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Rehabilitation Articles

Tendonitis or Tendinosis?

By Dillon Stickle


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.

Preventing Softball Injuries

SOFTBALL INJURY PREVENTION

Softball injuries in young athletes are on the rise and nearly as frequent as baseball injuries, but they generally result in less time lost to competition. These injuries most commonly involve the back, shoulder, forearm, wrist, and hand. Pitchers are not more prone to injury than position players; catchers and infielders have similar injury rates. however, pitcher injuries differ from position player injuries because pitchers use a windmill motion that places unique demands on the back, neck, shoulder, forearm, and wrist.

WHAT ARE THE MOST COMMON OVERUSE INJURIES IN SOFTBALL?

For pitchers, the most common overuse injuries are shoulder tendinitis (inflammation of the tendon), back or neck pain, and elbow, forearm, and wrist tendinitis. For catchers, back and knee problems in addition to overhead throwing shoulder problems are the most common. For other position players, overhead shoulder and sometimes elbow problems predominate.

HOW CAN OVERUSE SOFTBALL INJURIES BE PREVENTED?

Overuse injuries are preventable. Some tips to keep young athletes in the game for life include:

• Warm up properly by stretching, running, and easy, gradual throwing.
• Rotate playing other positions besides pitcher.
• Concentrate on age-appropriate pitching.
• Adhere to pitch count guidelines (see tables).
• Avoid pitching on multiple teams with overlapping seasons.
• Flexibility of pitchers needs to be the focus during the season rather than strengthening.
• Don’t pitch with pain, and see a doctor if the pain persists for a week.
• Don’t pitch more than two consecutive days until age 13, and then no more than three days in a row.
• Don’t play year-round.
• Radar Guns should only be used during competition for best pitch of speed vs. change up (ages 15+).
• Communicate regularly about how your arm is feeling and if there is pain or fatigue.
• Develop skills that are age appropriate.
• Emphasize control, accuracy, and good mechanics.
• Speak with a sports medicine professional or athletic trainer if there are any concerns about injuries or prevention strategies.
• Return to play only when clearance is granted by a health care professional.

Lacrosse Injuries

WHAT ARE THE COMMON INJURIES IN LACROSSE?

Overall, lacrosse is a moderate risk sport in which the vast majority of injuries are minor strains, sprains, and bruises. However, more significant injuries can occur.

• Non-contact, ankle and knee ligament sprains, sustained while cutting and dodging are common in both girls and boys lacrosse. At the scholastic level, ankle sprains represent 21% of all reported injuries for girls and 16% for boys.

• Knee injuries, including anterior cruciate ligament (ACL) tears, are the leading cause of lost game and practice time for both girls and boys.

• Muscle strains of the hamstrings, quadriceps, and groin are common and related to similar, non-contact mechanisms.

• Head and face injury, including concussion, are less frequent but still an important issue for the game. Most commonly related to body to body or body to ground contact in the boys game and inadvertent stick or ball contact in the girls games, these injuries are more frequent in game than practice situations.

• Shin splints and foot blisters are common and related to continuous running and changing field surfaces.

• Abrasions about the uncovered lower extremities are common and required appropriate cleaning and protection.

• Seen more commonly in baseball and hockey, commotio cordis is very rare cardiac arrhythmia related to ball to chest contact. The few cases in lacrosse have involved adolescent boys. The condition is best treated by early activation of the EMS system and utilization of onfield AEDs.

Preventing Basketball Injuries

AS BASKETBALL SEASON APPROACHES, HERE ARE SOME VERY HELPFUL HINTS TO HELP YOUR CHILDREN AVOID INJURIES.

HOW ARE BASKETBALL INJURIES TREATED ?

Ankle Sprains
Treatment for an ankle sprain involves rest, ice, compression, and elevation (RICE). The need for X-rays and evaluation by a physician is determined on a case- by-case basis and depends on the severity and location of pain. Pain and swelling over the bone itself may need further evaluation. An injury to the ankle in a child who is still growing could represent a simple sprain or could be the result of an injury to the growth plates located around the ankle and should be evaluated by a physician.

Jammed Fingers
Jammed fingers occur when the ball contacts the end of the finger and causes significant swelling of a single joint. Application of ice and buddy taping the finger to the adjacent finger may provide some relief and allow the athlete to return to play. If pain and swelling persist, evaluation by a physician or athletic trainer is recommended and an x-ray of the finger may be needed.

Knee Injuries
Basketball requires extensive stop and go and cutting maneuvers which can put the ligaments and menisci of the knee at risk. Injury to the medial collateral ligament is most common following a blow to the outside of the knee and can be often be treated with ice, bracing and a gradual return to activity. An injury to the anterior cruciate ligament is a more serious injury and can occur with an abrupt change in direction and landing for the jump. Although this ligament tear is most commonly a season ending injury that requires corrective surgery, current techniques used to repair the ACL ligament generally allow the player to return to play the following season.

 

Must Be the Shoes

What clinicians should understand about the minimalist shoe movement

By Robert Gillanders, PT, DPT, OCS

Sports Focus

One thing you might notice at your local 10K race this summer is the variety of running shoe styles in use. No longer is the average runner sporting just the traditional chunky-heeled running shoe. Instead, many are venturing into the relatively new "minimalist" shoe market. Some runners might even be in the ultimate minimalist shoe: bare feet.

The minimalist movement in running shoes coincides with renewed focus on running form within the industry, and how shoes influence form. The bestselling book Born to Run facilitated this when it promoted barefoot running, profiling tribal Mexican runners who sported little more than handmade rubber sandals on their way to winning ultramarathons.

Many now believe that the built-up shoes popularized in the 1980s, with cushioned heels and dense foam designed to control foot pronation, actually facilitated bad running form.

The soft enlarged heel would encourage "overstriding," which is when a runner's heel contacts the ground in front of the center of mass. The more "natural" way of running-which is encouraged by minimalist shoes because the soft heel is absent- is not to land on the heel at initial contact, but rather on the midfoot or forefoot. This occurs when a person is barefoot.

Given the growing popularity of minimalist shoes, it is worth taking a clinician's view of how running shoes factor into the rehabilitation process of the injured runner.


Knee Pain? First, Discover the Cause

It’s a common misconception that we humans have only one joint at the knee. A joint is the place at which two bones are joined to allow for movement. Technically, we have two joints at each knee. The three bones that make up the two joints are the femur (thighbone), the tibia (shinbone) and the patella (knee cap). The first joint—the patellofemoral, or PFJ—joins the kneecap and thighbone. The second joint—the tibiofemoral, or TFJ—joins the thigh and shinbone.

Every year, millions of Americans replace the TFJ knee joint, though it’s not always the joint causing the pain. In my experience, the PFJ is usually the main culprit behind knee pain, although total knee replacement surgery involves replacing the surfaces of the TFJ.

Pain from PFJ irritation can be severe, even crippling. It starts on the underside of the knee cap, grinding in the hollowed groove of the femur during weightbearing activities, such as walking up and down steps, standing for any length of time, walking, running and participating in sports.

Our physical therapists have had great success eliminating this irritation with simple exercises, stretching and deep-tissue massage. In my experience, the PFJ joint—not the TFJ joint—is the primary source of pain and physical limitation. I’ve helped many patients who had already scheduled a knee replacement to cancel surgery by working on the “correct” knee joint.

The Lowdown on Low-Back Pain

 By: Mary Biancalana, MS, CMTPT, LMT

Identifying myofascial trigger points that can cause low-back pain as well as their key perpetuating factors

Low-Back Pain

Myofascial trigger points are finally becoming an increasingly recognized etiology for (non-visceral) low-back pain. More and more research is pointing to the efficacy of low-cost intervention strategies due to the fact that we now know that many cases of acute low-back pain will resolve with soft-tissue and low-cost manual intervention, according to a July 2011 article in Spine Journal. Whether or not the cause of the episode is eliminated, however, can be the difference between chronic, multi-episodic occurrences or a full-function, pain-free life with minimal flare-ups. Considering the impact of muscular, postural and occupational perpetuating factors on the development of trigger points can improve clinical outcomes.

Doing a History
Our case scenario is a 53-year-old male who reports 2-3 times per year crippling low-back pain episodes. He reports that the pain runs up and down his back and into his upper buttocks. Imaging studies are unremarkable.

The report in the patient's own words often sounds like this: "My back just 'goes out' and I'm stuck crawling on all fours to go to the bathroom. There is no rhyme or reason, it just grabs me and I'm off work for a week flat on my back, in bed; it's too painful even to roll over and get up. This time, all I did was bend down to pick up a tissue I dropped. Not a heavy box or anything! Then on my way to stand up, pain shot into my low back, I was so mad and fearful, I just crawled into bed and stayed there."

Comfort & Function

By Lauren J. Stephenson, MA, ATC

Taping Uses
As clinicians, we know that understanding the whole picture is imperative in devising a comprehensive and effective rehabilitation plan when working with patients who have musculoskeletal injuries. We assess not only the injury site, but also deviations, deficiencies and malalignments throughout the kinetic chain in order to best address the source of the problem and return our patients to full activity as safely and efficiently as possible.

This concept is similar when applying tape to an athlete who has sustained an injury to the lower extremity. The clinician must take into consideration the properties of each type of tape, the nature of the equipment for the sport, the position the athlete plays, and the patient's personal preferences in addition to the injury. By incorporating these principles, taping procedures applied to the lower extremity will be functional, which will facilitate healing while allowing the athlete to continue participating in his sport.

Functional Taping
In order for any taping procedure to be functional, the patient has to be willing to keep it on while participating in sport. There are several factors that go into whether or not athletes will be compliant with wearing a supportive external device. Primarily, the taping procedure must be comfortable for them. While part of the equation depends on the actual application of the tape, the other is choosing a tape that will serve its purpose in providing support, allowing the joint to move through a pain-free range of motion while maintaining neurovascular integrity. Part of ensuring comfort and function is having an understanding of how taping procedures can be integrated into protective equipment.


The primary purpose of taping a joint is to support and protect injured joint structures. In many sports, other protective devices such as guards or padding are required to maintain safe play. The clinician must consider how a taping procedure fits underneath or outside of protective equipment. For example, a football player wears a cleat that's more of a high-top, with a wide heel counter, midsole and toe box. The structure of this type of cleat allows the clinician to add a significant amount of tape to the foot and ankle without causing too much crowding in the shoe.

Conversely, a soccer player traditionally wears a cleat that is a half- to a full-size smaller than his shoe size in order to allow for better ball handling. The soccer cleat design usually has a low top, narrow heel counter, midsole and toe box. Using a similar taping procedure to that used on the football player would not only compress the foot in the shoe, but would limit the ability of the soccer player to feel the ball, therefore limiting effective play. While the soccer player may have the same injury as the football player, the clinician can't apply the same taping procedure and maintain compliance.

Adolescents and ACL Injuries

By Robin Hocevar

Sports Rehab

High school athletic injuries are getting a lot of media attention lately and researchers at Duke University's department of orthopedic surgery are making sure areas beyond the concussion zone are getting the attention they deserve.

Robin Queen, PhD, Robert Butler, DPT, PhD, and William Garrett, MD, PhD, utilized the Michael W. Krzyzewski Human Performance Laboratory in setting out to learn the mechanics behind adolescent patients regaining symmetric loading patterns. Such information could prove indispensible in preventing future anterior cruciate ligament (ACL) re-injuries and understanding the effectiveness of the knee brace.

ACL injuries are common in soccer, basketball, football and lacrosse because of the focus on cutting, jumping and pivoting. Young, female athletes have the highest rate of ACL injury.

Return to Play

Two years following ACL replacement, the re-tear rate for ipsilateral knee injury or injury to the contralateral knee is about 3 percent, according to research by the Washington University School of Medicine, Barnes Jewish Hospital in St. Louis. In the shorter term, however, research shows injury rates to either knee reaching as high as 23 percent in a 12-month follow up. With such variability in re-injury rates, many researchers recommend longer-term follow-up.

"People who reinjure likely do so because they return to their previous level of activity with incomplete neuromuscular control," explained Butler. "They go back to their sport and they truly have not optimized their movement ability in post-operative rehab. However, this is not solely for the injured side since the chances of them tearing on the same leg vs. the opposite leg are approximately 50/50."

Minus a standard guideline in orthopedics for return to sports competition, six months after ACL reconstruction is in the normal time frame. However, many patients meeting rehabilitation goals return to low-level athletics as early as two months post-op. Return-to-play guidelines vary by gender, age and activity level.

Tips from the Experts

Tips from the Experts

Physical Preparation for Decoration


Photo by Stephanie Wallace

The time crunch for Holiday decorating both inside and out is officially on. As you may have hopes and aspirations of early preparations, the fact remains that there is a lot of work to do. Not to mention heavy lifting, repeated overhead reaching and lots of bending.

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