For Maximum Results, Call for an appointment!

Rehabilitation Articles

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.

Preventing Injuries at Work

Did you know there is a science that relates you to your work? In fact, it includes the anatomic, physiologic and mechanical principles that affect how efficiently you work. It’s called ergonomics, and it’s something you should take seriously. There are plenty of simple things you can do to help you work more efficiently and prevent injury while at work. An injury at work is more common than you think. One can easily pull a back muscle, strain the eyes, or develop long-term wrist pain by simply working. But by changing a few things, like the way you sit or position items at your desk, you can decrease the chances of a work-related injury.

Get that Desk in shape
Sore arms? Achy neck? If you use a keyboard and mouse, follow these tips to decrease the likelihood of carpal tunnel syndrome and achy joints:

Place the keyboard directly in front of you. As you type, your arms should hang comfortably and your shoulders will feel more relaxed. Adjust the slope of the keyboard so that your forearms, wrists and hands feel comfortable. Be sure your wrists and hands do not rest on hard edges. Use rest pads for your wrists if you commonly feel pain.

Make sure the mouse is located immediately to the right or left of your keyboard. Leaving it too far to any side or toward the keyboard's back can create strain. Only use a mouse that fits  well in your hand.

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.

Tips from the Experts

Tips from the Experts

Aging and Exercise

Exercise and promotion of physical activity are extremely important in the self preservation of each and every individual’s health especially as one enters into the ‘elderly’ population. Read more ...