Wednesday, September 26, 2012

Iliotibial Band Syndrome

Physical Therapist's Guide to Iliotibial Band Syndrome (ITBS)
Iliotibial band syndrome (ITBS) is one of the most common causes of knee pain, particularly in individuals involved in endurance sports. It accounts for up to 12% of running injuries and up to 24% of cycling injuries. ITBS is typically managed conservatively through physical therapy and temporary activity modification.

 
What is Iliotibial Band Syndrome (ITBS)?
Iliotibial band syndrome (ITBS) occurs when excessive irritation causes pain at the outside (or lateral) part of the knee. The iliotibial band (ITB) is a type of soft tissue that runs along the side of the thigh from the pelvis to the knee. As it approaches the knee, its shape thickens as it crosses a prominent area of the thigh (femur) bone, called the lateral femoral condyle. Near the pelvis, it attaches to 2 important hip muscles, the tensor fascia latae (TFL) and the gluteus maximus.
Irritation and inflammation arise from friction between the ITB and underlying structures when an individual moves through repetitive straightening (extension) and bending (flexion) of the knee. Typically, ITBS pain occurs with overuse during activities such as running and cycling.
ITBS involves many lower extremity structures, including muscles, bones, and other soft tissues. Usually discomfort arises from:
o    Abnormal contact between the ITB and thigh (femur) bone
o    Poor alignment and/or muscular control of the lower body
o    Prolonged pinching (compression) or rubbing (shearing) forces during repetitive activities
The common structures involved in ITBS are:
o    Iliotibial band
o    Bursa (fluid-filled sack that sits between bones and soft tissues to limit friction)
o    Hip muscles
ITBS can occur in:
o    Athletes performing repetitive activities, such as squatting, and endurance sports such as running and cycling
o    Individuals who spend long periods of time in prolonged positions, such as sitting or standing for a long workday, climbing or squatting, or kneeling
o    Individuals who quickly start a new exercise regimen without proper warm-up or preparation
 

Signs and Symptoms
With ITBS, you may experience:
o    Stabbing or stinging pain along the outside of the knee
o    A feeling of the ITB “snapping” over the knee as it bends and straightens
o    Swelling near the outside of your knee
o    Occasionally, tightness and pain at the outside of the hip
o    Continuous pain following activity, particularly with walking, climbing, or descending stairs, or moving from a sitting to standing position
Pain is usually most intense when the knee is in a slightly bent position, either right before or right after the foot strikes the ground. This is the point where the ITB rubs the most over the femur.
 
How Is It Diagnosed?
Your physical therapist will ask you questions about your medical history and activity regimen. A physical examination will be performed so that your physical therapist can collect movement (range of motion), strength, and flexibility measurements at the hip, knee, and ankle.
When dealing with ITBS, it is also common for a physical therapist to use special tests and complete a movement analysis, which will provide information on the way that you move and how it might contribute to your injury. This could include assessment of walking/running mechanics, foot structure, and balance. Your therapist may have you repeat the activity that causes your pain to see firsthand how your body moves when you feel pain. If you are an athlete, your therapist might also ask you about your chosen sport, shoes, training routes, and exercise routine.
Typically, medical imaging tests, such as x-ray and MRI, are not needed to diagnosis ITBS.
 
How Can a Physical Therapist Help?
Your physical therapist will use treatment strategies to focus on:
Range of motion
Often, abnormal motion of the hip and knee and foot joint can cause ITBS because of how the band attaches to hip muscles. Your therapist will assess the motion of your injury leg compared with expected normal motion and the motion of the hip on your uninvolved leg.
Muscle strength
Hip and core weakness can contribute to ITBS. The "core" refers to the muscles of the abdomen, low back, and pelvis. Core strength is important, as a strong midsection will allow greater stability through the body as the arms and legs go through various motions. For athletes performing endurance sports, it is important to have a strong core to stabilize the hip and knee joints during repetitive leg motions. Your physical therapist will be able to determine which muscles are weak and provide specific exercises to target these areas.
Manual therapy
Many physical therapists are trained in manual therapy, which means they use their hands to move and manipulate muscles and joints to improve motion and strength. These techniques can target areas that are difficult to treat on your own.
Functional training
Even when an individual has normal motion and strength, it is important to teach the body how to perform controlled and coordinated movements so there is no longer excessive stress at the previously injured structures. Your physical therapist will develop a functional training program specific to your desired activity. This means creating exercises that will replicate your activities and challenge your body to learn the correct way to move.
Your physical therapist will also work with you to develop an individualized treatment program specific to your personal goals. He or she will offer tips to help you prevent your injury from reoccurring.
 
Can this Injury or Condition be Prevented?
Maintaining core and lower extremity strength and flexibility and monitoring your activity best prevents ITBS. It is important to modify your activity and contact your physical therapist soon after first feeling pain. Research indicates that when soft tissues are irritated and the offending activity is continued, the body does not have time to repair the injured area. This often leads to persistent pain, and the condition becomes more difficult to resolve.
Once you are involved in a rehabilitation program, your physical therapist will help you determine when you are ready to progress back to your previous activity level. He or she will make sure that your body is ready to handle the demands of your activities so that your injury does not return. You will also receive a program to perform at home that will help you maintain the improvements that you gained during rehabilitation.
 
Real Life Experiences
Sarah is a 31-year-old mother training for her first triathlon. With a young child at home, she has to squeeze in her training sessions early in the morning. She rarely has time to cool down or stretch after riding her bike or running because she has to get home before her child wakes up.
Sarah signs up for her first race and begins to increase her cycling and running in preparation. One day during the middle of a long run, she feels a sharp pain at the outside of her knee. It starts hurting with every step, and doesn't go away, even after she stops and stretches. Far from home, she has to finish her run despite the nagging pain. When she gets home, she puts ice on it, but for the rest of the day she has trouble going up and down stairs, or squatting to pick up her son, and feels pain when standing up after driving the car. The next day, she tries to ride her bike, but the knee pain is still there and feels worse.
Wisely, Sarah stops running and cycling and contacts her physical therapist.
Sarah's physical therapist conducts a comprehensive evaluation of her hip and knee motion, strength, balance, and running mechanics. She uses special tests and measures to determine if Sarah’s pain is related to her iliotibial band or if there are other problems occurring simultaneously. She talks with Sarah about her training routine, including equipment (shoes, position on the bike, etc), the routes she runs and their surfaces, and her stretching program. The therapist diagnoses Sarah with iliotibial band syndrome. She guides Sarah through specific exercises in the clinic, including manual stretching of the hip joint by the therapist, sidelying leg raises for hip strengthening, and single leg squats to promote integrated core, hip, knee, and ankle function. Sarah will also perform these exercises at home as a part of her daily exercise routine to maximize improvement and help ensure her sustainable success.
Sarah's physical therapist helps her develop strategies for training, taking into consideration her lifestyle as a busy mother, to help her stay injury-free. Together, they outline a 6-week rehabilitation program for iliotibial band syndrome. Sarah will come to the clinic 1-2 times each week, where her therapist will assess her progress, perform manual therapy techniques, and advance her exercise program as appropriate. Sarah will also have a daily exercise routine to perform independently at home, including stretching and strengthening activities.
In 6 weeks, Sarah has met all of her physical therapy goals and completes her rehabilitation in the clinic. After building her training gradually over the next month, she is able to train and successfully crosses the finish line just as planned!
 
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:
o    A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, injuries.
o    A physical therapist who is a board-certified specialist or who has completed a residency in orthopedic or sports physical therapy, as he or she will have advanced knowledge, experience, and skills that apply to an athletic population.
You can find physical therapists that 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 therapy clinic for an appointment, ask about the physical therapists' experience in helping people with ITBS.
o    During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.
 
Further Reading
The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of ITBS. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011;19:726–736. Free Article.
Ellis R, Hing W, Reid D. Iliotibial band friction syndrome: a systematic review. Man Ther. 2007;12:200–208. Article Summary on PubMed.
Fredericson M, Weir A. Practical management of iliotibial band syndrome in runners. Clin J Sports Med. 2006;16:261–268. Article Summary on PubMed.
Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35:451–459. Article Summary on PubMed.
Levin J. Run down: battling IT band syndrome in long distance runners. Biomechanics. 2003;1:22–25. Article Summary Not Available.
Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sports Med. 2000;10:169–175. 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.

Acknowledgements: Laura Stanley, PT, DPT, SCS
Article originally appeared on: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=089d992a-4c46-4fe0-9fbd-52069837345a Click link for original article.

Wednesday, September 19, 2012

Workplace Wellness


Working at a computer work station all day can take a toll on the body. Repetitive activities and lack of mobility can contribute to aches, pains, and eventual injuries.
Sitting at a desk while using the keyboard for hours on a day to day basis can result in poor circulation to joints and muscles, it can also create an imbalance in strength and flexibility of certain muscles, and muscle strain. These issues can be easily remedied by taking frequent short breaks, or "micro breaks," throughout your day.
  • Get out of your chair several times a day and move around—even for 30 seconds
  • Roll your shoulders backwards
  • Turn your head side to side
  • Stretch out your forearms and your legs
Additionally, specific guidelines for your work station can help maximize your comfort and safety.

 

Your chair should have the following:

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

 

The position of the keyboard is critical:

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

 

The position of your computer monitor is important:

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

 

How can a physical therapist help?

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

 

Watch some short video clips of a Physical Therapist Demonstrate Exercises for the Workplace by clicking the following link from the American Physical Therapy Association:

http://www.moveforwardpt.com/Resources/Detail.aspx?cid=60640713-eb92-4fca-81ee-7b371ef0c209


This article originally appeared on www.apta.org.  Click the link above to read the original article.

Wednesday, September 12, 2012

Football!

In the spirit of Football Season...check out this amazing and inspiring video about former LSU Safety, Chad Jones, who severely injured his leg in a car accident soon after he was drafted to the NY Giants for the 2011 Fall Season. 

His spirit, drive and determination to never give up are awe inspiring and just give more meaning to why we do what we do as Physical Therapists!

Click here for the video link originially posted on Yahoo! Sports:

http://sports.yahoo.com/blogs/ncaaf-dr-saturday/exclusive-former-lsu-safety-chad-jones-road-back-144322667--ncaaf.html

Wednesday, September 5, 2012

Yoga!

Ever wonder what all the hype is about Yoga?  Well, since September is National Yoga Month, and we're all about Health and Fitness here at Progressive Physical Therapy, read on to learn more about this excellent way of keeping fit while improving your flexibility and relieving stress!

September is National Yoga Month and has been since 2008. It was created to teach people about the ways in which yoga can benefit health and encourage a healthy way of living. Yahoo! Sports offers 10 wonderful ways for us to all celebrate National Yoga month:


#1 Take a free class:

Celebrate National Yoga Month this September by receiving free yoga classes for one week at more than 1,600 different locations throughout the nation. Classes are offered to new students, so if you want to give yoga a try now is your chance.


#2 Download a free song:

Get in the mood for yoga by downloading the song "Om Namo," one of the many songs from the Yoga Revolution CD.


#3 Educate yourself on the health benefits of yoga:

Educate yourself on the health benefits of yoga in one or more of the following ways:

#4 Teach someone else to do yoga:

If you already know how to do yoga, give back by teaching your children, a friend or another family member.


#5 Make a donation:

Make a donation to the Give Back Yoga Foundation. You can choose to donate your funds to help prisoners or veterans. If you have the finances, this is a wonderful way to help prisoners receive books or veterans obtain a CD, book or DVD.


#6 Buy a yoga gift for yourself or another:

Purchase a yoga mat, attire or other gift to treat yourself or someone else. The following are suggestions:

#7 Try a new yoga pose (asana):

If you already practice yoga, try something different by learning a new asana. You may even find a new favorite.


#8 Download a free yoga video:

Enjoy yoga in the comfort of your home by downloading a free yoga video offered by Yoga Yak. This is a 55-minute class, so it is well worth the time spent to download it.


#9 Try yoga somewhere different:

If you usually practice yoga indoors, try it somewhere out of the ordinary. The outdoors can be a very relaxing way to experience yoga. Parks, beaches or backyards are great ways to experience nature and yoga at the same time.


#10 Make your own yoga mat cleaner:

Watch a video on YouTube to learn how to make your own yoga mat cleaner. Keep your mat clean to keep germs away.

Enjoy yoga all September with these 10 wonderful ways to celebrate National Yoga Month!

click here to read original article published on Yahoo! Sports: http://sports.yahoo.com/news/top-10-ways-celebrate-national-yoga-month-013400815--spt.html