Category Archives: Physical Therapy

Frozen Shoulder

Posted January 19, 2015 by Fit PT

A frozen shoulder may sound like something you would pull out of the deep freeze and thaw for dinner.  But believe me, if you’ve ever had the medical condition of frozen shoulder or in doctor speak, Adhesive Capsulitis, you know it is no picnic.

A frozen shoulder is the stiffening of the shoulder due to scar tissue, which results in painful movement and loss of motion.  The hallmark sign of this condition is being unable to move your shoulder—either on your own or with the help of someone else. It occurs in about 3% of the general population. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men.

The actual cause of Frozen Shoulder is not fully understood. Sometimes it just happens for no apparent reason, other times it comes on after surgery or injury to your arm.  There are a few factors which increase your risk for developing it.  These include: diabetes, hypothyroidism, hyperthyroidism, parkinson’s disease and cardiac disease.

Also, frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture or other injury. To prevent this problem, doctors often prescribe movement exercises and physical therapy right after surgery.

The progression of frozen shoulder usually follows a predictable pattern of three stages:  freezing, frozen and thawing.

In the “freezing” stage you slowly have more and more pain. As the pain worsens, your shoulder loses its motion. Your shoulder may ache all the time but is worse with movement and at night.  Freezing typically lasts from 6 weeks to 9 months.

In the “frozen” stage your pain slowly improves but your shoulder remains stiff. Activities such as reaching overhead, putting on your seat belt and reaching into your back pocket are difficult if not impossible to perform. This stage generally lasts 4 to 6 months.

During the  “thawing” stage shoulder motion slowly improves with less pain. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

Although frozen shoulder usually has to run it’s course, there is help available.   A visit to your primary care provider or orthopedic surgeon is often a good place to start. Treatment options for pain include anti-inflammatory medication, steroid injections, and physical therapy. In therapy we use ice and heat packs, manual therapy, massage techniques, and gentle but progressive stretching exercises to help improve motion, strength and function in your arm. We also instruct you in a home exercise program to keep your shoulder moving.

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Golfers and Total Joint Replacements

Posted December 19, 2014 by Fit PT

Joint replacement surgery of the knee hip or shoulder are operations often encountered by seniors, including many golfers. As the joints of our body age and deteriorate, they become arthritic, stiff and painful and can effect both a golfers performance and enjoyment of the game.

Many golfers undergo joint replacement surgery every year. We see lots of them in our clinic and they often ask if there is hope for a full return to their game after surgery. The most definite answer is yes! And often with improved enjoyment and performance of the game because of less pain and movement restriction.

Jack Nicklaus, considered by many to be the games greatest golfer, underwent hip replacement surgery after a long history of left hip arthritis. After years of conservative treatment, he elected to have his hip replaced. After successful rehab he was able to return to the game he loved and even compete on the senior tour.

From my experience as a physical therapist I see most golfers return to the course between 2 and 4 months after surgery. We begin with chipping and putting and then progress into iron play, shorter clubs first with partial swings, finally to full iron swings and drivers.

The following are general guidelines for golfers with joint replacements:

Avoid Playing in wet weather or slippery conditions to avoid slips and falls.

Use soft spikes versus metal to help avoid stress to the joint while still maintaining good traction and to avoiding falls.

Consider playing 9 holes when first returning to golf and use a golf cart with a flag. This will limit the effects of prolonged weight bearing and walking on the joint.

Play with your weight more towards the front of your feet, and with your foot turned slightly out during the swing. This can decrease the rotational stress on the joint replacement during the golf swing.

Remember, each person recovers differently with his or her own rate of healing. Do not rush back into golf because someone else you know was playing “ two weeks after surgery”. Do not compare your recovery pace to others. Follow your physicians and therapist’s recommendation of when it is safe to return to play.

Following rehab, find a qualified golf fitness/medical/teaching professional. Their guidance and expertise can help you get the most out of your new joint replacement and help improve golf performance.

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BPPV Vertigo-You Really Do Have Rocks In Your Head

Posted November 7, 2014 by Fit PT

If you think you have rocks in your head, you might be right! Every year, millions of people in the United States develop vertigo, a spinning sensation in your head that can be very disturbing. Like an on-going carousel ride in your head.

Benign paroxysmal positional vertigo (BPPV) is one of the most common types of vertigo. It is surprisingly common, effecting nearly 10% of older adults. BPPV is an inner ear problem that causes short periods of dizziness when your head is moved in certain positions. It occurs most commonly when lying down, turning over in bed, or looking up. This dizzy sensation is called vertigo.

Our bodies primary system for balance is called our vestibular system. Although only about the size of a dime, without an intact vestibular system, we would fall flat on our faces. We literally couldn’t stand up straight without it.

The vestibular system is very complex structure housed within our inner ear.   It is made up by a series of semicircular canals, named by their anatomical location. Inside the canals are tiny calcium crystals, sometimes called “ear rocks”. BPPV occurs when these tiny rocks break off and move to another part of the canal, usually the posterior canal. (Hopefully these terms don’t make your head spin!)

When you move your head a certain way, the crystals or rocks move inside the canal and stimulate the nerve endings, causing you to become dizzy. The crystals may become loose due to trauma to the head, infection, conditions such as Menieres disease or aging, but in many cases there is no obvious cause.

No medication has been found to be effective with BPPV. Fortunately, most people recover from BPPV with a simple but very specific head and neck maneuver performed by a physical therapist trained in vestibular disorders. The maneuver is designed to move the crystals from the semicircular canal, back into the appropriate area in the inner ear.

I recently had a patient come to see me for another condition but during her evaluation we discovered she became dizzy when she moved her head in certain directions. I learned from her that this dizziness had been going on for several years but she had rationalized living with it, thinking it was “just part of getting older”. “A quick exam confirmed BPPV and within two treatments her symptoms were completely resolved. She could hardly believe it was so easy, and is grateful to not have that dizzy feeling any longer.

In my experience, this maneuver is as close to a miracle cure that we have in physical therapy. Usually, within one to two visits we can completely rid a person of BPPV and the misery of the vertigo.

Although our treatment for this condition is usually a slam-dunk, it can sometimes reoccur. If it does reoccur it usually can be treated again with similar successful results. There are many other causes of balance and dizzy problems and often requires a team approach between physical therapy, audiology, and medical doctors to adequately diagnosis and treat. If you think you have rocks in your head, you may be right. If you are dizzy, it is worth you time to get it checked out by a medical professional trained in vestibular and balance problems.

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Low Back Pain – a Bad Penny

Posted September 1, 2014 by Fit PT

If you have had low back pain, you are not alone. At any given time, about 25% of people in the United States report having low back pain within the past 3 months, and 80% of us will have low back pain at some point in our lives.

Now for the good and bad news. The good news is that most cases of low back pain resolve within a few weeks on its own. The bad news is that low back pain can and often does return, like a bad penny, and can progressively worsen over time.

The symptoms of low back pain vary a great deal. Your pain might be dull, burning or sharp. You might feel it at a single point or over a broad area. Sometimes, it might spread into one or both legs. The one thing all low back pain has in common; misery!

There are 3 different types of low back pain:

  • Acute—pain lasting less than 3 months
  • Recurrent—acute symptoms come back
  • Chronic—pain lasting longer than 3 months

Often, low back pain occurs due to overuse, strain, or injury. It could be caused by frequent or strenuous bending, twisting and lifting. Too much sitting can also be a contributing factor. Low back pain can come on all at once, or gradually over time. Sometimes, the actual cause of low back pain isn’t always readily apparent.

Although low back pain is rarely serious or life threatening if you ever have low back pain accompanied by loss of bowel or bladder control, or numbness in the groin or inner thigh, seek medical attention immediately. It might indicate a serious condition called “cauda equina syndrome” at which the nerves at the end of the spinal cord are being squeezed.

There are several conditions that may contribute to low back pain, such as: degenerative disk disease, lumbar spinal stenosis, herniated disks, osteoarthritis, and fractures.

In chronic and recurrent cases, x-rays and other imaging diagnostic tests such as an MRI may be done to determine the cause of your back pain. Because not all low back pain is the same, treatment should be tailored for your specific symptoms and conditions. Often a visit to your primary care provider is a good starting point. In some cases, they may refer you to a physical therapist for evaluation and treatment.

As experts in restoring and improving mobility and movement in in peoples lives, physical therapists play an important role, not only in treating persistent or recurrent low back pain, but also in preventing it, and reducing your risk for having it come back, like a bad penny.

Here are a few simple tips to help prevent low back pain:

  • Participate in regular strengthening and stretching exercises to keep your back, stomach and leg muscles strong and flexible.
  • Keep your body in alignment, so that it can be more efficient when you move.
  • Keep good posture—don’t slouch
  • Use good body positioning at work, home, or during leisure activities.
  • Keep your spine straight and the load close to your body during lifting.
  • Ask for help before lifting heavy objects.
  • Maintain a regular physical fitness regimen—staying active goes a long ways in preventing many types of injuries, including low back pain.

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What is Physical Therapy?

Posted August 19, 2014 by Fit PT

You have probably heard of physical therapy. Maybe you had a conversation with a friend about how physical therapy helped get rid of his or her back pain, or you might know someone who needed physical therapy after an injury or surgery. You might even have been treated by a physical therapist yourself. But have you ever wondered about physical therapists—who they are and what they do? In my 14 years as a physical therapist I have noticed that most people know a little about PT, but often are not aware of our profession, our educational background and the variety of services we provide.

What we do in physical therapy, (also known simply as PT) has been around a long time. Hippocrates was known to employ the healing benefits of massage and hydrotherapy in ancient healing. The earliest modern day physical therapists worked in hospitals treating patients with Polio and injured soldiers from World War II.

Today, physical therapists are highly educated, licensed health care professionals who work in a variety of settings. The education levels of physical therapist are similar to pharmacists and lawyers. In about 3 years after college, physical therapists receive either a Masters or Doctorate Degree in physical therapy. Some therapists choose to specialize in specific areas and take additional tests to certify them as board certified clinical specialists. You will find PT’s working in a variety of workplaces including outpatient clinics, hospitals, skilled nursing homes, home health care and with athletes and sports teams.

I believe the two most important concepts we emphasize in physical therapy are movement and function. Healthy movement is the ability to move freely without pain and restrictions. When we stop moving, or move poorly or un-evenly, our bodies will pay for it sooner or later. The old saying: ‘use it or lose it’ is so true. Healthy function is when we can live, work, and play without pain or injury.

As physical therapists we are trained to diagnose and treat movement problems. We seek out the source of the problem and strive to restore proper movement and balance in our patients. It is a process that can take some time, but can yield long lasting results. We value our role as a conservative alternative for those looking to avoid surgery or taking medication for their problems.

For me, the most rewarding part of being a physical therapist is seeing the quality of life improve in a patient. When a patient can move better, with less pain, and return to those things that are most important to them, we are successful!

Nevada is known as a Direct Access state, which means you can see a physical therapist directly, without a physician referral. Most insurance plans have a physical therapy benefit. If you have insurance, sometimes a physician referral is required to see a physical therapist, and sometimes it is not. Check your plan or call the clinics in our area for more information. We are fortunate to have several good therapists in our community. Keep in mind that regardless of whether your physician refers you, or you come to a physical therapy clinic directly, you always have a choice of where to receive physical therapy care. We hope you choose to Get To Fit, and if you do, we promise to do all we can to help you feel better, move better and live better!

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