Wednesday, March 28, 2012

· As kids return to the baseball diamonds this spring, learn how to keep them injury free....

Pitcher's Elbow

Pitcher's Elbow, also known as medial epicondyle apophysitis, is a common injury that occurs among young baseball players. Caused by "overuse" and "repetitive motion," Pitcher's Elbow causes pain and swelling inside of the elbow, and can limit one's range of motion.

Causes

The forceful and repetitive nature of overhand throwing for baseball players (pitchers in particular) can cause inflammation of the growth plate inside the throwing elbow, causing Pitcher's Elbow. Adolescent baseball players are most likely to experience this injury because their elbow structure (bones, growth plates, and ligaments) is not fully mature or developed. The following risk factors contribute to Pitcher's Elbow:

o Age. Young baseball players (particularly between the ages of 9 and 14) are at greater risk because their elbow joint (bones, growth plates, and ligaments) are not fully developed and are more susceptible to overuse injuries.

o Pitching too many games. The number of games pitched should be carefully monitored and the league's pitch count rules followed. Research has proven that overuse in baseball contributes to injuries such as Pitcher's Elbow. If pain occurs before pitch count limit is reached, the player should stop immediately. Rotating pitchers within games is a good idea to ensure adequate rest is given to each pitcher.

o Curveballs and breaking pitches. Both of these types of pitches appear to put more stress on the growth plate than other pitches. These pitches should be limited, especially in players between the ages of 9 and 14.

o Improper mechanics. Improper throwing mechanics can put undue force on the elbow joint. Proper throwing mechanics can help a young player avoid unnecessary injury and develop proper technique that improves their game.

How a Physical Therapist Can Help

Physical therapists are experts in restoring and improving mobility and motion in people's lives, and eliminating pain. For young baseball players, this means a physical therapist can work with you to help prevent Pitcher's Elbow from occurring, and recover if it has occurred.

In addition to following the guidelines for pitch counts and recommendations for rest, a physical therapist can help baseball players prevent the occurrence of Pitcher's Elbow by teaching them stretching and strengthening exercises that are individualized for their specific needs. Everybody is different, which means Pitcher's Elbow may occur for different reasons for each person. A physical therapist can help a player recover, by designing an individualized treatment plan to regain range of motion, flexibility, and strength.

Article originally appeared on http://www.apta.org/. Click the following link to view the original article: http://www.moveforwardpt.com/Resources/Detail.aspx?cid=73bd9453-80d8-422d-b399-859a6fe420da

Thursday, March 15, 2012

Physical Therapist's Guide to Lymphedema

· Physical Therapist's Guide to Lymphedema

Lymphedema is swelling generally in the arms or legs due to a blockage in your lymphatic system. It's estimated that about one third of women who undergo axillary lymph node dissection during breast cancer treatment will develop lymphedema. Identifying and treating lymphedema early helps ensure faster and better outcomes, but even treatment later on, during the chronic stages of the disease, can still help.

To determine if you have lymphedema, check with your physician or physical therapist immediately if you have swelling in one of your limbs and you:

o Have cancer or have been treated for cancer

o Have a cardiac, kidney, or liver condition

What is Lymphedema?

The lymphatic system collects lymph (excess fluid, proteins, and other substances) from the body tissues and carries them back to the bloodstream. Lymph is moved slowly through lymphatic vessels and is passed through the lymph nodes. Swelling ("edema") may occur when the lymph increases in the body tissues. Lymphedema occurs when the normal drainage of fluid is disrupted by a blockage or a cut in the lymph nodes in the groin area or the armpit. Lymphedema can be a hereditary condition, but it's most commonly the result of blockages caused by infection, cancer, and scar tissue from radiation therapy or the surgical removal of lymph nodes.

You're at greater risk for lymphedema if you:

o Had surgical removal of lymph nodes in the underarm, groin, or pelvic region

o Received radiation therapy to the underarm, groin, pelvic region, or neck

o Have scar tissue in the lymphatic ducts, veins, or under the collarbones caused by surgery or radiation therapy

o Have cancer that has spread to the lymph nodes in the neck, chest, underarm, pelvis, or abdomen

o Have tumors in the pelvis, abdomen, or chest that involve or put pressure on the lymphatic vessels and/or the large lymphatic duct thereby blocking lymph drainage

o Have inflammation of the arm or leg after surgery

o Are older

o Have an inadequate diet or are overweight, as these conditions may delay recovery from surgery and radiation therapy and may increase the risk for lymphedema

Lymphedema

Signs and Symptoms

With lymphedema, you may have:

o Swelling in your arms, legs, shoulders, hands, fingers, or chest

o Skin that feels tighter, harder, or thicker than normal in the affected area

o Aching or a feeling of heaviness in your arm or leg

o Weakness in your arm or leg

o Inability to move certain joints, such as your wrist or ankle, as freely as usual

o "Pitting" in the tissues of your limb (an indentation that is made by pressing a finger on the skin that takes time to “fill in” after the pressure is removed)

o Clothing, rings, bracelets, or shoes that fit tighter than before

o Repeated infections in your arm or leg

o Joint pain

o Difficulty doing your daily activities

If you have fever and chills, and your limb with lymphedema is red, swollen, or painful, and feels warm to the touch, you may have an infection.

How Is It Diagnosed?

Your physical therapist will review your medical history and medications and perform a thorough physical examination that includes the following information:

o Your actual weight compared with your ideal weight

o Measurements of your arms and legs

o How well you’re able to do activities of daily living

o History of edema, previous radiation therapy, or surgery

o The time between surgery and when you first noticed the swelling

o Other conditions such as diabetes, high blood pressure, kidney disease, heart disease, or phlebitis (inflammation of the veins)

How Can a Physical Therapist Help?

Your physical therapist will serve as an important member of your health care team and will work closely with you to design a treatment program to help control the swelling and meet your goals for returning to your activities.

In the early stages of lymphedema, when the swelling is mild, it can often be managed by compression garments, exercise, and elevation of the affected limb to encourage lymph flow. For more severe swelling, the physical therapist may use a treatment called "complete decongestive therapy." The initial step often includes manual lymphatic drainage, which feels like a light form of massage and helps improve the flow of lymph from your arm or leg. This is followed by compression bandaging that helps to reduce the swelling. Your therapist will carefully monitor the size of the limb throughout your treatment sessions.

Once the limb has decreased to the desired size, your physical therapist will help you begin to take over your own care by:

o Developing a safe and sensible exercise program that will increase your physical fitness without unnecessarily straining your affected arm or leg

o Updating your compression garments to ensure proper fitting, working with you to find the type of garment that best meets your needs

o Educating you about proper diet to decrease fluid buildup in your tissues and skin care to reduce the risk of infection

Can this Injury or Condition be Prevented?

Some risks, such as treatment for cancer, can’t be avoided. If you’ve had radiation therapy, or your lymph nodes have been removed but you don’t have lymphedema, your physical therapist will help you identify and manage the risks that you can control to avoid it.

Your physical therapist will:

o Design a safe and sensible home exercise program to improve your overall fitness and help you avoid the weight gain that can increase your risk of lymphedema

o Develop a safe and sensible exercise program that will avoid straining the affected limb and help you reduce the risk of developing lymphedema following surgery or infection

o Periodically assess the size of your limb and, if there is an increase in limb size, providing conservative, early intervention to help prevent the swelling from getting worse

o Help you maintain good skin care and hygiene

Poor drainage of the lymphatic system might make your arm or leg more susceptible to infection, and even a small infection could lead to serious lymphedema. You can help prevent lymphedema by avoiding cuts and abrasions, needle sticks and blood draws, burns, and insect bites on the affected limb.

What Kind of Physical Therapist Do I Need?

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

o A physical therapist who is experienced in treating lymphedema

o A physical therapist who has completed special training in lymphedema management and has advanced knowledge, experience, and skills that may apply to your injury

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

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

o When you contact a physical therapist for an appointment, ask about his or her experience in helping people with lymphedema.

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 American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

APTA has determined that the following articles provide some of the best scientific evidence on how to treat lymphedema. 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 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.

Bevilacqua JL, Kattan MW, Yu C, et al. Nomograms for predicting the risk of arm lymphedema after axillary dissection in breast cancer. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 8. Abstract Summary.

Cohen MD. Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity. Phys Ther. 2011. August 25 [Epub ahead of print]. Article Summary on PubMed.

Quirion E. Recognizing and treating upper extremity lymphedema in postmastectomy/lumpectomy patients: a guide for primary care providers. J Am Acad Nurse Pract. 2010;22:450–459. Article Summary on PubMed.

Gilchrist LS, Galantino ML, Wampler M, et al. A framework for assessment in oncology rehabilitation. Phys Ther. 2009;89:286–306. Free Article.

Acknowledgments: APTA’s Section on Women’s Health and Oncology Section; Patricia Ohtake, PT, PhD original article appeared on: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=8fadc252-aa62-472d-9f22-977837a30acc

Monday, March 5, 2012

Frozen Shoulder

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:

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.