Category Archives: Treatment

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.

How Can I Prevent My Shoulder From Dislocating Again?

Dislocating a shoulder is a traumatic experience. After having it put back in place (or like Mel Gibson, you smack your shoulder into a wall), there is a good chance you will have some questions about what happens next.

After a short period of time in a sling, you will progress to exercises like pulleys, wall climbing for range of motion; and closed grip pull downs, rowing on a machine and shrugs, for shoulder blade strength.

Patients can compensate for loose ligaments by increasing the strength and control of the rotator cuff and shoulder blade muscles. These muscle groups help pull the ball (humeral head) into the shoulder socket (glenoid) and will pull more tightly if they are strong.

Strengthening programs for the rotator cuff include rotation exercises as shown:

Shoulder RTC Ex

Low, or even no resistance, high repetition exercises can teach and rehabilitate the shoulder all it needs to know for a while. It may take 4 months to feel completely normal again.

Exercises that increase coordination of the shoulder are also important. Contact your physical therapist to learn exercises specific to YOUR needs.

Call Paul O’Brian, PT, CSCS at Accelerate Physical Therapy, P.C. in Arvada, Colorado. (303) 421-2210

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

The IF (Inflammation Factor) Rating™

Inflammation is part of your body’s response to nearly any type of physical injury. It’s one of the ways that your body protects itself, and begins its repair process.

The IF (Inflammation Factor) Rating™ estimates the inflammatory or anti-inflammatory potential of individual foods or combinations of foods by calculating the net effect of different nutritional factors, such as fatty acids, antioxidants, and glycemic impact.

Nutrition Data provides IF Ratings for most foods in its database. IF Ratings appear on Nutrition Facts pages and have a format similar to the example below.

Photo: Self Nutrition Data Self Nutrition Data
Photo: Self Nutrition Data

The IF Rating™ provides an estimate of this food’s effect on inflammation.  A negative IF Rating™ means that the food is considered to be inflammatory (i.e. increases inflammation), and a positive IF Rating™ indicates that the food is considered to be anti-inflammatory (i.e. reduces inflammation). There is no upper or lower limit for the IF Ratings, so you’ll see a wide range of values reported. IF Ratings are also dependent on serving size, so you’ll see the IF Rating™ value change if you change the serving size in the Serving Size drop-down at the top of the Nutrition Facts page.

How to interpret the values: Foods with positive IF Ratings are considered anti-inflammatory, and those with negative IF Ratings are considered inflammatory. The higher the number, the stronger the effect. The goal is to balance negative foods with positive foods so that the combined rating for all foods eaten in a single day is positive.

 

IF Positives
This food contains known anti-inflammatory nutrients, including monounsaturated fat, selenium, docosahexaenoic acid (DHA) and folate.

IF Negatives
This food contains known inflammatory nutrients, including arachidonic acid and saturated fat.

 

For more GREAT nutritional information, try this website: http://nutritiondata.self.com/help/inflammation

Key Professionals

Vast changes are occurring in the nation’s health care delivery system. The physical therapy profession has kept pace with rapid advances in science and technology to provide the most effective patient treatment possible. Physical Therapists help hundreds of thousands of individuals daily to:

• restore health
• improve function
• alleviate pain

Conditions we commonly treat

Soft Tissue Injuries
A muscle, tendon or ligament injury can bleed or swell, and effects your recovery time. Cold, compression, heat, massage and electrical methods will speed your healing and return to normal activities.

Inflammatory Conditions
Overuse causes tendon and ligament tissue to become irritated, causing pain in movement and at rest. Your independent treatment and exercises can accelerate your recovery. Your physician may have also prescribed medications to reduce the inflammation. Your physical therapist is an expert in providing treatments to reduce inflammation.

Post-Operative Rehabilitation
After orthopedic or general surgery, treatment to reduce inflammation, gait problems, impaired range of motion, muscle weakness and pain are addressed by a physical therapist to accelerate healing and yet protect surgically repaired tissues.

Neurological Injuries
Neurological injuries and diseases, including stroke, spinal cord injury, Multiple Sclerosis and acutenerve damage result in pain, numbness, loss of strength, daily functions and mobility. Physical therapists use techniques to overcome physical impairments restore function.

Athletic and Sports Related Injuries
Professional and recreational athletes suffer injuries treated to accelerate recovery time. Treatment and exercise decrease the recovery time. The development of strength, flexibility, coordination and reflexes of the injured part should lead to complete recovery.

Chronic Pain and Stress Related Pain
Pain may persist for months or even years following injuries. Stress factors, postural weaknesses, headaches, musculoskeletal irritation, and shortening of muscles respond to specific treatment techniques and exercise administered to designed to reduce pain.

Muscle Imbalances and Postural Defects
Postural weakness and muscular imbalances produce irregular curves of the spine and chronic pain. Physical Therapists provide consistent exercise to improve muscle performance and flexibility.

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

Aquatic Physical Therapy
Our partnership provides therapeutic exercise in the healing and forgiving medium of the Wheat Ridge Recreational Center pools for Aquatic Rehabilitation.

 

Are you drinking enough water?

Healthful self-hydration is very important to a fit lifestyle. Many times our patients suffer from muscular and spinal and joint pain, leg cramps and general malaise that could be an imbalance of fluids and electrolytes. We suggest drinking 2 glasses of water as soon as the discomfort begins.

One should consume 1/2 oz. of pure water per pound of your body weight daily (200 lbs= 100 oz. each day) and at a slow but steady sipping pace of about 3-5 oz per half hour for optimal liver and kidney clearance. Proper hydration is essential to your healing and your health each and every day.

People taking medications or even vitamins may have a unique need to add water to their diet. Exercise and forced-air heat like furnaces and car heaters dry you out as well. Many bottled drinks are in fact, less effective than plain old water. If your urine is yellow, or your feet are dry, add 2 glasses of water to your normal routine. Drink extra water on days you exercise, have massage, or require the heater in your house or car. Stop the pain. Don’t get dehydrated!

glass of water | prevention

Eight a day

The body loses, on average, about two to three quarts of fluid daily through perspiration, exhaled moisture, and excretion. You must replace this fluid, hence the rule of thumb about consuming the equivalent of at least eight 8-ounce glasses of water daily. Some of the water you need comes from solid foods, especially fruits and vegetables. You get the balance from liquids you consume (juices, milk, soups), which are just as good as water.

Any change in diet, particularly an increase in protein or salt consumption. or an increase in exercise or outdoor temperature may raise your fluid needs. Certain drugs, notably diuretics, will increase water loss, as will alcohol or caffeine. Dehydration is a particular problem among the elderly, in part because the thirst mechanism becomes less efficient as we age.

Normally thirst is the best sign that you need more fluids. But if you’re exercising or working strenuously in the heat, you can lose a quart of water an hour. Don’t wait until you’re thirsty: drink before, during and after your workout.  If you fail to do this and need to replenish the water you’ve lost, weigh yourself after your workout, and drink a pint of fluid for each pound you’ve lost.

One glass of water shuts down midnight hunger pangs for almost 100% of the dieters studied in a University study.

Lack of water is the #1 trigger of daytime fatigue.

Preliminary research indicates that 8-10 glasses of water a day could significantly ease back and joint pain for up to 80% of sufferers.

A mere 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on the computer screen or

Drinking 5 glasses of water daily decreases the risk of colon cancer by 45%, plus it can slash the risk of breast cancer by 79%, and one is 50% less likely to develop bladder cancer.

Drinking one glass of water before going to bed avoids stroke or heart attack.
why people need to urinate so much at night time.

Gravity holds water in the lower part of your body when you are upright (legs swell).
When you lie down and the lower body (legs and etc) seeks level with the kidneys, which remove the water then because it is easier.

Drinking water at a certain time maximizes its effectiveness on the body:
2 glasses of water after waking up – helps activate internal organs
1 glass of water 30 minutes before a meal – helps digestion
1 glass of water before taking a bath – helps lower blood pressure
1 glass of water before going to bed – avoids stroke or heart attack
Water at bed time helps prevent night time leg cramps. Your leg muscles are seeking hydration.

 

Are you drinking the amount of water you should every day?

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.

Physical Therapy and Neck Pain

Physical therapy is a process of using knowledge of anatomy and physiology with exercises, soft tissue healing, posture and body mechanics and applying these principles of healing specific tissues following injury. Physical therapy conditions focuses on the spine and its joint structure including spinal segments, muscles, tendons, and ligaments.

Major goals of physical therapy with respect to neck injuries are:
· Correct spinal positional faults or limitations of spinal motions.
· Appropriate stretching and strengthening through cervical spine.
· Educate patients on proper posture and ergonomics.
· Accelerate the stages of healing by reducing pain and reducing the inflammatory cycle.
· Activity modification to reduce or eliminate future occurrences.
· Manage exacerbations.

A physical therapist can make sure you are practicing optimal exercises for your condition, and can modify the exercise as you progress. Many patients do NOT require referral from a physician to be seen by a physical therapist. You can check with your insurance company to see if a physician’s referral is required. If a referral is not required you may be seen directly by one of our Physical Therapists.

We use techniques including traction, joint mobilizations, soft tissue mobilizations, muscle energy techniques and stretching to assist in aligning the cervical spinal segment. Once aligned, the cervical spine will be allowed to move as needed to restore normal joint mechanics. Eliminating impingement of nerves, physical blocks in the spine or facet joints.

Appropriate stretching and strengthening through cervical spine.

Classically we “stretched then strengthened”. In truth both are needed to restore normal function. The Cervical spine has three planes of movement. Flexion motion is like nodding, rotation is like shaking your head “No”, and side bending is bringing your ear to your ear to your shoulder. Stretches generally begin in each plane and then become more advanced to use motions from multiple planes.

Strengthening begins with extension strengthening and achieving neutral spinal position. Scapular strengthening and postural exercises are included early in cervical programs. Then typically exercises in the other two planes are included. We finish cervical strengthening with compound motions of the neck and UE strengthening. The therapist will use their clinical judgment as to when to bring in each level of stretching and strengthening.

Educate patients on proper posture and ergonomics.

Good posture is imperative in recovering from neck injuries. Pain is your body telling you that something is wrong with your alignment and soft tissue is being stressed in some way. Changing posture can alleviate the stress and eliminate the pain. Sit up straight! It feels better and puts the least amount of strain on your spine! If you sit or bend too often or for too long a period of time, bend in the opposite direction to balance the stresses out and relieve muscle tension. Thinking of military type posture with shoulders squeezed and chest out, chin in, stomach tight with standing, walking, lifting and bending. Ergonomics for each situation can be evaluated and corrected by a physical therapist.

Accelerate the stages of healing by reducing pain and reducing the inflammatory cycle.

We use soft tissue mobilization, massage, relaxation techniques and modality treatments to assist in pain and inflammation reduction. This coupled with improved muscle balance with respect to flexibility and strength, proper posture and body mechanics is a significant help the therapy process.

Activity modification to reduce or eliminate future occurrences.

“Time waits for no one”! Unfortunately with injuries our life doesn’t stop. Modifying how we go about daily activities may also assist in our speed of healing. This includes body mechanics but also eliminating activities that are exacerbating our injury or limiting how much time we spend performing each activity. For example: taking breaks each hour from computer work to walk around or stretch or carrying less groceries in with each trip from the car. Careful progressions in overall activity can be helpful in recovering.

Manage exacerbations

As hard as we may try it is likely that some situation will occur that will flare up our symptoms or we will have a lapse in judgment of what our injury will tolerate. When these exacerbations occur quick management is important to limit the duration and intensity from what may be weeks to months to only a few days. Quick attention with your therapist or using the principles that have been learned from your sessions in therapy will limit exacerbations.

Target Tissue Training – Part Two: Functional Stress for Tensile Tissue

When a therapist approaches a patient’s rehab program, we must consider the severity of injury. We design our programs to appropriately stress the injured tissue.

In treating tendons and ligaments, we consider the mechanics of injury, adaptation to activity, and healing response during rehabilitation. A  single high load strain, repetitive loading or misuse injuries can cause sprains, partial tears or ruptures in ligaments.  Muscle will rarely contract hard enough to tear a tendon. Achilles and patellar tendons rupture in combination with external forces.

Repetitive strain begins with micro damage, resulting in pain, swelling and degradation of the tendon/ligaments mechanical properties.  This can make the tissue more susceptible to traumatic overload injuries. Tensile load is experienced in small percentages.  Stretching tendon length to 1.5%-3.0% past it’s full length is common in normal activities. Injury is created usually with a stretch of 10% more than a tendon’s full length.

After a soft tissue injury the tendon/ligament will go through a typical soft tissue healing phases: Inflammation (3-7 days to 6 weeks); proliferation (2-3 weeks); remodeling (after 2-3 weeks for more than one year).  All these phases overlap.

Through the remodeling phase, the tissue fibers increase cross-links and align in the direction of tensile load.  Rehabilitation provides progressive loading that avoids inflammation. We cannot impede the healing process or cause scar tissue to form. The paradox of functional tissue training comes in balancing between sufficient loading to guide the healing process, and overzealous loading, which continues inflammation and tissue degradation.

We minimize inflammation with early mobilization and PROM-AAROM program. This may be increased as the tissue progresses into the remodeling phase by progressive AROM, isometric and eccentric exercises followed by high repetition progressive exercises including CKC with proprioceptive and perturbation activities assisting in return to normal upper level activities.

Careful management of exercise type and intensity for tendon or ligament injury relative to the phase of recovery the tissue is the key.  Optimal management will produce minimal pain, faster healing, and return to normal activities.


About the Author:
Ross Hutchinson, PT, CSCS, has been actively involved in Colorado physical therapy since 1991.
You can contact Ross at his Arvada, Colorado office.