Tag Archives: strengthening

Juvenile Rheumatoid Arthritis

July 19, 2016 Teresa Stockton - Blog, Pediatrics

Definition

Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis, is a disease of the joints in children. It can affect a child over a long period of time. JRA often starts before the child is 16 years old.

In Juvenile rheumatoid arthritis, the joint becomes swollen. It will make the joint painful and difficult to move. JRA can also lead to long term damage to the joint. For some, JRA can interfere with the child’s growth and development.

There are 5 major types of juvenile rheumatoid arthritis:
• Pauciarticular JRA—4 or less joints are affected in the first 6 months of illness
• Polyarticular JRA—5 or more joints are affected in the first 6 months of illness
• Enthesitis associated arthritis—swelling of the tendon at the bone
• Psoriatic arthritis—associated with a skin disease called psoriasis
• Systemic onset JRA (also called Stills disease)—affects the entire body, least common type of JRA

Causes

Juvenile rheumatoid arthritis is caused by a problem of the immune system. The normal job of the immune system is to find and destroy items that should not be in the body, like viruses. With JRA, the immune system attacks the healthy tissue in the joint. It is not clear why this happens. The immune system problems may be caused by genetics and/or factors in the environment.

People of Hispanic American, Asian American, Pacific Islander, Native American, or African American descent are at higher risk.
Having prediabetes means that you are at high risk for developing diabetes and may already be experiencing adverse effects of elevated blood sugar levels.

Risk Factors

Girls are more likely to get JRA than boys.

There are no clear risk factors for JRA. Factors that may be associated with some types of JRA include:
• Family history of:
• Anterior uveitis with eye pain
• Inflammatory back arthritis (ankylosing spondylitis)
• Inflammatory bowel disease

Symptoms

• Symptoms may include:
• Joint stiffness, especially in the morning or after periods of rest
• Pain, swelling, tenderness, or weakness in the joints
• Fever
• Weight loss
• Fatigue or irritability
• Swelling in the eye—especially associated with eye pain, redness, or sensitivity to light
• Swollen lymph nodes
• Growth problems, such as:
• Growth that is too fast or too slow in one joint (may cause one leg or arm to be longer than the other)
• Joints grow unevenly, off to one side
• Overall growth may be slowed

Some symptoms are specific to each type of juvenile rheumatoid arthritis . For example:
• Symptoms common with pauciarticular JRA include:
• Problems most often found in large joints. These joints include knees, ankles, wrists, and elbows.
• If the left-side joint is affected, then the right-side similar joint will not be affected. For example, if the right knee is affected, then the left knee will be healthy.
• May also have swelling and pain at on the tendons and ligaments attached to the bone

• Symptoms common with polyarticular JRA include:
• Problems found most often in small joints of the fingers and hands. May also affect weight-bearing joints like the knees, hips, ankles, and feet.
• Joints on both sides of the body are affected. For example, if the left hand is affected, then the right hand will also be affected.
• May also have a blood disorder called anemia. This is an abnormally low number of red blood cells.
• One type of polyarticular JRA may occur with:
• A low-grade fever
• Nodules—bumps on parts of body that receive a lot of pressure such as elbows

• Symptoms common with systemic onset JRA include:
• Some of the first signs may be a high fever, chills, and a rash on the thighs and chest. May appear on and off for weeks or months
• May have swelling in the heart, lungs, and surrounding tissues
• The lymph nodes, liver and/or spleen may become enlarged
• Children with enthesitis arthritis often have tenderness over the joint where the pelvis and spine meet.
• Children with psoriatic arthritis often have finger or toe swelling. There may also be damage on fingernails.

Often, there are remissions and flare-ups. Remission is a time when the symptoms improve or disappear. Flare-ups are times when symptoms become worse.

Diagnosis

You will be asked about your child’s symptoms. You will also be asked about your family medical history. A physical exam will be done. An eye examination may also be done to check for swelling in the eye. Your child may be referred to a specialist if JRA is suspected. The specialist is a doctor that focuses on diseases of the joints.

Images may be taken of your child’s bodily structures. This can be done with x-rays.

Your child’s bodily fluids may be tested. This can be done with:
• Blood tests
• Urine tests
• Tests of joint fluid

Treatment

Talk with your doctor about the best plan for your child. The plan will work to control swelling, relieve pain, and control joint damage. The goal is to keep a high level of physical and social function. This will help keep a good quality of life. Treatment options include the following:

Medication

There are several types of medication that may be used:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)—to help swelling and pain
• Disease-modifying antirheumatic drugs (DMARDs)—to slow the progression of the disease
• Tumor necrosis factor (TNF) blockers—to decrease swelling, pain, and joint stiffness
• Interleukin inhibitors—to reduces disease activity
• Corticosteroids through IV or by mouth—for swelling
• Steroid injections into the joint—may help relieve swelling and pain in some children

Polyarticular JRA may become inactive in children who begin medications within 2 years of onset.

Physical Therapy

Exercise is done to strengthen muscles and to help manage pain. Strong nearby muscles will support the joint. It also helps to recover the range of motion of the joints. Normal daily activities are encouraged. Non-contact sports and recreational activities may be good options. Physical activities can also help boost a child’s confidence in their physical abilities.

Physical therapy may be needed. This will help to make the muscles strong and keep the joints moving well.

Maintenance Devices

Splints and other devices may be recommended. They may be worn to keep bone and joint growth normal. Some joints may get stuck in a bent position. These devices can help prevent this.

Prevention

There is no known way to prevent JRA.

by Jacquelyn Rudis

RESOURCES:
American College of Rheumatology
http://www.rheumatology.org

Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:
The Arthritis Society
http://www.arthritis.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Hofer MF, Mouy R, et al. Juvenile idiopathic arthritides evaluated prospectively in a single center according to the Durban criteria. J Rheumatol. 2001. 28:1083.

Juvenile idiopathic arthritis (JIA) enthesitis related. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) oligoarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) polyarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) systemic-onset. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

JAMA Patient Page. Juvenile idiopathic arthritis. JAMA. 2005;294:1722.

Petty RE, Southwood TR, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol.1998; 25:1991.

2/5/2013 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: De Benedetti F, Brunner HI, Ruperto N, et al. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Eng J Med. 2012;367(25):2385-95.

2/24/2014 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Limenis E, Grosbein HA, et al. The relationship between physical activity levels and pain in children with juvenile idiopathic arthritis. J Rheumatol. 2014 Feb;41(2):345-351.

9/2/2014 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Guzman J, Oen K, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis. 2014 May 19.

Last reviewed December 2015 by Kari Kassir, MD Last Updated: 12/20/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

Is Aquatic Therapy For You?

July 14, 2016 Teresa Stockton - Aging, Back, Blog, General Information, Sports and Fitness, Women's Health

Aquatic therapy offers an alternative environment for therapeutic exercise. If you have tried traditional physical therapy, or have restrictions on your physical therapy program, aquatic Therapy may be the perfect solution for your physical therapy needs.

Why Aquatic Therapy is Beneficial

Less pressure: The buoyancy of the water decreases the amount of pressure, or compressive forces, on your joints and spine. When you’re immersed in water up to your neck, the weight pressing down on your body is reduced by 90%. When the water is up to your waist, the pressure is reduced by 50%.

Reduced swelling: The pressure of the water helps to move fluid from the injured area back into the body. Decreased swelling is essential for regaining the strength and motion needed for recovery.

Ease of movement: Water is an element that supports and assists movement. It offers a safe setting for regaining strength and joint range of motion.

Faster progress: Aerobic conditioning can often be performed in the water, even when it may be too soon or too difficult to do in the clinic. Staying stable in the water, challenges your core and balance. Plus, sports specific activity can begin earlier than on land.

Who Can Benefit From Aquatic Therapy

• Chronic pain patients requiring a more gentle form of therapy
• Patients at risk of falls due to balance and gait disorders
• Patients with severe arthritis or other weight-bearing restrictions
• Prenatal and postnatal patients
• Patients with general deconditioning
• Sports medicine and orthopedic patients requiring an accelerated component to their rehab protocol

This information was written by Life Fitness Physical Therapy, a privately-owned, outpatient physical therapy practice operating 14 clinics in the metro and surrounding Baltimore, Maryland area. Life Fitness Physical Therapy was founded in 2000 based on the core values of providing the highest level of customer service and clinical excellence in outpatient physical therapy. For more information click here.

The Most Common Causes of Pitching Arm Injuries

July 5, 2016 Teresa Stockton - Arm, Blog, Sports and Fitness

The most common causes of pitching arm injuries to high school, college and professional pitchers are overload, overuse, lack of proper conditioning and improper throwing mechanics.

• Overload is the result of throwing too many pitches during one outing. Maximum pitch counts for various age groups, or for an individual pitcher’s normal strength and stamina, are effective in preventing overload.

• Overuse is the result of pitching too often and not having an adequate recovery time or a good arm maintenance program (stretching, running, strengthening, throwing) between pitching assignments. Coaches and trainers should be aware that each individual pitcher varies in arm strength, arm fatigue, arm tightness and soreness and require different recovery time needs. Make certain you provide your pitcher with a good active recovery program between pitching assignments.

• Proper conditioning involves the entire body; the legs and core muscles as well as the throwing arm. Coaches should supervise a proper stretching and warm-up procedure that is performed daily before throwing a ball.

• Pre-season is one of the most frequent times for arm injuries. Pitchers throw too much and too hard, too early. Also, they have not ingrained their normal rhythm and often are attempting to learn new techniques or new pitches. Another major factor of injury during pre-season is that pitchers are not working with a normal in-season rotation schedule and do not get enough recovery time from a lot of necessary drill work that involves throwing (pick-offs, defensive plays, etc.).

• Improper throwing mechanics. If a pitcher has improper throwing techniques, with the body or arm, there is a great chance of early fatigue of the throwing mechanism, and of course injury. The more power and force generated, the greater the chance of injury. In a competitive situation, most pitchers will not admit they are fatigued, experiencing minor pain or have a minor injury. It is important that you, a coach, trainer or physical therapist be able to recognize changes in the pitcher’s mechanics, performance, or mannerisms.

This information about common causes of pitching arm injuries was written by University Physical Therapy, an outpatient physical therapy group with eight locations in New River Valley, Virginia. University PT is THE choice for outstanding sports rehabilitation, physical therapy and occupational therapy services. For more information click here.

Exercise May Reduce Risk of Low Back Pain

May 12, 2016 Teresa Stockton - Back, Blog

Low back pain is a common complaint that can last a few days or weeks or become a chronic condition with significant impact on well being. Treatments can vary depending on the cause.Chronic back pain can be difficult to successfully treat and it may take some time to find what treatment works best for each person. Since treatment is not guaranteed to work, prevention is the best option. Back pain is often the result of long term stress on the back such as poor posture, sedentary behavior, or regular strain on the back. Prevention will likely involve a number of different steps to reduce these stresses. However, existing studies have not found clear recommendations for the best methods to go about it.

Researchers wanted to investigate the effectiveness of a number of interventions for the prevention of low back pain. The study, published in JAMA Internal Medicine, found that exercise alone or in combination with education was most effective for preventing low back pain.

About the Study
The systematic review of 21 randomized controlled trials included 30,850 men and women without low back pain. The participants were randomized to 6 different prevention strategies, including exercise, education, exercise plus education, back belt, and shoe insoles. The control groups received no intervention, minimal interventions, or placebo.

When compared to the control group exercise was associated with:
• Fewer low back pain episodes in the first 12 months (in 4 trials with 898 people)
• Fewer sick days due to back pain in follow up 12 months or longer (in 2 trials with 128 people)
• Reduction in short-term (4 trials with 422 people) and long-term low-back pain episodes (2 trials with 138 people) when combined with education

Education alone, back belts, and shoe insoles did not appear to have any benefit during the trials.

How Does This Affect You?
A systematic review combines the results of several smaller studies to arrive at one result. The benefit of this type of review is that it increases the number of participants which increase reliability of results. However the review is only as reliable as the studies that are included and the method used to combine the results. There were some flaws in every trial that were included in this analysis. For example, many of the included trials had a high dropout rate during the trial which decreases the reliability of their results.

Low back pain is often associated with an imbalance or weakness of certain back muscles. An exercise program will improve your physical fitness, strengthen your back muscles, and help you maintain a healthy weight. Regular physical activity may also help maintain a healthy weight which can also put strain on your back. Choose exercises or activities that you enjoy and will make a regular part of your day. For most people, this could include 30 minutes of moderate aerobic exercise per day.

Check with your doctor before starting any exercise program.

by Cynthia M. Johnson, MA

RESOURCES:
Family Doctor—American Academy of Family Physicians
http://familydoctor.org

Ortho Info—American Academy of Orthopaedics
http://orthoinfo.aaos.org

SOURCES:
Acute low back pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 2, 2016. Accessed March 22, 2016.

Steffens D, Maher CG, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016 Feb 1;176(2):199-208.

Last reviewed April 2016 by Michael Woods, MD

Starting a Workout Program

May 5, 2016 Teresa Stockton - Blog, Sports and Fitness

Yes, we get it, exercise is important, but that alone isn’t enough to make all of us get off of the couch. If you are having trouble starting a workout program that works for you and your schedule, get creative and start small. For most of us, we need someone or something to give us a small push in the right direction – and that’s exactly what we’re going to do. You don’t have to go to a gym with a lot of intimidating machinery, and weights – you can go to a physical therapy clinic. A physical therapist can work with you to develop a functional exercise routine that works for you and your goals… and if you need an exercise or wellness coach – they may just be able to make a recommendation. Okay, you’ve heard the sales pitch, but here are the basics you need to know. Whether you go to a gym, PT, or are starting a program on your own there are a few things you should take into consideration.

Benefits of Exercise

Improved circulation and cholesterol
Weight control
Assists with smoking cessation and addiction
Prevents/manages high blood pressure
Prevents bone loss
Boosts energy level and happy brain chemicals
Improves sleep, strength, and self confidence
Reduces risk of CHD/CVD, stroke
Delays/prevents chronic diseases
Reduces stress and anxiety while increasing relaxation
Prevents cognitive decline
Sharpens memory and boosts brainpower

Is Exercise Safe for Me?

If you have major health issues, consult your doctor before doing any exercise
Medical conditions can benefit from exercise even if you have a health issue or injury

Setting Yourself Up for Success

Set short term and long term goals THAT ARE OBTAINABLE!
Daily Reminders: schedule workouts on your calendar or set the alarm on your phone
Reward yourself for obtaining your goals (with something other than food)
Invest in a good pair of workout shoes
Workout with others
Start slowly
Do things you like and don’t focus on activities that you don’t like

How Often Should I Exercise?

Start small and build for success
American Heart Association recommends 30 min per day, most days of the week
SOMETHING IS ALWAYS BETTER THAN NOTHING!

How Hard Should I Work Out?

During cardio take the talk test: Can you speak in sentences while exercising?
Resistance training: You should be able to perform 10-15 reps with proper form

Stay Safe When You Exercise

Drink plenty of water before, during, and after a workout
Warm up, stretch, and cool down to help prevent injury
Wear good shoes that are appropriate for your foot type

This information about starting a workout program was written by Advance Rehabilitation, a physical therapy group with 15 locations throughout North and South GA, and 2 locations in North FL. Advance Rehabilitation is an outpatient physical therapy group that focuses on providing the highest quality rehabilitation services. They specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. For more information click here.

Baseball Video Throwing Analysis

May 3, 2016 Teresa Stockton - Blog, Sports and Fitness

Slow motion 2-D video throwing analysis for baseball players of all skill levels. The purpose of a baseball video throwing analysis is to break down the act of throwing to screen for abnormalities and deviations that may cause potential damage to the shoulder or elbow. Goals are injury prevention and optimizing performance by instructing players on the most efficient and effective mechanics of throwing. Includes evidence-based strengthening exercises and stretches from a certified strength & conditioning specialist. Provides player with proper arm care techniques, systematic warm-ups, cool-downs, throwing protocols, bullpen guidance and much more.

VIDEO ANALYSIS PROGRAMS TYPICALLY INCLUDE:
• Private Evaluation with a Physical Therapist
• Videography
• Biomechanical Analysis and Grading
• Recommendations on Areas for Improvement

WHY YOU SHOULD CONSIDER A VIDEO ANAYLSIS AS A PITCHER:
• Physical Therapy has proven to be immediately valuable in the rehabilitation of injuries and prevention of further damage to the shoulder or elbow
• Video analysis is the only technology available to view each phase of the throwing motion from all possible angles to screen and detect mechanical flaws that are causing injury
• Objective data obtained from the analysis is put through a rigorous grading process (The 8 Cylinders of Pitching) which determines the biomechanical efficiency of the throwing motion
• A structured rehabilitation and prevention program that incorporates the latest evidence-based interventions proven to be effective specifically to baseball players
• A baseball program will rehabilitate and optimize a player’s performance in a safe, scientifically sound manner and maintain good health through their careers.

April is Occupational Therapy Month

April 7, 2016 Teresa Stockton - Blog, Events

This month we celebrate occupational therapy, which helps individuals get back to doing all the things they love on a daily basis. Occupational therapy enables people of all ages live life to its fullest by helping them promote health, prevent or live better with injury, illness or disability. It is a practice deeply rooted in science and is evidence-based, meaning that the plan designed for each individual is supported by data, experience and “best practices” that have been developed and proven over time.

Occupational therapists and occupational therapy assistants focus on “doing” whatever occupations or activities are meaningful to the individual. It is occupational therapy’s purpose to get beyond problems to the solutions that assure living life to its fullest. These solutions may be adaptations for how to do a task, changes to the surroundings or helping individuals to alter their own behaviors.

When working with an occupational therapy practitioner, strategies and modifications are customized for each individual to resolve problems, improve function and support everyday living activities. The goal is to maximize potential. Through these therapeutic approaches, occupational therapy helps individuals design their lives, develop needed skills, adjust their environments (ex: home, school or work) and build health-promoting habits and routines that will allow them to thrive.

By taking the full picture into account a person’s psychological, physical, emotional and social makeup as well as their environment—occupational therapy assists clients to do the following:

• Achieve goals
• Function at the highest possible level
• Concentrate on what matters most to them
• Maintain or rebuild their independence
• Participate in daily activities that they need or want to do

Written by the American Occupational Therapy Association.
For more information, go to: www.aota.org

Baffling Blunders at the Gym

January 7, 2016 Teresa Stockton - Blog

Sometimes fitness trainers find it difficult to go into a gym and watch others exercise. Why? Because they see mistake after mistake being committed everywhere—some potentially dangerous. Here, are some of the most frequently performed workout blunders and how to correct them. Continue reading →

Shoulder Impingement Syndrome

August 20, 2015 contentadmin - Blog

ThinkstockPhotos-478265881

Article written by: Chris Wolfe, PT, Certified MDT, OCS
Director of Green Hills STAR Physical Therapy
www.StarPT.com

Shoulder disorders are some of the most common joint complaints, and shoulder impingement syndrome and rotator cuff tendonitis are considered to be the most frequent cause of shoulder pain and disability. The shoulder complex is unique in the body due to its structure and function. It is considered a ball and socket joint involving the large rounded end of the upper arm bone called the humerus and the small shallow socket of the shoulder blade. This disproportional shape allows for a wide range of directions that the arm can be moved; however, it does not provide much stability to hold it in place. The stability of the shoulder relies heavily on numerous ligaments, tendons and muscles; and the most common group is called the rotator cuff. The rotator cuff attaches to and surrounds the rounded end of the humerus and is bordered superiorly by a bony roof called the acromion. There is a small space between this bony roof and the rotator cuff. With reaching overhead, the space around the rotator cuff decreases, sandwiching and pinching the tendons between the two bones. This can lead to the disorder of shoulder impingement where the tendons become compressed and then inflamed.
Continue reading →

PT News

July 23, 2015 contentadmin - Blog, PT News

This Month in PT News. Featuring articles from PTandMe partnering clinics.

1.Degenerative Disc Disease and the Role of Physical Therapy
Written by the therapy Team at The Jackson Clinics Physical Therapy

The symptoms of degenerative disc disease are varied but regardless, it can limit the patient’s mobility and ability to perform daily activities. Painkillers can help patients with degenerative disc disease but they also benefit from physical therapy. Let’s take a look on the role of Oregon Spine & Physical Therapy in Eugene, Oregon in managing degenerative disc disease. Read More

2. Early Signs of Dehydration
Written by the therapy team at ARCH Physical Therapy & Sports Medicine

You have commonly heard the phrase, “MAKE SURE YOU ARE DRINKING ENOUGH WATER.” Hydration is important for the body not only as a daily practice, during physical activity, but also plays an important role in the aid of weight loss. The human body is made up of approximately 50-75% water. The percentage of water varies based on age and gender. Read More

3. You Win Some, You Lose Some- Lessons Learned as a Marathon Walker
Written by Tiffany Basore PT, DPT at The Center for Physical Rehabilitation

Growing up I was an athlete. While being a perfectionist and competitive by nature helped me reach some goals, it has also held me back. There were times in my life where I avoided things because I was afraid to fail. In 2009, I took a chance and trained for a ½ marathon. Despite playing multiple sports, long distance running has never been “my thing”. I was nervous to participate for fear of failure, but I put these thoughts aside and I trained. I followed a plan, I was consistent, and I didn’t get hurt. When race day rolled around I was nervous but I felt I had prepared well. I had been experiencing some mild health issues at the time which had altered my diet, but I didn’t worry too much about it. I woke up the morning of the race with my legs feeling like lead. I attributed this to being nervous and over-thinking things. I started the race hoping I just needed to get into my rhythm, but I never did. I trudged on for 12 of the 13.1 miles willing my non-cooperative body to keep moving. Just past mile 12, there was a hill. I knew there was no way my body would carry me to the finish line if I tried to run up it. My entire body was letting me down in a way it never had during any of my training runs. As I began to walk, a medic asked if I was okay. I stubbornly said yes, but when asked to walk a straight line, I couldn’t come close. He checked my blood pressure, oxygen, and blood sugar, all of which were too low. I had to stop. My body had failed me. I had failed. Read More