Tag Archives: injury

labral tear physical therapy

ATC Tip: The Labrum

Anatomy of the Shoulder
The shoulder can move in almost every plane of motion, it’s the most mobile joint in the human body; but more mobility = more instability. The shoulder joint is often described as a “ball in socket,” but it’s wide range of motion makes it a highly vulnerable joint. We have a network of soft tissue structures, such as the rotator cuff and ligaments, whose main job is to keep the humeral head in its assigned seat. However, often these muscles alone are not sufficient as they can become weak or tight and thus less efficient. The labrum is a small ring of cartilage that provides additional stability to the shoulder joint.

How Does a Labrum Become Damaged?
Direct trauma, shearing forces, or repetitive stress can cause damage to the labrum. Often, this damage will present as a tear in the labrum, which can restrict motion, decrease strength, and cause pain in the shoulder. Picturing that ring of cartilage, imagine a roughening of the edges of the bowl-like golf tee, or even a rip that flaps when the ball is spun around. It is not uncommon for a shoulder dislocation or subluxation to be accompanied by a labral tear; chronic shoulder instability can also lead to labrum injury.

What Does a Labrum Do?
Because the “ball and socket” is so shallow, the shoulder joint is often described, quite accurately, like a “golf ball sitting on a tee.” To picture the shoulder labrum, imagine a ring around the outer edge of a golf tee, effectively deepening the overall bowl shape, almost suctioning the humerus into the space. The labrum helps stabilize the shoulder by making the “ball” more difficult to remove from the “tee.”

How Can I Prevent a Labrum Injury?
The best way to prevent a labral tear is to strengthen the musculature surrounding the shoulder joint. The best case scenario is all of the muscles are working together to keep the shoulder joint moving fluidly through its full range of motion. Important within this group of muscles are the muscle that control the shoulder blades. By strengthening the stabilizing muscles individually and functionally, it helps them stay balanced and strong with the other, stronger muscles (like the RTC). The other way to prevent a labrum tear is to avoid excessive contact, repetitive overhead motions, and falls.

This article about athletic injuries was provided by PT & Me 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

To see a shoulder strengthening program visit our Sports Medicine Tip Page by clicking here.

PT News

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

1. How to Deal with Chronic Joint and Muscle Pain
Written by the Therapy Team at Cornerstone Physical Therapy – Gahanna, OH

All of us have experienced pain and discomfort in the muscles and joints at some point, especially with age. In most cases, the use of over the counter medications, hot/cold packs and rest help resolve the problem. Read more

2. Pain at the Mall
Written by the Therapy Team at the Jackson Clinics – Northern Virginia

As the outside temperatures drop, people contemplating undertaking an exercise program often consider walking at the mall. Benefits include a controlled climate, an absence of traffic, security and easily available restrooms and water. Read more

3. Quality of Care in Rehab
Written by the Ian M. Campbell, DPT at Intermountain Physical Therapy – Boise, ID

What does quality care mean in rehabilitation? One can drive through their city and likely notice multiple physical therapy (PT) clinics. Some may be privately owned and operated, others run by local hospitals. Read more

knee injuries physical therapy

Common Causes of Knee Injuries

While most of us take our knees for granted, injuries can occur quite easily and for a variety of reasons. Only when you suffer a knee injury, do you realize how much we rely on these joints on a day to day basis. Knee injuries cause discomfort and pain, but that’s not all. They can also be extremely debilitating and in serious cases, result in dramatically reduced mobility. So let’s take a look at some of the most common causes of knee injuries, and what to do in case you experience one.

What Are the Most Common Knee Injury Causes?

Well, there are a number of them – some more serious than others. Let’s take a look at some of the most common ones!

  • Fractures: Fractures are very common knee injuries and can affect the patella, which is the most commonly fractured bone around the knee. Fractures can also affect the ends of the tibia and femur in the area where they come together to form the knee joint. Incidents such as serious falls and road traffic accidents are common causes of fractures. And sometimes even the best knee brace for running or other sports won’t be able to prevent a fracture.
  • Dislocated knee: Knee dislocation is another common knee issue and it occurs when the knee bone is either partially or totally out of place. This could include the patella slipping or the femur and tibia sustaining injury that forces them out of alignment. Various different sports activities as well as falls and other high impact trauma can cause this injury.
  • Torn ligament: Tearing of the anterior cruciate ligament is also a common type of knee injury. This is more common among those that take part in athletics and sporting activities. Some of the common causes of this injury include a rapid change in direction when running or incorrectly landing from a jump. In many cases, this sort of injury also comes with additional injuries to the cartilage.
  • Torn tendons: This type of injury is more common among older people, particularly those who are active runners or do any sports that require a lot of running. The tendons of the patella can become stretched and then torn during this type of activity. Direct force to the front of the knees, falls, and incorrect landing following a jump are all common causes of a torn tendons.

There are many different causes of knee injuries, but usually they involve some sort of high impact trauma. This is why these types of injuries are often sustained by athletes as well as people who are keen on physical activities. Falls, incorrect landings following a jump, and the twisting of the knee can all cause various different knee injuries.

The knees are among the most easily injured joints in the human body, and also one of the most common reasons for people seeing their doctor. So in the event of a knee injury, no matter what the cause, it is important to seek medical advice because a knee injury can escalate from simple twisting of the knee to a dislocation or worse pretty quickly. Because the treatment for a knee injury varies based on the severity as well as the type and cause of the problem, ranging from medication and physical therapy to even surgery, consulting a medical professional is the first step to treating your knee successfully.

More information about common knee injuries can be found in the PTandMe injury center.

Physical Therapy Month 2017 – Managing Pain Safely

This Physical Therapy Month we want patients to try physical therapy first! Physical therapy is a safe non-invasive form of treatment for patients experiencing musculoskeletal pain or injuries.

PHYSICAL THERAPY is a safe and SMART alternative to opioids.

Great candidates to be referred to physical therapy instead of prescribing pain pills include:

  • A patient that has had pain for more than 90 days
  • A patient that complains of pain disturbing their sleep or daily activities
  • A patient that has a history of substance abuse or has been on pain medication for an extended period of time
  • A patient that expresses an interest in avoiding opioids

Try physical therapy and see the difference!

causes of carpal tunnel

Common Causes of Carpal Tunnel Syndrome

Common Carpal Tunnel Causes

Carpal Tunnel happens when the tendons become swollen (tenosynovitis) or if the tunnel size itself decreases because of injury-causing compression to the median nerve.  When compression occurs, a person can experience numbness, tingling, or a dull sensation of the thumb, index, middle and ring fingers. Symptoms may include pain during pinching and gripping, or a feeling of clumsiness and the inability to hold things. The best way to avoid carpal wrist pain is to understand the main causes of carpal tunnel and use that information at work and at home.

WHAT IS THE CARPAL TUNNEL?
The carpal tunnel is a small space at the wrist in which the median nerve and nine tendons pass through. The median nerve travels on top of the tendons through the tunnel. The tunnel itself is made up of your wrist bones and along the top of the tunnel is a thick fibrous ligament called the transverse carpal ligament.

COMMON CAUSES OF CARPAL TUNNEL
Carpal Tunnel is typically not related to a specific injury. Some common causes of carpal tunnel syndrome include:

Genetic Predisposition – Many cases can be a result of physical characteristics of carpal tunnel or medical conditions associated with CTS, which also run in the family.

Repetitive Movements – Certain types of work, leisure, and sports activities require use of the hand and wrist repetitively. Occupations such as manufacturing/assembly line workers, grocery checkers, musicians, carpenters, and many others require the same movements. Common hobbies such as golfing, knitting, and gardening also require repeated movements that cause carpal tunnel syndrome.

Injury or Trauma – Sprain or fracture of the wrist can cause swelling and pressure to the median nerve.

Pregnancy & Menopause – Hormonal fluctuation in women plays a role in CTS. Such fluctuation may cause fluid retention and other changes that cause swelling in the body. Fluid retention frequently occurs during the last trimester of pregnancy and is the reason for CTS.

Medical Conditions – Diabetes, hypothyroidism, lupus, obesity, and rheumatoid arthritis.

ACTIVITIES TO AVOID TO MINIMIZE SYMPTOMS

  • Avoid keeping your wrists bent in either direction. The best position for the wrist is neutral (straight)
  • Avoid rapid repetitive forceful or prolonged hand or arm use such as seen with factory work or data entry.
  • Avoid tight gripping and pinching
  • Avoid pressure to the palm or wrist
  • Avoid extreme cold or vibration.

PT News

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

1. Foot Pain in Dress Shoes
Written by the Therapy Team at the Jackson Clinics Physical Therapy – Northern Virginia

Have you ever had a long anticipated night on the town spoiled by sore feet? The source of your discomfort just might be those pretty shoes you have chosen to wear. Read more

2. Knee Pain… Could it be Patellar Tendinitis?
Written by the Therapy Team at Denali Physical Therapy – Anchorage, AK

What is Patellar Tendinitis?
The patellar tendon is a ligament that connects the shin bone to the patella that helps the muscles extend the knee. Read more

3. ARC Physical Therapy+ Expands with a New Clinic in Urbandale, Iowa
Written by the Therapy Team at ARC Physical Therapy – Urbandale, IA

ARC Physical Therapy+ is pleased to announce the opening of a new clinic in Urbandale, Iowa on September 25th, 2017. This makes the third ARC Physical Therapy+ clinic in Iowa and the 18th clinic across Iowa, Missouri and Kansas. Read more

Fall Prevention Physical Therapy

Physical Therapy for Balance & Fall Prevention

“Falls are the leading cause of injury death for Americans 65 years or older. Each year, about 35–40% of adults 65 and older fall at least once.”
— Center for Disease Control

Physical Therapy for Fall Prevention
Physical therapy fall prevention programs are tailored around each individual’s needs. The length of the program is dependent on the severity of the symptoms and the goals of each individual. Most patients will follow a gradual path of three distinct phases. After an initial evaluation to determine needs and goals of patient and we will set up treatment plan with patient input. The first phase typically includes therapeutic interventions designated to decrease symptoms and the establishment of a Home Exercise Program (HEP). We will then Continue the use of therapeutic interventions with the addition of ADL modifications, and energy conservation techniques. Finally we will continue the program until the patient’s goals are met.

The main objectives in a fall prevention program are to:

  • Increase independence with Activities of Daily Living (ADLs)
  • Increase independence with functional mobility
  • Decrease fall risk
  • Prevent future fall
  • Increase safety

Pain Relief
Our PTandMe licensed physical therapists are skilled in helping patients significantly reduce the risk of falls so that seniors can continue to age independently. If you or someone you know may benefit from a fall prevention program – call a clinic near you today and see what options are available for you! To find a PTandMe partnering location in your area click here.

Safe Lifting Practices for Back Injury Prevention

Lifting Safety: Safe lifting practices for back injury prevention.

Whether at home or at work safe lifting practices can keep your back healthy and safe. Before lifting heavy objects decide how you will lift carry & place the item before you pick it up. Test the weight of the load by moving or tipping it. Figure out if you can break the load down by placing the contents of large containers into a number of smaller ones before moving them. Is the path clear? What is the weight of the load? How much stress will be placed upon your back? Is there traffic, a tripping hazard, a doorway to go through, or a stairway to go up or down? Avoid carrying an object that requires two hands to hold, either up or especially down a flight of stairs. Use the elevator. Plan a rest stop, if needed. Knowing what you’re doing and where you’re going will prevent you from making awkward movements while holding something heavy. Clear a path, and if lifting something with another person, make sure both of you agree on the plan.

KEY STEPS FOR SAFE LIFTING PRACTICES

Establish a Base of Support: Use a wide, balanced stance with one foot in front of the other. Make sure that you have firm footing and that your feet are a shoulders-width apart. This staggered stance gives you the stability of not falling over and being able to secure the load.

Keep Your Eyes Up: Looking slightly upward will help you maintain a better position of the spine. Keeping your eyes focused upwards helps you keep your back straight.

Get a Good Grip: With your palms and make sure you have an adequate hold on the object. Be certain you will be able to maintain a hold on the object without having to adjust your grip later. You can use gloves to help maintain an adequate grip, but don’t rely on gloves because they can desensitize the fingers and make you unable to feel the object.

Lift Gradually with Your Legs: Without using jerky motions. By using your leg strength, your chance of lower back injury is greatly reduced.

Tighten you stomach muscles: As you begin the lift and keep you head and shoulders up.

Pivot – Don’t Twist: Move your feet in the direction of the lift. This will eliminate the need to twist at the waist.

Weight: A lighter load normally means a lesser risk of injury. The weight of the object should be within the capacity of the person to handle safely.

Handling: It is easier to pull or push a load than it is to lift, put down or carry.

Keep the Load Close: Holding a 20lb object with your hands 20 inches from the body creates more compressive force on your low back than holding it 10 inches away. This is because the muscles in your back have to work to counterbalance the weight when it is further from the body. As the compressive force on your low back increases, so does the risk of muscle strains, ligament sprains and damage to the disks in the spine.

Frequency: The more times a load is handled, the more tired the muscles become, making it easier for the person to be injured.

Distance: The farther the load has to be moved, the greater the risk of injury.

Duration (TIME): Where the job involves repetitive movements, reducing the time spent on handling will help to ensure the movements are not causing unnecessary strain.

Forces Applied: Forces should be applied smoothly, evenly and close to the body. Forces exerted should be well within the capacity of the person, and the person should maintain proper posture.

Nature of the Load: Loads that are compact, stable, easy to grip, and capable of being held close to the body are much easier to handle.

Terrain: Rough ground, steep slopes, slippery and uneven floors, stairs and cluttered floors make moving a load awkward and increase the chance for injury.

Environment (Climate & Lighting): If it is too hot, too humid, too cold or the lighting is inadequate, the capacity to work safely is reduced.

Condition of the Workplace: Safe and comfortable working conditions, with adequate space to perform the task, and tools and equipment that are well-maintained, make their job safer.

Age/Gender: Young and old workers alike may be at an increased risk of injury from manual materials handling activities. Ensure abilities of employees are in line with functional job requirements.

Training: Proper training for the specific task is vital to reduce injury.

Team Lifting: If one person cannot lift or move a heavy, large or awkward object safely, organize a team lift. Team lifting reduces the risk of injury, reduces fatigue and makes the task much easier.

Raise/Lower Shelves: The best zone for lifting is between your shoulders and your waist. *Put heavier objects on shelves at waist level, lighter objects on lower or higher shelves.

Avoid Lifting from the Floor: Lifting from the floor can greatly increase your risk of injury for two reasons. Firstly, it is difficult to bring objects close to your body when picking them up from the floor, especially large objects where your knees can get in the way. Secondly, your low back must now support the weights of your upper body as you lean forward, in addition to supporting the weight of the item you are lifting. Lifting the same 20lbs from the floor more than doubles the amount of force on your low back when compared with lifting is from waist height. Even a one pound object lifted from the floor increases you risk of injury if you use a bent over posture.

Get Help When You Need It: Don’t try to lift heavy or awkward loads on your own. Even though the muscles in your upper body may be strong enough to handle the load, the muscles, ligaments and disks in your lower back may be injured because of the additional forces they have to withstand. Get help from a co-worker, and whenever possible, use a cart, hand truck or other mechanical device to move the load for you.

This content was written by Fit2WRK who has partnered with PT and Me to give a comprehensive look into the services physical and occupational therapists provide. For more information on Fit2WRK click here.

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

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.