Physical Therapy and the Camaraderie of Healing

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

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ClosI 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....

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.

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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

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!

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

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

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

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

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!

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!!

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