Category Archives: Injuries

Physical Therapy to Prevent Falls in the Elderly

falls

Did you know that 1 in 3 adults over age 65 has a fall in a given year?’ Not only can falls cause serious injuries, but they can cause older adults to become less active due to fear of falling and this can affect their long­term health. The fear of falling can also prevent older adults from being able to respond appropriately to prevent falls when they lose their balance. Balance can be affected by multiple factors including medications and health conditions as well as the person’s posture, strength deficits, gait deficits and balance disorders.

The therapists at Accelerate Physical Therapy can help older adults who are at risk for falls. We provide a full assessment of gait, balance, posture and strength and then develop a treatment plan based on the client’s individual needs. Therapeutic exercise to address balance deficiencies can be highly beneficial to increase the client’s confidence and ability to respond to balance challenges. Gait training can prevent falls by improving foot clearance and dynamic stability. Increasing strength and postural control allows the client to improve reactions and tolerance to regular activity.

Anoslipfallther aspect of fall prevention is discussing home safety habits. Our physical therapy evaluation will also include a. discussion of client’s home environment and their ability to perform daily activities safely. We will educate clients in fall prevention at home through good safety practices and the use of appropriate assistive devices.

Physical therapy is an excellent resource to prevent falls in any clients who have experienced falls or are reporting difficulty with their balance, and for those with chronic health conditions causing weakness or unsteady gait. We look forward to teaming up with our referring physicians to prevent falls in older adults, veterans and the actively challenged.

Youth in Sports

The participation of children in organized athletic activities raises many concerns in parents’ mind:

  • At what age is my child ready to participate in organized athletics?
  • What is the risk of significant injury?
  • What sports carry the highest likelihood of injury?
  • Are there specific injuries related to specific sports?

In 2001, American Orthopaedic Society for Sports Medicine (AOSSM) prepared this information to help provide parents with some answers.

smilingrugby

Should my child participate in organized athletics?

Yes!  Participating in sports is a fundamental part of our way of life.  When kept in the proper perspective, athletic activities can become an important part of a healthy growth and development pattern.  A child’s participation in sports should be regarded as an extension of school time, playtime or family time – coaches or parents should never view it as an end unto itself.

Participating in sports is a very healthy way, both physically and socially, for a child to channel youthful energy in a positive manner.

When is a child mature enough to begin participating in organized sports?

Understanding a child’s social development is the first step in answering this question.  Children under age six cannot compete in an adult sense.  They live in a “play world” of their own where even play with other children is often incidental.

These youngsters have minimal ability appreciate achievement in a sporting sense and are difficult, if not impossible, to organize.  The adult measurements of competition are lost on pre-schoolers.  Sports activities for children in this group are best promoted as playground opportunities.

Between ages six and ten, children come to appreciate interaction with their peer groups but, psychologically, still do not compete in the adult sense.  Play and fun are the primary goals for these youngsters, with structure, organization and scoring, at most of secondary importance.  Children in this age group generally have very short attention spans and generally cannot perform in the adult-imposed structure of most sports activities.  They are ready for group interaction but not for many restrictive rules or structure.

Between age ten and the onset of puberty, a youth develops increasing awareness of the goals, structure and discipline require for team sports.  The prime motivation of children this age is still joining in and having fun with their teammates. However, they will accept increasing amounts of structure and are becoming more goal-oriented.

During and after puberty the aspiring athlete develops an increasing sophisticated perspective of the structure and organization of team sports, the post-pubescent athlete is ready to develop sports-related discipline.

When is a child physically capable of participating in organized sports?

In terms of physical capabilities of the young athlete, participating in sports depends upon both chronological age and physiological maturation.

The positive effect of sports activity or training on the body is measurably less in the pre-pubescent (before puberty) athlete that in the post–pubescent (after puberty) athlete.  The benefits of conditioning to the cardiopulmonary system (heart and lungs) are scientifically measurable in the younger athlete, but are of a much lower magnitude than in the older child.  Training with weights also can have a positive effect in the pre-pubescent athlete, but it cannot result in the dramatic increase in muscle mass or strength that is seen in the post-pubescent athlete.

One of the major factors responsible for this lack of response to weight training is that the pre-pubescent child has not undergone the hormonal changes, which physiologically permit the muscle-bulking phenomenon to occur.

It should be noted that no matter what the form of specific training or sport activity, stretching and flexibility drills should be included in any pre-participation or warm-up program, even in the very young.

Is there anything to be gained from sports activity and training at an early age?

Given the fact that children have certain physiological and psychological limitations is there any reason for them to participate in sport before puberty?  Once again, the answer is yes!

Youngsters involved in such activities develop motor skills, proper training habits and a work ethic, which can carry over to life in general.  They will also benefit from proper training with weights, cardiovascular conditioning and from the non-parental discipline.  Involved parents, coaches and administrators should encourage such activities, while refraining from imposing adult performance standards.

How should organized youth sports programs be structured?

The phenomenon of puberty is a troublesome period in any youngsters’ life and athletic participation during this time may actually compound nature’s “built-in” problems.  A major reason is that most youth sports programs group participants according to chronological age.

Anatomic age (stage of body development), emotional age (maturity) and social age do not always coincide with calendar (chronological) age.  An ideal system would be to group athletes by more than one standard.  For example, arrange them not only by chronological age and weight, but also by emotional and physiological maturity.

The post-pubescent athlete can be thought of in near-adult terms.  This athlete will practice with competitive goals in mind and can physically benefit from strength and endurance training. A youth in this age group should also participate in an aggressive stretching and flexibility program, which is sport specific.

However, the best system is only as good as the coach or parent who understands the psychosocial and physical maturity factors involved – and who will foster athletic participation at a level appropriate for each individual child.

What type of sports should a youngster participate in?

The young athlete should participate in a variety of sports activities.  Psychologically, the sports goal for a child under ten, and perhaps even the older pre-pubescent should be fun.  Physically, the young athlete should be encouraged to acquire basic individual skills.  There is no overriding reason to recommend participation in non-contact sports over contact sports.

Sports participation by these younger athletes should be an opportunity to develop motor skills and to have fun.  These limited goals will give the child a healthy mental attitude as well as a healthy body, both of which will benefit him or her throughout life.

Above all, a pre-pubescent child-athlete must not become the focus of the personal athletic dreams of wishes of a parent or coach.  While parental and coaching guidance is of immense value, the young athlete should not be pressured to swim or play football, for example, when another sport better fits his or her emotional and/or physical make-up. The post-pubescent athlete will usually select athletic endeavors based on a personal skill or through associations with a particular role model or peer group.

What is the risk of injury in youth sports?

The question is not whether injuries accompany youth sports, but whether there is undue risk.  Many studies have documented a very low incidence of injury in the total spectrum of youth sporting endeavors.  Interestingly, the occurrence of injury in the pre-pubescent athlete has been documented as being much lower than in the post-pubescent athlete, and lower in the post-pubescent than the young adult.

This is probably due to the fact that the younger athlete has a lower ratio of kinetic energy to body mass – the more immature the physical body, the lower the speed and power.

Since the magnitude of injury is almost always directly related to energy expended in a traumatic event, the younger athlete is less likely to get injured then his older counterpart.  The athletic injuries, which do occur, are usually minor contusions and sprains.  Fractures, dislocations and major ligament injuries can happen, but are more common in older age groups.

Parents have expressed concern about the potential for injuries to the growth areas of developing bones and muscle in the pre-pubescent athlete.  This concern has proven to be more perceived than real, as several scientific studies have failed to document a significant increase in physeal injuries (damage to the growth areas of bones) in young athletes. Only in extreme cases, such as young gymnasts in intense training for long periods of time, are at some risk to growth plate injuries.

An argument against organized youth sporting activities, which is based on the potential for injury, is not realistic.  Although documentation is not available, it is probable that injuries resulting from participation in organized sports are fewer than those suffered on the playgrounds, or by falling off bicycles or skateboards.

Young people have definite physical and emotional energies.  It is probably less hazardous to release these energies in directed endeavors than through alternative means.  Any traditional organized sport is certainly safer than riding a motorcycle, for instance.

Are there specific injuries associated with specific sports?

While each of the individual and team sports has a family of injuries most common to it, listing of individual sports and injuries will be ignored her in favor of a generalized discussion based on contact versus non-contact sports.

The most notable examples of contact sports practiced in the United States are football, ice hockey, wrestling and basketball.  In each of these sports the athlete’s body is used to physically control the opponent and, thus, to influence the play of the game. Using the body in this manner creates the opportunity for injury.

Fortunately, the majority of injuries in these contact sports are bruises and scrapes.  The more significant injuries such as fractures, dislocations or major ligament damage occur in the post-pubescent athlete.  Parents should be responsive to complaints of pain and discomfort from athletes in all age groups and be aware that any athlete who is not playing up to skill level may be suffering from a significant injury.

In non-contact sports, major fractures, dislocations or ligamentous injuries are usually associated with accidental rather than intended collisions.  Minor sprains, muscle pulls, blisters and overuse syndromes are commonly seen injuries in non-contact sports.

The overuse syndrome is usually related to sports requiring repetitive, high-stress motion such as tennis, swimming, track, golf and baseball.  Injury occurs as a result of constant repetition of a particular movement.  Stress fractures, shin splints and tendonitis are examples of overuse injuries.

The treatment in each case is early recognition of the problem, followed by abstinence from competition and at least a decrease or change in training until the affected area is totally symptom free.  Training intensity and duration can then increase again. Return to the previous level of training should be gradual and well planned.  If the symptoms of overuse persist beyond a few day of rest or it they recur, a physician should evaluate the athlete.

youthrugby

Are youth athletics worthwhile?

Yes! While very few athletes participate on organized teams beyond high school, and even fewer beyond college, sports activity creates a physical fitness discipline and a positive learning experience which carries through to an active, healthy adult life.

Participation carries a risk of injury but, once again, the question is not whether the risk is present but whether the risk is undue.  A question of similar importance is how best to direct the naturally occurring physical energies of youth.

The American Orthopaedic Society for Sports Medicine is convinced that appropriate sports and physical training are safe and healthy applications of these energies. Physical fitness is advisable throughout an entire lifetime and is achievable only through physical activity.  The discipline, motivation and training required to remain fit should begin as a youngster.

This is general information.  It does not purport to encompass all risks associated with youth sports activities, nor is it a substitute for your own good judgment.

Expert Consultant:  Louis C. Almekinders, MD

Revised 2001.

Shoulder Impingement

What is Shoulder Impingement?

Impingement refers to mechanical compression and/or wear of the rotator cuff tendons. The rotator cuff is actually a series of four muscles connecting the scapula (shoulder blade) to the humeral head (upper part of the shoulder joint.) The rotator cuff is important in maintaining the humeral head within the glenoid (socket) during normal shoulder function and also contributes to shoulder strength during activity. Normally, the rotator cuff glides smoothly between the undersurface of the acromion and the humeral head.

How is Shoulder Impingement Treated?

The first step in treating shoulder impingement is eliminating any identifiable cause or contributing factor. This may mean temporarily avoiding activities like tennis, pitching or swimming. A The mainstay of treatment involves exercises to restore normal flexibility and strength to the shoulder girdle, including strengthening both the rotator cuff muscles and the muscles responsible for normal movement of the shoulder blade. This program of instruction and exercise demonstration may be initiated and carried out either by the doctor or a skilled physical therapist.

Source: American Orthopaedic Society for Sports Medicine

Conditions We Commomly Treat

Soft Tissue Injuries
A muscle, tendon or ligament tear bleeds and swells. Control swelling and recovery time. Use cold, compression, bandaging, heat and massage.. Clinical treatment with ultrasound and electrical stimulaiton will speed your healing and your return to normal activities.

Athletic and Sports Related Injuries
Athletes are treated to emphasize recovery time. Treatment and exercise decreases recovery time. The development of strength, flexibility and coordination leads to complete recovery.

Inflammatory Conditions
Overuse of a body part which causes tendon and ligament tissue to become irritated in movement and at rest. Treatment and exercise can accelerate your recovery.

Neurological Injuries
Neurological injuries, including stroke, spinal cord injury, Multiple Sclerosis and nerve damage result in pain or numbness, and loss of strength daily functions and mobility. Physical therapists use techniques to restore normal function, control pain and improve strength and reflexes and suggest adaptive equipment to overcome disabilities.

Post-Operative Rehabilitation
After surgery, treatment to reduce inflammation, gait problems, impaired range of motion, muscle weakness and pain are provided. Restoring normal movement patterns and careful progression of activities by a physical therapist accelerates healing and protects surgically repaired tissues.

Chronic Pain and Stress Related Pain
Difficulty in managing postural weaknesses, headaches, musculoskeletal irritation, and long term shortening of muscles can be developed to reduce the frequency and intensity of these personal battles with pain.

Muscle Imbalances and Postural Defects
Postural weakness and muscular strength imbalances effect irregular curves of the spine and chronic pain. Consistent exercise changes muscle strength and joint flexibility to lessen the chance of irritation.

Geriatric Rehabilitation
Thirty two years of Medicare participation has given us a unique perspective and commitment to the management of all geriatric physical therapy needs.

Physical Therapy: Treatment and Training

All of the following describe generally accepted, well established and widely used physical therapy procedures and modalities provided at Accelerate Physical Therapy. These procedures are used as primary or adjunctive techniques in soft tissue treatment for the progressive development of strength, mobility and to improve functional outcomes.

Physical Therapy Procedures

The level of complexity can characterize the following physical therapy procedures and the expertise required to perform the task. These procedures involve training exercises or modalities requiring more specific skill than those characterized as modalities, but may be provided by assistants under the direct supervision of a licensed physical therapist.

Soft Tissue Mobilization is the skilled manual application of techniques designed to normalize movement patterns through the reduction of soft tissue pain and restrictions for the following reasons:
Muscle spasm around a joint
Trigger points
Adhesions
Neural compression

Joint Mobilization is the passive movement performed in such a manner (particularly in relation to the speed oft he movement) that it is, at all times, within the ability of the patient to prevent the movement if they so choose. Skilled manual joint tissue stretching is used to improve, and as possible, normalize joint movement of the spine and extremities and is performed for the following reasons:
To improve joint play/mobility
Improve intrascapular arthrokinematics
Reduce pain associated with tissue impingement or friction
Functional Activities involve the instruction, active-assisted training and/or adaptation of activities or equipment and has the following results:
Improves a person’s capacity for homemaking, including meal preparation
Improves a person’s capacity form communication, utilizing equipment
Facilitates return to work at previous level of function in lifting, driving, climbing, pushing, pulling, etc.
Job site modification to decrease postural dysfunction/pain

Therapeutic Exercise with or without mechanical assist or resistance has the following indications:
Improve cardiovascular fitness
Reduces edema
Improves muscle strength and coordination
Improves connective tissue strength and integrity
Promotes circulation to enhance soft tissue healing/metabolism
Increases bone density
Increases endurance, reduces fatigue

Massage – Manual or mechanical manipulation of soft tissue to achieve:
Reduced swelling
Reduced muscle spasms
Improved outlying circulation
Increased muscle tone prior to exercise
Reduced adhesions
Increased muscle length

Neuromuscular Re-education is the skilled application of exercise with manual, mechanical or electrical facilitation and through its use enhances motor response, strength and recruitment rate with independent control.

Neurodevelopmental Activities/Reflex and Sensory Integration/Proprioceptive Neuromuscular Facilitation (PNF) involves the skilled use of activities and exercises that promote neuromuscular responses through carefully timed proprioceptive stimuli to normal neurologically developed sequences. It also improves neuromotor response and reduces risk of impromptu muscle failure. It improves tolerance and enhances strength, normalizes movement patterns and improves cell waste and bacteria removal, and increases the muscular sense and perception of movement, stabilization and reaction time. These techniques achieve sensitization, or if required, desensitization of joint movement.

Gait Training – Crutch walking or walker instruction to a person with lower extremity injury or surgery:
Promotes normal gait pattern with assistive device
Promotes safety in proper use of assistive device
Instructs in progressive use of more independent devices (platform walker, walker, crutches, an cane)
Instructs in gait on uneven surfaces and steps (with and without railings) to reduce risk of fall or loss of balance
Instruction in the use of equipment to limit weight bearing for the protection of a healing injury or surgery

Straight Plane Exercises with or without mechanical assistance or resistance has the following effects:
Improves strength and coordination
Reduces atrophy
Improves reaction, recruitment and endurance
Supervises safe progression of resistance
Teaches techniques which promote accelerated muscle development
Increases size and strength in musculotendinous tissue and tensile strength

Activities of Daily Living involves the instruction, active-assisted training and/or adaptation of activities for personal care or equipment for mobility and self-care. This includes:
A person’s capacity in mobility and self-care to move from floor or sitting levels to standing, fluently and without pain.
Aids in sleeping without pain, grooming and self care including hygiene.

P.T. Physical Agents (Modalities)

The primary use of thermal modalities is for pain, swelling and to improve the rate of healing soft tissue injuries. Extended use is supported by consistently measured changes. Certain diagnoses and post surgical conditions may require periods of treatment beyond the normal ranges of 3-6 weeks.

Additional procedures are occasionally necessary to help control swelling, pain or inflammation during the rehabilitation process. They may be used intermittently as a therapist believes appropriate, or regularly if there is specific measured improvement during the treatment.

If our patient is not responding within 3-4 weeks, alternative treatment, further diagnostic studies, or further consultations with their physician or another physical therapist should be considered.

Ultrasound is the use of sonic generators to deliver acoustic energy for thermal and/or non-thermal soft tissue treatment. There may be a concurrent delivery of electrical energy. Ultrasound can be used to obtain the following results:
Softening scar tissue and reduce pain associated with scar tissue and adhesions
To soften collagen fiber
Accelerate soft tissue healing process
Increase flexibility of muscles and tendons
Reduce muscle spasms and reduce pain associated with muscle spasms

Hot Packs
Reduce pain or raise the pain threshold before exercise, postural training and gait training
Reduce muscle spasm to promote increased movement
Increases circulation to aid healing

Cold Packs
Lowers body tissue temperature for reduction of inflammation
Lessens pain resulting from injury or exercise by increasing the pain threshold
Reduces swelling and hemorrhage. Used in combination with compression and elevation
Lessens pain and inflammation from tendinitis and bursitis
Diminishes muscle spasm to promote stretching and decreases exercise induced muscle soreness
Increases circulation to aid healing

Electrical Stimulation
Applies electrical current (AC or DC) over skin to muscles, joints or other soft tissue for the following reasons:
Relaxes muscle spasms (including TENS)
Reduces pain (including TENS)

Iontophoresis – The transfer of medication (including but not limited to steroidal anti-inflammatories and pain relievers) through the use of electric stimulation. This procedures has the following results:
Pain reduction
Inflammation reduction
Reduction in swelling
Aids circulatory problems in the extremities
Decreases muscle spasms
Breaks down calcium deposits and softens scars

Phonophoresis – The application of ultrasound using a medicated lubricant that introduces molecules into the tissue similar to those used in iontophoresis.

Contrast Baths – Involves alternating immersion of the extremities; promotes circulation and has the following results:
Reduces swelling in the subacute stage of healing
Improves outlying circulation
Decreases joint pain and stiffness

Paraffin Baths
A form of heat application that uses paraffin wax/mineral oil mixture applied safely at 126 degrees Fahrenheit.
Symptomatic resolution of pain
Elevates pain threshold
Prepares for exercise, mobilization of the distal extremities and gait training

TORN MENISCUS: When Do We Need Surgery?

man with sore knee

If It’s Aint Broke, Don’t Fix It

If you were told you had a meniscus tear either by physical evaluation or by testing such as MRI should you have a surgical repair?  If it’s not very painful, not locking and not changing functional tolerance, I say “No”.

Exam Findings – We evaluate using physical findings. Physical exam is as important as testing. You may have a positive test but no other symptoms. Symptoms such at locking or catching and high level of joint effusion (fluid) are as telling as tests when considering management strategies. Increased levels of effusion indicate severity of injury.

Common Symptoms: Popping, swelling and stiffness. Pain, especially when twisting or rotating your knee. Difficulty or inability straightening your knee fully or experiencing what feels like your knee were locked in place.

Location: The location (zone) of the tear is one of the important factors in determining treatment. Tears at the outer edge of the meniscus (red zone) tend to heal well because there is good blood supply. Minor tears may heal on their own with a brace and a period of rest. If they do not heal or if repair is deemed necessary, the tear can be sewn together. This repair is usually successful in the red zone.

The inner two-thirds (white zone) of the meniscus does not have a good blood supply, so it does not heal well either on its own or after repair. Typically the torn portion is removed (partial meniscectomy) and the edges of the remaining meniscus are shaved to make the meniscus smooth and limit catching.

Type of Tear: Also, the pattern of the tear may determine whether a tear can be repaired. Longitudinal tears are often repairable. Radial tears may be repairable depending on where they are located. Horizontal and flap (oblique) tears are generally not repairable.

Another factor when considering treatment is that repairs to the lateral meniscus (on the outer side of knee) typically heal better than repairs to the medial meniscus (on the inner side of the knee).

Physical Therapy: In many instance we can manage meniscal tears without the risk of surgery and the after effects of surgery. Meniscal rehabilitation can range from 4 weeks to 4 months. Typically we see results to independent programs by 8 weeks. High repetition low intensity exercise with decreased weight bearing can help heal meniscus tears and improve joint effusion. Muscle training to improve support about the knee and keep proper alignment through the entire limb. Modalities and NMES for muscle activation are effective treatments to restore normal function.