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Rehabilitation Articles

Management of the Elbow Complex

LEARNING OBJECTIVES
•    Accurately describe at least two examples of the anatomic and bow mechanical relationships of the elbows that relate to normal function.
•    Describe without queues the pathomechanics of at least two selected elbow injuries.
•    Independently outline an evidenced based examination with at least three intervention techniques for selected elbow conditions.

ANATOMY
Articulations
There are three primary articulations: the humeral ulnar, humeral radial, and the proximal radial ulnar joint.

Carrying Angle
Another thing to consider when reviewing anatomy is the carrying angle.  There is a normal valgus angulation. In men, that normal angulation ranges between 11 and 14 degrees, and in women, 13 to 16 degrees. The female pelvis is a bit wider which may be a component on why there is a difference in gender. Again, keep in mind the normal position of the elbow is going to have a bit of a valgus angulation.

A Better Grip on Hand Therapy

Interrupting the damaging downward spiral of desensitization, weakness and pain

While edema, scar management, range of motion and strength are the four pillars, we must have a foundation on which to improve hand function. That foundation is sensation. Without sensation in the hands, we limit their use, protect the area or extremity, and slowly lose functional use of that limb.


Sensory limitations can be caused by carpal and cubital tunnel syndrome, surgical complication, and physiological response to surgery, including edema and excessive collagen production causing heavy scar tissue, among other origins.
Therapists primarily confront two types of sensation dysfunctions: hyposensitivity and hypersensitivity. Both are problematic in their own way, and both require education and rehabilitation to return the patient to the highest level of function. With sensation insults, we often see texture discrimination issues, stereognosis concerns, and diminished protective sensation including hot and cold sensation and touch-pressure threshold detection levels.

Challenging Geriatric Patients

Giving older patients the push they need to get results.


We talk a lot about the soft ageism of low expectations. Simply put, we often fail to ask our older patients to complete tasks that are challenging enough to create meaningful change. Nowhere is this more evident than in assessment and treatment of trunk strength and core stability. When was the last time you asked an older patient or client to perform a plank? More than 20 cross-sectional and longitudinal studies indicate that core strength is important for the successful performance of activities of daily living in old age.


Conversely, a number of studies have started to ask why balance and resistance training alone poorly translate into improvements in balance, functional tasks, activities of daily living and fall rates. A consensus is emerging that core strength training must be a component of any program aimed at the overall health and well-being of older adults.

What to Expect When They're Expecting: PTs Who Treat Patients During & After Pregnancy

Many women's health PTs treat patients during and after pregnancy. Here are some of the services they offer and why they say it's important to spread the word to other health care professionals.
By Michele Wojciechowski | December 2017

At Swedish Medical Center in Seattle, Washington, on any given day you might see certified lymphedema therapist Peg Maas, PT, DPT, performing lymphatic massage on a patient. But it's not because the woman has cancer, although she is a cancer survivor. It's because she's pregnant. Specifically, Maas is seeing the patient because of fluid retention due to pregnancy. "I've had women who have been pregnant after having cancer and have had fluid management problems from their lymphedema," she explains. "We do lymphatic massage and compression the same as we do when women aren't pregnant. We don't leave the swelling alone and just say, ‘You're going to be puffed up because you're pregnant.' It's not just fluid, and it puts women at greater risk of infection." Maas' experience is 1 example of what physical therapists (PTs) who focus on women's health can do to treat patients with and without specialized conditions during and after pregnancy. For this article, PT in Motion interviewed 5 PTs who all are board-certified clinical specialists in women's health physical therapy.

3 Tips for Great Posture

Posture impacts our body’s mobility and functionality more than we realize. Poor posture can increase a person’s risk for injury, while good posture can decrease pain. In this article, we are going to offer 3 tips for maintaining excellent posture all day, every day.


Good Posture Can Reduce Pain
Having bad posture doesn’t necessarily mean that you’ll experience pain. However, maintaining good posture or correcting bad posture can help reduce existing pain. This is something we help patients with every day. For example, if a patient complains of neck pain, a change in the way they crane their neck at the computer can go a long way in reducing pain. It should be noted that posture changes do not typically act as a miraculous cure for pain conditions. Rather, postural changes can be used in conjunction with physical therapy and other treatment modalities to relieve pain in the patient.

Anterior Knee Pain

What Muscles Should I Strengthen?

 Pain in the front of your knee or under your kneecap is often called patellofemoral pain. You may feel this pain after exercising or when you sit too long. The pain may be a nagging ache or an occasional sharp twinge. Because the pain is around the front of your knee, treatment has traditionally focused on the knee itself and may include taping or bracing the kneecap, or patella, and/or strengthening the thigh muscle the quadriceps that helps control your kneecap to improve the contact area between the kneecap and the thigh bone, or femur, beneath it.


However, recent evidence suggests that strengthening your hip muscles can also help. The theory is that strong hip muscles can decrease the stress in your knee. A study published in the January 2018 provides new insights and evidence-based suggestions on how to strengthen your entire leg to decrease your knee pain and help you return to full activity.

KNEE AND HIP MUSCLES. Knee pain that is in the front of your knee or under your kneecap is often called patellofemoral pain (A). Strengthening exercises for patellofemoral pain have historically focused on the muscles in the front of your thigh, the quadriceps muscles, because they help track the movement of the kneecap (B). There is now evidence that stronger hip muscles can help lessen the stress under the kneecap, indicating that it is best to strengthen both the knee and hip muscles to avoid the movement shown here, which can cause knee pain (C).

Plantar Fasciitis: Will Physical Therapy Help My Foot Pain?

One out of 10 people in the United States experience persistent pain along the bottom of the foot, a condition known as plantar fasciitis. In this country alone, outpatient clinics receive more than 1 million visits a year from people seeking help for this type of foot pain. In 2014, the Orthopaedic Section of the American Physical Therapy Association published updated clinical practice guidelines on the best treatments for patients with plantar fasciitis. The guidelines present evidence that strongly suggests a combination of manual therapy and rehabilitative exercises to help patients with this foot condition. In a more recent study published in the February 2017 issue of JOSPT, researchers reviewed the records of people with plantar fasciitis who were sent to physical therapy to determine whether this treatment lessened their pain.

Pelvic Floor Dysfunction

What is pelvic floor dysfunction? When you are unable to control the muscles in your pelvic floor to have a bowel movement, it is called pelvic floor dysfunction. People with pelvic floor dysfunction contract these muscles rather than relax them. Because of this, they cannot have a bowel movement, or they have an incomplete one.

The pelvic floor is a group of muscles in your pelvic area. These muscles support the organs in your pelvis like a sling. The organs in this area include the bladder, uterus (women), prostate (men), and rectum (the area at the end of the large intestine where your body stores solid waste). By contracting and relaxing these muscles, you control your bowel and bladder movements.

What causes pelvic floor dysfunction? Most of the causes of pelvic floor dysfunction are unknown. Traumatic injuries to the pelvic area, such as in an accident, and complications from vaginal childbirth can contribute to this condition.

What are the symptoms of pelvic floor dysfunction? Several symptoms may suggest pelvic floor dysfunction. If you have any of these, you should discuss them with your physician. Some symptoms may also indicate other conditions, but a complete physical exam should be able to determine what is causing your symptoms.

Tendonitis or Tendinosis?


Distinguishing the signs and symptoms of joint pain – and why it’s a critical difference.

Sports Medicine Focus
Tendinosis, the degenerative condition in a tendon, is far more severe and much less diagnosed than its cousin tendinitis, an inflammatory condition. Although tendinosis diagnoses are less common, the condition is actually more prevalent, especially among athletes. The more alarming fact is that popular treatments for tendonitis can actually have little-to-no success when treating tendinosis, which could delay or even terminate an athlete’s career.

Patellar tendinosis is often referred to as “jumper’s knee” or “runner’s knee.” It occurs mostly with athletes whose knees, specifically the tendon, are making rapid movements in multiple directions and being overused, like those in sports such as volleyball and basketball, or with strenuous activities like running and hiking.

Tackling Tough Football Injuries

Injuries to the face, rib cage and neck aren't common, but can bring severe and devastating consequences.

By Tricia J. Hubbard, MS, ATC

Collisions and football go hand-in-hand. It's an unfortunate combination that creates injuries on high school, collegiate and professional football fields across the country.
Football players sustain approximately 1.2 million injuries per year, estimates show.  Injury risks rise with the level of play and age, as athletes get bigger, faster, and stronger and more aggressive.

The likelihood of sustaining a specific injury in football ranges from 11 percent to 81 percent. The knees, ankles and shoulders are especially vulnerable, and these areas account for almost half of all injuries.

Face, Rib Cage and Neck
While bone-rattling hits create plenty of knee, ankle and shoulder injuries, other less prominent parts of the body can be affected as well, such as the face, rib cage and neck. The consequences can be just as severe and damaging.

The foot, face and chest are on the opposite end of the spectrum, and constitute between 1 percent and 4 percent of injuries. Although the percentage of injury is low, the implications can be serious.  As sports medicine clinicians, you might not see these traumas every day, but you should be prepared to manage them.

•Facial injuries. Most facial injuries are minor. However, players occasionally sustain facial fractures from blunt trauma during play.

Fractures can include more serious injuries to the zygoma, or orbit, which can cause greater disability. The most common mechanism of injury is a digital poke to the eye. Linemen are more likely to sustain these injuries because offensive and defensive players engage in contact on every play; using the hands allows players to be more effective.

Cold-Weather Injuries

Exercising in wet or reduced-temperature environments can pose serious risks.

Exposure to cold environments -- and thus increased risk for cold injury -- is a common occurrence for many athletes and workers, including winter sport athletes, outdoor enthusiasts, endurance athletes, water-based athletes, military personnel and those in the building and maintenance trades.No matter the reason for time spent outside in the cold, evidence-based risk assessment and swift intervention can help keep these athletes and workers safe.

Frostbite and Hypothermia
The most common injuries associated with cold exposure during physical activity are hypothermia and frostbite. Hypothermia is traditionally defined as exhibiting a core temperature of less than 95 degrees Fahrenheit, and is classified as mild, moderate, or severe.1,2

Preventing Baseball Injuries

BASEBALL INJURIES

Injuries in young athletes are on the rise, but elbow and shoulder injuries in children are on the verge of becoming an epidemic. Thousands of children are seen each year complaining of elbow or shoulder pain.

Tips from the Experts

Tips from the Experts

Hard Core Strength


Over the past 10 to 15 years, ‘core stability’ has become synonymous with abdominal strength. The fact of the matter is that the abdominal muscles are given too much credit when it comes to real core strength. The abdominals posses a limited and specific action. Actually, the ‘core’ consists of several muscles that run the length of the trunk and torso stabilizing the spine, pelvis and shoulders. When engaged, they provide a stable foundation for both arm and leg functional mobility allowing us to generate powerful movements through our extremities. Core strengthening exercises are an important part of overall fitness training that, except for the occasional sit up or crunch, are often neglected.

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