- Your Bridge to Health -

Repetitive use of the shoulder and age-related changes can both lead
June 4, 2019

The shoulder is a rather incredible part of the human anatomy. As the most flexible and mobile joint in the body, the shoulder allows the arm to move in a wide range of directions, which is necessary for performing many of the dexterous tasks needed in daily life. Unfortunately, this extreme flexibility comes at a price, as repetitive use of the shoulder joint can damage it and cause pain over time.

Often thought of as a single joint, the shoulder is actually a ball-and-socket made up of both the glenohumeral and acromioclavicular joints. Forming these shoulder joints are the upper arm bone (humerus), shoulder blade (scapula), and the collarbone (clavicle), as well as a number of associated tendons, ligaments, and muscles. The humerus and scapula are surrounded and connected by the rotator cuff, which is a group of muscles and tendons that keeps the shoulder stable and allows for its wide range of rotation. There is also a fluid-filled sac called the bursa between the rotator cuff and a bony prominence on the top of the scapula (acromion), which provides cushioning during movement.

The shoulder is one of the most common locations in the body to be affected by pain, with as much as 26% of the general population dealing with shoulder pain at any given point in time. Shoulder pain can come about immediately or develop gradually, and the type of condition that’s responsible is related to several factors, including age.

The rotator cuff is commonly involved in many cases of shoulder pain

Injuries involving the rotator cuff are among the most common causes of shoulder pain in people of all age groups. In general, younger individuals with a rotator cuff injury usually have a history of repetitive overhead activities that involve the shoulder, like athletes involved in baseball, tennis, or swimming. On the other hand, older individuals usually show signs of a gradual onset of shoulder pain that is often the result of sustained damage to the rotator cuff that has taken place over time.

There are a number of injuries that are collectively referred to as “rotator cuff disorders” because they all include damage to rotator cuff tendons and share similar features and symptoms. These terms are often used interchangeably, but each one should be understood independently because of its unique characteristics:

  • Rotator cuff tendinitis: irritation and swelling of one or more of these tendons
  • Rotator cuff tear: a partial or complete tear of one of these tendons
  • Shoulder impingement syndrome/subacromial impingement: term used to describe when the tendons become compressed—or “impinged”—as they pass through the narrow space beneath the acromion and the humerus

The most common symptoms of rotator cuff disorders are pain, swelling, tenderness, loss of strength, and impaired flexibility, which can together cause various degrees of disability, especially for athletes. These types of injuries can occur from age-related changes, trauma, or both, and the likelihood depends largely on a patient’s age and activity levels. Older age-especially being older than 40-and regular participation in overhead occupations or sports both increase the risk for damaging the rotator cuff. Shoulder impingement syndrome can be further broken down into the following three stages, which provides a clearer picture of the role that age can play in this process:

  • Stage 1: normally affects younger patients under the age of 25; at this stage, the condition can still be reversed with treatment
  • Stage 2: affects individuals between ages 25-40 and represents a continuation of the process that began in stage 1, as it grows worse and becomes less reversible
  • Stage 3: typically affects people over the age of 40; at this stage, the damage has resulted in either a partial or complete rotator cuff tear

The likelihood of frozen shoulder also increases with age

Another fairly common cause of shoulder pain is a condition called adhesive capsulitis, or frozen shoulder. Frozen shoulder occurs when scar tissue forms within the shoulder capsule, which is made up of strong connective tissue that helps keep the shoulder stable. This causes the shoulder capsule to thicken and tighten around the shoulder joint, which means there is less room to move the shoulder normally, eventually causing it to “freeze”.

Frozen shoulder affects up to 5% of the population, but the reasons it develops are not clearly understood. In general, it’s believed that not moving the shoulder joint normally for a long period of time is one of the leading factors, as most people who get frozen shoulder have kept their shoulder from moving due to a recent injury, surgery, pain, or some other condition. Age also plays a part, as frozen shoulder most commonly affects people between the ages of 40-60, which could be due to sustained damage to the shoulder over time or lack of shoulder movement. Women and individuals with arthritis, diabetes, cardiovascular disease, and other health conditions are also more likely to develop frozen shoulder.

Another common shoulder injury seen in many age groups is called a labral tear. The labrum is a cup-shaped rim of cartilage that lines the inside of the shoulder joint. It is the attachment site for the ligaments and supports the joint along with the rotator cuff tendons and muscles. If the labrum is pushed beyond its limits, either from a single injury or due to repeated damage over time, it can get torn and cause symptoms like pain, a feeling of instability, a catching or locking sensation, and/or a loss of shoulder strength and flexibility. Labral tears are most commonly seen in athletes of sports that involve overhead motions-like baseball pitchers-but older adults are also at an increased risk because the labrum becomes more brittle with age.

When the labrum gets damaged or torn, it puts the shoulder at risk for looseness and dislocation, which can lead to shoulder instability. This condition occurs when the structures of the shoulder joint become stretched, torn, or detached, which allows the ball of the shoulder joint to move either partially or completely out of the socket. Like labral tears, shoulder instability can either be caused by a single, traumatic event or develop gradually over time, and the primary symptom is a persistent feeling that the shoulder is loose or slipping in and out of the joint. People of any age can experience shoulder instability, but young, active patients that dislocate their shoulder are at an increased risk for experiencing regular instability later in life

.

After a broken wrist, PT will help ensure a safe & effective recovery
May 30, 2019

The wrist is a complex joint where 15 different bones meet, each of which performs its own specific function. All of these bones play an important role, and if a problem or injury occurs in any one of them, it can affect the way that the entire wrist moves and functions. The radius is a bone of the forearm that connects the elbow to the wrist, and it’s the most commonly injured bone in this region. When the term “broken wrist” is used, it usually refers to fractures of the distal part of the radius, where it meets the wrist. Distal radius fractures—as these injuries are called—are often serious and may require surgery, but regardless of what treatment is needed, physical therapy will be essential to ensure that you have a complete recovery.

The radius is located on the thumb side of the wrist and is the larger of the two bones that make up the forearm. Along with the ulna, these bones permit movements of the elbow, hand, and wrist, and the distal radius takes on a large portion of the loads upon the wrist. This is one of the main reasons the distal radius is so vulnerable to fractures. Distal radius fractures are the most common fractures in the arm and are some of the most common fractures in the entire body. In fact, of all the fractures that are seen in the ER, about one-sixth involve the distal radius.

The vast majority of distal radius fractures occur after falling and landing with the hands outstretched, which is often called a “fall on an outstretched hand,” or FOOSH injury. Falls in sports like soccer and basketball, as well as biking, skateboarding or rollerblading accidents can all lead to a distal radius fracture if the person lands with enough force. Older individuals with osteoporosis are also at an increased risk for distal radius fractures because their bones are more fragile and can therefore break from even a minor fall.

After experiencing a distal radius fracture, a person will usually experience immediate pain, swelling, tenderness, and bruising. Many individuals will also have a wrist that hangs in an odd or bent way (called a deformity), as well as difficulty moving the wrist and fingers. Upon examination, these injuries are usually classified as follows:

  • Type 1: a “nondisplaced” fracture in which the bone is broken but still rests in a normal position
  • Type 2: a fracture where a fragment of bone is shifted from its normal position
  • Type 3: the most serious type of fracture, with multiple breaks of the bone or bones

How physical therapy can help you recover from any type of distal radius fracture

In most cases, type 1 and 2 fractures are treated non-surgically with a cast being worn for a period of time until the bone heals, while type 3 fractures are usually treated with a surgical procedure to repair the fractured bone. But regardless of which type of treatment is used, a course of physical therapy will be necessary to help you regain the range of motion, function, and strength of your wrist. To give you an idea of what this process looks like, below are some highlights of a typical treatment program for a broken wrist:

  • While the wrist is still in a cast: during this period of time, your physical therapist will likely prescribe some gentle exercises the keep the shoulder, elbow, and fingers moving so that these parts of the arm don’t lose their abilities while the wrist is immobilized
  • After the cast is removed/after surgery: once the cast is removed, the wrist usually feels stiff and the arm feels weak, so your physical therapist will prescribe treatments to address these issues and restore the function of your wrist with the following:
    • Hands-on techniques (manual therapy) to help your joints and muscles to move more freely with less pain
    • Ice and heat therapy to address the pain in your wrist
    • Stretching and strengthening exercises to help you regain your ability to move your wrist normally
    • Exercises that are specific to the sport or physical activity you’re involved in to help you more quickly return to the things you love

A broken wrist is often a serious injury that can set you back for a while, but seeing a physical therapist during the recovery period will help ensure that you’re making your way back to full strength in the safest and fastest manner possible. So if you’ve recently broken your wrist, the best choice you can make is to contact your local physical therapy clinic to find out how treatment will fit into your recovery process and when you can start.

Take action to relieve your hand or wrist pain right now
May 21, 2019

Hand or wrist pain can be a real nuisance. Because of the frequent use of these body parts, a significant portion of daily movements can result in pain and serve as a constant reminder of one’s condition. This situation can be made even worse when the very activities responsible for the pain—like using vibrating tools or assembly-line work—are part of your occupation and therefore cannot be avoided.

As a result, people who are impaired by hand or wrist pain may not be able to perform their job as well as they normally do, which can lead to further personal and economic consequences. Similarly, athletes and active people who are bogged down by pain will often experience frustrating repercussions that interfere with their livelihood and enjoyment of life. But regardless of its cause, duration, or intensity, most people with hand or wrist pain want the same thing: immediate and lasting relief so they can get back to living their lives.

If you’re dealing with hand or wrist pain, whether it’s from a finger sprain, wrist tendinitis, carpal tunnel syndrome, or some other cause, there are a number of steps you can take right now to reduce it. Most of these suggestions can be completed on your own at home, but it’s always best to talk to your doctor or therapist for additional guidance and before trying anything new. For immediate pain relief, we recommend:

  • Exercises: moving your hands and wrists in specific ways can help improve their strength and flexibility, which will in turn alleviate pain and other symptoms; they should be done slowly and deliberately, and if you feel any numbness or pain, stop and contact your doctor
    • Wrist supination/pronation: stand or sit with your arm at your side with the elbow bent to 90° and palm facing down; then rotate your forearm, so that your palm faces up and then down
    • Thumb flexion/extension: begin with your thumb positioned outward, then move it across the palm and back to the starting position
    • Wrist ulnar/radial deviation: support your forearm on a table on a rolled-up towel for padding or on your knee, with your thumb upward, then move the wrist up and down through its full range of motion
    • For more exercises, click here
  • Night splints (for carpal tunnel syndrome): symptoms of carpal tunnel syndrome are often worse at night because the hand is more likely to bend while you’re sleeping; a night splint holds the wrist in a neutral position, which prevents it from bending too much and can improve symptoms in the process; ask your doctor for more information and if a splint is right for you
  • Hot and cold therapy: heat is good for increasing blood flow, which can accelerate the healing process in inflamed or damaged areas, while cold therapy is helpful for reducing swelling, pain, and other bothersome symptoms; some patients benefit from alternating between hot and cold therapy throughout the day
  • Avoid over-stressing your joints: if your pain is from a repetitive strain injury like carpal tunnel syndrome, try to find ways to modify your habits in order to avoid putting too much stress on the hands and wrists; in particular, improve your posture and body positioning at your job, take frequent breaks, and rotate between various tasks as often as you can if it’s allowed
  • Limit your phone time: the risk for certain hand conditions—like De Quervain’s tenosynovitis, which is inflammation of a sheath that covers the tendons within the wrist—is actually higher in those who use their phones excessively; so if you spend several hours on your phone every day and are dealing with pain, consider reducing your screen time to give your hands and wrists a break

Prevent hand and wrist pain with position changes & simple exercises
May 14, 2019

Most people don’t realize just how much they rely on their hands and wrists until a problem arises. This is often the case for anyone with hand or wrist pain, which can turn many everyday activities into challenging tasks that require a strategy to overcome or complete avoidance in some cases. As a result, daily life may become a series of obstacles that each need to be faced with a specific approach in order to keep painful encounters at a minimum.

There are a number of conditions that can affect the hands and wrists, which consist of a complex network of bones, ligaments, muscles, and tendons that are all essential for allowing a wide range of functions. When a problem occurs with any of these structures—such as being stretched too far, becoming inflamed, or experiencing other types of damage—the resulting symptoms will often have an impact on other aspects of hand and wrist motion, too.

It goes without saying, then, that most people would probably prefer to not experience hand or wrist pain in the first place. The good news is that many of the conditions responsible for pain can be prevented, and some causes are more preventable than others.

The dangers of repetitive motions

Throughout a typical day, you use your hands and wrists almost constantly. From the vigorous brushing of your teeth in the morning, to the turning off of lights before getting into bed, and with just about every other action in a typical day, you are utilizing these body parts and need them to function. But over time, performing certain tasks on a repetitive basis can actually go on to damage some of the structures of the hands and wrists in what’s called a repetitive strain injury.

A repetitive strain injury (RSI) is a potentially disabling condition that results from overuse of a body region or structure—usually the hand or wrist—after performing the same movement over and over. Repetitive motions, like typing on a computer, cutting hair, working on an assembly line, or even using a cellphone can all cause increase stress and fatigue of different structures, resulting in pain and other symptoms in the hand or wrist.

Carpal tunnel syndrome is by far the most common and well-known RSI, as up to 5% of the adult population is currently affected by it. This type of RSI is believed to be caused by tasks that involve repeated hand motions, awkward positioning of the hand or wrist, vibration, or excessive gripping, and individuals who work in industries like manufacturing, food processing, and textiles are likely at the highest risk. Over time, these movements can cause the median nerve within the carpal tunnel to be compressed, which leads to pain, tingling, weakness, and/or numbness in the hand or wrist.

Other RSIs of the hand and wrist include ulnar tunnel syndrome, radial tunnel syndrome, trigger finger, trigger thumb, wrist tendinitis, and De Quervain’s tenosynovitis. Each of these conditions also result from performing the same movements repeatedly, and in turn, their painful symptoms will make it difficult to complete these very same tasks. But this also underscores a very important point: learning how to modify certain movements that can be damaging or even avoiding them entirely—whenever possible—is exactly how to prevent an RSI from developing in the first place. Here are some helpful tips to keep in mind that will reduce your chances of experiencing hand and wrist pain:

  • Adjust your posture and the positioning of your hands and wrists
    • Try to keep your shoulders square rather than rolled forward when sitting, standing, and walking
    • Hunched posture contributes to strain down the entire arm to the hands and wrists, so try to perform tasks with the arms at a comfortable distance from the body: not too close and not too far
    • Keep your wrists in a neutral position that’s parallel to the ground, or slightly bent downwards towards the keyboard; avoid flexing your wrists and angling them upwards to reach the keyboard
  • Try to avoid repetitive straining movements
    • Pay attention to how you use your hands when performing tasks at work and elsewhere, especially those that are done repeatedly
    • Avoid tasks that require constant bending or twisting of your hands for extended periods of time; if these movements are part of your profession, try to take frequent short breaks and even shorter “micro-breaks,” switch hands, and rotate tasks whenever it’s possible to do so
  • Modify your workstation positioning and habits
    • Although the association between computer use and carpal tunnel syndrome has not yet been proven, bad typing habits and workstation setup can still strain the wrists and possibly lead to an RSI; you can avoid this by optimizing your workstation and habits with the following:
      • Make sure your forearms are level and wrists are not flexed and in a neutral position when you type
      • Don’t rest your wrists on the table surface
      • Try to avoid reaching too far on the keyboard with one hand
      • Change your hand positions often and take frequent breaks
  • Exercises and stretches
    • Stretching and conditioning your hands and wrists is another one of the best ways to avoid repetitive strain, especially for those who work in high-risk occupations; here are a few helpful stretches to get you started:
      • Wall stretch: extend your arm along a wall, parallel to the ground and with your palm facing the wall; attempt to open your chest so that your shoulders and arm are perpendicular, then extend the fingers and palm away from wall as much as possible; hold for 30-60 seconds
      • Doorway stretch: hold your elbow at a right angle and place your forearm along doorframe; lunge forward, keeping the chest and pelvis facing squarely forward; hold for 30-60 seconds
      • For more tips and stretches, click here or here.

Hand or wrist pain can strike at any age and complicate simple tasks
May 7, 2019

The hands and wrists are one of the main tools that we use to navigate the world around us. Whether it’s driving to work, typing away on your computer, or picking up your child, the use of your hands and wrists is absolutely vital to your ability to function normally in everyday life. But this frequent use also comes with a possible downside: when something goes wrong that leads to pain in these regions, it can throw many aspects of your life completely out of sorts.

The hand and wrist consist of 27 bones and 20 muscles, plus a number of associated joints, ligaments, and tendons that connect them to one another. Each of these structures serves an important role that contributes to the overall functioning of the hand and wrist, but the sheer number of working parts means there are many things that could possibly go wrong. There is a wide range of conditions that can result in pain in this area, and the likelihood of experiencing an issue varies with age and tends to increase as you get older. But hand or wrist pain can develop at any stage in life and needs to be understood and dealt with accordingly in every situation.

Traumatic injuries are most common in youth and adolescence

For children, adolescents, and young adults, the majority of hand and wrist problems are due to traumatic injuries. Sprains, strains, fractures, and dislocations are frequently seen in this age group, particularly in those who are involved in sports and physically active. A sprain occurs when a ligament—which connects together the bones to a joint—is stretched too far and the tough fibers of the ligament become either partially or completely torn. A “jammed” finger resulting from sports like basketball is usually a sprain of a finger ligament, while skier’s thumb and gamekeeper’s thumb are two terms used to describe damage to the ulnar collateral ligament of the thumb. As the name suggests, skier’s thumb is often seen in skiers when the thumb gets caught on a ski pole and jerked away from the index finger, which can stretch or even tear this ligament.

If the force in a traumatic injury is strong enough, it may lead to a dislocation in which the bones of the joint separate from one another. Strains, which are seen less often in this region, are the result of stretching or tearing of muscles and tendons—which connect muscles to bones. Broken bones (fractures) are among the most common injuries to the hand and wrist in younger patients, and they usually result from fingertips getting crushed in closing doors, children putting their fingers in machinery or other equipment, and in contact sports. Fractures of any of the wrist bones—including the scaphoid, hook of hamate, and distal radius—are also quite common, and usually occur from falling forcefully with the hands outstretched.

Progressive conditions more likely in older age

The risk for these types of injuries remains fairly high throughout life for most people—especially those that are very active—but there are also a number of other conditions that become much more likely as we age.

Carpal tunnel syndrome affects about 5% of the population, but the majority of patients don’t notice symptoms until after the age of 30. The greatest risk factor for carpal tunnel syndrome is performing any task that requires repetitive hand motion, awkward hand positions, strong gripping, mechanical stress on the palms, or vibration. Though office work and repetitive typing may be a potential cause, the most common professions that lead to it are those with assembly-line work like manufacturing, sewing, baking, and cleaning. Older age increases this risk even more. Symptoms usually start with a burning or tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then radiate up the arm, which can make it a challenge to grip items and perform many other tasks that involve the hands.

Arthritis is the inflammation of various tissues within joints. It can occur just about anywhere in the body, but the hand and wrist are some of the more common locations it strikes. Although there are many different types of arthritis, they all involve the wearing down of cartilage, which is the smooth cushioning tissue that lines the ends of joints. Osteoarthritis is by far the most common type of arthritis, and the likelihood of developing it increases with age: studies have shown that about 60% of adults over 60 and 80-90% of those over 75 have some evidence of osteoarthritis. Another common type called rheumatoid arthritis can occur at any age, but is usually seen between the ages of 20-40. In all cases of hand and wrist arthritis, the inflammation makes regular movements difficult and can stifle daily functioning.

Other conditions that may affect the hands and wrist at various ages include the following:

  • Wrist tendinitis: a condition in which one or more tendons in the wrist becomes inflamed and irritated, which leads to pain and disability; tendinitis can occur at any age but is more common in adults, especially those over the age of 40; as tendons age, they become less elastic and can tolerate less stress, which makes it easier for them to become damaged
  • De Quervain’s tenosynovitis: this is a type of tendinitis that develops on the thumb side of the wrist; it causes pain and tenderness in the wrist or below the base of the thumb and often gets worse with repetitive hand or wrist movements; as with other types of tendinitis, tenosynovitis is more common after the age of 40
  • Dupuytren’s contracture: an abnormal thickening of tissue between the skin and tendons in the palm, which may limit the use of the fingers or eventually cause them to be pulled in towards the palm in a bent position; the causes of this condition are unknown, but it’ more common in men over the age of 50
  • Ulnar tunnel syndrome (Guyon’s canal syndrome): similar to carpal tunnel syndrome, this condition involves compression of the ulnar nerve and leads to a tingling sensation in the ring and little fingers; it’s particularly common in weightlifters and cyclists

Physical therapy is the best option knee and hip osteoarthritis
April 25, 2019

Osteoarthritis currently affects as many as 31 million Americans, making it by far the most common of a group of conditions that are all generally referred to as “arthritis.” Although all types of arthritis affect the joints and lead to a similar set of symptoms, osteoarthritis stands out due to its high incidence and because it’s a progressive condition that gets worse over time.

In a normal joint, a type of tissue called cartilage surrounds and protects the ends of each bone, which prevents them from touching each other and helps to absorb shock from movement and pressure. In osteoarthritis, this layer of cartilage begins to gradually wear away due to a number of possible factors. This means that there is less protection and more friction between the bones in the affected joint, and over time, this process can lead to inflammation and damage of many structures within the joint.

Osteoarthritis can develop in just about any joint, but the vast majority of cases occur in the knees and hips. The reason is that the knees and hips are both weight-bearing joints that must bear the impact of our bodyweight every time we’re on our feet. Taking on too much weight or pressure on these joints can cause the cartilage to wear away faster and accelerate the damage that occurs in osteoarthritis. This is why being overweight or obese is a major risk factor for osteoarthritis in all weight-bearing joints.

The symptoms of hip and knee osteoarthritis are quite similar: pain, swelling, tenderness, and stiffness in the affected joint, as well as a possible “popping,” “cracking,” or “grinding” sensation that comes about with movement. Pain usually tends to get worse during and after activity, and has the added effect of making it difficult to move the joint through its complete range of motion. The end result of these symptoms is being impaired in many activities and movements that involve the legs, such as walking, running, standing up from a chair, and ascending or descending stairs.

Only a physical therapist will focus on finding ways to help you move better

If you experience symptoms of knee or hip osteoarthritis, it’s usually safe to say that you’re next goal is to find some pain relief as fast as possible. There are a number of treatment options available for these types of conditions, from the most mild of simply resting the affected joint, to the most extreme of undergoing surgery to replace the damaged joint. But the best possible choice you can make to manage your osteoarthritis is to see a physical therapist.

Physical therapists are movement experts that are trained to help patients move more easily and efficiently. While there are many interventions out there that claim to relieve pain and improve function, only physical therapy will provide you with a comprehensive treatment plan that involves a variety of movement-based strategies to address your deficits and strengthen any areas of weakness. Physical therapy focuses on finding active ways to help you overcome your symptoms, and it trains patients to continue these healthy habits in the long term.

Each physical therapy program will differ depending on the severity of the osteoarthritis, and the age and abilities of the patient, but most interventions used fall into one of the following three categories:

  • Pain-relieving modalities: your therapist may use ice, heat, ultrasound, machines that emit electrical currents (TENS), or other similar treatments to reduce your pain levels on the spot
  • Exercise therapy: exercise is central to all physical therapy programs and is crucial for helping you overcome your impairments and be able to better move your affected joint; the two primary types of exercise therapy are:
  • Stretching exercises: since flexibility is usually reduced in the hip or knee affected by osteoarthritis, these exercises will help to improve your ability to bend and straighten your knee or rotate your hip with movements you can tolerate
  • Strengthening exercises: lack of movement due to pain can result in muscle weakness and even less ability to complete tasks normally; building the muscles back up around the hip or knee has been associated with less pain and better function, and will therefore be a major focus on most treatment plans
  • Manual therapy: this is a hands-on treatment in which the physical therapist will gently move muscles and joints to improve their motion, flexibility, and strength, and will usually target areas that are difficult to treat on your own

There is a great deal of research that has shown both exercise therapy and manual therapy to be effective treatments for patients with hip or knee osteoarthritis. In one study published in 2016, it was found that “An exercise therapy intervention provides short-term as well as long-term benefits in terms of reduction in pain, and improvement in physical function among people with hip osteoarthritis.” Another study published in July of 2018 highlighted how greater participation levels in physical therapy lead to better outcomes for patients with knee osteoarthritis, with a conclusion that stated:
Increased number of physical therapy visits was associated with improved outcomes, and some of this benefit persisted eight months after physical therapy ended.

Finally, a study published last September showed how even better outcomes can be achieved when both exercise therapy and manual therapy are combined. In this high-quality analysis, researchers reviewed a number of studies on the topic and found that:

Orthopedic manual therapy interventions with exercise therapy compared with exercise therapy alone provide short term benefits in reducing pain, improving function, and stairs ascending-descending time in people with knee osteoarthritis.

Take these steps to reduce arthritis symptoms in daily life
April 16, 2019

The term “arthritis” is used to describe more than 100 different conditions, all of which are defined by inflammation of one or more joints and a resulting set of bothersome symptoms. The exact cause in each case depends on what type of arthritis is present, but the common thread between them is a firm but flexible material tissue called cartilage. Cartilage normally surrounds the ends of bones in each joint to protect them and absorb shock, but problems can arise when it’s altered in any way.

In osteoarthritis, the most common type of arthritis, this protective cartilage gradually wears away over time due to age-related changes and several other factors. In rheumatoid arthritis, the cartilage erodes because the body’s immune system mistakenly identifies it as foreign and begins to attack it. Similar processes occur in all other types of arthritis as well, but the end result is always the same: after enough cartilage has worn away, the affected joint will no longer function normally.

Between pain, stiffness, and this reduced range of motion, most patients with arthritis begin to notice impairments in their daily lives and find that many otherwise simple tasks have become a challenge. Arthritis symptoms and the resulting amount of disability will of course vary depending its type and severity, but all patients will experience some difficulties functioning at one point or another. This brings up another similarity between all individuals with arthritis: a desire to make the pain go away.

How to alleviate arthritis symptoms on your own

Unfortunately, there is no cure for arthritis that will make cartilage grow back or completely stop the loss of it from occurring, but there are actually a number of steps you can take to reduce or eliminate your symptoms right now. Below are some of the best home remedies available. Consider discussing these options with your healthcare provider if you’re unfamiliar or have any questions:

  • Bracing: wearing a brace is associated with a number of potential benefits for individuals with arthritis, such as enhanced stability, reduced swelling and pressure on the joint, and increased confidence when walking; braces help to shift bodyweight away from the damaged area of the affected joint, which alleviates pain and discomfort in the process; braces come in a variety of shapes, sizes, and styles, and are most commonly used for patients whose knees or ankles are affected by arthritis; talk to your doctor if you’re interested in wearing a brace for your arthritis
  • Exercise: staying physically active is one of the best possible ways to treat arthritis symptoms, as it builds strength and improves the flexibility of joints; all forms of exercise can be helpful, but aquatic exercise is particularly recommended because it’s low impact and therefore does not put any added pressure on painful joints
  • Hot and cold therapy: another simple home remedy is applying ice or heat to the affected joint when symptoms arise; cold therapy can reduce inflammation, swelling and pain, while heat can relax muscles and help lubricate joints, which can also relieve muscle and joint stiffness in the process; it’s often best to start with ice and then alternate with heat to maximize benefits
  • Mobility devices: if your arthritis is severe enough, a device like a cane, walker, or wheelchair may be necessary to improve your mobility and allow you to get around on your own more easily; although this may be a difficult adjustment, it’s important to follow your doctor or physical therapist’s instructions and learn how to properly use your device in order to stay mobile
  • Anti-inflammatory medications: some arthritis patients experience immediate joint pain relief from over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and aspirin; talk to your doctor if you’re not sure if these drugs are right for you or how much/how frequently to take them
  • Diet: lots of research has shown that what you eat can have a significant impact on the amount of inflammation present in your joints, and that eating anti-inflammatory foods can actually reduce inflammation and swelling responsible for arthritis symptoms; for example, the Mediterranean diet, which emphasizes lots of vegetables, whole grains, fish, and healthy fats, has been associated with lower levels of inflammation and may therefore be worth considering
  • Physical therapy: if it feels like you’ve tried everything for your arthritis symptoms—including all the tips on this list—and your symptoms still haven’t gotten any better, it may be time to see a physical therapist for a comprehensive treatment program; ask your doctor for a referral or simply make an appointment on your own, since all states allow for some direct access to physical therapy

Reduce chances of developing osteoarthritis with lifestyle changes
April 9, 2019

Few conditions are as well known to the general public as arthritis, which is probably because about 54 million Americans—or about 23% of the population—are currently affected by it. These figures could naturally be a bit alarming and lead some to wonder what their personal risk is for developing arthritis and if there’s anything they can do to reduce it.

The truth is that there are many different types of arthritis and a multitude of factors that play into each individual’s chances of getting it. While some of these factors are completely out of one’s control and cannot be altered, others are considered “modifiable,” and making changes to them may have a significant impact on your personal risk for arthritis.

Osteoarthritis is by far the most common of the more than 100 different types of arthritis. As many as 31 million individuals currently have osteoarthritis, and the majority of cases are seen in those who are over the age of 65. Osteoarthritis is also the most preventable of all forms of arthritis, whereas for many other types—like rheumatoid arthritis, for example—not as much can be done to prevent them from occurring because their causes are not well understood.

Focusing on the risk factors that you can control

Osteoarthritis is a complex process that results from a number of different causes. Older age does play a part because the body naturally undergoes several changes that make joints more vulnerable to developing it. Therefore, since nothing can be done to stop the aging process, older age is considered a “non-modifiable” risk factor for osteoarthritis. Other non-modifiable risk factors are being female (since females are at an increased risk for all forms of arthritis) and family history (since some people are more likely to get it because of their genetic background.)

But these are just a few of the factors that determine a person’s risk, and there are many others that are actually modifiable. Below is a breakdown of the risk factors for osteoarthritis that you do have control over and some associated suggestions on how you can modify them in order to keep your personal risk as low as possible:

Maintain a healthy weight

  • Excess weight is one of the biggest risk factors for osteoarthritis, and it also happens to be one that you have the power to change
  • Here’s why: when you are overweight, the extra pounds put added pressure on weight-bearing joints like the knees and hips; each additional pound of bodyweight adds nearly four pounds of stress to the knees and increases pressure on the hips by nearly six fold, and over time, this extra strain breaks down cartilage in joints and increases the risk for osteoarthritis
  • For individuals who are overweight, losing at least 5% of their bodyweight may decrease the amount of stress on the hips, knees, and lower back; one study actually found that overweight women who lost 11 pounds decreased their risk for osteoarthritis by more than 50%
  • Tips: losing weight is no easy task, and there are many components that go into it, but your primary focus should be on eating right, making necessary lifestyle changes, and exercising more, which actually happens to be another major modifiable risk factor

More physical activity

  • Weight and activity levels go hand-in-hand as the two osteoarthritis risk factors that can be appropriately addressed to manage your risk
  • Exercising and becoming more physically active will not only help you achieve and maintain a healthy weight, but serves a number of other important purposes as well: it keeps your joints moving and prevents stiffness, strengthens the muscles around joints, and improves your mobility, all of which play a part in reducing the risk for osteoarthritis
  • Inactivity, on the other hand, can actually make joints more likely to be affected by osteoarthritis
  • Tips: aim to get the recommended 150 minutes of moderate-intensity activity (like brisk walking) or 75 minutes of a vigorous-intensity activity (like jogging) AND two days of strength training each week; it’s important to point out that physical activity includes anything that keeps you moving, so shoveling snow, taking the stairs at work, and mopping the floor all count towards your totals

Other

  • Avoid injury: injuring weight-bearing joints like the knees or hips can make cartilage wear out quicker, so it’s best to take steps to lower your risk whenever possible, such as:
    • Participate in a sport-specific injury prevention program
    • Take adequate time to rest and recover
    • Avoid overtraining and pushing your body too hard
  • Get injuries treated: if you do notice any pain or soreness developing in any of the joints that osteoarthritis normally occurs in, get it looked at right away by a physical therapist or your doctor
  • Control your blood sugar: studies have shown that diabetes may be a significant risk factor for osteoarthritis, as high glucose levels may speed up the formation of molecules that make cartilage stiffer and more sensitive to stress; so if you’re diabetic or prediabetic, it’s extra important to watch your glucose levels and keep them within a healthy range to reduce your risk for osteoarthritis

Arthritis can affect individuals of all ages
April 2, 2019

Arthritis is one of the most commonly recognized conditions responsible for pain, and there’s a clear reason why: it happens to be one of the leading causes of disability throughout the world. Many people also tend to associate arthritis with older age, which can lead to the perception that it’s only something to worry about “when that time comes.” While it is true that the risk for certain types of arthritis do increase with age, there are actually many different forms, and it’s important to understand that you can be affected by it at any stage of life.

The first point that needs to be made about arthritis is that it’s not a single disease. Instead, the term “arthritis” is used describe over 100 conditions that affect the joints or tissues around the joints. While there are unique characteristics of each type of arthritis that require special attention, they all involve inflammation of one or more joints in the body, and generally result in pain and stiffness in and around the affected joint(s).

Right now, approximately 54 million Americans—which is about 23% of the population—have some type of arthritis. For some individuals, arthritis symptoms may be barely detectable or come and go, while others are severely impaired by their condition on a daily basis. The amount of disability that arthritis causes will typically depend on its specific type, intensity, and possibly the person’s age.

Most common type of arthritis—osteoarthritis—is more likely to occur in older adults

Osteoarthritis is far and away the most common type of arthritis. While figures vary, it’s estimated that as many as 31 million individuals are currently affected by osteoarthritis in the U.S. This type of arthritis is also typically associated with older age, and in this case, the connection is somewhat accurate.

In every joint in the body, two bones meet in order to allow movement. The ends of each of these bones are normally covered by cartilage, which protects the bones from rubbing against one another and serves as a shock absorber for impact upon the joint. Osteoarthritis causes the cartilage in certain joints to become stiff and lose its elasticity, which makes it more vulnerable to damage. Over time, the cartilage may begin to wear away, which greatly reduces its ability to absorb shock and increases the chances of the bones coming in contact with one another.

Osteoarthritis can occur at any age, but the chances of getting it increase significantly as the body grows older. The majority of people with osteoarthritis are at least 40, and some studies have shown that about 70% of individuals over the age of 70 have at least some signs of it, whether they notice symptoms or not. The main reason for this is that the aging process leads to certain changes in the body that cannot be reversed. Bones become less dense and more fragile, and the there is less water in the cartilage as it also begins to shrink in size. The result of these changes is less protection of the bones, which often results in inflammation and symptoms like pain and stiffness.

Rheumatoid arthritis and juvenile arthritis are more common at other ages

Another fairly common type of arthritis is called rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease, which means it’s caused by the body’s immune system mistakenly destroying healthy tissue in the lining of joints for unknown reasons. This attack causes the joints to become inflamed, swollen, and painful, but other areas of the body may also be affected, and symptoms like fatigue, fever, and loss of appetite may occur. About 1.5 million Americans have rheumatoid arthritis, and three times as many women are affected by it as men.

Rheumatoid arthritis also tends to be associated with older age, but unlike osteoarthritis, it does not occur due to age-related changes and is usually seen earlier in life. The average age for onset of rheumatoid arthritis is between 30-60, but it’s also seen in younger individuals as well. Regardless of age, rheumatoid arthritis is a chronic disease that gets progressively worse over time. Symptoms vary from person to person, but in most cases it causes periods of increased symptoms (flares) followed by periods of symptom-free remission.

The chances of developing arthritis are even lower in childhood, but there is still a risk that must be acknowledged. The most common type of arthritis in those under the age of 17 is juvenile arthritis, which affects about 300,000 individuals.

The term juvenile arthritis includes many different inflammatory and autoimmune disorders that, like rheumatoid arthritis, cause the immune system to attack its own healthy cells in joints. It’s not clearly understood why this occurs, but both genetic and environmental factors likely play a part. Whatever its cause, juvenile arthritis also leads to a similar set of symptoms, such as pain, swelling, and stiffness that can interfere with a child’s daily functioning. So as with all forms of arthritis, these children require a set of tools and treatments to alleviate their symptoms and allow them to carry on with their lives in less pain.

PT is a much safer and more effective alternative to opioids
March 28, 2019

Try as we might, it’s nearly impossible to avoid all pain in our lives. Whether it’s twisted ankle or a bad back, we all experience some pain at one point or another, which is why the presence of pain is by far the most common reason people seek out health care. But treating pain, especially chronic pain lasting for more than three months, is not always an easy or straightforward matter. Treatment often requires a multifaceted approach that includes a number of different components due to the many variables that contribute to a patient’s perception of pain and their response to treatment.

Opioids are natural and synthetic drugs that are commonly prescribed for pain. Some patients, such as those with cancer or other serious illnesses, and those who are on end-of-life care, may require opioids due to the extreme amount of pain they are in. Opioids may also be appropriate for a limited period of time for certain short-lived (acute) painful conditions; however, it’s not clear if they are also effective for patients with chronic pain. But this has not stopped medical professionals from prescribing these drugs to address all types of conditions.

Since the late ‘80s and early ‘90s, opioids have been prescribed on a grand scale to individuals dealing with both acute and chronic pain. Over the years, prescribing these drugs has become a standard practice that many doctors assumed was safe and effective, even though there has always been a lack of high-quality research on the benefits and harms of opioids. As a result, opioids have been overprescribed for far too long, as at least 400,000 people have died of an opioid overdose between 1999-2017.

The epidemic has brought light to the situation and raised questions about prescribing these drugs to patients dealing with pain, and professional organizations like the CDC have provided guidelines as to when and how to give prescription, and what to do to address this problem. One of the central messages that has been stressed by healthcare leaders in various positions is that physical therapy should be utilized as a first-line treatment and an alternative to opioids for managing pain. Here are some examples:

  • In August of 2016, the U.S. Surgeon General at the time, Vivek Murthy, MD sent a letter to 2.3 million medical professionals to address the opioid epidemic provide a call to action to end it. The letter was combined with an infographic to assist these professionals in the prescription of opioids, and one of the central recommendations made was to consider non-opioid therapies first, with physical therapy being listed as an important alternative.
  • The current U.S. Surgeon General Jerome Adams, MD spoke at an event hosted by the American Physical Therapy Association (APTA) this past January, during which he focused on the opioid crisis and the role of physical therapy in addressing it. He highlighted the essential role that physical therapists can play by offering pain-relieving services to patients, and stressed the importance of educating these individuals on a national scale.
  • A task force made up of experts in various medical fields was created in 2018 in order to establish guidelines for managing pain and the role of opioids in the process. One of the key guidelines was that restorative therapies like physical therapy should be a central component of patient care. It points out that these therapies play a significant role in managing acute and chronic pain, and that positive patient outcomes are more likely when they are used.

There are many reasons why physical therapy has become recognized as such an effective alternative to opioids. Narcotics like opioids are only meant to decrease someone’s perception or sensation of pain, and they are not intended to actually address the issues that are causing it. This is why opioids are only supposed to be used temporarily until the pain subsides. Physical therapy, on the other hand, is not a temporary solution. Instead, it focuses on identifying the origin of the pain, and then creates a personalized treatment program designed to alleviate it permanently.

The benefits of physical therapy and its power to help patients avoid opioids have also been highlighted in a number of recent research studies. One study investigated whether seeing a physical therapist early for low back pain had an impact on the amount of healthcare each patient used and if they received an opioid prescription. The results showed that early physical therapy reduced healthcare utilization and costs, and also lowered the rates of opioid use, which may improve the efficiency of healthcare.


But despite the many signs that physical therapy is a much smarter and safer solution to pain than opioids, there is still a ways to go in changing how doctors manage patients in pain. In another study that reviewed data on patients with low back pain over 14 years, it was found that doctors only referred about 10% of patients to physical therapy, and this rate remained low through the entire period of time. The number of doctor visits that led to an opioid prescription, however, increased during this time in this same population.

This shows that while it’s important for medical professionals to do their part by prescribing opioids only when they are absolutely necessary and for short periods of time, patients must realize that they also have a choice in this matter. Seeing a physical therapist first will help you get on the path to an active and self-directed approach to pain, which focuses on patient participation to yield the best possible results. This approach to care also comes without the side effects and serious risks associated with an opioid prescription, meaning patients can be more confident that their treatment will help them improve while avoiding the dangers of these medications.