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Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis (JRA; Juvenile Chronic Polyarthritis; Stills Disease)

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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 JRA, 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 JRA:

  • 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
JRA 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.

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:
  • Arthritis and a family history of psoriasis in a first-degree relative (for psoriatic arthritis)

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 JRA. For example:

  • 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 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 bon
  • 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.

arthritis_card_dealt

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 Juvenile rheumatoid arthritis 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

JUVENILE RHEUMATOID ARTHRITIS 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.

PHYSICAL THERAPY FOR JUVENILE RHEUMATOID ARTHRITIS
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.

JUVENILE RHEUMATOID ARTHRITIS 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 Juvenile rheumatoid arthritis.

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 Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T506592/Juvenile-idiopathic-arthritis-JIA-enthesitis-related. Updated July 15, 2016. Accessed September 29, 2016.

Juvenile idiopathic arthritis (JIA) oligoarticular. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114122/Juvenile-idiopathic-arthritis-JIA-oligoarticular. Updated July 16, 2016. Accessed September 29, 2016.

Juvenile idiopathic arthritis (JIA) polyarticular. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116580/Juvenile-idiopathic-arthritis-JIA-polyarticular. Updated July 15, 2016. Accessed September 29, 2016.

Juvenile idiopathic arthritis (JIA) systemic-onset. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115968/Juvenile-idiopathic-arthritis-JIA-systemic-onset. Updated July 15, 2016. Accessed September 29, 2016.

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 Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115968/Juvenile-idiopathic-arthritis-JIA-systemic-onset: 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 Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115968/Juvenile-idiopathic-arthritis-JIA-systemic-onset: 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 Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115968/Juvenile-idiopathic-arthritis-JIA-systemic-onset: 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.

hip pain physical therapy

What is Causing Your Hip Pain?

The hip is a large weight bearing ball and socket joint. We use our hips to help move our legs, and for the most part it’s stable and doesn’t give us a whole lot of trouble.  That’s not the case for everyone however. Let’s take a look at hip pain and what the main culprits are.

The Most Common Types of Hip Pain
The most common type of hip pain is arthritis which literally means” swelling of the joint”. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are 3 types of arthritis that may ultimately require surgical intervention such as a hip replacement. Other traumatic injuries, birth deformity or childhood hip disease can also cause hip joint damage.

Osteoarthritis is caused by wear and tear of the joint and is typically seen in people 50 years or older. The articular cartilage becomes soft and wears down causing pain, loss of range of motion, and swelling.

Rheumatoid Arthritis is an autoimmune disease whereby your body’s immune system attacks your joints causing pain and swelling.

Traumatic Arthritis can occur following a severe hip injury or fracture. In this case, the trauma causes cartilage damage which can lead to hip pain and stiffness over time. Avascular Necrosis is a condition following a traumatic injury to the hip whereby the blood supply to the femoral head is compromised resulting in pain and damage to the articular cartilage.

For more information on hip pain or what to expect from hip replacement recovery check the articles below:

       
This article about hip pain was provided by PTandMe physical therapy partner: STAR Physical Therapy. More information about STAR Physical Therapy and their 65 locations throughout TN  can be found on their website at www.STARpt.com
concussion physical therapy

What We Know About Concussions is Changing

As concussion research continues we’ve learned that a few of the things we have held as truth isn’t entirely accurate. Including the fact that a person with a concussion shouldn’t be allowed to sleep for long periods of time. So let’s take a look at how concussion treatment is evolving from what was… to what it is now.

Old School vs. New School Concussion Treatment
The first step to treating a concussion is to seek medical help.  Your health care provider is knowledgeable and can help you or your child return to work or sport safely.

Old School Concussion Rehabilitation

  • It’s just a “Mild, Grade-1” concussion.
  • They didn’t have loss of consciousness, it’s not a concussion.
  • Should we have a CT scan or MRI?
  • An athlete needs to be hit on the head to sustain a concussion
  • Injury to the brain only occurs at the initial impact of the concussion.
  • Should I wake them up every couple of hours?
  • Male athletes have a higher chance of sustaining a concussion than females.
  • He’s young, he’ll bounce back quick.
  • Protective equipment will prevent concussion if the newest modelis used.

New School Concussion Rehabilitation

  • Medical professionals with “up-to-date” education on concussions will not use the historic grading scale. The grading scale has been abandoned in favor
    of a symptom-based, multi-faceted approach to concussion management that emphasizes the use of objective assessment tools aimed at capturing the spectrum of clinical signs and symptoms,cognitive dysfunction and physical deficits, and a symptom-limited, graduated exercise protocol leading to a return to play.
  • Approximately 90% of concussions are NOT accompanied with loss of consciousness.
  • Conventional CT or MRI scans will not diagnose a concussion and are not needed or recommended for the vast majority of sport related concussions. While these types of neuroimaging are crucial in the diagnosis of intercranial hemorrhaging and detecting brain lesions, approximately 78% of concussions will have normal scans.
  • Concussions can occur with any movement or jostling of the head as in whiplash injuries or rotational force, causing injury to the brain.
  • Traumatic brain injury is an evolving process at the microscopic level of thebrain. Chemical and metabolic changes occur for days, weeks to months after impact. That is why it is important to prevent any additional concussions andavoid a second impact syndrome during this time period.
  • Encourage plenty of rest with uninterrupted sleep. Since fatigue and drowsiness are common symptoms associated with concussions, sufficient sleep will allow the brain to heal and is necessary for recovery.
  • Studies show a higher probability in female vs. male athletes. This is likely due to their genetic make up and the fact that women are more likely to self report symptoms vs their male counterparts.
  • Due to their continued brain development at these ages, children and adolescents actually recover more slowly.
  • Evidence shows that protective equipment such as helmets, mouth guards and other protective devices may lower risk but no equipment eliminates the risk of concussion

This article about concussions was provided by PTandMe physical therapy partner: The Center for Physical Rehabilitation. More information about the Center and their locations throughout Grand Rapids, MI can be found on their website at www.pt-cpr.com

Additional articles from PTandMe about concussions can be found here:

concussion baseline testing   

concussion treatment   

vanilla smoothie

Healthy Recipes 101: Vanilla Protein Shake – PTandMe

Healthy Recipes 101 features fit and lean recipes to help you feel great!

VANILLA PROTEIN SHAKE
If you are looking for a healthy meal replacement, this is it! This vanilla protein shake was given to us by a colleague, who we have on good authority, drinks these regularly.

Ingredients
• 1-1/2 1-1/2 cups unsweetened Vanilla Almond Milk
• 1 scoop Vanilla Protein Powder
• 1 tbsp. flaxseed oil or ground flaxseed meal
• ¼ tbsp. of cinnamon
• 1 -2 packets of Stevia to sweeten (optional)
Directions
Put everything into a blender and process until smooth. Enjoy!

 

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PT News for July 2017: PTandMe

This July in PT News… Featuring articles from PTandMe partnering physical therapy clinics!

1. Hands-On Physical Therapy Effective for Common Shoulder Conditions
Written by the Physical Therapy Team at Rehab Associates of Central Virginia
click here for more information about this great group of clinics

Shoulder problems are one of the more common issues that affect the musculoskeletal system, as its prevalence in the general population has been reported as high as 4.8%. The most common shoulder condition that causes pain is shoulder impingement syndrome (SIS) Read more

 

2. Is Dry Needling Right for You?
Written by the Physical Therapy Team at ARC Physical Therapy Plus in Shawnee, KS
click here for more information about this great group of clinics with locations in Kansas, Missouri, and Iowa

Dry needling is growing in popularity; learn the basics, and if it’s right for you from ARC Physical Therapy Plus physical therapist Diana Dickey. Read more

 

3. Winning the Battle Against Arthritis
Written by the Physical Therapy Team at STAR Physical Therapy
click here for more information about this great group of clinics with over 60 locations throughout TN.

Osteoarthritis is a slow progressive breakdown of joint structures that can significantly impact mobility, function, and independence. Rheumatoid arthritis is an autoimmune disease that causes inflammatory joint symptoms. Physical therapy for both OA and RA are to regain/maintain range of motion, reduce pain and improve function. Read more

McKenzie Method

McKenzie Method: Mechanical Diagnosis and Treatment

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The McKenzie Method is a philosophy of active patient involvement and education that is trusted and used by practitioners and patients all over the world for back, neck and extremity problems.

McKenzie Method – Three Steps to Success:

1. A logical step-by-step process to evaluate the patient’s problem quickly. This mechanical examination can “classify” most patient conditions by the level of pain or limitation that results from certain movements or positions. A McKenzie assessment can eliminate the need for expensive and/or invasive procedures.

2. McKenzie treatment prescribes a series of individualized exercises. The emphasis is on active patient involvement, which minimizes the number of visits to the clinic. For patients with more difficult mechanical problems, a certified McKenzie clinician can provide advanced hands-on techniques until the patient can self administer.

3. By learning how to self-treat the current problem, patients gain hands-on knowledge on how to minimize the risk of recurrence and to rapidly deal with recurrence if it occurs. The likelihood of problems persisting can more likely be prevented through self-maintenance.

prevent throwing injuries

Guidelines to Prevent Throwing Injuries

throwing injuires

In this monthly series about how to prevent throwing injuries, we examine the proper ways to exercise and prevent throwing injuries in baseball. If you have any sudden significant increase in pain, swelling, or discoloration while performing or following exercise, discontinue immediately and contact your primary care provider.


PRONE ROW
Lay on your stomach with your arm hanging off the edge toward the ground. Squeeze your shoulder blade and bring your elbow toward the ceiling while keeping your forearm perpendicular to the ground.


PRONE ROW WITH EXTERNAL ROTATION
Lay on your stomach with your arm hanging off the edge toward the ground. Turn your wrist so your palm is toward your feet. Squeeze your shoulder blade and bring your elbow toward the ceiling while keeping your forearm perpendicular to the ground. Once your arm is parallel with the ground rotate the back of your hand toward the ceiling while keeping the elbow bent.


PRONE T (HORIZONTAL ABDUCTION)
Lay on your stomach with your arm hanging off the edge toward the ground. Lift your arm straight out to your side and squeeze your shoulder blade with the palm continuing to face toward the ground.


PRONE Y (SCAPTION)
Lay on your stomach with your arm hanging off the edge toward the ground. Lift your arm at a 45 degree angle over your head with your thumb facing toward the ceiling. Squeeze your shoulder blade down and toward your spine.

This information was written by Advance Rehabilitation Physical Therapy, an outpatient physical therapy group with 24 locations in Georgia and Florida. Advance Rehabilitation is a physical therapy practice that focuses on providing the highest quality rehabilitation services. They specialize in physical therapy, sports medicine, industrial rehabilitation and athletic training. Their staff includes highly-trained professionals that serve as a bridge between injury and recovery to help patients get back to pre-injury status as quickly as possible. For more information click here.

See the entire Guidelines to Prevent Throwing Injuries series here:

   Prevent Throwing Injuries

   prevent throwing injuries

throwing injuries PTandMe

crossfit

The Skinny on CrossFit

If you find going to a new gym nerve-wracking, joining a CrossFit gym might be downright terrifying. Walking into the warehouse-like gym and seeing people flipping tires while loud music pumps out of the stereo system and primal grunts and screams reverberate off the walls can be intimidating. Just take a deep breath, slip on your sneakers, grab your water bottle, and get ready to change your life completely.

Created by Gary Glassman, CrossFit is a high-intensity strength and conditioning program. It uses functional movements and varied workouts to help people lose weight, build muscle, and live healthier lives. While every CrossFit trainer is certified and able to adapt workouts to your needs, it is important that you consult your physician about any pre-existing conditions before beginning a new workout regime.

If you are nervous about going to your first CrossFit class, you can rest easy knowing it probably will not be very intense. Before you can participate in the daily workouts, you need to complete the Foundation Training. This is where you will learn the proper form and technique for the nine fundamental movements. Once you feel comfortable with these movements you can join the masses.

You first week at a Crossfit gym (typically called a “Box”) will be like your first week at a new school. There will be new friends to make, lots of questions to ask, and new skills to learn. You won’t be doing advanced moves in the beginning but you will still be working hard and will find yourself sore and tired by the end of the week.

Each class consists of a 15-minute warm-up, followed by 15 minutes of skill work. This is a great opportunity to improve on a move you are struggling with, or tackle an exercise you are nervous about in the Workout of the Day (WOD). After the skill work segment, you will move on to the WOD. The amount of time to complete a workout varies depending on the objective. Sometimes you will be racing against the clock, while other times you will be aiming for a timed personal best. A cool-down will round out your workout.

10 Components of CrossFit

Doing CrossFit is a full mind and body experience. There are 10 specific elements of physical fitness you will practice during each workout. Your overall fitness level will be determined based on your competency in all these domains.

  • Cardiovascular and Respiratory
  • Stamina
  • Strength
  • Flexibility
  • Power
  • Speed
  • Coordination
  • Agility
  • Balance
  •  Accuracy

 

Building Blocks of CrossFit
There are nine foundational movements every new CrossFit member must understand and master to ensure they get the most out of their workout and avoid injury. The three basic movements are: Squats, Presses, and Lifts. These movements increase in difficulty from Level 1 to Level 3. Once an athlete is comfortable with the form and technique associated with an exercise, they can progress to the next level.

Squats
The first movement you will learn when you join a CrossFit gym is an air squat. This basic movement is the foundation for the next two levels of squats. Squats are excellent lower-body exercises that engage your hamstrings, glutes, and quadriceps. As you progress through the three levels of squats, you will also begin to engage your upper body and core, making the squat a full-body workout.

Level 1 – Air Squat:

  • Stand with your knees shoulder-width apart and your toes angled out at approximately 10 degrees.
  • Keep your back, shoulders, and core tight.
  • Extend your arms out in front of you.
  • Press your hamstrings back and down.
  • As you lower yourself to the ground, press your knees out.
  • At the lowest point of the movement, your hips should be lower than the crease in your knees.
  • Press up through your hamstrings and glutes to return to the starting position.
  • Rest your hands at your side.

Level 2 – Front Squat:

  • Begin in the same stance as for an air squat.
  • Hold a bar in front rack position. (Rack position: Rest the bar on your shoulders across your chest. Your elbows should be up and your triceps parallel to the floor. Loosely grip the bar at slightly wider than shoulder width, with palms facing the ceiling.)
  • Once you are comfortable holding the bar, complete the same downward movement executed in an air squat.

Level 3 – Overhead Squat:

  • Begin in the same stance as for an air squat.
  • Hold a bar over your head with your palms facing forward.
  • Elbows should be locked and your wrist and forearms aligned (no bend or flexion).
  • Complete the same downward movement executed in an air squat.
  • Keep your chest up and eyes forward during this movement. If you feel like you are leaning too far forward you might be compromising the exercise. Reduce your weight and continue.

Presses
Presses are fantastic for targeting and toning your upper body. They will engage your arms, shoulders, back, and, depending on what level you are on, your legs. As with squats, there are three levels of press.

Level 1 – Shoulder Press:

  • Stand with your feet hip-width apart and eyes looking forward.
  • Rest the bar across the front of your shoulders, gripping it slightly wider than shoulder width.
  • Use a hook grip to secure your hands around the bar. (Hook Grip: Cross your middle finger and index finger over your thumb.)
  • Press the bar upwards.
  • As the bar moves straight up, only your head should move back to allow the bar to travel in front of your face.
  • At the top of the movement your arms should be fully extended above your head with elbows locked.
  • Follow the same line to lower the bar back to the starting position.

Level 2 – Push Press:

  • Hold the bar in the same position as for a shoulder press.
  • Keep your torso upright and your core engaged, and slightly lower your body by bending your knees.
  • Explosively straighten your knees and use the momentum in the movement to press the bar above your head.
  • Arms should be fully extended with locked elbows at the top of the movement.
  • Lower the bar back to starting position.

Level 3 – Push Jerk:

  • Hold the bar in the same position as for a shoulder press.
  • Lower your body into a quarter-squat position.
  • Perform a vertical jump.
  • When you are in the air, press the bar above your head.
  • Land with your feet in the exact same spot they took off from and with a slight bend in your knees.
  • Finish the movement by fully extending your hips and knees.
  • Return the bar to your shoulders.

Lifts
The three progressive lifts in CrossFit engage your entire body. These full body movements allow you to make the most out of any workout. If you are short on time, incorporate these exercises into your routine to torch calories and burn muscle.

Level 1 – Deadlift:

  • Place the bar in front of you and stand with your feet hip-width apart.
  • Bend forward at the hips, bending your knees slightly, and grip the bar at a point that is wider than hip-width.
  • The bar should be in contact with your shins and your shoulders should be slightly ahead of it.
  • Keep a flat back as you lower your glutes and pull up on the bar (arms should not bend).
  • Straighten your back and legs while lifting the bar in a vertical line up your body.
  • When the bar passes your knees, fully extend your hips forward.

Level 2 – Sumo Deadlift High Pull:

  • Use a wide stance for this movement.
  • With your hands narrowly apart (about two fist-widths), grip the barbell in front of you with your palms facing down.
  • Keep your arms straight and chest up while you slightly bend your knees into a quarter-squat.
  • Explosively stand up and shrug your shoulders, pulling the bar up in a vertical line.
  • By the time your hips are fully extended, your elbows should be above the bar pointing up and your hands should be aligned with your shoulders.
  • Slowly lower the bar back to the ground by reversing this movement to complete the repetition.

Level 3 – Medicine Ball Clean:

  • Swap out the barbell for a medicine ball.
  • Squat down over the ball.
  • Keep your chest up and gaze ahead.
  • Keep your arms straight and grab the ball on opposite sides.
  • Explode up, shrug your shoulders, and slip your body under the ball so that it lands in front of your face.
  • Catch the ball at the bottom of a front squat with your hips below your knee joints.
  • Complete the movement by standing up with your arms remaining bent, and the ball in front of your face.

WOD are you Talking About?
It’s no secret that CrossFit has a lingo of its own. If you’ve ever heard someone talking about CrossFit, you might wonder what language they are speaking and why they hate their friends Josh and Nancy so much. While they might be talking about a person, it is more likely your CrossFit friends are discussing a tough workout they just did. Each WOD is given a name. WODs are usually named after women (in the same way storms are, because they are so intense they leave you feeling like you were hit by a hurricane) or after fallen war heroes. Here are two notorious WODs that people love to trash.

Six Benefits of CrossFit
CrossFit is a tough workout, you can’t deny that. But, if you are willing to take a shot and get your sweat on, you will reap the rewards. Here are just a few of the many benefits CrossFit will have on your health and life.

The best thing to do if you are considering joining a CrossFit gym is to stop by and check one out. They have certified coaches on site who will be more than willing to answer your questions and put your fears to rest. Who knows, you could be the next breakout star at the CrossFit games!

Isokinetic Devices

Isokinetic Devices for the 21st Century Therapist

Isokinetic Devices

Isokinetic devices have had their time in the spotlight of the rehab world. Like an actor past his prime, these monstrous machines mostly sit in dark lonely corners collecting dust. Some get used regularly but only as a place for sitting and storing odds and ends. However, companies such as CSMi (Computer Sports Medicine Inc.) among others have revived this once proud and prominent piece of equipment and have applied modern technology and rehab principles to bring about a new golden age of isokinetic devices and rehab.

Historically, isokinetics was introduced in the late 1970s and hit it’s stride in the 1980s through the 90s. Various protocols were created in this time and have been researched extensively creating the body of knowledge we now have. Unfortunately, isokinetics lost favor as healthcare laws changed and the industry started the search for more low-cost treatment regimens.

ISOKINETIC DEVICES TESTING
There are now fewer therapists who know how to use the equipment and most that do are unaware of the improvements that have been made over the last twenty years. Historically, joints are measured at two or three varying speeds but only in the concentric mode of contraction. While this is still the gold standard of testing, it fails to assess the all important eccentric mode of contraction. Recently, CSMi introduced the interrupted stoke test on their machine, the Humac Norm, which allows the therapist to separate concentric and eccentric modes. Our muscles function as eccentric controllers of motion and the ability to test this provides us with a better view into the muscle’s strength and function.

There are other testing modes available as not all patients are appropriate for isokinetic testing. Isometric testing is something all therapists use daily in the form of manual muscle testing(MMT). However, this is not a precise measurement and can vary between therapists. Testing a patient isometrically on a machine is a safe, effective and precise test for your older, untrained and post-surgical patients. It provides an exact amount of torque as compared to the MMT 5-point system. Additionally, proprioception can be assessed for either velocity or joint position matching.

TREATMENT
In addition to testing, isokinetic devices offer various treatment modes are where these machines show their true capability. Continuous Passive Motion can be utilized for regaining range of motion, reducing swelling and pain, reducing apprehension and muscle guarding and regaining musculotendonous mobility.

Active Assisted Programs can be utilized to regain end-range motion and multi-angle isometrics can be utilized to increase joint stability and neuromuscular control within the entire available range of motion. Also, proprioception training can be utilized to enhance positional and motion control.

Strength training with eccentric loading allows for targeted strengthening by isolating the eccentric beginning in slower speeds and progressing into deceleration training to mimic plyometric loading.

Isotonic strengthening programs are available for various purposes. One is power training which is utilized to increase concentric explosiveness. Another is used to prepare patients for an independent gym program. Finally, dynamic isotonic control training includes the ability to load the concentric and eccentric motions at different torques and utilizes games and other programs as visual feedback to the patient.

ARGUMENTS AGAINST ISOKINETICS
One argument against isokinetics concerns patellofemoral, post-op ACL and knee osteoarthritis patients. Open chain knee extension has been labeled public enemy number one for these patients and while this has been examined extensively, steps such as limiting the range of motion, using anti-shear devices and techniques, altering patient positioning and matching the appropriate treatments to the patient reduces shearing and compression, improves safety and ultimately debunks this myth.

Now, I know that critics of isokinetics will also argue that isolating muscles is not functional. That would be true if a therapist utilized these machines as the sole treatment. But by incorporating it into an eclectic approach, patient outcomes are maximized. Your lower extremity patients will still perform scapular and thoracic control exercises and you will still strengthen the core. Soft tissue work and joint mobilization will still be needed and functional training must still occur. However, if one link in the chain is weak, the entire chain will fail. Utilizing these machines throughout the course of rehab to find and isolate those weak links is what will take your patient’s recovery of function to the next level. This is true for all of your extremity patients, nit just knees. Remember, a functional movement cannot occur with a dysfunctional or unbalanced segment.

This information was written by Daniel Bodkin, PT, DPT, ATC – STAR Physical Therapy, Columbia (North), Tennessee
Established in 1997 with one clinic and one mission – to serve. Today, STAR Physical Therapy has grown to offer that direct service in more than 60 clinics, and while they’ve grown, one thing that has not changed is their commitment to you, their communities, and their employees. Their foundational mission is “To Serve.” Their commitment to the patient and physician is to provide clinicians that are “great mechanics of the human body™.” For more information click here.

hand therapy week PTandMe

ASHT: Hand Therapy Awareness Week

hand therapy week PTandMe

Prevent hand and wrist injuries while cooking. Professional hand therapists promote wrist and hand health in the kitchen.

USE THE RIGHT TOOL FOR THE JOB
Use easy-to-grip versions of tools like spoons, knives and bottle/can openers to decrease the stress on your hands and use scissors to open bags (or packages) instead of your thumbs.

SIT OR STAND UP STRAIGHT
Correct posture is important because the nerves that operate your fingers start in neck. During activities which require you to be looking down at what you are doing, like chopping vegetables, take a moment to stand up straight, turn your head side to side/up and down, and stretch your arms over your head.

SLIDE, DO NOT LIFT
When working in the oven, always slide the shelf out so you can get a good, safe grasp of the panhandles.

KEEP YOUR SHOULDERS DOWN
Your arms should be at your sides and the counters you work on should be waist high. Many kitchen counters are too high for the average person. As a result, you may be forced to raise the shoulder you are using to cut the food and lean to the opposite side of your body when preparing food. This causes increased stress on the neck, shoulder and arm muscles and nerves.