Physical Therapy in the Real World

Observations, stories and education from an orthopedic Physical Therapist.

[chambersburgphysicaltherapist]

Plantar Fasciitis

As the weather gets warmer more people begin wearing sandals, flip flops and walking barefoot.  While this is OK in moderation walking or standing without foot support can lead to foot pain.  One of the more common causes of foot pain is caused by inflammation of the plantar fascia.  This is a band of connective tissue that connects the ball of the foot to the heel.  Onset usually occurs with first steps in the morning and is a sharp, sometimes stabbing pain in the heel or arch of the foot.

Fortunately you do not have to live with this.

I have had great success with the following protocol for treatment of plantar fasciitis:

Treatment protocol includes 6-8 sessions of:

Biphasic electric stimulation

Ultrasound

Graston technique to both the plantar fascia and calf muscle

Strapping of the foot to unload the plantar fascia

For best results clients are instructed to:

perform GENTLE stretching of the hamstrings, calf muscles and the plantar fascia.

Tape the arch over a sock with athletic tape on days they do not attend therapy

Avoid painful activity such as running or cutting sports in favor of low-impact activities

Roll out the plantar fascia using a lacrosse ball or a frozen water bottle

Use of a night splint. My personal favorite is the Strassburg Sock

[chambersburgphysicaltherapist]

Pain in the neck

Neck pain can occur from a variety of sources; most of these are amenable to physical therapy treatment. If you have neck pain after trauma like a car accident or fall you should seek immediate medical attention. Neck pain which radiates past the elbow should be taken seriously, although this is often treatable through therapy.

In my experience most neck pain is a result of poor postural habits and muscular tension. This often will manifest itself as a loss of motion and tension type headaches. Tension headaches can radiate up the back of the neck or the side of the neck into head. Frequently people with muscular tension and tension headaches will also have jaw pain from clenching or grinding their teeth as well.

Some self treatment techniques to try if these symptoms sound familiar are:

Heat

Stretching

Massage

Gentle rotation back and forth

Deep diaphragmatic breathing

Yoga is excellent as it encourages good posture and incorporates deep breathing and stretching

If improvement does not occur within 2 weeks Physical Therapy can be helpful in determining the cause and best treatment for your neck pain. Manual Physical Therapy is key to freeing soft tissue restrictions and getting the joints in your neck and thoracic spine moving properly in order to alleviate pain.

Eat healthy, exercise and be well.

[chambersburgphysicaltherapist]

New Wonder Drug discovered!

A wonder drug has been discovered. The health benefits are amazing and there are minimal side effects. It has the following benefits:

-increased strength

-improved bone density

-improved endurance

-improved lipid profile

-resistance to age related memory loss

-improved hormonal balance

-elevated mood

-improved immune system performance

Known side effects:

-highly addictive

-shortness of breath

-sweating

-muscle soreness

Cost: free

 That's right it's exercise!

[chambersburgphysicaltherapist]

Help! My head is spinning.

Dizziness or vertigo are a common experience. Interestingly the feeling of spinning can be caused by a myriad of different causes. For children the self-induced dizziness from spinning at the playground is great fun. On the adult end of the spectrum drinking alcohol lightens the endolymph in the semicircular canals and can cause dizziness or giddiness. Many prescription drugs can cause dizziness; in fact approximately 80% of prescription drugs list dizziness as a known side effect. Heart arrythmias, a stroke, both low and high blood pressure can cause light headedness or dizziness. So, what does this have to do with Physical Therapy?

One of the conditions that is easily treatable by a Physical Therapist is called Benign Paroxysmal Positional Vertigo or BPPV. The primary symptom of BPPV is intense spinning or dizziness with position change, usually lasting not more than a minute or two. Sometimes this dizziness will cause nausea and vomiting. The dizziness can be brought on by rolling in bed, bending over to pick something up or any other rapid head movements. I often see patients with BPPV after they have gone to the dentist or hairdresser and had their head tilted back for an extended period of time. This is caused by a free floating crystal in one of your semicircular canals in the inner ear. So what can PT do in this case?

Treatment of BPPV first involves ruling out more serious causes for dizziness(see first paragraph). After this screening process the client will be placed in various positions, including the Hallpike-Dix maneuver to determine what semicircular canal the crystal is in. Once this is determines there are a series of maneuvers to reposition the crystal that is causing the dizziness. In many cases the dizziness can resolve after 1 or 2 visits. This is a great relief for someone if they are dizzy and really gratifying for me as a therapist because it is one of the few things that can be fixed within one or two visits.

[brainsandbodies]

What makes your knuckles pop?

From Anatomy In Motion

If you’ve ever laced your fingers together, turned your palms away from you and bent your fingers back, you know what knuckle popping sounds like. Joints produce that CRACK when bubbles burst in the fluid surrounding the joint. Joints are the meeting points of two separate bones, held together and in place by connective tissues and ligaments. All of the joints in our bodies are surrounded by synovial fluid, a thick, clear liquid. When you stretch or bend your finger to pop the knuckle, you’re causing the bones of the joint to pull apart. As they do, the connective tissue capsule that surrounds the joint is stretched.  By stretching this capsule, you increase its volume. And as we know from chemistry class, with an increase in volume comes a decrease in pressure. So as the pressure of the synovial fluid drops, gases dissolved in the fluid become less soluble, forming bubbles through a process called cavitation. When the joint is stretched far enough, the pressure in the capsule drops so low that these bubbles burst, producing the pop that we associate with knuckle cracking.

Keep reading

[brainsandbodies]

Update:

Today in PT school I learned more about this effect as it applies to the spine (not the knuckles), joint manipulation, and intervention. 

Enjoy!

[chambersburgphysicaltherapist]

Shoulder impingement in the Spring

As the weather starts to warm and spring sports practices get under way, I usually see an increase in the number of clients coming to me with shoulder pain.  This due to the unique demands that are placed on the shoulder in overhead and throwing sports such as baseball, softball, volleyball and tennis. 

Here is some information about shoulder impingent syndrome:

Shoulder impingement occurs when the ball part of the shoulder impinges upon the rotator cuff and bursa. Often patients are confused because the have been diagnosed with shoulder bursitis by one healthcare provider and rotator cuff tendonitis by another. These are both consequences of the same process. Shoulder impingement can be a result of a bone spur or tightening of the joint capsule, but most often is a result of the following:

poor posture

lack of flexibility

weak posterior rotator cuff

overuse

Symptoms of shoulder impingement include:

Painful arc typically between 80 and 100 degrees.

Pain lifting out or overhead

Pain when lying on the affected side

Typically shoulder impingement is easily treated through Physical Therapy. Treatments will usually include:

Modalities to decrease inflammation

Manual therapy to help restore normal motion of the joint

Corrective exercises including stretching and strengthening.

Key corrective exercises that can be performed with bands are

Rowing with external rotation 2-3 sets of 15 with light resistance

Internal and external rotation 2-3 sets of 15 with light resistance

[chambersburgphysicaltherapist]

Return to running after plantar fasciitis

Complete each step before moving on to the next step. There should be minimal to no increase in pain before you move to the next step, otherwise repeat the step. If there is a substantial increase in pain call the office.

Week 1:

3x/ week on alternate days jump rope for 1 minute, rest 1 minute x3

Week 2:

3x/ week on alternate days jump rope for 1 minute, rest 1 minute x6

Week 3:

2x/ week on jump rope for 1 minute, rest 1 minute x10.

1x/ week run 1 minute, walk 1 minute x5.

Week 4:

1x/ week on jump rope for 1 minute, rest 1 minute x10.

2x/ week run 1 minute, walk 1 minute x5.

Week 5:

3x week on alternate days run 1 minute walk 1 minute x8.

Week 6:

3x week on alternate days run 1 minute walk 1 minute x12

Week 7:

3x week on alternate days run 1 minute walk 1 minute x16

Week 8

:3x/ week run 20 minutes. Thereafter you may increase time or mileage by 10% every 2 weeks.

[chambersburgphysicaltherapist]

Do you know squat?

The ability to squat is a foundational movement that is important for every human. Before we learn to walk, we stand and squat and bounce. Toddlers will go into a deep squat and play for 10 minutes at a time. They squat with perfect form every time. In the western word we lose the ability to perform a perfect squat at 5 years old. This corresponds to the start of formal education and hours spent in a chair. We lose the flexibility to perform a deep squat, then gradually as we age we also lose the motor control and strength. As a Physical Therapist, I spend a lot of time re-teaching people how to squat. This usually starts with standing up out of a chair, sometimes beginning with a pad to raise the chair up; to make the task easier. Gradually the height of the surface is lowered until the person is capable of performing a squat that is a least good enough to get off the toilet! You would be surprised how difficult it is for many older adults to get off a 14-inch high toilet. Many of my clients simply need to be able to squat with their body weight to return to their normal lives.

Being able to perform a body weight squat and practicing this movement on a regular basis has many benefits:

Strengthens all major muscle groups in the legs

Improves balance

If performed to full depth helps maintain functional flexibility

Maintains good core control

Can decrease problems with stress incontinence

Maintain quality of life (i.e. getting off the pot or out of the recliner)

The ability to squat has also been correlated with decreased morbidity and mortality in older individuals

Of course if someone is younger and more athletic the squat is progressed to add weight in a variety of manners. Progression can include back squats, front squats, overhead squats and addition of dead-lifting. All these variations form the basis for more advanced athletic endeavors. Later posts may explore these variations, but bottom line (pun intended) is this:

Squat for health, squat to live longer and squat to have a good life.

[chambersburgphysicaltherapist]

Managing Post Knee Surgery expectations

When approaching post-surgical rehabilitation it is important that you manage your expectations post surgery. Many of my clients are eager to get moving and get back to usual activities. As a Physical Therapist this is my goal as well. However, most people have the mindset that the “problem” has been fixed by surgery and that the rehabilitation is easy. This is simply not true.

Expectations can come from peer group: for example many of my clients have  friends who had knee replacements and are walking around without pain or a limp. All of these people are pleased with their new knees, but have forgotten the post-surgical pain and the 6-8 weeks of hard work to regain range of motion and progress to walking without a walker or cane. Expectations for younger athletes often come from the media. Professional athletes will return to play from ACL reconstruction 9 months post surgery. Th0se we see in the media are the elite .01% of their sports. There are also millions of dollars at stake. It is not practical or safe to push a high school athlete to return to play this quickly. Whether rehabilitating a 90 year-old after a knee replacement or a 16 year-old soccer player after and ACL reconstruction it is important to have realistic expectations. Here are some general guidelines (please realize there is quite a bit of variability from person to person, also listen to any restrictions from YOUR Physical Therapist and surgeon)

Post knee replacement:

2-3 weeks post. You are not going to sleep well. Physical Therapy will be uncomfortable and even painful at times. You will walk with a walker. There will be a lot of swelling and bruising.

4-6 weeks. You should be feeling human again. You should have 90% of motion and be walking with a cane. You may start to sleep for more than 2 hours at a time.

6-8 weeks. You should have full motion. Most people are walking without a cane. You will fatigue quickly and your knee will still swell quite a bit; especially if you are on your feet a lot.

9-12 months. Swelling will subside. The knee will start to feel like it is normal. You still should not kneel or engage in high impact activities.

Post ACL reconstruction:

2-3 weeks. You are not going to sleep well. Physical Therapy will be uncomfortable and even painful at times. You will walk with a crutches. There will be a lot of swelling and bruising.

4-6 weeks. You should be feeling human again. You should have full motion and be sleeping well. You should be walking normally.

6-8 weeks. Most daily activities like walking, going to class and stairs should be fairly comfortable. Therapy will be challenging, but should be more like “working out”

4-6 months. Most protocols allow starting to jog or run in this time frame.

6-9 months. Return to sport specific training and drills.

12 months. Return to competition.

15-18 months. Knee will feel back to “normal”.

[chambersburgphysicaltherapist]

Busted: Back Pain

There are countless myths about low back pain. Many times our knowledge and attitude about what does and does not cause back pain is the most important part of the recovery process. If we can dispel some of the myths about back pain it can be enormously helpful in getting on the road to recovery. Here are some of the common myths I hear from patients and need to clear-up:

Why did this happen to me? I didn't do anything unusual.: Most back problems are not brought on by anything you did wrong. The truth is we most people will experience back pain at some point in their life. Many estimates are that more than 80% of people will have back pain.

I need an MRI so we know “what is wrong”: Disc bulges, herniations, arthritic changes are normal even in people with NO back pain. There is no evidence to suggest that one of these problems are the cause of your pain. More than 90% of people will respond to conservative treatment like Physical Therapy. If there is no response to conservative therapy in 6-8 weeks further imaging may be necessary, but this is the minority of cases.

I need to rest my back. Rest may be necessary for a day, but extended rest leads to deconditioning and increases the likelihood that low back pain will become a recurrent or chronic problem. Exercise has been shown over and over to be the best long-term solution for back pain.

My low back pain is going to get worse as I get older and will lead to disability. Unlike most other conditions back pain is likely to improve as we age. Middle aged people are most likely to have back pain with the incidence decreasing as people enter their 6th decade. Most back pain is not disabling.

Heavy lifting causes back pain. Heavy lifting done with proper mechanics is unlikely to cause back pain. Our spines have fantastic support from many muscles, ligaments and fascia. Lifting with poor mechanics is much more likely to cause back pain than the weight of what was lifted. What can cause back pain is YOUR weight. Reaching or maintaining a healthy weight greatly reduces your risk of back pain.

If you have questions about back pain you should be fully evaluated by a healthcare professional. The bottom line is that most back pain is treatable through exercise, healthy lifestyle and manual therapy.

[chambersburgphysicaltherapist]

Happy 2017!

Welcome to a New Year!

Hopefully your New Year's resolutions are still intact. A common resolution is to start exercising or begin a new fitness routine.  You can see the throngs of newbies at the local YMCA and other fitness centers.  The problem is that by the end of January more than 75% of the people that started will give up. By February almost 90% are done. 

How can this be avoided?

A few tips:

1. Pick exercise you enjoy.  If you would rather dance than lift weights, sign up for a dance class. 

2. Go with a friend.  Keep each other accountable.  You are much more likely to continue if you have social support.  An even better idea, go with a group of friends.

3. Mix it up.  You will get bored with the same routine.  Vary what your doing it will keep you fresher physically and mentally.  Try new activities, you might just find something you enjoy even more.

4. Track what you eat.  Most people will start eating more when they exercise.  That is OK, but make sure you are eating good quality foods and not overestimating how much you are burning in your workouts.

5. Allow for adequate recovery after workouts and STRETCH!

Have a great start to 2017!

[chambersburgphysicaltherapist]

An Open Letter to Santa

Dear Santa,

I am writing to you as a concerned Physical Therapist. I know this is a busy time of year with your big night coming up. I look forward seeing you, again, after you get your cortisone injections in your knees on December 26. You were feeling better after I worked with you last year, for 6 weeks, and you promised me you would do your exercises and improve your diet. Unfortunately you gave up about 3 weeks after you stopped coming to PT. I've been watching, too, and your limping again and you are jollier( heavier) than ever.

I'm here for you Santa. Schedule an appointment for January. I have a plan. I'll help you get started on an exercise program to improve your strength and balance. We will include some aerobic exercise. I have plenty of modalities and manual skills to help decrease your pain and improve your flexibility. I even know some great fitness instructors that I can set you up with once your knees are feeling better.

I also encourage you and Mrs. Claus to commit to a lifestyle change. Some Christmas cookies once a year are OK, but you really need to improve your diet. The DASH diet, the Zone are good. Really any diet plan that cuts down on sugar and can lower your glycemic index and help you decrease your body mass index. Every step you take 3 times your body weight is transferred through your knee. Even a few pounds lost will improve your knee pain, and the reindeer will thank you as well!

So, let's get started in 2017. Think of the new Santa with no knee pain, better able to lift your bag of toys and with a lot more energy for the whole year. See you soon.

Sincerely,

Your friendly neighborhood Physical Therapist

[neurosciencenews]

Increasing Muscle Strength Can Improve Brain Function

Increased muscle strength leads to improved brain function in adults with Mild Cognitive Impairment (MCI), new results from a recent trial led by the University of Sydney has revealed.

The research is in Journal of American Geriatrics. (full access paywall)

[chambersburgphysicaltherapist]

How to get back to running after plantar fasciitis

Return to Running after Plantar Fasciitis

Complete each step before moving on to the next step. There should be minimal to no increase in pain before you move to the next step, otherwise repeat the step. If there is a substantial increase in pain call the office.

Week 1:

3x/ week on alternate days jump rope for 1 minute, rest 1 minute x3

Week 2:

3x/ week on alternate days jump rope for 1 minute, rest 1 minute x6

Week 3:

2x/ week on jump rope for 1 minute, rest 1 minute x10.

1x/ week run 1 minute, walk 1 minute x5.

Week 4:

1x/ week on jump rope for 1 minute, rest 1 minute x10.

2x/ week run 1 minute, walk 1 minute x5.

Week 5:

3x week on alternate days run 1 minute walk 1 minute x8.

Week 6:

3x week on alternate days run 1 minute walk 1 minute x12

Week 7:

3x week on alternate days run 1 minute walk 1 minute x16

Week 8:

3x/ week run 20 minutes.

Thereafter you may increase time or mileage by 10% every 2 weeks.

[chambersburgphysicaltherapist]

Maybe it is your lifestyle..

Just an observation from the clinic yesterday:

I was working with a patient in our gym which has 2 large windows. My next scheduled patient was a male, 25 with the chief complaint of low back pain.  While working in the gym I saw a young couple pull up.  They got out and sat on the hood of the car finishing their cigarettes and sharing a 2 liter bottle of soda.

After my initial evaluation we started with the basics:

Poor diet including excess sugar consumption impairs your ability to heal.  Smoking impairs blood-flow to all tissues in your body.  We know that smokers have increased incidence of low back and neck pain.

Please taker care of yourself, so I can help you heal....

[chambersburgphysicaltherapist]

Do I need and MRI?

When a patient comes to me with back or neck pain one of the first questions I am asked is “Shouldn't I have an MRI so we know exactly what is going on?”

The answer to this question is “No” in most cases.

An MRI is only needed if there is there is reason to suspect a serious medical condition such as cancer or aneurysm or if there is compromise of a spinal nerve root. Another criteria for advanced imaging it that if after 6-8 weeks of Physical Therapy your back or neck pain has not improved. The fact is that Physical Therapy will greatly reduce or eliminate back and neck pain in 80-90% of cases. Additionally, recent reviews of MRI's in patients with and without back pain have demonstrated an inability to predict what is causing pain. I believe the reason for this is that the spine is a dynamic structure that is poorly evaluated by lying in a tube and taking a static picture. Mechanical diagnosis by a Physical Therapist is superior because we evaluate the spine by reproducing pain and take into account the surrounding anatomical structures such as the hips, shoulders and thoracic spine.

Be well and feel free to ask questions.

[neurosciencenews]

Intrinsic Reward Helps Make Exercise a Habit

The morning alarm is more than a signal that it’s time to get up - for many people it means it’s time to hit the gym. But if exercise is not a habit, that cue from the alarm may trigger a debate over whether to exercise or go back to sleep.

The research is in Sport, Exercise and Performance Psychology. (full access paywall)