Category Archives: Physical Therapy

ACL Tears – Devastation With Hope

Posted May 26, 2015 by Fit PT

It seems we hear a lot about ACL tears now days. High profile athletes such as Adrian Peterson, running backs for the Minnesota Vikings, and Robert Griffin III, Quarterback for the Washington Redskins have suffered this injury and made successful comebacks.

So just what is the ACL and why does it seem to be such a common injury?   The ACL is the acronym for the Anterior Cruciate Ligament (no wonder we just say ACL!) It is one of the four main ligaments of the knee. Like all ligaments, it is a tough band of tissue that connects two bones in an effort to stabilize and coordinate motion at a joint.

Specifically, the ACL connects the bottom, flat end of the femur- or thigh bone- to the top, flat end of the tibia or shinbone.  By doing so it prevents the tibia from slipping forward relative to the femur, thus helping to keep the upper and lower legs in one line.

The ACL also helps the tibia resist internal rotation, or being twisted inwards.   Without an intact ACL, walking becomes extremely difficult, the knee feels unstable, and motions that cause inward rotation of your lower leg, such as changing directions or planting can cause the knee to collapse under the player’s own weight.

So how does the ligament become torn?  (Queasy stomachs beware!)

Any motion or force that forces the lower leg to sharply turn inward or move forward can cause an ACL rupture. It can tear if you twist your knee while keeping your foot planted on the ground, if you stop suddenly when running, if you jump and land on a extended or straight leg, or experience a direct hit to the knee.

When an ACL tears, players often report hearing or feeling a “pop” in the knee.  Severe pain and significant swelling is not far behind.   Then come the tears because a torn ACL means a trip to see the orthopedic surgeon.

In general, ligaments do not heal well on their own, and completely torn ACL’s generally do not heal at all.  In fact, reconstructive surgery actually involves replacing the ligament altogether. To do so, surgeons typically remove a piece of muscle tendon from elsewhere in the patients body, called a “graft”, and use it to serve as a new ACL. It’s actually pretty dang amazing what these doctors can do!

Some orthopedic surgeons refer their patients to physical therapy for a short course of rehabilitation before surgery. The goals of therapy at this point are to decrease swelling, and increase range of motion and strength of your knee as much as possible.

Following surgery an athlete will work with physical therapists to slowly regain strength and range of motion as the body cements the new ACL into place. The entire rehab process usually takes between nine to twelve months.

You know the prognosis for a full recovery is good following an ACL repair when you see Adrian Peterson or RG III running and cutting up the field. As with any successful rehab of this sort, these guys undoubtedly worked amazingly hard to get back to where they are today. They are great examples that show that even after a devastating injury such as an ACL tear, athletes, with the help of amazing surgeons, and dedicated therapists can and do get back to action!

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Total Knee Replacement

Posted April 27, 2015 by Fit PT

Walk into our therapy clinic at any given time and chances are you will find someone who is rehabbing a “new knee” It is one of the most common conditions we treat in therapy. It has rightfully earned the reputation for being one of the most difficult, but important conditions to rehabilitate after surgery.

Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.

The knee is the most commonly replaced joint in the body. The knee joint takes the brunt of force with movement, and is prone to injury and especially to arthritis as we age. Often, conservative measures are taken before surgical consideration. The first line of treatment of knee arthritis includes activity modification, anti-inflammatory medication, weight loss and physical therapy. When conservative measures do not relieve the pain then a joint replacement surgery is an option.

I am a firm believer that a little physical therapy before your surgery can go a long ways in making your recovery smoother and speedier. The better physical shape you are in before knee replacement surgery, the better your results will be (especially in the short term).

Before surgery, your physical therapist will teach you exercises and show you how you will walk with assistance after your operation. Your therapist also will discuss precautions and home adaptations, such as removing loose rugs or strategically placing a chair so that you can sit instead of squatting to get something out of a low cabinet. It’s always easier to make these modifications before you have surgery.

If you smoke, quit! That may help improve your healing after surgery. If you are overweight, focus on weight loss prior to surgery. Losing excess body weight may help you recover more quickly, and help improve your function and overall results following surgery.

An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and cannot do.

More than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you could before you developed arthritis.

With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports for the rest of your life after surgery.

Realistic activities following total knee replacement include unlimited walking, swimming, golf, light hiking, biking, ballroom dancing, and other low-impact sports. With appropriate activity modification, knee replacements can last for many years.

Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following the directions of your orthopedic surgeon and physical therapist are important and will contribute to the final success of your surgery.

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Fall Prevention

Posted March 25, 2015 by Fit PT

A popular television commercial shows an elderly woman who has fallen on the ground and cry’s out: “Help, I’ve fallen and can’t get up!”.

In physical therapy we see the consequences of those falls. Broken bones, head injuries and bad bumps and bruises are some of the effects of falling. These patients come to our clinic after they have fallen, but I always feel disappointed because often the fall could have been prevented with appropriate fall prevention and awareness.

Falls can diminish your ability to lead an active and independent life. Statistics show that about one third of people over the age of 65 and almost half of people over the age of 80 will fall at least once this year. The fact is most people over the age of 65 are at some sort of fall risk and should have it addressed.

There can be many reasons someone falls, but there are certain risk factors that can significantly increase the chance you will take a tumble. These reasons include:

  • Leg muscle weakness
  • Difficulty with balance or walking
  • Vision problems (cataracts, macular degeneration, wearing bifocals)
  • Medical conditions that limit your ability to get around, such as Parkinson disease, stroke, or diabetes
  • Conditions that cause confusion, such as dementia and Alzheimer disease
  • Taking more than 4 medications at the same time or taking sedatives or antidepressants
  • Using a cane or other walking device
  • Home hazards (throw rugs, pets underfoot)
  • Low blood pressure

Fortunately, there is help available and often requires a team approach between a physical therapist trained in balance and vestibular problems, an audiologist trained in specific balance testing, and your medical doctor. A good exam will take an in-depth look at your medical history, home environment, strength and mobility and will use specialized balanced and testing equipment to pin point the specific causes of your balance problems.

Based on the evaluation results, your physical therapist will design an exercise and training program to improve your balance and strength.

Balance training has been shown to be an important and effective part of falls prevention. At FIT Physical Therapy we design exercises that are designed to challenge your ability to keep your balance.  These exercises such as single-leg standing, balance boards and obstacle courses are very effective in preparing your body to stay steady in the variety of environments you live and function in.

Vestibular exercises are vital to do if your vestibular system is at all involved (which it is in most cases). These are highly specialized exercises combining head and body movements that help strengthen a weak or ineffective vestibular system.

Whole body strengthening exercises are a key element of fall prevention when they are done in conjunction with balance training. Ideal strengthening exercises will focus on your legs and the muscles used in maintaining posture.

Aerobic exercise is physical exercise of relatively low intensity and long duration; it can help improve almost every aspect of your health. Walking is one of the safest forms of aerobic exercise, no matter what kind of problem you have.

Remember the saying, an ounce of prevention is worth a pound of cure when it comes to balance and falls. If this is a concern to you or a loved one, seek out the assistance of qualified health care providers, before you’ve fallen and can’t get up!

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Cold or Heat Therapy

Posted February 19, 2015 by Fit PT

The use of hot and cold treatments for pain and injury has been around a long time. In therapy clinics we use both all the time to help decrease pain and swelling after injury. There are lots of products available that offer hot and cold treatment– from fancy jetted hot tubs to a bag of frozen peas. Which products are best? How do you know when to put ice or heat on after an injury? Well let’s dive into the world of what we call in therapy– thermal agents.

To understand the appropriate application of ice and heat it is important that there are two basic types of injuries: acute and chronic.

Acute injuries are sudden, sharp, traumatic injuries that occur immediately (or within hours) and cause pain (possibly severe pain). Most often acute injuries result from some sort of impact or trauma such as a fall, sprain, or collision and it’s pretty obvious what caused the injury.

Chronic injuries on the other hand, can be subtle and slow to develop. They sometimes come and go, and may cause dull pain or soreness. They are often the result of overuse, but sometimes develop when an acute injury is not properly treated and doesn’t heal.

Cold therapy with ice is the best immediate treatment for acute injuries because it reduces swelling and pain. Ice is a vaso-constrictor (it causes the blood vessels to narrow) and it limits internal bleeding at the injury site.
To ice an injury, wrap ice in a thin towel and place it on the affected area for 10 minutes at a time. Allow the skin temperature to return to normal before icing a second or third time. You can ice an acute injury several times a day for up to three days.

Cold therapy is also helpful in treating some overuse injuries or chronic pain in athletes. For example, an athlete who has chronic knee pain that increases after running may want to ice the injured area after each run to reduce or prevent inflammation.

The best way to ice an injury is with a high quality ice pack that conforms to the body part being iced. That bag of frozen peas can make an effective ice pack! Also, an ice massage with water frozen in a paper cup (peel the cup down as the ice melts) is an effective way to ice an injury, especially in a smaller injury area.

Heat is generally used for chronic injuries or injuries that have no inflammation or swelling. Sore, stiff, nagging muscle or joint pain is ideal for the use of heat therapy. Athletes with chronic pain or injuries may use heat therapy before exercise to increase the elasticity of joint connective tissues and to stimulate blood flow. Heat can also help relax tight muscles or muscle spasms. Don’t apply heat after exercise. After a workout, ice is the better choice on a chronic injury.

Because heat increases circulation and raises skin temperature, you should not apply heat to acute injuries or injuries that show signs of inflammation. Safely apply heat to an injury 15 to 20 minutes at a time and use enough layers between your skin and the heating source to prevent burns.

Moist heat is best, and what we use most often in therapy clinics. If you don’t have a jetted hot tub at home you could try using a hot wet towel or a hot shower. You can buy special athletic hot packs or heating pads if you use heat often. Be careful to never leave heating pads on for more than 20 minutes at a time or while sleeping.

Because some injuries can be serious, you should see your doctor and/or therapist if your injury does not improve (or gets worse) within 48 hours.

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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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