this injury because they land this way."

The current study looked at the knees, hips and ankles in isolation, and the next step for the team will be to examine the joints in combination. If future studies allow the researchers to identify particular movement patterns as helpful, the research could be directly translated into new techniques for rehabilitation therapists and the public in general.

Brown said the current study builds on a similar study published in June 2011 that examined ankle injuries based on the amount of clearance between the foot and the ground. In that study, she found that participants with previous ankle injuries kept their feet closer to the ground, with their toes pointing downward, while running.

"I always try to encourage people who are having a lot of problems with their ankle to see a health care professional who would be able to help them," she said. "There are negative long-term consequences to ankle instability, such as ankle osteoarthritis, that may be preventable with treatment."

Article adapted by Medical News Today from original press release:
University of Georgia. (2011, October 19). "Key To Avoiding Ankle Re-Injury May Be In The Hips And Knees Suggests UGA Study." Medical News Today. Retrieved fromhttp://www.medicalnewstoday.com/releases/236142.php.

Barefoot Shoes More Effective When Running Style Is Correct

2011-10-19T06:08:00.000-07:00

Barefoot Shoes More Effective When Running Style Is Correct

Adopting the correct foot-to-ground strike style can help runners who suffer from chronic running injuries who are using barefoot-style shoes avoid additional risks. These are the findings of new research on Vibram FiveFingers, a sock-style shoe that simulates the effect of running barefoot while protecting the foot.

The American Council on Exercise (ACE), is the largest nonprofit fitness certification, education and training organization in the world and also America's leading authority on fitness. They announced the result of the research, by the University of Wisconsin, La Crosse, Exercise and Health Program, and led by Dr John Porcari, and Caitlin McCarthy, in a statement at the end of September.

The research is not published in a peer-reviewed journal, but you can download a copy of the report from the ACE website.ACE's Chief Science Officer, Dr Cedric X. Bryant, said:"We've seen an increasing number of individuals using barefoot-style running shoes, and felt it critical to examine this trend.""The bottom line is that runners must first and foremost modify their running style for ultimate safety and benefit, and this should be done gradually through regular practice. Once that is achieved, Vibram FiveFingers can be a safe and effective shoe for those who want to experience the feel of barefoot running," he explained.

Promoters of barefoot running say it is safer because it reduces the risk of injury compared to running in traditional shoes. They say this is because running shoes encourage runners to strike with their heels first, which causes more pounding and stress.

Running barefoot, conversely, encourages the foot to land near the ball, resulting in less pounding and less risk of injury. Vibram say their product helps runners achieve the safer forefoot-strike of barefoot running while avoiding the abrasion on the soles.

ACE asked the researchers to look into what happens when runners switch from traditional running shoes to minimalist shoes like Vibram FiveFingers, which they describe on their website as "a quirky-looking sock-style shoe with separate compartments for each toe".For the study, the researchers recruited 16 healthy, injury-free, female "recreational joggers", aged from 19 to 25.Before the evaluation, each jogger was fitted with a pair of Vibram FiveFingers Bikila which are designed for running.For two weeks before the test, to get used to their new shoes, the volunteers wore them when they went out running, for 20 minutes at a time, three times a week.After this two-week acclimatization, the researchers carried out lab evaluations of the volunteers' running style as they were invited to run on a on a 20m runway under three different conditions: (1) wearing the Vibrams; (2) wearing a pair of traditional running shoes; and running truly barefoot.

The researchers evaluated a 3-D motion analysis and took measures of ground-reaction forces as the runners completed seven trials for each of the three conditions. The order of the trials for the Vibrams and the running shoes was random, but the barefoot trial was always measured last.The results showed that:

· All the runners were rear-foot strikers when they ran in traditional shoes.
· Half of them switched to fore-foot strike when they ran in Vibrams or barefoot.
· The other half kept to the same rear-foot strike style through all of the conditions.
· Those who switched to fore-foot style, showed greater "plantar flexion" (pointing the foot away from the leg, as when you step on the gas pedal), which seemed to allow
better absorption of the forces of impact.
· Those who continued with rear-strike style when running in Vibrams or barefoot, had a higher rate of loading, and their loads were higher, than when they ran in
traditional shoes.
· When they ran in Vibrams or barefoot, all runners showed reduced knee flexion, which is usually linked to lower rates of injury.
· But, when runners wore Vibrams, they showed more pronation, similar to when running in regular shoes, which could increase the risks of injury in the lower limbs that
can come from overuse.

Porcari said the bottom line is:"Just because you put the Vibrams on your feet doesn't mean you'll automatically adopt the correct running stride."Pete McCall, an ACE exercise physiologist, who has been exercising (but not running) in Vibrams since mid-2009 said:"If you want to run in the Vibrams, you should be prepared to change your gait pattern."You need to give yourself time adapt to them, he added.Porcari agreed: "Running in Vibrams could be good for some if they adopt the appropriate running style."He advised people to get "explicit" instruction and spend time practising how to land on the ball of the foot, as opposed to the heel. Otherwise people could do themselves more harm than good:"Simply switching to Vibrams doesn't guarantee that a person is not going to experience more injuries," he cautioned.

Written by Catharine Paddock PhD
Copyright: Medical News Today

Joint Replacements and the Baby Boomer Generation: How Progressive Physical Therapy can help you!

2011-10-05T07:16:00.000-07:00

Today in the U.S. our Baby Boomer generation is reaching an average age of 65. With this comes the changes in lifestyles due to pain or limited mobility which ultimately will affect the ability to live independently. Physical therapists are playing an ever important role in the lives of Baby Boomers as advocates as well as healthcare experts who hold the unique skill of helping to promote and maintain mobility and independence.

Thanks to many medical advances in joint replacement procedures there are numerous options available to people who may be living with chronic joint pain/stiffness. Physical therapists play a vital role in the overall outcome and success of joint replacement patients. The actual joint replacement procedure is only the first step. Physical therapy is ultimately what will determine the success of the procedure.

Boomers are expected to need rehab after hip and knee replacements in record numbers, according to a study in The Journal of Bone and Joint Surgery. By 2015, the demand for total knee arthroplasties is expected to double over 2005 levels, according to the study. The demand for hip revision procedures is projected to double by the year 2026.

Those numbers are slated to rise further as baby boomers continue to age. By 2030, boomers are expected to have 3.48 million total knee replacements (up 673% over today’s levels) and 572,000 total hip replacements (up 174%).

In addition to larger health needs, this generation is known for its independence. “In general terms, this generation is highly educated, has a desire to be in control, and wants to maintain their activity level,” she said. “These characteristics are sometimes difficult to reconcile with the trends we are seeing in inactivity and chronic disease, however I do think we will be dealing with a generation that has great access to information, wants the best provider, will be demanding, and will expect to get the best quality for the best price.” (Alice Bell, PT, GCS, director of physical therapy clinical services at Genesis Rehabilitation Services in Kennett Square, Pa.)

Physical therapists play an important role to all patients requiring therapy for post-surgical procedures and it is imperitive they stay up-to-date on the ever changing world of insurance and Medicare.

You can rest assured that the physical therapists at Progressive Physical Therapy stay current on the rapidly changing healthcare environment to bring you the best outpatient physical therapy care possible. Our therapists are members of the APTA (American Physical Therapy Association) and read the national publications and journals regularly.

Call today if you or someone you know is planning a joint replacement in the near future. We will give you a tour and explain what therapy will entail once you are cleared for therapy from your surgeon.

Please also read the article on the following link: (this article was referenced in this post)
http://news.todayinpt.com/article/20110606/TODAYINPT0105/110603005

Our New Shuttle Recovery Machine...the history and how it helps Physical Therapists treat a large variety of patients!!

2011-09-28T07:00:00.000-07:00

We have a new machine at Progressive Physical Therapy that will help make a significant difference in how we treat our patients and how our patients progress through their therapy! Read on to learn more!......

In 1965, the US Air Force proposed the launching of a secret Space Station…

to be named the Manned Orbiting Lab (MOL). Of prime concern to Gary Graham and a team of other bioscientists was the effect on an astronaut’s cardiovascular system during the long exposure to the zero gravity environment of space.

The Bioastronautics team proposed subjecting the astronauts to intermittent positive and negative acceleration forces parallel to the long axis of the body as a way of taxing their cardiovascular system and maintaining their orthostatic tolerance. The team developed a prototype they named the Cardiovascular Conditioner.

The government eventually scrapped the MOL Project. But, twenty years later, with additional research and development, Gary patented a Horizontal Rebounding exercise device. The CMC (CardioMuscular Conditioner) Shuttle 2000 used the basic principles derived from the Boeing cardiovascular conditioner.

And Shuttle Systems was born…

	1965 – Manned Orbiting Lab Gary Graham and the team of bioscientists at Boeing developed the Cardiovascular Conditioner as a potential exercise system for the Manned Orbiting Lab (MOL). Research studies on the prototype were very promising, but the government canceled the MOL project in favor of the NASA lunar mission.
	1985 – CMC Shuttle 2000 Gary resurrects the MOL project exercise system concept for use as an earth-bound exercise machine. Additional research and development results in a patented Horizontal Rebounding exercise machine named the CMC (CardioMuscular Conditioner) Shuttle 2000.
	1990 – Shuttle 2000-1 Initially, the CMC Shuttle 2000 would be used primarily as a physical therapy tool. Further R & D generated a more advanced model, the Shuttle 2000-1. Today, the 2000-1 remains a flagship machine with its numerous accessories and expanded versatility designed to meet the specific needs identified by practicing therapists and trainers. Five models of the Shuttle 2000-1 are currently in production.
	1993 – Shuttle MVP Shortly after the appearance of the 2000-1 Series, trainers and athletes began using the machine for conditioning and athletic training. However, professional and world-class athletes were seeking a Shuttle with more resistance. Thus was born the Shuttle MVP. With three models and resistance loads up to 650 pounds, the MVP has become the preferred tool for developing explosive power in the elite athlete.

1997 – Shuttle MiniPress

Bill Bollinger, a physical therapist, expressed the need for a small Shuttle that would be mobile and could be used in a patient’s bed, on a training table, on the playing field, or at home. The MiniClinic was introduced in 1997 and would later become the Shuttle MiniPress. Utilizing a variation of the Horizontal Rebounding Technology, the MiniPress weighs less than 15 lbs, provides resistance loads up to 100 pounds, and allows the therapist to “bring the press to the patient.”

2000 – Shuttle Balance

In response to a growing need for equipment focusing specifically on balance – and in conjunction with Robert Crouch of Precision Fitness in Adelaide and several physical therapists in Washington state – the Shuttle Balance was created. We also want to thank Mick Lynch, MD and his sister, Teresa Schuemann, PT, DPT, SCS, ATC, CSCS, for their pioneering work on balancing devices. The Balance has been demonstrated to be a very effective tool for fall prevention, balance training, rehabilitation and athletic development.

2009 – Shuttle Recovery---Progressive's New Machine!

With the shrinking square footage of the typical physical therapist/hospital treatment space and the challenging economic times the world is facing, we went back to the drawing board to develop a rehabilitation machine that provided a smaller footprint at a smaller price. The new Shuttle Recovery provides resistance as low as 12½ pounds all the way up to 200 pounds at full extension. PT's can treat kids to seniors, post-op patients to high school athletes. PT's can also change the elasticord load while the patient remains on the Recovery – we don’t have to get the patient off and on to progress their treatment.

To learn more about this machine and how Shuttle's can help with your recovery, visit: http://www.shuttlesystems.com/about/company-history

Call today to schedule an appointment! 898-0443

Last Chance!! Fan our NEW Facebook Page before the old one is deleted!

2011-09-21T06:25:00.000-07:00

https://www.facebook.com/pages/Progressive-Physical-Therapy-Inc/243574569017069

Click on the link above and then click "Like" on our NEW Business Facebook Page! This current page will be deleted soon and we would like you to continue following us on our NEW Business Page!!!!

Progressive Physical Therapy's New Facebook Page!

2011-09-14T08:51:00.000-07:00

https://www.facebook.com/pages/Progressive-Physical-Therapy-Inc/243574569017069

Click the link above and "Like" our new Facebook Page! The old page will be deleted soon and we would like you to continue following us on our new Business Page!

Vertigo and Physical Therapy

2011-09-07T07:58:00.000-07:00

Vestibular Rehabilitation

“Dizziness”, or Vertigo, is the 3^rd most common reason for seeking medical care in individuals over the age of 65 and it is the number one reason for those over the age of 70.

Vertigo is not an inner ear infection as many people believe, and cannot be treated with medication. It comes on suddenly with changes in the position of the head--lying down, turning to the side or looking up to a cupboard shelf for example. The attacks can be brief but disrupting.

Half of the people over the age of 65 will develop a condition known as BPPV (medically known as Benign Positional Paroxysmal Vertigo). This is a common and sometimes a disabling cause of dizziness that is readily diagnosed and treated. BPPV may be suspected by careful history and confirmed by appropriate physical examination. Pharmacologic therapy is of little benefit and exercise therapy is curative in over 90% of patients!

BPPV is caused by crystals that are normally found in one part of the inner ear migrating to another part. Moving the head activates the displaced crystals and they send a message to the brain that brings dizziness. The inner ear is not only for hearing; it's also for balance. The crystals can be brought back to their original site through a series of movements called the Epley repositioning maneuvers.

Other common causes of Vertigo also include Meneire’s, Perilymphatic Fistula, and Migraine Headaches among others.

Most patients experience similar symptoms regardless of the cause of their Vertigo. These can include: imbalance, unsteady gait, head movement sensitivity, visual motion sensitivity, disequilibrium in the dark or on uneven surfaces just to name a few.

Physical Therapy can greatly improve (and in over 90% of patients actually cure!) Vertigo symptoms through the use of “Vestibular Rehabilitation”. Techniques that Physical Therapists use in this form of rehab include exercises such as ankle sways and focus head turns. Physical Therapists also use different maneuvers to treat Vertigo such as: the Epley Maneuver (as mentioned above), the Brandt-Daroff Treatment, and the Semont Liberatory Maneuver.

The type of treatment the Physical Therapist chooses depends upon the underlying cause of the Vertigo, which is determined after careful examination of the patient by the Therapist. A treatment plan is then devised and acted upon in the same visit. Our Therapists have found great success with the use of the Epley Maneuver and are well trained in it’s technique.

If you or someone you know is suffering from Vertigo, give us a call today! You will be very surprised how effective Physical Therapy can be with this problem!

For more information on Vertigo and the Epley Maneuver, click the links below:

http://www2.wsls.com/lifestyles/2008/jun/25/physical_therapy_often_best_treatment_for_vertigo-ar-397642/

http://en.wikipedia.org/wiki/Epley_maneuver

http://www.cyberpt.com/cyberptbppv.asp

Ultrasound as a Modality used in Spine Rehabilitation

2011-05-11T08:27:00.000-07:00

Physical Therapists have many different treatment modalities to choose from when treating back pain or as part of a Spine Rehab program. One such modality is the use of Ultrasound. Ultrasound is a modality with many treatment uses. Today we will discuss how Ultrasound works and why it is such a useful tool in Spine Rehabilitation.

Ultrasound machines are a treatment modality used by physical therapists that utilize high or low frequency sound waves (those that are out of the range in which we hear). These sound waves are transmitted to the surrounding tissue and vasculature. They penetrate the muscles to cause deep tissue/muscle warming and this warming effect causes vessel vasodilatation and increased circulation to the area that assists in healing. This promotes tissue relaxation and therefore is useful in treating muscle tightness and spasms and is used to minimize muscle pain and movement dysfunction.

The physical therapist can also adjust the frequency on the machine to use waves that will decrease inflammation. The treatments help reduce stiffness, swelling, and pain and also increase circulation, and promote pain-free movement.

With back pain and injuries inflammation sets in and causes stiffness, pain and restriction of movement which further worsens the pain and stiffness. The heat that ultrasound waves produce cause the vessels in that region to dilate and increase blood flow to the area, which helps to decrease inflammation and promote healing of the injured tissues.

Ultrasound therapy is a painless procedure, and many people find it relaxing.

Our staff is very experienced in the use of Ultrasound as a treatment modality to treat Spinal injuries. Call us today to schedule an appointment if you or someone you know is suffering from back/spine pain and needs an expert who specializes in Spine Rehab! 386-898-0443

What is the Graston Technique® and how can it help with Spine Rehab/Back Pain?

2011-04-27T06:34:00.000-07:00

In our last blog we discussed our specialty in Spine Rehabilitation and mentioned we would further explore some of the modalities we use to treat Back Pain. In this issue we discuss the use of the Graston Technique® as one option in treating Back Pain. Read more to learn what the Graston Technique® is, how it works, what a patient can expect prior to, during and after treatment.

Graston Technique®

There are many treatment options available for back pain caused by soft tissue problems, such as a back muscle strain. One method of treatment is soft tissue instrument assisted mobilization, also known as the Graston Technique®.

Graston Technique® is an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. The Technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.

The Graston Technique®, originally developed by athletes, is changing the way clinicians — including athletic trainers, chiropractors, physical therapists, occupational therapists — and patients view treatment of acute and chronic soft tissue injuries.

The majority of practitioners specializing in this technique are osteopathic physicians, athletic trainers, physical therapists and occupational therapists, and it is also available to medical doctors and registered nurses.

Fairly extensive training is required in order to use the technique and we are trained and experienced in using the Graston Technique® for many conditions including back pain.

Soft Tissue Injuries and Back Pain

Most of the back is comprised of muscles, ligaments and tendons, and injuries to these soft tissues play a significant role in the pain and dysfunction associated with back problems. While it may not sound like a serious injury, a simple muscle strain or torn ligament in the back can cause excruciating pain and difficulty with movement.

When an injury within the soft tissue occurs, the tissue repairs itself in a haphazard pattern, forming scar tissue. While the scar tissue itself is not painful, it does tend to limit range of motion, and the ongoing stiffness may contribute to back pain or neck pain on an ongoing basis.

How the Graston Technique® Works

This form of manual therapy comprises soft tissue mobilization and incorporates the use of stainless-steel instruments. The goal of the therapy is to separate and break down the scar tissue, as well as stretch connective tissue and muscle fibers. There also appears to be a neurologic component to treating patients with the Graston Technique Instruments.

The Graston Technique® uses the instruments with a specialized form of massage that is designed to help the practitioner identify areas of restriction and break up the scar tissue. The concave and convex stainless steel instruments are used to comb over and catch on injured fibrotic tissue.

Using a cross-friction massage, which involves brushing or rubbing against the grain of the scar tissue, the practitioner re-introduces small amounts of trauma to the affected area. This temporarily causes inflammation in the area, which in turn increases the rate and amount of blood flow in and around the area. The theory is that this process helps initiate and promote the healing process of the affected soft tissues.

Treatment is rendered along the kinetic chain and thus a patient presenting with back pain might also receive treatment to the hip flexors, abdomen, hamstrings and other regions of the body.

Patients undergoing therapy with the Graston Technique can expect the following:

Prior to Treatment

Prior to an appointment with your physical therapist, patients are advised to complete five minutes of cardiovascular activity, such as riding a stationary bike or walking on a treadmill
At the office of the physical therapy clinic, ultrasound or heat treatment may first be applied to the injured area to warm up the soft tissue

During Treatment

The practitioner will utilize the appropriate Graston Technique® instruments to scan, then treat, the affected area of the back
Treatment generally consists of the clinician rubbing the affected area(s) with the handheld stainless steel Graston Technique® instruments, using very specific, calculated massage techniques
Treatment time is usually 30 to 60 seconds per area treated

After Treatment

The patient is advised to stretch the areas treated
Following stretching, the patient may begin low load, high repetitions of exercises using an elastic band.
It is common for patients to experience some discomfort during the procedure and possibly some bruising. Ice application for 15 to 20 minutes following the treatment may ease the discomfort.
Patients are advised they may be sore, bruise or exhibit small red dots over the area treated called petechiae.

It is recommended that an exercise, stretching and strengthening program be used in conjunction with this technique to rehabilitate the back and help the injured tissues heal.

The typical course of treatment generally range from 6 to 10 visits. No medications are required in conjunction with this specific treatment.

Contraindications

Not all candidates with pain related to soft tissue injury are candidates for Graston Technique® therapy. Patients any with the following are not good candidates for the treatment:

Open wounds
High blood pressure
Cancer (depending on the type and location)
Pregnancy (pregnant women should avoid having the therapy done over the spine, pelvis, abdomen or along certain acupuncture points)
Unhealed, complicated fractures

For a full list of both absolute and relative contraindications to the use of this therapy, please consult a trained Graston Technique® clinician by calling us today!

(web sources for this article include: http://www.spine-health.com and http://www.ssprehab.com/services/graston-technique)

Spine Rehabilitation

2011-04-06T08:41:00.000-07:00

Did you know that Progressive Physical Therapy specializes in Spine Rehabilitation?

Your recovery from spine pain or injury can be improved by learning new ways to strengthen your spine and prevent future problems. Our physical therapists can teach you ways to help reduce your pain now and form new habits to keep your spine healthy in the future without becoming dependent upon weekly or monthly interventions for years.

At your first physical therapy visit, our physical therapist (PT) will gather information about your spine condition. You may be asked questions about when it started, where you hurt, and how your symptoms affect your day-to-day activities. This helps your PT to begin zeroing in on the source of your problem and to know what will be needed to help relieve it.

Your therapist will evaluate your answers and your exam results to determine the best way to help you. He/she will then write a plan of care, which lists the treatments to be used and the goals that you and your therapist decide on to do your daily activities safely and with the least amount of discomfort. The plan also includes a prognosis, which is your therapist's idea of how well the treatments will work and how long you'll need therapy in order to get the most benefit.

The main goal of therapy is to make sure you have ways to take care of future spine pain or problems. You'll be shown ways to help control pain or symptoms if they don't go completely away and if they return in the future. Because you've experienced spine pain, there is a possibility you may have soreness in the future. You may be encouraged to continue with some of the exercises to help keep your spine healthy over time.

Treatment to control pain and symptoms includes a variety of options that your physical therapist will choose based upon your individualized care plan that he/she developed based upon his/her exam of your spine. They may include rest, positioning, ice, heat, ultrasound, electrical stimulation, soft tissue mobilization/massage, manual therapy, joint mobilization, traction and the Graston technique.

The next step in your therapy course would be the introduction of therapeutic exercise which is individually designed to help you to work on flexibility, stabilization, coordination and fitness conditioning.

This step is then followed by functional training which helps you with doing specific activities with greater ease and safety. Examples include posture, body mechanics, and ergonomics.

Once your pain is controlled, your range of motion has improved, and your strength is returning, you will be progressed to a final home program. Your therapist will review some of the ideas listed above to help take care of any soreness at home. You'll be given some ways to keep working on your range of motion and strength. Before you are done with therapy, more measurements may be taken to see how well you're doing now compared to when you first started in therapy.
We will be exploring some of the treatments and modalities discussed above in more detail with future blogs.

We hope you found this overview of Spine Rehabilitation helpful and will keep Progressive Physical Therapy, Inc. in mind for all of your or your family and friends' Rehabilitation needs!

Register your email at the top right of this page to be notified when new blogs are posted!

(source referenced for this blog: allaboutbackpain.com)

Manual Physical Therapy for Pain Relief

2011-03-30T06:29:00.000-07:00

Did you know that Charlie is Manual Therapy Certified?

Manual physical therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain (as well as other painful conditions in the neck and throughout the body) caused by muscle spasm, muscle tension and joint dysfunction. This certification is a graduate level program consisting of up to 20 additional college course credits. Charlie completed this graduate program at the University of St. Augustine where he earned his Doctorate in Physical Therapy.

It has been heavily researched and proven that Manual Therapy techniques work best for many painful conditions including Back and Neck Pain.

Also, did you know that while patients may be referred for physical therapy treatment by their primary care doctor, an orthopedic surgeon, or other doctor involved in their back care, most states, including Florida, have direct access laws permitting patients to seek help for low back pain from a licensed physical therapist without having to seek a written referral.

Check out this link to learn more about how Manual Therapy can help with painful conditions that you or someone you know may be suffering from!

http://www.spine-health.com/treatment/physical-therapy/manual-physical-therapy-pain-relief

Knee Replacement and Physical Therapy

2011-03-23T08:18:00.000-07:00

Knee replacement surgery is the most common joint replacement procedure. Many people have knee arthritis, but it can be difficult to know when the right time to have a knee replacement surgery is. Furthermore, there is confusion about what to expect from knee replacement surgery. Do you have questions? Look no further. You can find all you need to know about knee replacement surgery right here.

Click on this link to learn more about reasons people may need a Knee Replacement: http://orthopedics.about.com/od/hipkneereplacement/tp/kneereplacement.htm

Knee replacement surgery is very successful, but the success of the procedure is partly due to the rehabilitation period that follows the surgery. For patients to expect a good result from knee replacement surgery, they must be an active rehab participant.
Rehabilitation after knee replacement begins immediately. Patients will work with a physical therapist as soon as the surgical procedure has been performed. The emphasis in the early stages of rehab is to maintain motion of the knee replacement and to ensure that the patient can walk safely. The body reacts to surgery by making scar tissue, and patients may never recover normal motion if they do not focus on bending and straightening their knee replacement.

Call us today if you or someone you know is planning to get a knee replacement soon. We can schedule a visit for you to talk with Charlie or Jessie about what to expect with your rehab! 898-0443.

Suffering from Arthritis?

2011-03-02T10:15:00.000-08:00

Suffering from Arthritis or know someone who is? Check out this link to learn how Physical Therapy can improve your quality of life and call us today! 898-0443

http://www.medicinenet.com/arthritis_physical_and_occupational_therapy/article.htm

Progressive Physical Therapy, Inc.

2011-02-16T08:06:00.000-08:00

Progressive Physical Therapy, Inc. is a family owned and operated outpatient therapy clinic in Ormond Beach, Florida. Charlie Piazza, our owner/president, holds a Doctorate Degree in Physical Therapy and is also a Certified Athletic Trainer, Certified Manual Therapist, Certified Lymphedema Therapist, and Certified Hand Therapist. We specialize in treating all patients with any of these conditions as well as Sport/Orthopedic Injuries, General PT and Women's Health/Pelvic Floor Rehab. We also have an Occupational Therapist who is a Certified Hand Therapist on staff as well as on-site Massage Therapy. Follow us on Facebook, Twitter and Linkedin! Visit our Web site at: http://www.progressiveptinc.com/