Past Injury of the Month
June 2004
Chondromalacia:
This condition affects the knee joint, specifically the patellofemoral joint (the knee cap and the bone it sits on called the femur). We have two types of cartilage in the knee, the meniscus (one on the inside and one on the outside) these help absorb shock and disperse some of the forces through the knee joint. The second type of cartilage is articular cartilage which lines the ends of the bones in the knee including the knee cap or patella. Chondromalacia is when the articular cartilage wears down and the joint becomes irritated and an inflammatory process begins. Physical therapy is extremely beneficial for this condition because we look at the biomechanics of the knee, hip, pelvis, low back and feet to determine if there is a reason that this process is occurring. We address tightness, weakness and faulty mechanics to take the stress off the patella thereby striving to correct the condition vs. just treating the symptoms alone.
July 2004
Plantar Fascitis:
The plantar fascia is a strong, connective tissue that extends from the base of the toes and attaches to the heel of the foot. The plantar fascia functions as a support for the arch on the inside portion of the foot.
Injury to the plantar fascia can be caused by some of the following:
- Increase in activity (including increased running, running on uneven or hard surfaces, and jumping)
- Weight gain
- Wearing shoes without adequate support
- Increased or decreased arch height (high arches or flat feet)
- Muscle weakness in the ankle or small muscles of the foot and arch
- Decreased flexibility of muscles of the leg and ankle (especially the calf muscle)
- Decreased mobility of the joints in the foot and ankle
Treatment of plantar fascitis will focus on correcting any biomechanical problems in the walking or running pattern, increasing flexibility and strength of foot, ankle and lower leg musculature, correction of any soft tissue dysfunction, education on proper shoe wear or orthotic wear, increasing joint mobility if needed, and planning a home exercise program to prevent further injury in the future. Here at Sports & More Physical Therapy, will conduct an extensive biomechanical evaluation not limited to just the foot and ankle to determine the cause of the symptoms vs. just treating the symptoms alone.
August 2004
Piriformis syndrome:
The piriformis is a small triangular shaped muscle that originates on the sacrum (lower end of the spine) and extends to the top of the leg bone. It functions to externally rotate the hip or turn it out. Piriformis syndrome is often described as hip or back pain by the patient. Pain can radiate into the front of the thigh. Pain is often felt after prolonged sitting activities.
Injury usually occurs from a gradual shortening of this piriformis muscle. Typically other musculature like the hamstrings or hip flexors are also shortened. Other dysfunctions of the pelvis are also associated with this syndrome. Common problems in the sacroiliac joints and lower lumbar spine often may predispose the piriformis to injury.
Physical therapy treatment focuses on lengthening the piriformis and associated musculature as well as normalizing pelvic girdle movement and position. Home exercise programs often focus on stretching and lower abdominal control. The Sports and More therapists consider the complete biomechanical chain of factors related to this syndrome and tailor treatments and exercises to each patient.
September 2004
Preoperative Rehabilitation Prior to a Total Knee Arthroplasty
Preoperative rehabilitation treatment should be focused on three areas: range of motion, strength, and education. Postoperative range of motion will be no greater than preoperative range of motion independent of postoperative rehabilitation technique.10 Therefore, it is imperative to gain maximal knee range of motion prior to surgery with an emphasis on extension. Knee extension is essential to maintain stability at the knee and is traditionally more difficult to regain postoperatively. Strength of quadriceps is just as important for the same reasons as noted above. Hip musculature should not be forgotten, especially the hip abductors. Cardiorespiratory endurance may also be addressed via an arm ergometer or a stationary cycle as tolerated. Patient education should involve all that is expected of the patient including examples of standard exercises that will be used acutely.
Postoperative Rehabilitation Following Total Knee Arthroplasty
The type of fixation (cemented vs. noncemented), the difference between a primary prosthesis and a revision, and pre-operative limitations of the patient all help determine the postoperative rehabilitation. The acute phase postoperative rehabilitation should address range of motion, quadriceps and gluteus medius strength, bed mobility, transfers, and gait training. The subacute phase needs to continue to address the same aspects of the acute phase, but needs to include more functional activities. Outpatient rehabilitation is needed to maximize the patient’s outcomes by stressing functional strengthening of the entire lower extremity.
References
- Mendenhall S: 1999 Implant Review. Othop Network News 10: 1, 1999
- Martin SD, Scott RD, Thornhill TS: Current Concepts of Total Knee Arthroplasty. J Ortho Sports Phys Ther 28: 4 252-261, 1998
3. Kuzmar J, McPherson EJ, Dorr LD, Wan Z, Baldwin K: Rehabilitation After Total Knee Arthroplasty. Clin Ortho & Related Research 331 93-101, 1996
October 2004
SI Joint Dysfunction:
The sacroiliac joint is sometimes called the pelvic joint. This joint has a minimal amount of motion but causes significant pain when it is not moving correctly. Pain complaints are often described as a feeling of “hip” pain or “low back” pain. Some people may also feel pain into their leg. Often a person will feel a “locking” sensation when changing positions or pain with a prolonged position like sitting or standing.<p>
Injury to this joint is frequently due to an improper positioning within the joint. Imbalance in the musculature surrounding the joint can also be a major factor. Injuries can occur from a fall or other accident but are most often an insidious onset. An SI joint that is too mobile or one that is not moving enough each can cause pain.<p>
Physical therapy can be an effective method of treating SI joint dysfunction. Therapy may involve re-alignment of the joint, mobilization of the joint, returning the soft tissue to good health and stabilization of the pelvis. Evaluations at Sports and More PT, Inc. consider the biomechanical chain from the foot through the cervical spine. The general goal is not only to alleviate the pain but to remediate the dysfunction causing the pain.
November 2004
Spondylolysis and Spondylolisthesis – “Spondy”
Spondylolysis is a stress fracture of the vertebra that makes up with spinal column. The most common areas affected are the 4th and 5th lumbar vertebra. If the stress fracture occurs bilaterally (on both sides of the vertebra), the body of the affected vertebra may slip forward. This condition is known as spondylolisthesis.
Risk factors include genetics (thin vertebral bone) and overuse injuries. Sports that require lumbar extension or bending backward at the waist, increase risk. These sports include gymnastics, football, weight lifting, and dancing. Other predisposing factors include decreased flexibility and decreased core (abdominal and low back) strength.
Symptoms include low back pain, muscle spasm, increased back pain with lumbar extension, pain with sitting for prolonged periods, and possible hip, buttock, and leg pain.
Conservative treatment options include avoidance of aggravating activities, improved lower extremity flexibility, and core stabilization and strengthening. At Sports & More Physical Therapy, INC, a thorough biomechanical assessment will be performed to determine the potential cause of injury and correct that cause to avoid further injury.
February 2005
Adhesive Capsulitis
Adhesive Capsulitis is commonly referred to as a “frozen shoulder” and presents as a loss of both active and passive range of motion of the shoulder because of a thickening of the capsule that surrounds the shoulder joint. The primary restriction of motion is lifting the arm to the outside (Abduction) and behind the head (external rotation). Adhesive capsulitis is more commonly seen in women between the ages of 50-60 years old. Generally, it is the result of self-limiting behavior because of an on going inflammation process, such as a rotator cuff tendonitis. However, adhesive capsulitis may occur insidiously as well. Adhesive Capsulitis has a higher incidence in patients with diabetes mellitus.
Treatment for adhesive capsulitis involves passive range of motion and mobilization of the shoulder joint and scapula into the restricted ranges. In addition, patients need to reeducate the scapula and shoulder joint in order to function properly. A daily home exercise program is necessary to help regain lost motion. Recovery from adhesive capsulitis is variable and may take up to 18 months.
March 2005
Achilles Tendonitis
The Achilles tendon attaches the calf muscles known as the gastrocnemius and soleous to the heel bone or calcaneus. Achilles tendinitis is an inflammation of the tendon due to microscopic tearing of collagen fibers in the tendon itself. The condition usually has an insidious onset and is often characterized by a dull, aching pain in the Achilles tendon during and after repetitive activities such as walking or running. Achilles tendinitis is most commonly seen in runners and in athletes participating in sports involving excessive running and jumping.
Treatment for Achilles tendinitis may include manual soft tissue work, stretching, strengthening and ice. Most commonly, Achilles tendinitis can be attributed to faulty lower extremity biomechanics due to functional weakness in the muscles of the hip, knee, and ankle. A thorough functional evaluation by a licensed physical therapist can help identify these contributing factors.
April 2005
Shoulder Impingement
The glenohumeral joint is composed of the humerus or upper arm bone and scapula or shoulder blade. The shoulder is a common site for injury due to overuse and its high degree of mobility. Muscles of the arm, scapula and neck influence movement at the shoulder, and the tendons of these muscles can become inflamed with repeated overhead activity, movement associated with poor posture or muscle imbalance. Shoulder impingement is caused by a narrowing of the space between the head of the arm bone and the scapular either due to bony changes or poor mechanics. The tendons which pass through this space can become inflamed and cause pain if they are repeatedly “pinched” in this narrow space.
Treatment for shoulder impingement includes manual soft tissue work, stretching, strengthening, postural education and ice. Evaluation of this diagnosis also includes a screening of the neck because some shoulder pain may actually be attributed to the neck. A thorough functional evaluation by one of Sports and More’s Physical Therapists can help identify these contributing factors.
May 2005
Lateral Ankle Sprain
The ankle joint is protected by ligaments, muscles and tendons. A ligament attaches one boney surface to another bone. Three ligaments protect the outside (lateral) aspect of the ankle and include the anterior talofibular (ATF), calcaneofibular (CF), and posterior talofibular (PTF) ligaments. These ligaments help prevent the ankle from inversion injury (“rolling” your ankle or turning it inward).
When an inversion injury occurs, one or more of the ligaments may be injured, referred to as a “sprain”. A lateral ankle sprain can cause swelling, pain, decreased range of motion and difficulty walking. Initially it is important to protect the ankle to avoid further injury with rest, ice, compression and elevation. A physical therapist can assist in regaining full motion, functional strength, balance, and proprioception. Here at Sports & More Physical Therapy, the therapist will perform a biomechanical assessment and shoe wear assessment to address the cause of injury. Another important goal of therapy is to assist in preventing future ankle injuries as well as other injuries that may develop after an untreated lateral ankle sprain.
June 6, 2005
Iliotibial Band Friction Syndrome
Iliotibial Band Friction Syndrome (“Runners Knee”) is a condition involving inflammation of the iliotibial band at the outside part of the knee. ITB syndrome is an overuse injury often seen in runners as it results from a chronic irritation of the ITB rubbing over the outside part of the femur as the knee flexes and extends during the running cycle. This chronic irritation eventually results in pain and inflammation. Runners at risk for such a condition include those with bowed legs (genu varus), high arches, or feet that over pronate. Initially it is important to rest and ice the affected area to decrease inflammation. Choosing proper footwear for individual foot types is important in the prevention and treatment of ITB friction syndrome. Improvement of hip flexibility and strength often is necessary for complete rehabilitation. At Sports and More Physical Therapy, one of our therapists will complete a full biomechanical analysis to determine the cause of the ITB friction syndrome to decrease pain and allow you to keep on running!
April 2006
Hip Bursitis
(Trochanteric Bursitis)
Hip pain can be due to many different problems in the weight bearing chain. Pain specifically on the outside of the hip is often due to the irritation of a bursa. A bursa is a sac of fluid which is present in many of our joints as a normal part of the structure. Its job is to provide lubrication where friction occurs. When an abnormal or excessive amount of friction or force occurs where the bursa is located it will swell and become painful. The treatment for this should be to identify the abnormal forces that are causing the irritation and address these forces. The muscles that attach to the greater trochanter cross the buttocks and run down the thigh and attach to and below the knee. Therefore it is essential to have a biomechanical evaluation of the entire weight bearing chain – feet, ankles, knees, hips, spine – to determine where and what imbalances are creating the excessive forces to manifest at the outside of the hip.
Treatment to the bursa itself such as ultrasound, injection of a steroid, or the application of heat or ice may be helpful in reducing the inflammation of the bursa temporarily but the cause of the irritation must be addressed if the problem is to be eliminated. Imbalances that are causing the hip pain may also be causing other problems in the chain. Similarly, attempts at compensation in walking due to the hip pain may cause problems elsewhere in the weight bearing chain such as the low back, upper back, knee or foot on the same or opposite side. Treatment from a biomechanical approach will include restoration of range of motion of the related joints, stretching of the related of the muscles that cross the hip and other joints in the weight bearing chain and strengthening of the lower extremities (legs).
If you have experienced pain on the outside of your hip(s) or have been diagnosed with hip (trochanteric) bursitis please call to make an appointment or contact Sports & More Physical Therapy, Inc. to speak with one of our physical therapists about treatment possibilities.
May 2006
Intervertebral Disc Herniation or Bulge
The intervertebral discs are located in between the vertebrae or bones that make up the spine. The purpose of the disc is to provide shock absorption, mobility, and nutrition to the spine. At each level of vertebrae and disc, nerves exit from the spinal cord and innervate the extremities. In the low back, these nerves provide sensation and strength to the legs; in the neck, the nerves provide sensation and strength to the arms.
The discs are made up of a tough, connective tissue on the outside called the annulus fibrosis and is filled on the inside with a jelly-like material called the nucleus pulposis. An injury to the disc can cause back pain and pain that extends into the extremity. Patients also report numbness, tingling, and burning sensations into the arm or leg. Causes of injury to the discs include: poor posture, repetitive activity, improper lifting mechanics, loss of motion in the spine, degeneration of the discs, and traumatic injury.
With a disc bulge, the jelly-like material can bulge outward and put pressure on the nerves, leading to increased pain. A disc herniation refers to a break in the outer, tough covering of the disc, allowing the inner material to leak out. This also can cause pain or symptoms in the back and into the extremity.
The physical therapists at Sports & More Physical Therapy will biomechanically assess the spine in addition to upper and lower extremities to determine the cause of injury in addition to determining the best possible treatment options and prevention of additional injury in the future.
June 2006
Knee Osteoarthritis
Arthritis, more specifically, Osteoarthritis is a disease that occurs in weight bearing joints, most commonly in the knees, hips, back, and fingers. Arthritis is an inflammatory disease in a joint and is also referred to as degenerative joint disease. OA usually develops in weight bearing joints because they absorb more stress and are therefore susceptible to breakdown in comparison to non weight bearing joints like the shoulder or elbow.
OA is very commonly seen in the knees at the patellofemoral joint. This is where your kneecap and thigh bone (femur) articulate with one another. The degenerative changes can be present on the outer or inner parts of the kneecap (patella) and even on the femur. As a result bending and straightening your leg may be painful, or it may be difficult to get up from a seated position because of pain. Common symptoms are pain and stiffness in the affected joint(s), which tend to be most dramatic when first waking up in the morning and lessen as activity increases.
Physical therapy would address the pain associated with arthritis as well as working on strength and flexibility deficits that are present around the joint. At Sports and More we do a thorough evaluation to address the symptoms as well as address surrounding joints that may have also been affected as a result of compensations.
July 2006
Medial Collateral Ligament (MCL) Sprain of the Elbow
The MCL of the elbow, or ulnar collateral ligament, is located along the inside (medial) aspect of the elbow and connects the ulna bone in the forearm to the end of the upper arm bone or humerus. The MCL’s primary role is to help provided stability to the medial elbow joint. Injury to the MCL can be caused by multiple factors which may include trauma from a direct blow, elbow dislocation, or overuse due to repetitive motion. MCL injuries are commonly seen in athletes participating in throwing sports. Excessive stress is placed on the MCL due to distractive forces which occur along the medial aspect of the elbow joint during the throwing motion. Often following injury to the MCL, the muscles along the medial aspect of the elbow/forearm enlarge or hypertrophy. This scenario can frequently be seen in adolescent throwing athletes and is commonly called “little league elbow”.
Symptoms of MCL injury can include medial elbow pain and swelling which may improve with rest, but usually return upon further exertion. Gradual loss of range of motion is common and individuals usually have difficulty fully straightening (extending) the elbow. In more advanced cases, pain may also be present on the outside (lateral) aspect of the elbow.
Treatment for MCL injury may include manual soft tissue work, stretching, strengthening, and icing. Most commonly, the condition can be attributed to faulty upper extremity biomechanics, and in particular, functional weakness and altered mechanics of the shoulder. A thorough functional evaluation by a licensed physical therapist can help identify these contributing factors. Therapists at Sports and More Physical Therapy, Inc. are skilled in upper extremity functional assessment and can develop a comprehensive treatment program to address the underlying causes of injuries such as this one.
SEPTEMBER 2006
Injury of the Month
Hamstring Strain
With the start of football season and multiple other running sports many individuals will suffer from a strain to the hamstring muscle (a group of muscles on the backside of the thigh collectively called the hamstrings). This injury if not treated properly can be a source of chronic pain and lead to compensations that may also hinder return to sport and delay functional activities. Often there is an underlying assymetry or imbalance that predisposes the hamstring to injury. The hamstrings function in running to slow down the leg. They contract eccentrically or in other words the muscle lengthens as it contracts (opposed to a concentric contraction where the muscle shortens during contraction). The muscle can strain from overload, improper warm up or an underlying imbalance. In any case a therapist at Sports & More is trained in the biomechanical approach to identify the underlying cause and treat the root of the injury as well as educate and help prevent future episodes. Therapy usually includes soft tissue techniques, joint mobilizations and functional therapeutic exercises to restore joint and soft tissue mobility for optimal functioning. The therapist will also determine readiness to return to sport using a variety of "functional" tests aimed at facilitating the decision to return to safe play.
October 2006
Degeneration of the intervertebral disc, often called degenerative disc disease (DDD), is a common disorder of the lower lumbar and cervical spine. DDD is not actually a disease but is a degenerative condition where the disc loses vertical height. Disc degeneration is a normal part of aging and is generally not a problem by itself. The height loss of the disc is often due to a lack of water retention of the disc. As the disc dehydrates, it losses it’s ability to shock absorb the adjacent vertebrae. In addition, the lack of height can lead to compression of a nerve root or stenosis.
Treatment for DDD involves restoring range of motion and mobility of the spine, addressing flexibility, and ensuring good core abdominal strength. It is important to note that restoring the disc to its previous height/state is not possible. However, a thorough evaluation by a physical therapist can address the above noted areas. They can provide treatment and a home exercise program that is appropriate for the individual.
NOVEMBER 2006
Injury of the Month
Myositis Ossificans Traumatica
By: Amanda Niles, MPT, LAT, ATC
Soccer and football teams are winding down their regular seasons and getting ready for tournament play in many local high schools and colleges. An injury that is not commonly seen, however, can be very dangerous to an athlete is myositis ossificans traumatica. A typical story for this injury is a soccer player who is kicked or a football player who is hit forcefully in the mid-thigh and develops pain and significant bruising. Many repetitive microtraumas or one blunt trauma can cause deep tissue bleeding. Limitations can include pain with walking, running, and going up and down stairs. If left untreated, the painful area gradually develops masses of cartilaginous consistency (becomes very hard compared to surrounding tissue and muscle) and, within 4-7 weeks, a solid mass of bone can be felt. This can be very painful as the bone is actually growing up into the muscle tissue. Other common sites on the body for this to occur can be the pectoralis major and biceps.
At Sports & More Physical Therapy, early conservative treatment with rest, ice, elevation, and immobilization minimizes additional trauma and decreases the likelihood of bone formation. An individualized treatment program would be created emphasizing soft tissue and joint mobilizations to restore proper range of motion. Active range of motion exercises progressing to eccentric strengthening and resistive exercises usually affect a satisfactory recovery. Depending on the sport, the therapist would then take the athlete through several functional tasks related to the sport in order to determine if he or she is ready to return safely back to full athletic participation.
DECEMBER 2006
Injury of the Month
Morton’s Neuroma
By: Matt Webb
Morton’s Neuroma is a benign thickening of the tissue that surrounds the nerves leading to the toes in the feet. It most frequently occurs between the third and fourth toes as a result of excessive pressure or chronic irritation. There are no visible signs of a neuroma, but the individual will feel a burning discomfort in the ball of the foot radiating out to the toes. A neuroma may also create a numbness sensation in the toes.
Foot structure and footwear choice are often linked to the development of neuromas. In some cases, Morton’s neuroma may result from abnormal movement of the foot caused by bunions, hammertoes, or overpronation (flat feet). High-heeled or tight/narrow shoes place excessive pressure and pinching of the nerves between the metatarsal bones.
Effective treatment of neuromas by a physical therapist may include anti-inflammatory modalities, lower extremity flexibility, joint and soft tissue mobilization, footwear modification, and specific functional strengthening. At Sports and More Physical Therapy, a therapist will perform a biomechanical analysis and consider all potential aggravating factors to develop an appropriate treatment plan.
January 2007
Injury of the Month
Sever’s Disease
By: Dee Queen, MPT, LAT, ATC
Sever’s Disease, or calcaneal apophysitis, is an inflammation of the growth plate on the back of the heel bone (calcaneus) where the Achilles tendon attaches. It is not actually a disease, but rather a condition that affects young adolescents, typically between the ages of 10-14 y.o. during onset of puberty when the growth plates are still open and weak. It also commonly occurs during or just after a growth spurt. It is caused by repetitive forceful pulling or traction on the bone by the powerful Achilles tendon and is similar to Osgood Schlatter’s Disease in the knee. It may affect one or both heels and symptoms may include heel pain with running, walking, or playing sports, tenderness to the touch at the back of the heel, and possibly a small bump on the heel bone.
Treatment can include rest/activity limitations, use of modalities such as ice, taking an anti-inflammatory (as prescribed by the child’s doctor), and physical therapy. Physical therapy treatment typically includes a complete lower extremity flexibility program (especially stretching the often tight calf muscles), strengthening and balance exercises, and addressing altered foot mechanics. If the condition is more severe it may require the use of temporary heel lifts to reduce stress on the area or possibly immobilization via a walking boot or cast provided by your doctor. The therapists at Sports & More P.T. will perform a full biomechanical evaluation to determine the appropriate treatment plan to address your child’s specific needs and get him or her back to his/her activities or sport as soon as possible.
February 2007
Injury of the Month
Lateral Epicondylitis
By: Brianne Tonker, MPT
Often called by the more common name of Tennis Elbow. The name can be deceiving, though, as it is not an injury exclusive to tennis players. It is an injury that is extremely common in today’s society and can be associated with computer mouse use, painting or repetitive lifting.
The condition is inflammation or microscopic tearing at the origin of the tendon for the extensor carpi radialis brevis (ECRB) and the other wrist/finger extensors as well as the forearm supinator (turn palm upward).
Symptoms include pain in the outside of the elbow with resisted wrist extension. This is a motion that occurs when lifting an object palm down or using a mouse. Pain can also be caused by supination, the motion that occurs when turning a doorknob.
Treatment for lateral epicondylitis is typically conservative and can include physical therapy, bracing, activity modification. Invasive treatment may involve the use of cortisone injections and surgery. The physical therapists at Sports and More Physical Therapy will perform a thorough biomechanical evaluation of the condition. They can assist patients in learning how to avoid activities which will cause added irritation to the muscles. We will also instruct the pt on stretching and strengthening activities that will assist in recovery. In the clinic, therapists will identify causative factors and address these through manual techniques to restore joint and soft tissue mobility and function.
March 2007
RSD
Jason Harloff
One type of CRPS is reflex sympathetic distrophy or RSD. This is a very painful condition that usually results after an injury. Although rare, and most commonly seen in adult women, it can occur at any age and gender. One of our nervous symptoms is called the sympathetic nervous system. It is responsible for "flight or fight" response. It affects circulation and with this condition, this nervous system goes haywire and patient's often complain of burning and intense pain at the site of the condition. Patient's also present with an extremity that is red/purple in color and the temperature of the skin may be cold to the touch. The motion of the affected body part is affected and markedly diminished. The most commonly affected areas are the hands and feet. Although the exact pathology of the condition are confusing, the treatment involves aggressive physical therapy to prevent worsening of the condition. Patient's who are diagnosed with RSD by their physician should seek the evaluation and treatment of a physical therapist for treatment. Here at Sports & More PT, we utilize a functional and manual approach both on land and in the aquatic environment to restore joint motion, facility normal weight bearing and return the patient to their prior level of functioning. The earlier the treatment is initiated the better the prognosis to return to a painfree, active lifestyle.
April 2007 INJURY/CONDITION OF THE MONTH
Hip Pointer Injury
By: Brent Young, MPT
The term “hip pointer” is frequently heard in the athletic community. Specifically, the term refers to a contusion, or bruise, of the bone of the pelvis known as the iliac crest. Usually, the injury is located over the anterior (front) portion of the bone. Traumatic blows to this area can result in a contusion which causes rupturing and bleeding from small blood vessels known as capillaries. This allows blood to permeate into muscle, tendons, and surrounding soft tissues.
The muscles of the thigh are the primary muscles affected by the injury. Symptoms may include: visible bruising, swelling, tenderness to touch over the affected area, muscle soreness, loss of hip and knee range of motion, and altered gait (walking).
Physical therapy intervention for a hip pointer injury may include: modalities such as ice and ultrasound; soft tissue mobilization; hip and knee range of motion; functional lower extremity strengthening; restoration of normal gait; and sports-specific training. Therapists at Sports and More Physical Therapy, Inc. are skilled in musculoskeletal evaluation and treatment and can develop a comprehensive treatment program to address the symptoms and residual functional deficits caused by injuries such as this one.
May 2007
CONDITION OF THE MONTH
Cervicogenic Headaches
BY: Jennifer Catalfano, DPT, LAT, ATC
Cervicogenic headaches are referred pain which is perceived in the head that originates in the cervical spine. These headaches can occur at any age and with or without a traumatic event. Pain usually begins in the neck and refers to one side of the head and may be increased with prolonged postures. An individual with a cervicogenic headache generally demonstrates stiffness and/or pain in the cervical spine and may be unable to tolerate noise or bright lights. These headaches can be debilitating and often interfere with activities of daily living.
Since cervicogenic headaches mimic several other neurological pathologies, it is important to undergo a thorough evaluation by a physical therapist or medical professional to rule out a more serious condition. At Sports & More Physical Therapy, INC., treatment for cervicogenic headaches includes manual therapy and therapeutic exercise. Manual therapy techniques promote optimal functioning of the joints within the cervical spine by restoring joint and soft tissue mobility. Therapeutic exercises targeting the deep neck flexors to support the head and neck and scapular stabilizers to facilitate proper posture are a key component in the management of cervicogenic headaches. The combination of these interventions works to decrease the frequency and intensity of the headaches and while allowing the individual to return to daily activities.
JUNE 2007
LUMBAR STRAIN
By: Rachel Sellinger, DPT
A patient that presents with a lumbar sprain could have a history including one or more of the following:
1. Awkward movement, over stretch, fall or motor vehicle accident
2. Pain initially at onset but typically worsens over the next few days
3. Pain is commonly unilateral (if bilateral one side is typically worse)
4. Pain described in the low back or lumbar spine
5. Possible complaints of pain in the buttock or posterior thigh
The patient with a “lumbar strain” would have guarded posture and decreased range of motion in some or all directions secondary to pain limitations. A patient most likely would not present with any neurological signs such as tingling, decreased sensation or change in reflexes. The quadratus lumborum, a deep back muscle, along with posterior/lateral hip muscles are commonly tighter on the more symptomatic or involved side. Tenderness in these muscles would also be expected. The patient would also have decreased endurance strength of the back musculature. The key to treatment would be to determine the etiology of the problem in the first place. Muscle imbalances in strength and or flexibility, joint assymetries, compensations due to previously untreated injuries are some common examples of possible reasons for dysfunction of the lumbar spine.
Treatment at Sports and More would include a thorough biomechanical evaluation to determine the root cause of the symptoms as well as a focus on patient education for appropriate posture and tips such as using a towel roll for lumbar support when sitting. Stretching of both the low back muscles and the lower extremity muscles would be key in restoring proper mobility. Soft tissue manipulation and joint mobilization would help to decrease the tenderness and restore mobility. Finally, strengthening to the core stabilizers and patient education on good body mechanics during functional activities would improve the endurance of the trunk muscles and help the patient to perform function more safely in the future to prevent re-injury.
August 2007
Osgood Schlatters Disease
By: Digby Watt, MPT, MTC, CSCS
Dr Osgood and Dr Schlatter first defined this condition which was consequently named after them, and is also known as tibial tuberosity apophysitis. It is a common cause of knee pain in many children and young athletes, especially those involved in running and jumping activities which are more stressful to the knee.
Signs and symptoms often include pain, swelling and tenderness over the tibial tuberosity (bony prominence on the upper shin bone) just below the patella (kneecap). Pain usually worsens with activity especially running and jumping, and usually improves with rest. There is often tightness in the surrounding muscles, especially the quadriceps and there may be weakness and/or tightness in the hip and ankle.
Repetitive stress on the growth plate (epiphysis) located at the tibial tuberosity where the patella tendon attaches causes it to become swollen and painful. This often occurs during a growth spurt in adolescents and the repetitive stress associated with running and jumping may cause the patella tendon to pull away from the tibial tuberosity and can cause a bony lump where the tendon attaches.
Treatment includes rest and/or activity modification, ice, Physical Therapy and possibly anti-inflammatory medicine. At Sports and More Physical Therapy, Inc a thorough biomechanical evaluation will be performed to address the patient’s specific needs and promote a safe return to sport. This may include addressing and/or treating any muscle weakness, tightness (often in the hip flexors and quads) and imbalances; joint mobility limitations; footwear; and emphasis will be on cross training to decrease stress to the patella tendon and promote healing.
September 2007
by: Jason Harloff, MSPT, LAT, ATC
What is Aquatic Physical Therapy??
Aquatic Physical Therapy is actually physical therapy that is performed in the water environment. It utilizes the properties of water such as bouyancy, hydrostatic pressure and temperature to produced desired effects on the body. Aquatic physical therapy is appropriate for many clinical conditions and diagnoses however there are some precautions and contraindications that your therapist should be aware of prior to recommending this medium for therapy. Here at Sports & More Physical Therapy, patients are first evaluated on land to determine first if the patient is appropriate for aquatic physical therapy as well as to determine through a biomechanical evaluation the root causes of present symptoms. Your therapist then may recommend aquatic physical therapy soley or in conjunction with land based physical therapy. Aquatic physical therapy here at Sports & More is NOT aerobics or just exercises in the water, we utilize many techniques including Bad Ragaz, Halliwick, manual therapy, core stability and functional therapeutic exercise to restore joint and soft tissue mobility, strengthen weakened and often imbalanced areas to return our patients to the highest functional level possible. If you feel you may benefit from aquatic physical therapy, please give our office a call at 845-6160 and ask for Jason.
October 2007
Patellofemoral Syndrome
By: Jason Harloff, MSPT, LAT, ATC
Patellofemoral syndrome is a condition that affects the knee cap (patella) and the surface of the femur it glides on. This problem is much more than just tightness on the outside and weakness on the inside of the knee which is how this diagnosis is commonly explained medically. A full biomecanical evaluation needs to be conducted in order to determine the forces that are acting on the patella that may cause the irritation in the first place. This is especially true if the symptoms are unilateral (one sided). Here a Sports & More, all patients undergo a thorough biomechanical evaluation in order to determine the etiology of symptoms to ultimately address the root causes so the problem can truely go away! Root causes can stem from the hip, foot and ankle, sacroiliac joint and lumbar spine. In addition faulty mechanics in gait (walking) and other functional activities can cause compensations that manifest in the knee.
Labral Tear - Shoulder
By: Dee Queen, MPT, LAT, ATC
The shoulder, or glenohumeral joint, is a ball and socket joint. It is often described as a golf ball sitting on a golf tee because the joint allows for a lot of mobility but lacks stability. There are many muscles and ligaments which help to stabilize the shoulder joint. The glenoid labrum is actually a type of cartilage that is attached to the rim of the socket. It helps to deepen the socket to provide more stability. It also serves as an attachment for other tissues including ligaments and one of the biceps tendons. The labrum may become torn with injury to the shoulder, especially with trauma such as dislocations or subluxations. It is also more commonly injured in throwing athletes. There are actually a few types of tears that may occur and they may be mild to severe. Symptoms of a labral tear may include shoulder pain with certain activities and/or painful “clicking” in the shoulder with movements.
Because the labrum is deep within the joint it is often difficult to diagnose on physical exam, thus an MRI or CT scan may be warranted when a tear is suspected. Treatment for labral tears does not always require surgical intervention. Conservative treatment with physical therapy typically includes restoring optimal joint motion and mobility and strengthening of the rotator cuff and scapular stabilizer muscles. If surgery is required, rehab typically lasts 3-5 months, depending on the type of sport or activities to which a person needs to return. Regardless, the therapists at Sports & More P.T. will utilize manual therapy techniques and customize an exercise program to each patient’s specific needs to help restore efficient shoulder mechanics.
For helpful information on this condition (including diagrams/pictures), please go to the following link: www.hopkinsmedicine.org/orthopedicsurgery/labrumtear.html
JANUARY 2008
Core Stability
By: Brianne Tonker, PT
There is a lot of talk in health and fitness circuits about core muscles. Yoga, Pilates and all of the Martial Arts use the core extensively as the base for their movements. So what is this core that is so often discussed? How do you engage core muscles? Why is it good for a person to know how to engage their core?
The core includes all of the organs and muscles of the trunk. The specific muscles that are trained with the core are the abdominal muscles. There are 4 major groups of abdominals: the rectus abdominus (6-pack abs), internal and external obliques (side abs) and the transverse abdominus (TA). People are generally very good at training the first three groups of abdominals and they are usually asymmetrically strong compared to the transverse abdominus (TA). This muscle forms a smile extending from the R to L hip bones where they jut out under the level of the belly button. The TA is the front half of the belt of support made from the muscles in the trunk.
It is more difficult to train the TA than it is to train all of the other core muscles because most people are unable to engage it intuitively. To engage a muscle is to contract it while performing some activity. The best way to engage the core is to think about pulling your belly button into your spine. If you do this while you have a finger just inside where both of your hip bones jut out, you should feel the TA engage. It will go from soft feeling to hard. It is very important that while engaging your core that you do not hold your breath as this can raise the blood pressure in your head.
Engaging your core is something people should know how to do in everyday life. This simple act supports the bony structure of your trunk. Thus, it takes some of the pressure off your back. It is especially important for people with low back problems to know how to engage their core. When you engage your core, you are less likely to depend on the large back muscles to maintain stability. When these muscles are engaged, they can cause increased pressure on the nerves in the back, thus causing pain. Engaging the core while sitting, bending, walking or performing any other activity can decrease the pressure on the spine and often give people some relief from low back pain.
Here at Sports and More Physical Therapy, we strive to look at the whole system when rehabbing any individual and education on how to engage the core and why this is important is instrumental in the prevention of future problems.
JANUARY 2008
Core Stability
By: Brianne Tonker, PT
There is a lot of talk in health and fitness circuits about core muscles. Yoga, Pilates and all of the Martial Arts use the core extensively as the base for their movements. So what is this core that is so often discussed? How do you engage core muscles? Why is it good for a person to know how to engage their core?
The core includes all of the organs and muscles of the trunk. The specific muscles that are trained with the core are the abdominal muscles. There are 4 major groups of abdominals: the rectus abdominus (6-pack abs), internal and external obliques (side abs) and the transverse abdominus (TA). People are generally very good at training the first three groups of abdominals and they are usually asymmetrically strong compared to the transverse abdominus (TA). This muscle forms a smile extending from the R to L hip bones where they jut out under the level of the belly button. The TA is the front half of the belt of support made from the muscles in the trunk.
It is more difficult to train the TA than it is to train all of the other core muscles because most people are unable to engage it intuitively. To engage a muscle is to contract it while performing some activity. The best way to engage the core is to think about pulling your belly button into your spine. If you do this while you have a finger just inside where both of your hip bones jut out, you should feel the TA engage. It will go from soft feeling to hard. It is very important that while engaging your core that you do not hold your breath as this can raise the blood pressure in your head.
Engaging your core is something people should know how to do in everyday life. This simple act supports the bony structure of your trunk. Thus, it takes some of the pressure off your back. It is especially important for people with low back problems to know how to engage their core. When you engage your core, you are less likely to depend on the large back muscles to maintain stability. When these muscles are engaged, they can cause increased pressure on the nerves in the back, thus causing pain. Engaging the core while sitting, bending, walking or performing any other activity can decrease the pressure on the spine and often give people some relief from low back pain.
Here at Sports and More Physical Therapy, we strive to look at the whole system when rehabbing any individual and education on how to engage the core and why this is important is instrumental in the prevention of future problems.
February 2008 – Tip of the Month
Brent Young, PT, MPT
Activity Pacing
Purposeful “pacing” of common everyday tasks referred to as activities of daily living (ADL’s) can often lead to a healthier, more productive life, particularly for individuals coping with various musculoskeletal conditions such as osteoarthritis for example.
Our bodies typically have certain thresholds for activity at which point potential physical ailments such as generalized fatigue, muscle soreness and joint pain occur. People suffering from pain associated with osteoarthritis and other related musculoskeletal conditions commonly have a lower threshold, or tolerance, for activity before experiencing these musculoskeletal conditions. Often, the result of “over doing it” with ADL’s can be several days or potentially even longer periods of inactivity due to residual muscle soreness, joint pain and inflammation, etc.
Frequently, the onset of these symptoms could be avoided through strategic planning and pacing of ADL’s. For example, a person may have multiple rooms in their home to clean. Rather than attempting to clean every room in the home at one time, an individual might break this larger task into smaller tasks, spreading the work more evenly throughout the day, or perhaps over the course of several days if necessary.
Each person is unique and possesses his or her own threshold for activity. An individual’s threshold is directly linked to his or her degree of wellness and any medical conditions affecting the person’s general health. Figuring out the appropriate level of activity pacing often requires focus and frequent self examination in combination with controlled trial and error. A thorough physical therapy evaluation by a licensed physical therapist can help identify biomechanical causes of pain. The physical therapist can also provide tailored recommendations for appropriate pacing of activities, thereby enhancing an individual’s outcomes and ability to remain active and productive in his or her life.
MAY 2008
Plantar Fascitis:
The plantar fascia is a strong, connective tissue that extends from the base of the toes and attaches to the heel of the foot. The plantar fascia functions as a support for the arch on the inside portion of the foot.
Injury to the plantar fascia can be caused by some of the following:
- Increase in activity (including increased running, running on uneven or hard surfaces, and jumping)
- Weight gain
- Wearing shoes without adequate support
- Increased or decreased arch height (high arches or flat feet)
- Muscle weakness in the ankle or small muscles of the foot and arch
- Decreased flexibility of muscles of the leg and ankle (especially the calf muscle)
- Decreased mobility of the joints in the foot and ankle
Treatment of plantar fascitis will focus on correcting any biomechanical problems in the walking or running pattern, increasing flexibility and strength of foot, ankle and lower leg musculature, correction of any soft tissue dysfunction, education on proper shoe wear or orthotic wear, increasing joint mobility if needed, and planning a home exercise program to prevent further injury in the future. Here at Sports & More Physical Therapy, will conduct an extensive biomechanical evaluation not limited to just the foot and ankle to determine the cause of the symptoms vs. just treating the symptoms alone.
JUNE 2008
SI Joint Dysfunction:
The sacroiliac joint is sometimes called the pelvic joint. This joint has a minimal amount of motion but causes significant pain when it is not moving correctly. Pain complaints are often described as a feeling of “hip” pain or “low back” pain. Some people may also feel pain into their leg. Often a person will feel a “locking” sensation when changing positions or pain with a prolonged position like sitting or standing.<p>
Injury to this joint is frequently due to an improper positioning within the joint. Imbalance in the musculature surrounding the joint can also be a major factor. Injuries can occur from a fall or other accident but are most often an insidious onset. An SI joint that is too mobile or one that is not moving enough each can cause pain.<p>
Physical therapy can be an effective method of treating SI joint dysfunction. Therapy may involve re-alignment of the joint, mobilization of the joint, returning the soft tissue to good health and stabilization of the pelvis. Evaluations at Sports and More PT, Inc. consider the biomechanical chain from the foot through the cervical spine. The general goal is not only to alleviate the pain but to remediate the dysfunction causing the pain.