- Your Bridge to Health -

2019 Literature Review part 2: shoulder, wrist, and hand pain
December 10, 2019

We distribute newsletters every week to educate you—our patients—on some of the most common injuries and conditions that we treat, and to explain why we always recommend seeing a physical therapist first when dealing with any type of pain. In working towards this goal, we also regularly summarize research studies that show how physical therapy typically leads to the best possible outcomes, and how it helps patients avoid surgery and other costly or unnecessary treatments in the process.

With the end of the year approaching, we’d like to look back at some of our favorite study summaries of 2019 in a four—part newsletter series with each one focusing on a different topic or region of the body. In part 2, we review research on physical therapy for wrist pain, hand pain, and shoulder pain.

Wrist and hand pain

Pain in the wrist or hands can result from a number of different causes. Some conditions (like carpal tunnel syndrome) develop from performing the same movements over and over, while others (like rheumatoid arthritis) are based on a more complex process that is largely uncontrollable. Injuries like wrist sprains and broken fingers are also fairly common, especially in athletes and active individuals.

Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial (2019)

  • Background: carpal tunnel syndrome (CTS) is a common condition caused by a pinched nerve in the wrist, which usually leads to numbness, tingling and weakness in their affected hand; it can be treated either surgically or non—surgically with interventions like physical and manual (hands—on) therapy
  • How the study was conducted: 103 patients with mild or moderate CTS underwent either a manual therapy program or no treatment (control group) for 10 weeks
  • What the results showed: the manual therapy group experienced significantly greater improvements than the control group in several outcomes, with lower pain scores, reduced symptoms, and better functional status
  • Take—home message: patients with CTS should seek out care from a physical therapist first to receive manual therapy, as it may lead to notable improvements and help them avoid surgery

Hand exercises for patients with rheumatoid arthritis: an extended follow—up of the SARAH randomised controlled trial (2017)

  • Background: rheumatoid arthritis (RA) is a debilitating long—term disease that often leads to pain, fatigue, and less mobility, especially in the hands; physical therapy with stretching and strengthening exercises is often suggested as an effective intervention for these patients
  • How the study was conducted: a follow—up analysis was performed on an original study of 490 RA patients that received either a personalized exercise program—consisting of strengthening and stretching exercises—or no treatment (control); the original study identified improvements from this program, and the follow—up was intended to see if these improvements lasted in the long term
  • What the results showed: even though patients gradually performed fewer exercises (which they were instructed to complete regularly), they still showed better hand function scores compared to the control group for up to two years
  • Take—home message: a strengthening and stretching exercise program can lead to long—term improvements in RA, so patients with this condition are advised to visit a physical therapist to begin treatment

Shoulder pain

The shoulder is a complex ball—and—socket made up of two joints. It is extremely mobile and allows the arm to rotate almost 360°, but this comes at a cost, as it’s also one of the most commonly injured areas of the body. Up to 26% of the general population is dealing with shoulder pain at any given point in time, with a higher concentration in those who regularly perform overhead movements (like painters, baseball players, and tennis players). Shoulder pain can come about immediately or develop gradually, with certain conditions being more likely to arise in older age.

EXERCISE THERAPY IN THE NON—OPERATIVE TREATMENT OF FULL—THICKNESS ROTATOR CUFF TEARS: A SYSTEMATIC REVIEW (2018)

  • Background: the rotator cuff is a group of muscles and tendons in the shoulder that allows arm motion, and it’s often injured or torn in overhead sports like baseball; it’s not completely clear if surgery or non—surgical treatments like physical therapy and exercise are better for complete—or full—thickness—tears
  • How the study was conducted: a systematic review was performed, which collects and analyzes all related research on a single topic; 35 studies—including nine high—quality studies called randomized—controlled trials (RCTs)—were included in this review, all of which evaluated the effectiveness of exercise for treating full—thickness rotator cuff tears
  • Results: all of the RCTs showed that exercise was effective, as it led to an 86% reduction in pain, an 83% improvement in range of motion, an 89% improvement in strength, and an 85% improvement in function
  • Take—home message: patients with rotator cuff tears should attempt a course of physical therapy first before considering the option of surgery, as an exercise—based intervention can lead to various improvements

In our next newsletter, we review our top summaries on studies that cover knee pain, ankle pain, and foot pain.

2019 Literature Review part 1: neck, back, and jaw pain
December 3, 2019

We distribute newsletters each week to help educate you—our patients—on some of the most common injuries and conditions that we treat, and to explain why we always recommend seeing a physical therapist early when dealing with any type of pain. In working towards this goal, we also regularly summarize research studies that show how physical therapy typically leads to the best possible outcomes, and how it helps patients avoid surgery and other costly or unnecessary treatments in the process.

With the end of the year approaching, we’d like to look back at some of our favorite study summaries of 2019 in a four—part newsletter series, with each one focusing on a different topic or region of the body. In part 1, we review research on physical therapy for neck pain, back pain, and issues with the jaw called temporomandibular disorders.

Neck pain

Of all conditions that cause disability, neck pain ranks fourth. It’s estimated that about 30% of adults experience neck pain each year, and up to 70% will deal with it at least once in their lifetime. A number of conditions can cause neck pain—including strains and sprains, osteoarthritis, spinal stenosis, a and herniated disc—but the end result is usually a limited ability to function normally.

Timing of physical therapy consultation on 1—year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort (2018)

  • Background: physical therapist—led interventions like hands—on (manual) therapy and stretching and strengthening exercises are commonly recommended for neck pain, and research suggests that the timing of when a patient starts treatment will affect their costs and use of other healthcare services
  • How the study was conducted: 308 patients with neck pain who underwent physical therapy were placed into one of three groups based on when they first consulted with the therapist; these groups were early consultation (started treatment within 14 days), delayed consultation (within 15—90 days), or late consultation (within 91—364 days)
  • What the results showed: patients who consulted with a physical therapist early saved about $2,172 compared to the late physical therapy group and $1,063 compared to the delayed physical therapy group; the early physical therapy group also showed a lower risk for being prescribed opioids and having injections or imaging tests compared to the late treatment group
  • Take—home message: the timing of physical therapy makes a difference, and patients with neck pain are urged to start sooner rather than later in order to reap the greatest benefits at the lowest costs

Back pain

Back pain—especially low back pain (LBP)—is even more common than neck pain. LBP actually ranks as the most common painful condition and the number one cause of disability in the U.S. Recent statistics have shown that about 25% of the population has been affected by LBP for at least one full day within the past three months, about 80% of people will experience it at some point. While most cases of LBP will improve after some time, some patients are affected by persistent—or chronic—pain that lasts for several months or longer.

Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs (2018)

  • Background: although physical therapy is recommended for patients with LBP, not all patients start treatment right away, and this delay may affect what other healthcare services (like tests and other treatments) they end up using
  • How the study was conducted: the medical records of 46,914 LBP patients were divided into five groups depending on whether they received physical therapy and when treatment started; these groups were 1) no physical therapy, 2) immediate physical therapy (treatment started within three days), 3) early physical therapy (4—14 days), 4) delayed physical therapy (15—28 days), 5) late physical therapy (29—90 days); the amount of healthcare these patients used and the associated costs were then compared between groups
  • What the results showed: the longer patients waited to begin physical therapy, the more healthcare services they used and the higher the costs of their treatment; seeing a physical therapist immediately or early was associated with the lowest costs and healthcare usage
  • Take—home message: patients with LBP are encouraged to see a physical therapist sooner rather than later, as doing so will likely lead to better outcomes and lower costs

Comprehensive Nonsurgical Treatment Versus Self—directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial (2018)

  • Background: lumbar spinal stenosis (LSS) is a common condition in which the space that surrounds the spinal cord narrows, which can cause pain and weakness in the lower back, buttocks and thighs; most patients with LSS are treated with conservative care like physical therapy, but more research is needed on its effectiveness
  • How the study was conducted: 99 patients with LSS were randomly assigned to undergo either a conservative treatment that included exercise, education, and manual (hands—on) therapy, or self—care, which did not include any specific interventions; patients’ walking ability, pain, and function was assessed for up to 12 months
  • What the results showed: patients who completed the conservative treatment program experienced significantly greater improvements than the self—care group in walking ability, pain, and function that lasted into the long term
  • Take—home message: since conservative treatment that includes physical therapy was beneficial, patients who have LSS should strongly consider seeing a physical therapist to reduce their pain levels and improve their functional abilities

Temporomandibular disorders

The temporomandibular joint connects the part of the skull directly in front of the ears (temporal bone) to the lower jaw (mandible). It allows you to move your jaw up and down and from one side to the other, which is necessary for talking and chewing. Temporomandibular disorder—or TMD—is a general term used to describe a variety of conditions that cause pain and dysfunction of this joint, which can lead to problems moving the jaw.

The effectiveness of exercise therapy for temporomandibular dysfunction: a systematic review and meta—analysis (2017)

Background: physical therapy and exercise—based interventions (exercise therapy) are frequently used for TMDs, but the research is mixed as to how effective exercise therapy is for these disorders

How the study was conducted: a systematic review and meta—analysis was performed, which collects and analyzes research on the same topic; six high—quality studies called randomized—controlled trials were included, all of which compared exercise to other treatments or placebo for patients with TMDs

What the results showed: patients who underwent exercise therapy experienced moderate short—term benefits of reduced pain and improved flexibility compared to other treatments; a mixed approach to exercise therapy may be associated with the best outcomes

Take—home message: exercise therapy appears to be effective for TMDs, and patients with these conditions should therefore see a physical therapist to begin this type of treatment program

In our next newsletter, we review our top summaries on studies that cover shoulder pain, wrist pain, and hand pain.

Better results and lower costs by seeing a physical therapist early
November 26, 2019

Evidence on use of physical therapy during an initial episode of low back pain is mixed

Low back pain (LBP) is one of the most common health conditions, as about 65-80% of adults will experience it at some point in their lifetime. Many treatment options are available for LBP, and as a result, there is significant variation in how these patients are managed. Physical therapy has long been regarded as an effective treatment for patients with LBP, but some disagreement exists regarding its benefits, and not all international guidelines recommend it. In addition, evidence on the use of physical therapy for an acute episode of LBP—meaning it’s lasted for less than four weeks—is mixed. For these reasons, a study was conducted to evaluate the relationship between physical therapy and the use of other treatments for patients with back pain. The study particularly focused on the timing of therapy and if seeing a physical therapist sooner rather than later had an impact on their use of other healthcare services.

Patients are categorized into three groups based on when they accessed physical therapy

The researchers looked through a large database to identify the medical records of patients over the age of 66 who received treatment for LBP over a one-year period. This process led to a total of 431,195 patients being included in the analysis. Once these records were collected, patients were primarily grouped based on the amount of time between their first visit with a doctor for LBP and their first physical therapy visit. The acute treatment group consisted of patients who saw a physical therapist within four weeks, the subacute treatment group saw a physical therapist within four weeks to three months, and the chronic treatment group did so in 3-12 months. For each patient, the researchers counted the episodes of surgery, injections, and back-related doctor visits that occurred after the initial doctor visit to determine if there was an effect of the timing of physical therapy.

Low back pain patients should start physical therapy early to avoid other treatments

The results showed that in total, only 16.2% of patients received physical therapy within one year of seeing a doctor for LBP. Of these patients, 52% received physical therapy in the acute period, 18.1% received physical therapy in the subacute period, and 29.9% received physical therapy in the chronic period. Lastly, 11.9% of patients overall received an injection and 3.1% underwent surgery for their pain. Further analysis revealed that there was a significant reduction in the likelihood of having surgery in the acute and subacute groups compared to the chronic group. There was also a lower chance of having an injection, and a reduction in the number of doctor visits for LBP in the acute and subacute groups compared to the chronic group. Lastly, it was found that patients who started physical therapy in the acute period had the lowest risk of receiving these other interventions and frequent doctor visits, followed by those in the subacute group, and then the chronic group.

These findings suggest that patients who start physical therapy within four weeks of seeing a doctor for LBP are likely experiencing improvements, and therefore do not need to continue seeing a doctor or have other treatments like injections or surgery. Although it was not discussed in the study, this can also mean lower costs for patients, as surgery is an expensive intervention that may only lead to similar outcomes when compared to physical therapy. For these reasons, patients with LBP are strongly encouraged to see a physical therapist, preferably as soon as possible. Following this route will increase their chances of experiencing a successful outcome while avoiding other risky and expensive interventions. Patients should also consider seeing a physical therapist now in order to get the most out of their healthcare plan. As the year winds down, it’s recommended that everyone with a health insurance policy reviews it and checks on the current benefit status. For those who have already met their deductible or out-of-pocket maximum for 2019, co-pays will likely be lower or non-existent on physical therapy visits for the rest of the year, before deductibles renew on January 1, 2020.

-As reported in the April ’12 issue of Spine

Seeing a physical therapist first can lead to better results
November 19, 2019

Some patients may put off going to physical therapy for any number of reasons, sometimes for an extended amount of time. Individuals might believe that their condition will improve on its own, that treatment is too expensive for their budget, or they may not be aware that physical therapy is even an option at first. Whatever the reasoning behind it, delaying physical therapy is actually quite common, but those who wait are missing out on unlocking the full potential of its benefits. These examples should make it clear that physical therapy is a great overall choice for injuries and painful conditions, but when you see a physical therapist is another important factor that can affect what happens next.

For any type of pain or physical limitation, consulting a physical therapist first means that patients will be getting started on their path to recovery right away. As a result, these patients have generally been found to have better outcomes and a lower chance of needing other interventions compared to patients who either don’t undergo physical therapy or delay starting it. For patients that initiate physical therapy early these benefits are even greater. What follows is a selection of studies that display how seeing a physical therapist as soon as possible can lead to lower costs and better results in the long run:

The Effect of Timing of Physical Therapy for Acute Low Back Pain on Health Services Utilization: A Systematic Review (2019)

  • How the study was conducted: this study was a systematic review, which collects and analyzes the findings of several studies on the same topic; in this case, 11 studies were evaluated that investigated the association of early physical therapy and the use of healthcare services compared to delayed therapy or usual care
  • What the results showed: early physical therapy was found to improve healthcare efficiency and reduce the overall use of healthcare services and opioids, as well as the overall costs of treatment

The Influence of Patient Choice of First Provider on Costs and Outcomes: Analysis From a Physical Therapy Patient Registry (2018)

  • How the study was conducted: researchers evaluated the medical records of 603 patients with neck and back pain to costs and patient outcomes between those who accessed physical therapy directly and those who were referred by another medical professional
  • What the results showed: all patients improved in pain and disability, but patients who saw a physical therapist directly displayed significantly lower costs than those who were referred through a traditional model of care

Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort (2018)

  • How the study was conducted: researchers divided 308 patients with neck pain into different groups depending on when they consulted a physical therapist, with an early consultation being within 14 days, a delayed consultation being within 15-90 days, and a late consultation being within 91-364 days
  • What the results showed: early physical therapy was also associated with an average savings of $2,172 on healthcare costs over one year compared to late physical therapy, as well as a lower risk for patients being prescribed opioids, having a spinal injection, or undergoing an imaging test

If you’re dealing with any sort of pain and have been thinking about seeing a physical therapist, now is a great time of the year to do so in order to get the most out of your healthcare plan. As the year winds down, we strongly recommend reviewing your health insurance policy and checking on your benefit status. If you’ve already met your deductible or out-of-pocket maximum for 2019, you will likely have a lower co-pay or possibly no co-pay on your physical therapy visits for the rest of the year, before your deductible renews on January 1, 2020.

Opioids can be avoided by seeing a physical therapist first.
November 12, 2019

Visiting a physical therapist for injuries and painful conditions is always a smart choice that can lead to similar—or better—outcomes compared to surgery, and at a lower cost. But this is just one of the numerous benefits that physical therapy can provide. Here, we break down why physical therapy is a far better treatment for pain than addictive opioids, and how it can help patients avoid these drugs when its accessed right from the start.

It’s now a well-known fact that the U.S. is in the midst of an epidemic revolving around over-prescribed pain medications, especially opioids. Although the U.S. represents less than 5% of the world’s population, it consumes more than 80% of the global supply of opioids. The number of prescriptions for opioids increased by 600% from 1997-2007, and there has been a threefold increase in the abuse of these drugs over the past few years.

These figures show just how significant a problem opioid addiction has become. Though many patients do need these medications because they have painful conditions that can’t be treated effectively with other interventions, some doctors prescribe them because they provide instant relief. In other cases, patients are prescribed opioids to help them deal with pain following surgery. Unfortunately, this can have some negative effects, too, as research has shown that patients who continue to use opioids after surgery tend to have worse outcomes than those who don’t.

Physical therapy has a much different profile than opioids, as it offers a wide range of possible benefits that far outweigh any risks involved. Narcotics like opioids are only meant to decrease one’s perception or sensation of pain, and they are not meant to address the actual cause of the pain. This is why these medications are only supposed to be used temporarily, until the pain subsides. Physical therapy, on the other hand, is always focused on identifying the origin of the pain and alleviating it with a carefully designed treatment program. When a patient sees a physical therapist before undergoing any other treatments, studies have shown they are also reducing their chances of an opioid prescription in the future. Below are a few studies that underscore this point:

Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain (2017)

  • How the study was conducted: the medical records of 454 patients with a new diagnosis of low back pain were analyzed to determine the effect of physical therapy on patients’ access of other healthcare services, including opioids
  • What the results showed: patients who participated in physical therapy had a lower chance of being prescribed opioids in the following year

Association of Early Outpatient Rehabilitation With Health Service Utilization in Managing Medicare Beneficiaries With Nontraumatic Knee Pain: Retrospective Cohort Study (2017)

  • How the study was conducted: the healthcare usage of patients with knee pain was evaluated over 12 months and categorized according to if and when they underwent physical therapy
  • What the results showed: patients who went to a physical therapist early on were found to be 33% less likely to use narcotic analgesics like opioids and 50% less likely to receive non-surgical invasive procedures than patients who did not

Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs (2018)

  • How the study was conducted: the medical records of nearly 150,000 patients with low back pain were analyzed to better understand the effects of seeing a physical therapist first
  • What the results showed: when patients saw a physical therapist initially, they had a significantly lower chance of receiving an opioid prescription compared to those who did not

We would also like to remind you that now is a great time of year to see a physical therapist to get the most out of your healthcare plan. Deductibles usually renew in the new year, so if you haven’t done so recently, review your health insurance policy and check on your benefit status. If you’ve already met your deductible or out-of-pocket maximum for 2019—or are close to meeting them—you will likely have a lower co-pay or possibly no co-pay on your physical therapy visits for the rest of the year, before your deductible renews on January 1, 2020.

Physical therapy can help avoid the expenses of surgery
November 5, 2019

Undergoing physical therapy can help avoid the expenses and potential risks associated with surgery

If you experience an injury or happen to be in pain for a long period of time, relief may eventually become your number one priority. There are many treatment options available to address these types of issues, and what’s right for you depends on several important individual factors. But in nearly every case, one thing remains true: trying physical therapy first is a smart move that will usually help you avoid other unnecessary tests and treatments.

Physical therapy is not a magical cure-all that will immediately fix any physical problem you have, but it does have an incredibly wide range of applications, and it can be used to treat patients of any age and activity level. Every physical therapy treatment program is individually tailored with each patient’s abilities and goals in mind, and by carefully guiding them with exercises and movement-based techniques, significant improvements can usually be expected after treatment is completed.

Another route that some patients may follow is to have surgery to address their injury or painful condition. Surgery has great value that can often lead to positive outcomes, and it may be necessary in certain situations, but it does come with some potential downsides as well. The cost of most surgeries is usually quite high, recovery time can be extensive, and there are also some risks involved with the procedure itself. Physical therapy, on the other hand, is universally regarded as an affordable, safe intervention with minimal to no associated risks. In addition, physical therapy can lead to similar—or sometimes better—outcomes compared to surgery, and in some cases it can actually help patients avoid the need for surgery altogether when they access it first. Below are a few studies that highlight some of the advantages of physical therapy over surgery:

How does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? A systematic review of randomised trials (2019)

  • How the study was conducted: this was a systematic review, which collects and analyzes the findings of several studies on the same topic; in this case, 12 studies were evaluated that compared surgery and physical therapy for patients with various types of tendinopathy (an injury involving a tendon)
  • What the results showed: physical therapy was found to be just as effective as surgery in the midterm and long term for reducing patients’ pain and improving their function and flexibility

Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury? (2018)

  • How the study was conducted: 105 patients with a torn anterior cruciate ligament (ACL) underwent either physical therapy or surgery to treat their injury; five years later, they were evaluated with an MRI and several other tests
  • What the results showed: after five years, there were only minimal differences between patients treated surgically compared to those who had physical therapy

Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. (2018)

  • How the study was conducted: 80 patients with a hip condition called femoroacetabular impingement syndrome were randomly assigned to undergo either surgery or physical therapy; then for two years, these patients were evaluated regularly to compare their outcomes
  • What the results showed: all patients improved significantly, there were no significant differences between the two groups after two years, and no clear advantages of surgery were found

Association of Early Outpatient Rehabilitation With Health Service Utilization in Managing Medicare Beneficiaries With Nontraumatic Knee Pain: Retrospective Cohort Study (2017)

  • How the study was conducted: the healthcare usage of patients with knee pain was evaluated over 12 months and categorized according to if and when they underwent physical therapy
  • What the results showed: patients who had early physical therapy were found to be 42% less likely to undergo surgery than those who did not

These are just a few examples in the research that show why physical therapy is a better option than surgery for any injury or painful condition you might be dealing with. We’d also like to remind you that now is a great time of year to see a physical therapist for those trying to get the most out of their healthcare plan. If you haven’t done so already, review your health insurance policy and check on your benefit status now. If you’ve already met your deductible or out-of-pocket maximum for 2019, you will likely have a lower co-pay or no co-pay at all for the rest of the year, before your deductible renews on January 1, 2020.

For patients who repeatedly sprain their ankles hands-on PT can help
October 29, 2019

Many patients who sprain their ankle once have long-term issues

Ankle sprains are the most common injury in athletes and those who are physically active. In addition to the initial pain and disability that these injuries cause, up to 41% of patients who sprain their ankle once will go on to develop a condition called chronic ankle instability (CAI). Individuals with CAI tend to experience continual pain and soreness, and a sensation that the ankle is giving out. As a result, they are more likely to sprain their ankle again, which can lead to serious long-term disability. Exercise therapy is one of the more commonly used treatments for patients with CAI, with exercises that strengthen muscles and improve balance and proprioception (the sense of knowing where one’s body is in space) being most effective. Another popular treatment is called manual therapy, in which a physical therapist moves and manipulates certain joints in specific ways to improve their mobility and alleviate symptoms. In some cases, manual therapy will target the nerves as well as the joints and soft tissue of a region. Although research has shown both exercise and manual therapy to be effective for patients with CAI, no studies have evaluated manual therapy that focuses on the nerves of the ankle. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to determine if manual therapy can provide any additional benefits to an exercise program for CAI patients.

Patients are randomly divided into two groups

Patients with CAI were invited to participate in this study and then screened with specific criteria to determine if they were eligible. This process led to 56 patients being included in the study and then randomly assigned to one of two groups: experimental group I or experimental group II. Under this design, all patients participated in an exercise program that took place for four weeks, but the experimental group II also received a course of manual therapy. The exercise program consisted of six exercises that were repeated during two sessions per week and got progressively more difficult each week. These exercises—which a physical therapist supervised—focused on strengthening the muscles surrounding the foot and ankle and improving each patient’s proprioception, which is closely related to balance. Manual therapy consisted of several techniques applied to the joints and nerves of the ankles, which lasted for 20-30 seconds each with two minutes of resting in between. All patients were assessed before each treatment program, immediately afterwards, and then one week later for a number of outcomes, including pain, strength, ankle instability, and flexibility.

Greater benefits are achieved when exercise is combined with manual therapy

One week after treatment ended, it was found that patients in both groups improved in all of the outcomes that were measured; however, patients in experimental group II experienced greater improvements than those in experimental group I. This was found to be the case in most of the measurements taken, but was particularly true for ankle instability and strength, both of which had scores that were considerably higher in the group that underwent manual therapy. These results suggest that although exercise therapy is capable of producing benefits in patients with CAI, adding manual therapy to this exercise program leads to even better overall outcomes. Individuals who suffer from CAI are therefore encouraged to see a physical therapist if this step has not already been taken. Physical therapists are movement experts that can diagnose your condition and provide you with a comprehensive, personalized treatment program involving these components that will set you up for a positive outcome.

-As reported in the December ’16 issue of Manual Therapy

For ankle/foot pain, rest, massage, and footwear adjustments are best
October 15, 2019

Try to think about all the movements that are needed to get you through a typical day. Chances are, regardless of what type of work you do or what your day consists of, you’ll notice that you probably use your feet and ankles at least a fair amount. This is even more true for active individuals, as most forms of physical activity will require some walking, running, and possibly even jumping to complete.

It’s easy to overlook the significant amount of work that the feet and ankles are doing to keep you stable and allow you to get around, but this can all change when pain enters the picture. Dealing with a sore ankle or nagging heel pain that hits you the first thing in the morning will likely alter your entire perspective and force you to make some adjustments to your daily routine to make moving easier.

Foot and ankle pain are quite common and can result from a number of different injuries, but the end result is usually a limited ability to live out your day as you’d like. For this reason, when it does strike, your next question is probably related to making it dissipate as quickly as possible. Fortunately, there are a number of steps you can take on your own to address an ankle or foot injury and get you back to full strength quickly. We recommend the following:

  • Adhere to the RICE protocol: after traumatic injuries—especially ankle sprains—your first step should always be to respond with the RICE protocol within the first 24-72 hours; doing so will relieve painful symptoms and reduce your risk for further damage to the area during this time
    • Rest: take some time to rest and recuperate immediately after the injury and avoid any activities that can aggravate your pain; this can range from a few days to a week or more, depending on the injury; for severe ankle sprains, crutches may be needed to help you avoid putting pressure on the ankle
    • Ice: in the first few days after a traumatic injury, ice is your friend, as it will slow down blood flow and reduce inflammation, swelling, and muscle spasms; start using it right after the injury and apply it for 15-20 minutes every 1-2 hours during this time
    • Compression: after an ankle sprain, wrap an elastic bandage snugly around your ankle to help reduce inflammation and swelling; for severe ankle sprains, an ankle brace may be needed, which adds further protection from future injury
    • Elevation: within the first 48 hours after an injury, elevate your foot above your head for as much time as you can manage to drain the pooling of fluids away from the region and reduce swelling, inflammation, and pain
  • Massage: if you’re experiencing pain in one particular region, massage can help by improving circulation and reducing your soreness; for plantar fasciitis—for example—rub and knead the bottom of your foot near the heel with ample pressure; using a frozen water bottle to massage your foot is doubly effective because it also applies cold therapy to the area
  • Add shoe inserts: also known as insoles, arch supports, or orthotics, these devices can provide your foot with extra cushioning and added support; using an orthotic is particularly effective for individuals with plantar fasciitis due to flat feet
  • Replace your shoes: sometimes orthotics won’t be enough; if the soles of your shoes are worn out and not providing you with enough support, or if you notice that your feet are in pain after every time you use your shoes, it may be time to purchase a new pair; when buying athletic shoes, it’s best to go to a running store that has the capability of analyzing your gait to ensure you’re using the right pair for your foot type
  • Consider pain medications: depending on the severity of your issue, you may experience some relief with over-the-counter pain medications; non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil), and naproxen (Aleve) will reduce inflammation in addition to pain
  • Wear a night splint: for severe plantar fasciitis, a night splint may help by keeping your foot in a locked position overnight; this can prevent you from pointing your foot, and in effect, alleviate pain

Treat your feet right and stay conditioned to avoid injury
October 8, 2019

For most of us our feet provide the freedom to get from point A to B with minimal effort. But even though they provide this incredible ability, it’s easy to take the feet for granted, and perhaps we often ignore these wonderful appendages.

It becomes more difficult to disregard the feet, though, when something goes wrong with them. This is particularly the case when a foot or ankle injury prevents one from walking or running normally, leading to a redirection of the attention downwards.

Injuries to the feet and ankle actually rank among some of the most common in the entire body because they handle so much weight and are used so frequently. Ankle sprains are by far the most prevalent injury to this region—especially in active individuals—while others include plantar fasciitis, Achilles tendinitis, stress fractures, and growth plate injuries (in children). Unfortunately, there’s no magic formula that will prevent all foot and ankle injuries from occurring, but there are a number of steps you can take to significantly reduce your personal risk for experiencing one. We recommend the following:

  • Warm up and stretch: regardless of what activity you’re about to partake in, it’s always important to get the blood flowing with a warm-up and some stretching before physically exerting yourself; dynamic stretches that mimic the sport or exercise you’re participating in are best for reducing injury risk
  • Build up your strength: strengthening the muscles of the feet and lower leg is extremely important for injury prevention, as it will provide a more sturdy foundation for the rest of the body; strong muscles in this area will also improve balance, which can further reduce injury risk
    • Calf raises: stand with your feet shoulder-width apart, keeping the knees straight; raise the heels off the floor as high as you can, then return to the floor and repeat; to progress the exercise, stand with your toes on a step
    • Toe splay: sit in a straight-backed chair with your feet gently resting on the floor; spread your toes apart as far as possible without straining them and hold the position for 5 seconds, then repeat this motion 10 times
    • Resisted ankle inversion: sit on the floor with your legs outstretched and a band wrapped around the foot you want to work; tie the other end around something sturdy to the outside of the leg; keep the lower leg still and try to point the toes across to the other leg
    • Resisted ankle eversion: for eversion, move the attachment of the resistance band so it’s on the other side of the body, then turn the foot out and try to point your toes away from the other foot
  • Wear the right shoes: try to always use shoes that are appropriate for the activity; your shoes should provide support and comfort while being able to withstand the physical demands of the sport they’re being used for; it’s also a good idea to avoid wearing high heels regularly and to be careful about your sandal selection
  • Steer clear of the wrong surfaces: running or training on uneven surfaces can increase the likelihood of an injury, so it’s best to avoid these as much as possible
  • Train in moderation: many injuries result from overdoing it or increasing physical activity levels too aggressively; this is true for everyone, but especially those who have not been active in a long time and those starting a new sport or activity; try to advance your regimen gradually to avoid these types of injuries
  • Listen to your body: if you do notice pain in your foot or ankle, it’s probably a sign from your body that you’re overdoing it; learn the difference between typical muscle soreness (which often develops after working out) and lingering pain (which could be a sign of a more serious issue), and seek out help when the pain doesn’t subside

Foot & ankle injuries are a common problem for active individuals
October 1, 2019

Over time, exercise and physical activity tend to strain certain areas of the body to the point of pain, and this distribution is not equally divided. While the region that’s affected has much to do with the activity being performed, there are some spots that just seem to carry the brunt of the load no matter what.

The feet and ankles clearly fit this bill, as they are some of the most common locations for injury throughout the body. Problems arising here can occur in anyone, but those who keep an active lifestyle are far more likely to be affected than others. This is apparent across the age spectrum, as foot and ankle injuries are seen frequently in children and then remain prevalent into adulthood, with some people experiencing the same issues in the long term.

Understanding a few of the most common foot and ankle injuries at different ages is helpful, as it can prepare you to identify the signs of a problem and learn how to respond appropriately.

Developing bodies and high levels of activity contribute to risk in children

Children and adolescents often tend to have a seemingly never-ending supply of energy, some of which is spent on sports and exercise, among other things. The high participation levels in sports and the generally active habits of kids are the primary reasons foot and ankle injuries occur so frequently. But in addition, children’s bodies are still growing and have not yet fully developed, which increases their risk for injury even further. Below are some of the injuries that are most likely to be seen in this age group:

  • Sever’s disease: this overuse injury results from inflammation of the growth plate in the heel, which is an area of growing tissue near the ends of bones in children; these injuries are caused by repetitive stress to the heel and are most likely to occur during growth spurts, when a child’s heel bone grows faster than the muscles, tendons, and ligaments; symptoms include pain and tenderness underneath the heel
  • Ankle sprain: ankle sprains occur when the ligaments surrounding the ankle—which connect bones to bones—are stretched beyond their limit in a forceful motion; these are the most common injuries in all of sports, and they typically lead to pain, swelling, and an inability to put pressure on the ankle
  • Growth plate fracture: since growth plates are weaker than tendons and ligaments, incidents that would normally lead to an ankle sprain in older individuals could actually cause a growth plate fracture instead in children and adolescents; in some cases, both injuries occur at the same time
  • Stress fractures: these are small cracks or severe bruising within a bone that are caused by repetitive stress or force to the foot; they are particularly common in older adolescents who are extremely active in sports like soccer and gymnastics

Some problems remain common, while other new ones arise later in life

Foot and ankle injuries remain problematic later in life, too. Growth plate injuries are no longer a possibility since the plates are fully developed by adulthood, but a number of other issues become more likely in older age and repeated trauma to these regions. Among those are the following:

  • Ankle sprain: unsurprisingly, ankle sprains are still the most common sports-related injury in adults, just like children; in fact, about half of all ankle sprains are related to physical activity, and about 25,000 people sprain their ankle everyday; since growth plates are not present, twisting motions to the ankle typically result in a sprain or fracture of the ankle
  • Plantar fasciitis: generally considered to be the most common cause of heel pain in adults, this condition results from inflammation of the plantar fascia, a thick band of tissue that connects the heel to the toes; when this tissue is overstrained from repeated activity—like running—it becomes inflamed, which leads to a stabbing pain near the heel that’s most noticeable upon waking up
  • Achilles tendinitis: another overuse injury related to inflammation of the Achilles tendon, which connects the calf muscle to the back of the heel; it’s most common in runners who do lots of speed training, uphill running, or rapidly increase their training intensity or duration, and it leads to heel pain that usually comes on gradually as a mild ache in the back of the leg or above the heel
  • Stress fractures: these injuries also remain common in adults and are most frequently seen when the bones and their supporting muscles don’t have time to heal between exercise sessions, or when a person changes their usual exercise regimen with a sudden increase of activity or a change in workout surface
  • Turf toe: this is a sprain of the ligaments surrounding the big toe when it’s bent back too far (hyperextended), which is common in football players; it can occur from a sudden, forceful movement or repeated hyperextensions over a period of time, and leads to pain, swelling, and limited movement of the big toe