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Rehabilitation Articles

Injury Treatment: Hot or Cold?

Do you know when to use heat or cold therapy for an injury? If not, a recent review article by two University of Washington sports doctors, Matthew Karl, MD, and Stanley Herring, MD, can be your guide. Drs. Karl and Herring point out that the application of superficial heat to your body can improve the flexibility of your tendons and ligaments, reduce muscle spasms, alleviate pain, elevate blood flow and boost metabolism. The mechanism by which heat relieves pain is not exactly known, although researchers believe that heat inactivates nerve fibers, which can force muscles into irritating spasms, and that heat may induce the release of endorphins, powerful opiate-like chemicals that block pain transmission. Increased blood flow occurs in heated parts of the body because heat tends to relax the walls of blood vessels. That’s one reason why sports doctors recommend you steer clear of the practice of heating up already inflamed joints. Heat appears to be best for untightening muscles and increasing overall flexibility; the proper tissue temperature for vigorous heating is probably 104 to 113 degrees Fahrenheit (40 to 45 degrees Celsius) and the correct duration of temperature elevation is about five to 30 minutes. Although heating can reduce muscle spasms after a back injury, heat should not be used on sprained ankles.


Stay Injury Free During Cold-Weather Yard Chores

Brisk temperatures mark the end of physically draining summer yard activities for most of America: the planting, the mulching, the mowing and the removal of dead brush are finally just memories. But just when your back thinks it s time to hibernate and recover, leaves and snow start to cover the lawn, and your spine is called back into action. And don't think back injury is only a problem for the elderly or out of shape. In fact, the American Physical Therapy Association says that people between the ages of 20 and 50 are generally more likely than older individuals to injure their backs, because they may not be aware that they're out of condition and may place higher demands on their bodies. Raking and shoveling will never be completely safe or injury free, but there are definite steps you can take to reduce the risk of ending up in your physical therapist's office with a painful back injury. That way, you ll have a healthy, strong back come springtime when it's time to start planting again!

Raking Leaves

  • When raking leaves, make sure to moderate the amount of strain placed on your lower back. Use the power of your arms and legs to pull the rake.
  • During leaf bagging, or other activities that require stooping, don't bend at the waist. Either sit on the ground or assume a position that will keep your spine in line and the strain on the back to a minimum.
  • Try using a foam knee pad, alternating while kneeling on one knee and keeping your back straight.

Combating Knee Pain


Combating Knee Pain

By Kelly Krohn, MD

Your patients may be living proof of the saying "With age comes wisdom." But age also can bring some unpleasant things, such as joint degeneration of the knees. Increasingly, baby boomers are developing knee osteoarthritis. Approximately 10 percent of patients older than 65 have symptomatic knee osteoarthritis. In addition,  25 percent of people older than 55 reported having knee pain on most days of the month in the last year. 1 Many patients, particularly those who are active or overweight,  begin to feel the burden of knee pain as early as their 40s and 50s. These patients can benefit from an aggressive non-pharmacologic, nonsurgical treatment approach.  Several strategies, including muscle strengthening, aerobic activity, weight loss and biomechanical interventions, can help them avoid surgery-or at least postpone it.  This is especially good news since most knee replacements last only 10 to 15 years. Additionally, knee replacement surgery has considerable risk. Therefore, it behooves patients to avoid surgery-or at least delay it-so they only have to undergo one replacement in their lifetime.

Managing Risk

Baby boomers are at risk for developing knee osteoporosis for many reasons. Obviously, the obesity epidemic is a strong factor, since the knee is a weight-bearing joint. The action of walking transmits approximately three times the body weight across the knee joint. Activities such as running can cause the knee to absorb as much as 10 times a person's body weight. Therefore, every 10 pounds someone loses translates into at least a 30-pound load reduction across the knee joint when walking. Unfortunately, patients with knee osteoarthritis often have trouble with weight loss because exercise can be painful. Therefore, suggest an exercise program that's easy on the knee joints, but can produce aerobic fitness and weight stabilization or loss, if appropriate. This program may be particularly important to those who've spent their lives involved in sports. Aging athletes often are predisposed to knee osteoarthritis; many have fallen victim to previous knee injuries, including anterior cruciate ligament and meniscal tears. This group can benefit from a program that teaches them to choose their athletic activities carefully, while still whetting their appetite for sports.

Too Much Too Soon!

Intense competition and early specialization can drive young athletes to the breaking point.

By Diana Olsen Friedman

Sean McHugh, only 9 years old, already stands 5 feet tall and strikes an imposing figure on the pitcher's mound. He plays on a Little League team in Collegeville, Pa., and a traveling team that competes regularly in tournaments. And he transfers his athletic skills to football and basketball when the fall and winter seasons roll around.

His jam-packed schedule leaves little time for rest. And why would he want to slow down? Sean loves playing sports and is in it to have fun.

Even at a young age, Sean has not escaped unscathed and has had his share of injuries—a broken finger, fractured ankle and sprained knee. But he's resilient. "As soon as the cast comes off, he's ready to go," says Matt McHugh, his dad and coach of Sean's baseball team.

Sean isn't alone in the world of youth sports. In fact, injuries are becoming so common with preteen athletes that experts are concerned that sports are becoming increasingly dangerous for today's youth.

Hamstring Help

By Brian W. Ferrie

From strains to complete ruptures, injuries to this muscle group remain some of the most difficult to treat

Sports Rehab

A typical hamstring injury is immediately recognizable to even casual sports fans. Whether watching a running back surge downfield, a baseball player feverishly round second or a track star accelerate through the turn, it's almost impossible to be unsympathetic as his impressive momentum is instantly brought to a near halt.

Helpless hobbling follows as the athlete reaches for the back of his leg, often with a look of anguish on his face. The news can get worse too. In addition to knocking the participant out of that competition, hamstring injuries frequently entail lengthy and uncertain periods of rehab, not to mention the very real possibility of reinjury.


Under Repair

Michael J. Mullaney, DPT, and ­Christine M. Mullaney, DPT

Communication is a crucial component to rehab after rotator cuff surgery

In the past decade, rotator cuff rehabilitation has developed into a science: Understand the dynamics of the tear, consider the surgical technique and employ effective treatment interventions.

Before orthopedics clearly understood the rotator cuff's role in shoulder function, it was thought that simply "covering the hole" with various techniques was the key to success.1Today, clinicians have a better understanding of rotator cuff function and the importance of recreating the balanced force couples in the shoulder to restore maximal function.


Push Through the Pain

By Rebecca Mayer

If you have chronic back pain, the best remedy is to rest and avoid strenuous exercise, right? Wrong. According to the team of experts at New England Baptist Hospital (NEBH) in Boston, taking it easy is an outdated and ineffective approach.

With demonstrated effectiveness for improving function and work, exercise is a widely prescribed treatment for patients with acute, subacute or chronic low-back pain. There is no evidence that exercise increases the risk of additional back problems or work disability and current studies demonstrate that exercise may reduce pain and disability.

"Years ago, bed rest was the common advice given to patients after an episode or exacerbation," said Kristine Kono, PT, clinical supervisor of the outpatient center at NEBH. "Now we are encouraging patients to move, stretch and even lift very light weights during these episodes."


Frozen Shoulder

By: Dr. Edmond Cleeman

Frozen shoulder is a bit of a mystery in the medical world. Essentially a patient develops stiffness
of their shoulder without an inciting event. They just wake up one day with severely limited motion and pain. Patients have difficulty with some of the basic activities of daily living such as tucking in their shirt, fastening a bra, combing their hair and others. The pain can also interrupt sleep. As time goes on the pain can dissipate but the patient is left with stiffness.

Etiology (Causes) of Frozen Shoulder

• We do not know why frozen shoulder occurs in 95% of the cases.

• In the other 5%, patients develop stiffness as a result of trauma, calcium deposits, arthritis, or following surgery if scar tissue forms.

• Diabetic patients, women and people in their 40s and 50s have a higher risk for developing (being afflicted with) frozen shoulder.

• It appears that 3% of the population can suffer from frozen shoulder but this number jumps to 10% in diabetic patients.

Sprains and Strains of the Hip

By: Dr. Craig DuShey

It’s an interesting fact of life that we don’t appreciate a device’s inner workings until something goes wrong. So it goes with the hip. The intricate mechanics of the hip are something to behold: a 360-degree bundle of muscles, ligaments, and tendons that work in tandem to allow us a range of movements at the hip – from the simple motions of everyday life to the more complicated jumps, pivots and lunges on the sports field.

Hip injuries, then, can slow us down to the point of frustration. Let’s go through a quick rundown of common hip injuries in order to understand and demystify some of the strains and sprains before they turn into chronic conditions.

Spring Cleaning: Throw Out the Trash, not Your Back

By: Dr. Vikas Varma

There’s nothing worse than showing up stiff and sore to the office or passing on the weekend golf game on account of your back—nothing worse, that is, than knowing your injury was preventable. The good news is that protecting your back doesn’t require an extensive knowledge of yoga or Pilates. Prevention takes strong core muscles and simple back stretches that incorporate more than just bending and twisting.

The abs, pelvis, and leg muscles depend on the back for support; but our backs depend on these muscles in just the same way. Exercising your core is a great way to strengthen this support network to prevent future back injuries. If you’ve been noticing any extra strains or soreness in your back, stretch frequently, but think also about aligning your workout to focus a bit more on your core.

Skier’s Thumb

By: Dr. Richard Gilbert

Mechanism of Injury
“Skier’s thumb” represents an injury to the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb. As the eponym implies, it can be secondary to a fall while skiing, when the thumb is forcibly radial deviated when the hand is caught in a ski pole. These injuries can also occur secondary to any injury, such as a fall, which stresses the ulnar collateral ligament of the thumb MCP joint. Mechanism of injury resulting in a skier’s thumb.

It's All in the Swing: Preventing Tennis & Golfer's Elbow

By: Dr. Richard Gilbert

In our last newsletter, we talked about the range of outdoor activities that spring’s warm weather affords. A bad case of tennis or golfer’s elbow, however, can seriously dampen the enjoyment in a
round on the course or a friendly rally on the court. Tennis elbow is the result of micro-tears to the tendon that originates from the bony prominence on the outside of the elbow, known as the lateral epicondyle. Tennis elbow, or lateral epicondylitis, affects 1% to 3% of the population as a whole, but gets its name from the fact that it affects almost half of all tennis players at some point in


Tips from the Experts

Tips from the Experts

Spring cleaning and your aching body

It seems like only last week we were engaged in the tasks of autumn, picking up leaves and preparing our yards for the long winter ahead. Regardless of how well you may have done in the fall, and no matter how many hours you may have logged in that yard, yep, you’re going to do it all over again. Spring clean-up! Uhg!

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