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A rotator cuff injury can be caused by overuse, such as lifting overhead with poor mechanics, poor posture related to desk jobs, poor weight lifting mechanics or a fall on an outstretched arm. Unrelated to an injury, rotator cuff injuries/tears may also occur from normal age related changes and arthritis of the AC (acromio-clavicular) joint.
Pain usually occurs along the back of the shoulder to the outer aspect of the shoulder and can travel down toward the elbow. Diagnoses range from impingement where you have pain with certain tasks/movements to a complete tear where you are unable to lift the arm.
Physical therapy will guide you with a comprehensive approach to strengthen the appropriate rotator cuff and postural muscles. Targeted strengthening will help decrease your symptoms of impingement and rotator cuff tendonitis.
If you have a rotator cuff repair, physical therapy will guide you through your doctor’s orders to ensure safe return to your previous level of functioning.
Frozen shoulder can be caused by disuse after an injury or have an insidious onset, leading to the tissues around the shoulder stiffening until scar tissue develops. This stiffness significantly impacts range of motion and causes pain.
It is typically more common in females than males, especially women over 40 years old. If you have diabetes you may even experience these symptoms in both shoulders. Research shows that frozen shoulder will resolve on its own in two years, but who wants to wait that long?!?
You may receive a cortisone injection to help break up the scar tissue and physical therapy can help you get your mobility and function back in the fraction of that time!
Total Shoulder Replacement
Similar to other joint replacements, shoulder replacements are indicated for someone with severe arthritis in the shoulder joint. There are two kinds: a traditional total shoulder replacement and a reverse total shoulder replacement.
The traditional replacement is meant for individuals with arthritis and an intact rotator cuff. A Reverse replacement is meant for individuals with arthritis and no intact rotator cuff.
The reverse method actually changes the mechanics of the shoulder joint to allow you to still have functional motion despite lacking a proper rotator cuff.
While you will have some precautions following surgery, when allowed by your Doctor, physical therapy will help you safely regain your motion and improve your strength. It is a slow process, but retraining that shoulder through physical therapy will allow you to have functional use of that arm.
Shoulder bursitis is characterized by an inflammatory process occurring at the bursa (fluid filled sack that sits under a gathering of tendons). Repetitive movements and stress or trauma can lead to shoulder bursitis.
Often times, a cortisone injection can help decrease the inflammatory response. Physical therapy is extremely important to help decrease the stress occurring at the bursa by restoring appropriate strength and flexibility to the shoulder joint.
Slow progressions are important so that the bursa does not become re-inflamed.
Tendonitis in the shoulder is common in the rotator cuff and biceps tendons, characterized by an acute inflammatory process in the tendon. When this becomes a chronic issue, it is called Tendonosis. These injuries can occur from repetitive and overuse injuries or trauma such as lifting a heavy load overhead.
Impingement can also lead to symptoms of tendonitis, because there is increased friction on the tendon due to a decreased space for the tendons to pass through. Increased stressors typically occur when performing overhead activities.
Rest, ice and anti-inflammatory medications can help decrease pain during the acute phase, however physical therapy is also critical to restore proper strength of the shoulder blade and restore normal mobility to avoid any reoccurrence.
Individuals who spend a lot of time on their computer or have a desk job may experience numbness and tingling in the hands.
Individuals with hobbies such as knitting that require fine motor skills and repetition are also predisposed.
Physical therapy techniques can help improve tissue quality and decrease compression on the nerve.
Lateral Epicondylitis (Tennis Elbow)
Tennis Elbow produces a painful gripping on the outside of the elbow as a result of repetitive sport requiring grip, such as tennis.
It is also symptomatic in individuals using their hands a lot, notably power tools, such as mechanics.
Physical therapy can help you strengthen the appropriate musculature to help ensure the forces placed on the tendon are dispersed appropriately.
Manual techniques such as Graston will also help improve the flexibility of the tissue. A brace can help for the short-term while you correct the underlying deficits in physical therapy.
Medial Epicondylitis (Golfer’s Elbow)
Golfer’s elbow produces painful gripping on the inside of the elbow, most common in bowlers and golfers.
Similar to the above diagnoses, repetitive movements worsens the condition and rest is strongly recommended to help promote tissue healing.
Physical therapy can help improve the tissue flexibility to decrease excess stress on the tendon. This in association with proper strengthening will ensure you can get back to the sport your love pain-free!
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A total hip replacement is intervention for individuals that have had functionally limiting pain due to arthritis.
The hip joint is a ball-and-socket joint, like a golf ball on a tee, so restoring normal motion is typically an easy process since the joint has an abundance of movement.
There are two surgical approaches: through the front of your hip or the side/back of your hip. Each approach has different precautions, and your surgeon will dictate if/for how long you will have precautions.
Glute weakness is very evident after a hip replacement leading to difficulty with functional mobility such as stairs and walking. Physical therapy interventions can help target your specific weakness to get your back to your daily routine.
Hip Bursitis/ITB Syndrome
Hip Bursitis is a result of weakness in the hips and core. It leads to unnecessary stress on the IT Band and friction of the tendons, resulting in inflammation of the tendon and the bursa (fluid filled sac) that sits under those tendons.
Rest is highly recommended from activity/sport to allow the inflammatory process to calm down while addressing strength and flexibility imbalances through physical therapy.
Glute med strength is extremely important as weakness in this muscle leads to overuse of the ITB for stability in the hip and knee.
Physical therapy will focus on strengthening of the glute med muscle in addition to the surrounding hip and core stabilizers.
FAI (femoral-acetabular impingement) will occur when either the ball or socket of the hip joint are oversized. When the bony surfaces are too big for the surface it connects to, impingement symptoms occur.
Patients typically complain of pain around the hip and use a C-shaped hand around the hip to describe their pain. This bony overgrowth leads to excessive stress on the labrum of the hip and can lead to a labral tear for many patients.
Labral tears can also occur from a twisting and pivoting movement and is a common injury in hockey players. Labral symptoms include catching and clicking associated with deep pain in the hip.
Core stability is extremely important to help you manage your symptoms of a labral tear/hip impingement. Ensuring that the body has appropriate control of the pelvis and lower lumbar spine through physical therapy can help maintain a neutral pelvic position and decrease excessive stress on the hip joint.
An ACL injury occurs when planting the leg with a decelerating, cutting, or jumping movement, resulting in instability of the knee.
70% of ACL injuries are non-impact, meaning the individual is not hit, and 50% of the injuries occur with an MCL and meniscus injury.
You may experience symptoms of the knee giving way after an ACL injury and many individuals require operative repair of the ACL to allow you to return to an active lifestyle.
Physical therapy will help you get your motion back and maximize your quadriceps, hip and core strength to prevent future injury.
Physical therapy will safely guide you through the protocol provided by your doctor to get you back to your daily routine or the sport that you love.
There are two types of knee replacements: partial and total. A partial replacement is a replacement of one side of the knee due to arthritis.
A total replacement is a replacement of the whole knee, including resurfacing of the patella, due to arthritis.
It is EXTREMELY important to maintain early motion through physical therapy to limit scar tissue development and restore normal motion and function.
A meniscus injury is a painful clicking and locking in the knee that makes it very painful to twist and turn. Depending on the location of a tear, surgical intervention may be able to repair the tear.
Research shows that individuals younger than 40 years old are more likely to have success with a meniscus repair. Other surgical intervention involves simply cutting out the piece of torn tissue to decrease your symptoms of clicking/locking.
Many individuals are successful with non-operative treatment of a meniscus injury through physical therapy. Physical therapy will focus on maintaining your mobility and improving your strength to decrease stress on the knee and symptoms of clicking/locking.
ITB (iliotibial band) syndrome is caused by unnecessary stress on the IT Band and friction of the tendons, resulting in inflammation of the tendon near the outer knee or the hip. Rest is highly recommended from activity/sport to allow the inflammatory process to calm down while addressing strength and flexibility imbalances in the hip and knee through physical therapy.
Patellar tendonitis is a common diagnosis when the patient presents with front of the knee pain. It is a more common diagnosis in females due to alignment of their body with wider hips and decreased quadriceps strength compared to males.
Patellar tendonitis is commonly an overuse injury, occurring with repetitive tasks and/or sports and is most frequently diagnosed in individuals who participate in a jumping sport. Decreasing the stress on the quadriceps by focusing on glute strengthening in physical therapy will help decrease your pain.
A subluxing patellar is extremely painful and usually occurs in the same method of injury as an ACL tear. With a valgus force, the knee is twisted and buckles inward. This force can be placed on the knee either from an external force or twisting movement, and the kneecap may be pushed out of the groove it sits in.
Swelling under the knee cap and throughout the knee will occur and inhibit the quadriceps muscle, so physical therapy is important to restore the quadriceps strength to limit buckling and giving way of the knee.
Once you have subluxed the kneecap once, you are further predisposed to experience this injury again without proper physical therapy and continued strengthening.
Quad Tendon Repair
A quad tendon tear occurs from a traumatic injury, including a fall with the leg caught behind you. Repair to this tendon requires ample healing time, so you will be placed in a Bledsoe brace from the top of the thigh to the middle of the shin to ensure that the tissue is well protected.
It is important to progress your range of motion as allowed by your Doctor’s orders and your physical therapist can help guide you through this process. Maintaining strength in the knee, hip and core through physical therapy is critical to helping you return to your previous level of functioning.
A bulging or herniation of one or more discs in the neck can cause pain when the disc presses on a nerve.
This can cause pain that radiates to the shoulders, back or arms. In most cases, the pain is resolved with physical therapy and pain management treatments.
If you have surgery to remove the damaged disc, physical therapy will guide you through your doctor’s orders to ensure safe return to your previous level of functioning.
This occurs when the vertebral canal in the neck becomes narrow. As a result, the nerves and spinal cord become compressed and pain develops.
Spinal stenosis is often the result of aging and is common in people over the age of 50. A number of treatments by a physical therapist can help improve the condition of your neck.
Cervical osteoarthritis is a degenerative condition that can cause neck pain and stiffness. Sometimes confusion is created when general terms are used interchangeably to refer to cervical osteoarthritis, including cervical spondylosis, degenerative joint disease, or simply neck arthritis.
The disease is present when the articular cartilage within the facet joints has deteriorated, both due to age-related water loss and the breakdown of protein fibers. As cartilage wears away and raw bone rubs against bone, painful inflammation develops, causing bone spurs to form.
Bone spurs may compress surrounding cervical spinal nerves, resulting in pain and other symptoms. Symptoms of weakness, throbbing and tingling can spread through the shoulders, arms and hands. In some cases, inflammation of the lubricating agent of the spinal joints can cause additional inflammation and/or headaches.
Physical therapy will help to restore the proper alignment and movement resulting in decreased pain and improved mobility and posture.
Whiplash, also called neck sprain or neck strain, is injury to the neck. Whiplash is characterized by a collection of symptoms that occur following damage to the neck.
In whiplash, the joints, discs, ligaments, cervical muscles, and nerve roots may become damaged. Whiplash is caused by an abrupt backward and/or forward jerking motion of the head, often as a result of a car accident or impact to the head.
Sports injury and falls are also common reasons for neck strain. Symptoms of whiplash may be delayed for 24 hours or more after the initial trauma.
People who experience whiplash may develop pain and stiffness usually within the first few days after the injury. In the past, whiplash injuries were often treated with immobilization in a cervical collar.
However, the current trend is to encourage early movement instead of immobilization. Ice is often recommended for the first 24 hours, followed by gentle, active movement and physical therapy.
A pinched nerve occurs when there is “compression” (pressure) on a nerve. Nerve compression often occurs when the nerve is pressed between tissues such as ligament, tendon or bone. Inflammation or pressure on a nerve root exiting the spine may cause neck pain.
It may also cause pain to radiate from the neck into the shoulder and arm. This condition is called cervical radiculopathy. How long it takes for symptoms to end can vary from person to person.
Treatment varies, depending on the severity and cause of the nerve compression. Physical Therapy can help to stretch and strengthen the muscles to relieve the pressure on the nerve.
A tension headache is the most common type of headache. It is pain or discomfort in the head, scalp, or neck, and is often associated with muscle tightness in these areas.
Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to poor posture, stress, depression, head injury, or anxiety.
They may occur at any age, but are most common in adults and older teens. Any activity that causes the head to be held in one position for a long time without moving can cause a headache.
Activities may include typing or other computer work, fine work with the hands, and looking down at your smart phone. To prevent tension headaches, learn and practice stress management.
Some people find relaxation exercises or meditation helpful. Practice good posture when reading, working, or doing other activities.
Exercise the neck and shoulders frequently when working on computers. A physical therapist will prescribe the proper exercises to relieve the tension and give training for improved posture.
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Plantar Fasciitis leads to very painful first steps in the morning that usually subsides gradually with movement.
Tightness in the calf and Achilles tendon leads to excess stress on the structures on the sole of the foot (the plantar fascia).
Restoring ankle/foot mobility and flexibility through physical therapy helps decrease this stress.
With ankle sprains, you may experience pain on the outside of the ankle in addition to weakness and instability of the ankle.
A lace-up brace typically helps manage symptoms and pain initially until you’ve become stronger and more stable with physical therapy exercises.
Proprioception and balance training exercises during physical therapy are necessary to increase the stability of your ankle joint.
Achilles Tendon Tear
Achilles tendon tears typically occur from a forceful landing position. While partial tears have been seen in patients such as runners, it requires a decent amount of force to fully rupture the tendon.
A patient will be unable to push up on their toes with a full tear,while it will be painful and weak with a partial tear or Achilles tendonitis (inflammation of the tendon).
With an Achilles tendon repair you will be in a walking boot so that you are unable to press up on the toes. This is to ensure that the tendon is given time to heal properly.
Through physical therapy we will safely progress you by your Doctor’s orders out of the boot and help you regain your strength to return to normal mobility.