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Rehabilitation Articles

Physical Therapist's Guide to Shoulder Impingement

Shoulder impingement syndrome occurs as the result of chronic and repetitive compression or "impingement" of the rotator-cuff tendons in the shoulder, causing pain and movement problems. It can also be caused by an injury to the shoulder. People who perform repetitive or overhead arm movements, such as manual laborers or athletes who raise their arms repeatedly overhead (ie, weightlifters and baseball pitchers), are most at risk for developing a shoulder impingement. Poor posture can also contribute to its development. If left untreated, a shoulder impingement can lead to more serious conditions, such as a rotator cuff tear. Physical therapists can help decrease pain, and improve shoulder motion and strength in people with shoulder impingements.

Tennis Elbow vs. Golfer’s Elbow: the Causes, Symptoms & Treatments

Tennis Elbow and Golfer’s Elbow: what’s the Difference?

While many people are familiar with the names of these conditions, there is less widespread understanding about how they differ. Both tennis elbow, or lateral epicondylitis, and golfer’s elbow, or medial epicondylitis, are injuries to the tendons attaching your forearm muscles to the bone at your elbow. The “epicondyle” part of epicondylitis refers to the bony bumps or protrusions at your elbow.

Lateral epicondylitis affects the tendons attached to the outer (lateral) side of your elbow, which are connected in turn to the muscles that extend your wrist backward and straighten your fingers. Medial epicondylitis affects tendons connected to the inner (medial) side of your elbow, which are attached to the muscles that flex your wrist and contract your fingers when you grip something.
Both injuries are usually the result of repetitive strain on the tendons, and although you don’t have to be a golfer or tennis player to experience them, the repeated forceful motions involved in both sports make them very common.

Acute Neck Pain

Neck pain results when the spine is stressed by injury, disease, wear and tear, or poor body mechanics. Acute neck pain is abrupt, intense pain that can radiate to the head, shoulders, arms, or hands. It typically subsides within days or weeks with rest, physical therapy and other self-care measures. You play an important role in the prevention, treatment and recovery process of neck pain. However, if chronic, pain will persist despite treatment and need further evaluation.

Figure 1. (Side view)The neck region is called the cervical spine. Protected within the bones of the cervical spine are the spinal cord and nerves. The seven cervical bones, called vertebrae, are numbered C1 to C7. Each bone is separated and cushioned by shock-absorbing discs. The vertebrae are held in place by muscles and ligaments. The spinal nerves pass through bony canals to branch out to the neck and arms.

Movement Strategies for Low Back Pain

It can be painful or difficult to move in certain ways when you have a back problem. Some movements cause your back to arch a lot, while others cause your back to round too much. Your back will feel most comfortable moving in the middle between arched and rounded. This is your functional range of movement. The more you keep your back in this functional range of movement, the better you will feel. There are movement strategies you can learn and use to keep your back in the functional range as you reach, bend, lift and turn. This will help reduce your pain.

When you reach overhead into the cupboard, or to wash your hair, or while you kneel to garden, your back will want to arch. To keep your back in the functional range, practice the following movement strategies; first in the lying position (A), then on all fours (B), then in the standing position (C).


5 Physical Therapy Myths Debunked

If you’ve never visited a physical therapist before, or have heard some disquieting rumors that have discouraged you to do so, take a look at these 5 common misconceptions about physical therapy.


Fact: Yes, some discomfort may be experienced while undergoing physical therapy, but physical therapy is meant to reduce pain and not increase it. “No pain, no gain” is only true in rare cases. Let your physical therapist know when you are in pain, and they can adjust your therapy accordingly. The main objective is to help you heal while working within your pain threshold.

Carpal Tunnel Syndrome

 What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is pain, tingling, and weakness due to pressure on the median nerve in your wrist. The median nerve and several tendons run from your fore¬arm to your hand through a small space in your wrist called the carpal tunnel. The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).
Causes and Risk Factors
Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel space smaller. Sometimes it is not possible to tell what causes the increased pressure. However, certain lifestyle and medical risk factors that may contribute to carpal tunnel syndrome include:

• Illnesses such as hypothyroidism, rheumatoid arthritis, and diabetes
• Pregnancy
• Obesity
• Forceful gripping or grasping activi¬ties with your hands
• Making the same hand or wrist movements over and over, especially if the wrist is bent down (your hands lower than your wrists)
• Wrist injuries and bone spurs
• Smoking, because it can reduce blood flow to the median nerve

Acute Knee Pain: Tips & Exercises

You often lose strength and motion in your knee when it is painful and swollen. This can happen after injury or overuse. The exercises and tips listed below will help you decrease pain and swelling, increase range of motion, improve strength and help you return to your normal activities as soon as possible.

How to reduce pain and swelling

Rest: Avoid painful activities to give your knee time to heal. Limit your walking and other standing activities when your knee is painful or swollen. Use a cane or crutches to decrease the stress on your knee. It is best to use the cane on the opposite side of your painful knee. Use supportive shoes when you are standing or walking.

Ice & Elevation: Place a cold pack on your knee with a thin towel between your skin and the cold pack to prevent a rash or burn. Use ice 15-20 minutes, 2-4 times per day as long as your knee is warm, painful or swollen. Elevate your knee above the level of your heart to help with the pain and swelling.

Compression: If your knee is swollen, using a knee brace or wrap may help with the pain and swelling and provide support to your knee. Apply the elastic wrap loosely from your calf to right above your knee. You should be able to easily put two fingers under the wrap.

Range of Motion Exercises
It is important to begin moving your knee and ankle to prevent stiffness reduce swelling and increase circulation. Start by bringing your toes and foot towards your shin and then point your foot away 10-20 times every hour.


Rehabilitation for Arthritis

Arthritis is the most common cause of chronic disability. There is no cure for most forms of arthritis. But with some effort, you don't need to lose all the movement in your joints. A rehabilitation program can help you maintain and even improve your joints' strength and mobility. With some help from specialists and special equipment, arthritis won't always stop you from doing the things you enjoy or the things you need to do.

Rehabilitation is a hands-on form of care and relies on your participation and effort. It involves exercising, learning how to care for sore and swollen joints, and figuring out ways to minimize the stress on your joints. In the early stages of arthritis, the goal of rehabilitation is to maintain or improve your joint strength and range of motion. If your joint is severely damaged, rehabilitation will focus on managing your pain and finding special equipment to help you with necessary tasks. Rehabilitation also helps people recover from joint surgery. Your rehab program will involve managing your symptoms, exercise, and lifestyle changes.

Rehabilitation requires patience. It takes time to strengthen your joints and learn how to do familiar tasks in new ways. But the result can be a greatly improved quality of life.

Treating Patella Fracture

Overstressing patella fractures too soon could hinder the healing process

PT Focus
PTs face many unique challenges when treating a variety of orthopedic patients. To effectively manage orthopedic injuries, PTs must be knowledgeable of musculoskeletal tissue healing principles, be familiar with various rehabilitation programs, know how to skillfully apply rehabilitation techniques as well as fundamentally understand common and uncommon soft tissue injuries, fractures and diseases of muscles, bones and joints. Management of patella fractures, both nonoperative and postoperative, provides PTs with an opportunity to fully utilize each component of effective rehabilitation.

Causes and Types
Fractures of the patella most commonly occur from direct trauma, usually a fall on the knee or a direct blow to the patella. Less frequently, the patella can be fractured by a sudden, violent contraction of the quadriceps.
Patella fractures are classified as either transverse, stellate or vertical. These three categories can be further classified as displaced or nondisplaced. The arterial blood supply to the patella is derived from two systems of vessels from branches of the geniculate arteries. These two systems supply the middle third and apex of the patella. In cases of displaced transverse fractures, the proximal blood supply may be compromised leading to avascular necrosis of the proximal segment.

Overall, the management of patella fractures is based on classification and morphology of the injury. Treatment options range from nonoperative to operative with open reduction and internal fixation to partial or total patellectomy.

It's All In the Swing: Golf Injuries

Golf looks like an easy game to play, hitting a stationary object with a club into a relatively wide open space. Well, think again! To become a good golfer, it is recommended that you start young and practice, practice, and practice. Golf historically is perceived as being a low-risk sport when it comes to injuries. However, many young golfers, especially those who lack proper technique, suffer from acute or overuse injuries.


Acute injuries are usually the result of a single, traumatic episode, such as hitting the ground of a submerged tree root in a sand trap. Overuse injuries are more subtle and usually occur over time. These injuries will more often stem from the stress that the golfer puts on the back and shoulders when swinging. The three most commonly injured areas of the body are the back, shoulder, and elbow. They should be treated with rest, a good stretching/warm-up program, and good, sound advice from golf professionals.

Back to Basics for Balance & Gait

By Jennifer Bauer, MSPT on January 18, 2017

Achieve more with less while fine-tuning your fall prevention approach
The “Silver Tsunami” is approaching, and therapists need to be prepared. As the baby boomer generation enters retirement age and the medical system, therapists must ready themselves for a unique set of standards.
Cookie-cutter protocols simply aren’t acceptable any longer. Boomers want customized programs and more personalized care; this is the trend.

According to the National Council on Aging, 25% of the population over age 65 falls each year. As the population ages, this number rises. Therapists must fine-tune their approach to fall prevention, thereby streamlining their balance and gait training techniques.

Tools to Treat Foot Drop

From exercise to medications to modalities, clinicians have a lot of tools at their disposal to treat foot drop. Just as its causes are many, so are the treatments. While the same approach may not work for each patient, trial and error can help doctors and physical therapists figure out the best possible outcomes.

Foot drop is not a disease itself, but rather a symptom that develops as a result of various neurological, muscular or anatomical problems. Patients who suffer have difficulty lifting the front part of their foot due to muscle weakness or paralysis. Sometimes they drag their toes along the floor as they walk.

In a normal gait cycle, the toes pull up from the floor so a person avoids tripping on them. The toes of foot drop patients point down and strike the floor first, with their ankle flapping as they move the foot. They may develop a steppage or marching gait, raising their thigh when walking in a motion similar to climbing the stairs.

Tips from the Experts

Tips from the Experts


Millions of people suffer from low back pain each day. Most are between the ages of 30 and 50, and many endure not only back pain, but also severe pain or numbness running into one or both legs. The result: loss of activity, inability to work and inability to participate in the activities we enjoy most. It is estimated that some 80 to 90% of Americans will suffer from back pain during their lifetime, about 50% of which will have more than one episode. Often times, you will hear the name “Sciatica” associated with this pain, and rightly so.

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