- Your Bridge to Health -

Bearing the weight of the body, the knees are a common source of pain
August 6, 2019

There are certain areas of the body that are simply more prone to pain than others, and the knee is one region that clearly falls into this category. Knee pain ranks just behind back pain as the second most common condition that affects the muscles and bones. It’s the single greatest cause of disability in individuals who are 65 and older, but can occur in anyone regardless of their age, lifestyle, or activity level.

The knee is one of the largest and most complex joints in the body, and it’s incredibly vulnerable to injury because it’s used so much and consists of so many parts. It joins the thighbone (femur) to the shinbone (tibia), and is also made up of the kneecap (patella) and the other lower leg bone (fibula). All of these bones and the surrounding muscles are connected through a series of ligaments and tendons, which collectively help to stabilize the knee and allow it to bend, twist, and rotate.

Sudden injuries and overuse are most common in younger populations

For children and adolescents, most cases of knee pain are related to participation in sports. Whether in organized sports or when playing pick-up games with friends, kids and teens can get injured from a number of different causes. Many injuries are due to a fall or accident, which can push certain structures of the knee too far and cause them to tear. These are known as traumatic injuries, which are particularly common in athletes involved in sports that require cutting movements like basketball, football, and soccer. Sprains (which affect the ligaments,) and strains (which affect the muscles and tendons) are the most common types of traumatic knee injuries that cause pain in children, and in extreme circumstances, tears of the meniscus, ACL, or other knee ligaments are also possible.

In other cases, knee pain develops gradually over time, and pinpointing its cause is more challenging. What happens is performing certain movements over and over leads to minor damage, and over time this damage accumulates and leads to inflammation, irritation, and pain. Children who play a single sport all year round without taking enough time to rest and recover are at an increased risk for these overuse injuries, which may be more difficult to treat than traumatic injuries.

One of the more common overuse injuries of the knee in this population is called Osgood-Schlatter disease, which is an inflammation of the area just below the knee where the patella attaches to the tibia. It’s most frequently experienced in adolescents who regularly participate in sports with lots of running, jumping and/or rapid changes of direction, and the further they push their bodies, the greater the chance of developing this condition. Other overuse injuries include patellar tendinopathy (jumper’s knee), iliotibial band syndrome, and patellofemoral pain syndrome (runner’s knee), which are described in more detail later.

Age-related changes often responsible for knee pain later in life

Knee pain continues to be a common issue in older age, but the causes responsible tend to change later in life. The majority of cases of knee pain in adults are due to knee osteoarthritis (OA), which is a significant global health issue. The lifetime risk of developing knee OA is 45%, and the likelihood of getting it increases with each decade of life.

Knee OA is so common in adults because of gradual damage and natural changes that the body experiences through the aging process. The knees absorb a great deal of pressure every time you take a step. So over time, simply moving around and being active can stress and strain various structures of the knee. In addition, the muscles and ligaments tend to get weaker as the body gets older, and both the meniscus and the articular cartilage that protects the ends of bones of the knee eventually start to deteriorate. The combination of all of these changes is less protection between these bones, and the result is knee OA, which is characterized by pain, stiffness, and swelling. Knee OA affects at least 19% of adults aged 45 and older, and is a significant cause of disability in these individuals.

But knee OA is certainly not the only cause of knee pain in adults. The risk for traumatic injuries, like sprains, strains, tears of the ACL and meniscus, and fractures remains high for those who continue to regularly participate in high-energy sports. Overuse injuries involving the knee are also a concern for active adults, and the likelihood of experiencing these types of injuries increases with advancing age because structures can become more damaged over time. Below are some of the more common overuse injuries of the knee:

  • Patellofemoral pain syndrome (runner’s knee): accounts for 16-25% of all running injuries and involves the patella rubbing against the groove of the upper leg bone (femur), which causes a dull pain behind or around the patella; this pain is often aggravated from running, squatting, climbing stairs, or sitting, and may also be accompanied by swelling or a “popping” of the patella when bending the knee
  • Patellar tendinopathy (jumper’s knee): caused by repetitive strain to the patellar tendon, which attaches the bottom of the patella to the top of the tibia; leads to pain and stiffness at the front or below the patella and/or in the quadriceps, as well as an aching sensation that’s usually brought on after exercise
  • Patellar instability: a general term used to describe intermittent pain that comes with the feeling of the patella moving excessively or being unstable, and pain can be felt under, around, or most commonly, in front of the patella
  • Iliotibial band syndrome: an injury in which the iliotibial band—which runs from the hip to the top of the tibia—becomes irritated or inflamed from rubbing against the patella, leading to pain on the outside of the knee or hip that usually arises after running

PT & surgery lead to similar outcomes for patients with hip condition
July 30, 2019

Active participation in sports at a young age can eventually cause hip pain

Femoroacetabular impingement (FAI) is a fairly common condition that leads to hip pain and disability. The hip is a ball-and-socket joint in which the thighbone (femur) is the “ball” and the pelvic bone (acetabulum) is the “socket.” FAI occurs when the femur and acetabulum rub against each other during movement, which causes pain and decreases the range of motion of the hip. This condition may develop either due to certain hip shapes that increase the chances of these two bones coming into contact with one another, or it may be related to participation in sports. Athletes—particularly young athletes—that play sports like football and soccer are at an elevated risk for FAI because of the dynamic movements involved in their sport. Patients with FAI may be treated with a course of physical therapy or surgery may be recommended, and it’s not clear which of these approaches is more beneficial. Therefore, a powerful study called a randomized-controlled trial (RCT) was conducted to evaluate whether physical therapy or surgery is more effective for treating patients with FAI.

A group of 348 patients is randomly assigned to either physical therapy or surgery

Researchers invited patients with hip pain and features of FAI to participate in the RCT and screened responders with a specific set of criteria. This process led to 348 patients being included in the study, and these participants were then randomly assigned to receive either physical therapy or surgery to address their condition. Physical therapy consisted of four parts: a thorough assessment of each patient, education on their condition, an exercise program, and relief from pain when it was strong enough to prevent them from performing the exercises. The exercise program took place through 6-10 sessions over 12-24 weeks and was supervised by a physical therapist and repeated at home. Programs were individualized and progressed at each patient’s pace. Surgery was completed using arthroscopic techniques in which small incisions were made to guide a camera and small surgical instruments to perform the procedure. All patients were assessed at the beginning of the study and 12 months later using the international Hip Outcome Tool (iHOT-33), which is specifically designed for measuring quality of life (QoL) in young adults with hip pain.

Quality of life improves in both groups of patients

Twelve months after patients were randomized to treatment, scores on the iHOT-33 improved in both groups. Scores increased from 35.6 to 49.7 points in the physical therapy group, and from 39.2 to 58.8 in the surgery group. Further calculations showed that the average difference in improvements between these two groups was 6.8 points in favor of the surgery group; however, another evaluation showed that physical therapy was more cost-effective than surgery over 12 months. Taken together, these findings suggest that although surgery may lead to better overall outcomes than physical therapy, both treatments are effective for improving patients’ hip pain-related QoL. For this reason and because it costs less than surgery, physical therapy should at least be attempted as a first option. Young athletes and other patients dealing with symptoms of FAI are therefore encouraged to try physical therapy first and see how they respond to treatment before considering surgery.

-As reported in the June ’18 issue of The Lancet

Tending to mild injuries right after they occur can make a difference
July 16, 2019

Imagine yourself in the following situation:

You’re on the court, playing in the high school basketball state championship, and having the game of your life. In just over 25 minutes of play, you’ve scored a career high and have been logging a performance for the ages as your team approaches a victory with only minutes to go in the game…when the unthinkable happens. You jump for a rebound and land on the opposing center’s foot, twisting your right ankle inwards and spraining it in the process. Unable to put any pressure on the ankle, you fear the worst as medical staff approaches and tends to your injury. You immediately know that you won’t be able to play again for quite some time, and as you’re assisted off the court, all you can think about is the bright lights in that last instant before the unfortunate landing.

If you can relate to this story in any way, or if you ever encounter a sport injury like this in the future, you’ll know that the next set of questions is almost guaranteed to be the following: “how did this happen and how can I get back on the court or field as quickly as possible?”

While nothing can be done to change the fact that the injury did in fact happen, there is a great deal you can do to improve your chances of returning to your sport in a timely manner. For starters, what you do immediately after a sports injury will have a significant impact on how well and how quickly you recover, which is why you should be prepared for these types of situations with a response plan in place. Failing to completely recover from an injury will increase your chances of additional issues in the future.

The majority of mild injuries can be initially treated with the PRICE protocol

For most mild injuries and certain moderate injuries, the best thing you can do right after the incident is follow the PRICE protocol. Traditionally known as the RICE protocol—for rest, ice, compression, and elevation—the “P” was added more recently and stands for “protection.” Adhering to the principles of PRICE is crucial for alleviating initial symptoms and preventing any further issues from occurring in the first 24-72 hours after injury. Here’s what it should entail:

  • Protection: after an acute injury, an athlete should remove themselves from play and protect the injured area from additional damage by applying a bandage, elastic wrap, sling, or splint, or even tape may do the job; if the injury is to any part of the leg, avoid bearing weight on that side and consider using crutches
  • Rest: it’s important to take a break from your respective sport in order to allow your body to heal; the amount of rest needed depends on the type and severity of the injury, but if participation leads to pain, it’s wise to continue resting; keep in mind that this doesn’t necessarily mean you need to avoid all activities, but you should avoid those that can further aggravate your injury
  • Ice: cold treatment, or cryotherapy, is one of the easiest but most effective ways to reduce pain and other symptoms immediately after an injury; applying ice slows down blood flow to the injured area and in effect reduces inflammation and swelling, as well as muscle spasms; ice should be used as soon as possible after the injury and applied for 15-20 minutes every 1-2 hours for the first few days
  • Compression: pressure also helps to reduce inflammation and swelling, while also providing minimal support to the injured area; in most cases a simple elastic bandage will be sufficient, which should be applied snugly but not too tight, and directly to the skin by starting a few inches below the injury and wrapping in a spiral to a few inches above the injured area
    • There are also devices available designed specifically for compression that provide an even amount of pressure around an injured area for added benefits; some of these devices combine compression with cold therapy, which temporarily reduces blood flow and allows the cold to penetrate through the skin and deep into the muscles, ligaments, and bones
  • Elevation: by elevating the injured body part, you will be draining the pooling of fluids away from that area, which reduces swelling, inflammation and pain; this can be accomplished by positioning the injured area above the level of the heart for as much time as possible for at least the first 48 hours after the injury

Other home remedies to try right after an injury

The PRICE protocol can be supplemented with a number of other remedies that you can usually perform on your own at home, including:

  • Heat therapy: applying heat (thermotherapy) increases the flow of blood to the injured area, which in turn stimulates the body’s natural healing mechanisms, while also reducing pain and stiffness; thermotherapy can be applied at similar intervals to cryotherapy (15-20 minutes every 1-2 hours), but should not be used until after the initial inflammation from the injury has begun to die down (usually a few days)
  • Contrast therapy: switching back and forth between cryotherapy and thermotherapy alternately opens and constricts the blood vessels and increases blood flow to an injured area without causing additional fluids to accumulate
  • Pain medications: acetaminophen (Tylenol) may be best for the first day, as it reduces pain without increasing bleeding; after the first day or two, aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) will help to alleviate both inflammation and pain
  • Massage: lightly massaging the injured area may help prevent the build-up of fluid that leads to swelling

While these simple remedies are best for mild injuries, more severe injuries require care from a trained professional. In these cases, it’s best to see a physical therapist, who will perform a thorough evaluation of your condition and create a personalized and comprehensive treatment program based on your goals and abilities.

Prevent sports-related injuries with targeted training programs
July 9, 2019

In a perfect world, athletes would be able to participate in their respective sport at full tilt without having to worry about hurting themselves or dealing with the consequences of an injury. But alas, the world we live in is not perfect, and injuries remain one of the most unfortunate and inescapable components of sports.

No matter how old an athlete is, the sport they play, or their fitness level or experience in that sport, there will always be some risk for getting injured. In general, the risk for acute—or traumatic—injuries increases with the amount of contact and cutting movements involved in the sport, which is why basketball and football players are injured so frequently. But a significant number of injuries result from overtraining and failing to recover properly, which is one reason injuries are seen even in sports that appear to be less dangerous, like golf, for instance.

Getting injured can have both short- and long-term consequences that need to be acknowledged. Immediately after an injury, an athlete will usually be sidelined for days or weeks, temporarily preventing them from reaping the benefits of their particular sport during that time. But when an athlete is kept from participating in their sport for several months or longer, it increases the chances of losing physical fitness and gaining weight, not to mention the psychological effects of not being able to play can have on an athlete. In the worst-case scenarios, certain severe injuries and those that are not properly rehabilitated can lead to long-term impairments and make it extremely difficult for the athlete to ever regain their pre-injury capabilities.

Together, this should make it clear just how devastating sports injuries can be in some cases and why it’s important to take steps to prevent them. Sadly, there is no surefire way to eliminate the risk for all injuries in all sports, but there are a number of universal strategies that can significantly reduce it.

Injury-prevention programs should be a primary focus for all athletes

One of the most effective ways to reduce the risk for injury is by participating in a training program specifically designed for this purpose. There are a number of sport-specific prevention programs in which athletes improve their strength, flexibility, and conditioning by focusing on the dynamic movements involved in their respective sport. A number of studies have shown that these types of injury-prevention programs are effective for lowering the risk of injury in various sports, two of which are summarized below:

  • One study reviewed all the available research on exercise-based programs to reduce injury risk in tackle collision sports like American football, Australian football, and rugby. Nine studies were identified, and of these, seven supported the prevention programs as an effective method for lowering the incidence of injuries in these sports.
  • The other study was also a review of research that focused on a specific exercise called the Nordic Hamstring Exercise to prevent injuries of the hamstrings, a group of three muscles in the back of the thigh. Results showed that this single exercise reduced the overall number of hamstring injuries by 51% when these participants were compared to those not performing the exercise.

Additional tips to reduce the risk for injury in sports

There are a number of other general injury-prevention tips that apply to all athletes at all levels of play, and although some may seem simple or obvious, following them can go a long way in reducing your risk for injury. These include the following:

  • Avoid overtraining: take enough time to rest and let your body recover in order to avoid overuse injuries, especially if you play one sport; a good rule of thumb is to take at least one day off per week and one month off per year from training in a single sport and switch over to other sports instead during that time
  • Use proper equipment: make sure that all of your gear—including pads, helmets, and other protective devices—is in good, working shape and fits properly; also be sure to wear the appropriate shoes for the appropriate sport, and replace old or worn-out shoes
  • Warm up: always warm up before every practice and game/match; warm-ups should last at least 5-10 minutes and include low-level cardiovascular activities, stretching exercises, and movements that mimic those involved in your sport
  • Ease into it: when returning to a sport or activity after an extended absence—or if trying it for the first time—start off gently and slowly, and gradually work your way up to more aggressive play or training
  • Improve your form or technique: whatever your sport, it’s essential that you’re using a form or technique that is helping you excel rather than adding to your injury risk; if you have a coach, they will be able to help you work on this; for others, see a physical therapist for guidance on improving your form
  • Don’t play overly fatigued: if you feel too tired during a game or practice, don’t push yourself and sit out to recover; many injuries occur in athletes that are overly fatigued and incapable of performing at their optimal level, which is why it’s crucial to know where this line is drawn and how to respond if it’s crossed

Regardless of what sport you play, injuries are an unavoidable part
July 2, 2019

From the perspective of both a participant and a spectator, sports can be a glorious, epic, and uplifting affair. But on the other side of the coin, they can also be devastating, gut-wrenching, and downright deflating. There are a number of different types of events that would likely fall into that second category, but most are related to perhaps the toughest part of sports: injuries.

For all the fun and joy that come with sports, there is also an inherent risk for injury that simply cannot be completely avoided. All sports carry an injury risk due to their physical toll on the body through physical contact, collisions, and excessive exertion, regardless of its intensity. While many injuries are minor and will only sideline an athlete for short periods of time, others can have serious repercussions that affect careers in the long term.

To help put matters in perspective, here are a few key statistics from the CDC on national injury rates:

  • An average of 8.6 million sports- and recreation-related injuries occur each year; this means that about 34 injuries are reported for every 1,000 individuals participating in sports
  • Injuries are more common in males (61.3% of all injuries) than females (38.7%)
  • Injuries in the 5-24 year-old age group accounted for more than one-half of all episodes (64.9%)
  • General exercise is the most common activity associated with injury

Sports-related injuries come in many different forms, but they can generally be divided into two categories: acute and overuse. Acute injuries are those that occur due to a single, instantaneous event that damages one or more body parts. These types of injuries can be the result of a fall or collision—with another player or an inanimate object—and some examples include ankle sprains, ACL tears, and fractures of the wrist. Pain and swelling typically develop immediately after the injury, which makes them generally easy to diagnose.

Overuse injuries result from performing certain activities repeatedly over time, which leads to stress and minor damage to certain areas of the body that accumulates in the long term. Therefore, overuse injuries come on slowly and gradually due to the damage amassing in joints and other structures, eventually leading to a deep, aching pain in the region that’s been over-stressed. Because of their gradual onset and lack of a specific trauma, overuse injuries can often be shrugged off or dismissed as muscle soreness, which can lead to additional problems in the future when they are left untreated.

Strains, sprains, and other common sports injuries

Each sport comes with its own unique risk for injury based on the dynamic movements involved, and as a result, certain injuries are more likely to occur in some sports than others. But there are also a number of injuries that are seen frequently in a wide range of sports that have earned a certain level of distinction and infamy. Below are some of the most common sports-related injuries across all sports:

  • Sprains and strains: the most common overall injuries in sports are sprains and strains, which nearly every athlete has dealt with at some point; sprains occur when a ligament—the tough tissue that connects bones together in a joint—is suddenly stretched beyond its limits and damaged in the process; strains are injuries to muscle fibers or tendons—which anchor muscles to bones—and often occur from over-stretching or overusing a muscle
    • Ankle sprains are one of the most common injuries in sports; these usually occur when the foot turns inwards too aggressively, which tears the ligaments on the outside of the ankle; they are seen in many sports, including basketball, football, soccer, and volleyball
  • Groin strain: the groin is the area where the abdomen meets the leg and the inner thigh muscles attach to the pubic bone; it can be strained from sprinting or any type of activity that requires forceful movement of the leg, such as jumping, kicking, or changing directions while running; groin strains are especially common in soccer, hockey, football, and baseball
  • Strained hamstring: the three muscles in the back of the thigh form the hamstring; any of these muscles can be pushed beyond its limits in sports that involve sprinting, running, or extreme stretching, leading to a “pulled hammie”
  • Shin splints: pain down the front of the lower leg is referred to as “shin splints,” which occur when muscles, tendons, and bone tissue in this region are pushed too hard; they are commonly seen in runners, particularly those that increase the intensity of their routine too quickly
  • ACL tear: the anterior cruciate ligament (ACL), which helps to stabilize the upper leg bone to the knee, can be torn when an athlete suddenly cuts or changes direction; tears of the ACL are most commonly seen in football, basketball, and soccer, and often sideline athletes for extended periods of time
  • Patellofemoral pain syndrome: sometimes referred to as “runner’s knee,” this is an overuse injury that can result from the repetitive movement of the kneecap (patella) against the thighbone (femur), which can damage the tissue under the patella; in addition to running, this injury is also seen frequently in volleyball and basketball
  • Tennis elbow: repetitive use of the elbow—particularly due to a tennis stroke or golf swing—can lead to damage of the tendons that attach to bone on the outside of the elbow, and the result is an overuse injury called lateral epicondylitis, or tennis elbow
  • Other: Achilles tendinitis/tears, shoulder impingement/rotator cuff tendinitis and tears/shoulder instability, plantar fasciitis, femoroacetabular impingement/labral tears, wrist tendinitis, meniscus tears, low back pain, neck pain, frozen shoulder, hip bursitis, iliotibial band syndrome, patellar tendinitis

3 different types of exercise are effective for rotator cuff injuries
June 27, 2019

Physical therapy is commonly recommended, but it’s not clear which approach is best

Shoulder pain affects approximately 16-21% of the population, and it’s one of the most common reasons people seek out care from a doctor. There are many possible causes of shoulder pain, but a significant percentage of cases are due to a condition called rotator cuff tendinopathy. The rotator cuff is a group of muscles and tendons that surrounds the shoulder joint and provides it with the stability needed to do its job. Rotator cuff tendinopathy—also known as shoulder impingement syndrome and several other names—occurs when one of these tendons becomes damaged and inflamed. This may be due to a single, traumatic injury or from a gradual deterioration over time, and the result is always pain and difficulty moving the shoulder normally. Patients with rotator cuff tendinopathy are usually referred to physical therapy to undergo a treatment program that consists of exercise and other interventions. Research has shown that exercise can lead to promising results in these patients, but different authors have advised the use of several different approaches, and it’s not clear which is best. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to compare the effectiveness of three different exercise programs for patients with rotator cuff tendinopathy.

Each exercise program lasts for three weeks

For the study, researchers recruited individuals who had shoulder pain for at least three months and screened candidates with inclusion criteria to determine who would be the best fit. This process led to 120 individuals meeting the necessary criteria and being included in the RCT. From here, participants were randomly and evenly assigned to one of three groups: the open chain exercise group, closed chain exercise group, or range of motion (ROM) exercise group. Each group followed a specific type of exercise program, with the open chain group performing a series of rotation exercises that utilized resistance bands. The resistance of the band was set by the physical therapist so that the participant reported being challenged without experiencing excessive pain, and they each needed to perform 10 repetitions of each exercise. The closed chain exercises were designed to activate the rotator cuff muscles as a group and consisted of a wall press and other similar exercises, which all progressed in difficulty throughout the program. The ROM exercises focused on increasing flexibility and were also made progressively more difficult by adding resistance to them. In all three groups, participants attended three appointments with a physical therapist over six weeks, and were instructed to complete three sets of 10 repetitions for each exercise, twice per day over this time period. All participants were evaluated at the start of the study and after the six weeks with a questionnaire regarding their shoulder pain and disability.

All three programs lead to similar improvements

Results showed that participants in all three groups experienced significant improvements in shoulder pain and disability. When these improvements were compared, they were found to be similar between all groups, which meant that no single exercise program was superior to the others. These findings suggest that targeted exercises led by a physical therapist can reduce shoulder pain and disability in patients with rotator cuff tendinopathy, and that the specific exercises used may not be important so long as the rotator cuff is strengthened and mobility is enhanced. Additional research is now needed to confirm these results, define patient selection and further investigate if any single exercise program is superior, but this RCT should encourage patients currently dealing with rotator cuff tendinopathy to see a physical therapist. Taking this approach may help these patients experience a number of benefits and quickly experience relief from their shoulder pain.

– As reported in the June ’17 issue of Physiotherapy

For shoulder pain relief, try these exercises and home remedies
June 18, 2019

Shoulder pain can be one of the most disabling problems to deal with. Whether you realize it or not, you use your shoulder pretty frequently throughout most days, as it permits practically any movement that involves your arms. This is why any issue that causes pain and prevents your shoulder from moving normally can wind up being a burden to your daily life.

There are a number of conditions that can be responsible for shoulder pain, each of which may develop from a unique order of events. In some cases, the cause may be a single, traumatic event like a hard fall to the ground or sports-related injury. Tears of the rotator cuff (a group of muscles and tendons that stabilize the shoulder) and labrum (a rim of cartilage that lines the inside of the shoulder) often occur through this mechanism. Other cases of shoulder pain may develop gradually over the course of time due to repeated damage to the shoulder from overhead activities, which are usually referred to as overuse or repetitive strain injuries. These include conditions like rotator cuff tendinitis or shoulder impingement, and shoulder instability, tendinitis, and bursitis.

Unfortunately, there are also some conditions—like frozen shoulder—and cases of shoulder pain in which it’s not possible to figure out the exact cause, and sometimes problems in other parts of the body may be the culprit of pain in the shoulder. But regardless of what’s responsible, the end result for most people with shoulder pain is the same: daily challenges with any activities that require reaching overhead, across the body, or for far-away items. If you count yourself as one of the many who is impacted by shoulder pain and you deal with these issues regularly, a primary goal of yours is probably finding immediate relief.

Focusing on certain movements and avoiding others is the key

The good news is that there are plenty of ways for you to alleviate your shoulder pain right now. The key to this process is understanding that some movements and exercises can be helpful, while others can harm your shoulder and should be avoided. Below are some tips that you can follow to relieve your shoulder pain on your own, but be sure to consult with your doctor if you have any questions or your pain gets worse:

  • Cold therapy: applying ice reduces blood flow, which will in turn decrease inflammation and swelling, and alleviate pain in the process; cold therapy is recommended immediately after pain strikes, and ice packs should be applied for 15-20 minutes, up to five times per day
  • Heat therapy: applying heat to a painful shoulder increases blood flow and brings oxygen and nutrients to the area, which will accelerate the healing process and alleviate pain; this is recommended a few days after the onset of pain, and can be accomplished with a hot shower directly on the shoulder or a hot pack for 15-20 minutes; sometimes alternating hot and cold therapy is best
  • Over-the-counter pain medications: some patients with mild shoulder pain can experience relief with pain medications that don’t require a prescription, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil), and naproxen (Aleve); NSAIDs alleviate pain by reducing inflammation, which is particularly applicable for rotator cuff conditions, tendinitis, arthritis, and other shoulder problems
  • Activity modification: if you can identify the activity or set of movements that may have been responsible for your shoulder pain, it’s best to modify these activities by improving your form or avoiding them altogether whenever possible
  • Sleeping style: sleeping on your bad shoulder can make matters worse, so try to sleep on your back or the side of your body unaffected by shoulder pain to avoid exacerbating the problem
  • Massage: gently massaging your shoulder will help to alleviate stress and tension in the surrounding muscles, while also improving blood circulation and reducing swelling in the process, all of which can reduce your pain levels
  • Shoulder exercises and stretches: regularly performing shoulder exercises can help improve your strength and flexibility, which is a key component of overcoming shoulder pain
    • Codman’s rotation: also known as Codman’s exercise or the pendulum stretch, this is a simple exercise that can provide relief for most shoulder conditions, except shoulder instability; to perform it, bend forward at the waist with your back parallel to ground, and allow the involved arm to hang down, perpendicular to the floor; keep the arm and shoulder muscles relaxed, and move the arm slowly, either front to back, side to side, or in circles; repeat up to 20 times and switch directions
    • Overhead shoulder stretch: while sitting or standing, intertwine your fingers in front of you, then bend your elbows and raise your arms above your head; next, gently squeeze your shoulder blades together to move your elbows back, and continue for up to 20 repetitions
    • Arm-across chest stretch: hold your right hand out in front of you and keep it near your waist; reach your left hand behind your elbow, pulling your right arm to the left and across your chest; if you feel pain in your shoulder, lower your arm until the pain subsides; hold for 30-60 seconds, then relax and repeat with your left arm; repeat 3-5 times

Prevent shoulder pain by avoiding too many overhead activities
June 11, 2019

If you’ve recently found yourself grabbing an item on a top shelf, reaching for something in the backseat of your car, or throwing an object of any sort, then you were also witnessing the grand capabilities of the shoulder joint. The shoulder is the only joint that can rotate a full 360°, which makes it the most mobile and flexible joint in the body, and it’s this wide range of motion that also allows you to perform so many tasks without even giving you pause.

For individuals who are moderately active, the shoulder actually gets quite a workout in everyday life. It moves pretty much any time you use your arm, particularly when you lift or reach for an object, pick something up off the ground, and when you perform any sort of overhead motion in sports or other activities. All of these actions are possible because of the extreme mobility of the shoulder joint and the fact that you can move and rotate your arm in just about any direction. But these significant benefits also come with a significant cost: the shoulder is the most commonly injured joint in the body.

It’s not clear just how many people have shoulder pain, but some statistics have suggested that up to 26% of the population is affected by it. There are a number of potential issues that can go on to cause shoulder pain, but the majority of cases are due to repeatedly performing overhead movements. These types of movements are necessary in professions like painting and construction, and in sports like baseball, swimming, and tennis, which is why individuals involved in these activities are at the greatest risk for experiencing shoulder pain.

Over time, repetitive overhead activities can damage structures within the shoulder and result in pain, weakness, and other symptoms. Some of the most common problems that can arise in the shoulder are disorders of the rotator cuff (a group of muscles and tendons that helps to keep the shoulder stable), frozen shoulder, shoulder instability, and tears of the labrum (a cup-shaped rim of cartilage that lines the inside of the shoulder joint) and rotator cuff. While the specific development and symptoms of each of these conditions is unique, they all cause a certain degree of disability in daily life, especially for those with jobs that require the regular use of their shoulder. So for these individuals and anyone else interested, the next question may very likely be: is it possible to prevent shoulder pain in the first place?

It all comes down to changing your daily movements and habits

The short answer to the above question is yes, it is possible to avoid some types of shoulder pain. Unfortunately, there is no single, foolproof way to stop all shoulder pain from occurring because of the many variables that go into its development, but there are a number of steps you can take to reduce your chances. Each of these tips addresses a different aspect of shoulder use, but the underlying message is that modifying and improving how you move your shoulder is the best way to prevent pain from arising. Before trying any new exercises, be sure to consult with your doctor:

  • Limit overhead activities
    • If your profession does not involve regular overhead movements, be conscious of when you do perform them and try to avoid any activities that involve repeated overhead use of the shoulder
    • If your profession does involve lots of overhead movements, learn to use proper form during these activities, take frequent breaks throughout the day, and switch your arms as often as possible to more evenly distribute the load; also avoid straining your shoulder when reaching for objects
  • Modify your workstation: although work in an office environment may not sound as risky as painting or pitching, you may still be straining your shoulder if your workstation is not set up properly; below are some important ways you can modify and improve your workstation ergonomics—the process of arranging workplaces to better fit the people that use them—to reduce shoulder strain
    • Use proper posture: sit with your feet flat on the ground or on a footrest, with your lower back supported, shoulders relaxed, and hands and wrist in line with your forearms
    • Take regular breaks: aim for a 30 second “micro-break” every 30 minutes or so to shake out your arms and hands, and longer breaks to give your shoulder a rest every so often
    • Rearrange your desk: keep supplies that you use regularly within easy reach so you don’t have to twist or stretch to reach them
    • Invest in a headset: if you’re on the phone frequently, a headset is key
  • Increase shoulder strength: strengthening the muscles that support the shoulder will increase its stability and reduce the risk for pain
    • Scapular stabilizing exercise: lie face down with a pillow under your stomach and place your forearms on the floor with your elbows bent at 90°; slowly raise your arms up off the floor as high as possible and hold for 5-10 seconds; slowly return to the starting position; repeat up to 10x
    • Doorway stretch: stand in an open doorway and spread your arms out to your side; grip the sides of the doorway at shoulder height, and while maintaining your grip, lean forward until you feel a light stretch in the front of your shoulder; slowly return to starting position; repeat up to 10x
  • Improve shoulder flexibility: the more you stretch your shoulder, the better its range of motion will be, and keeping these muscles flexible will in turn help you avoid pain and injury
    • Sleeper stretch: lie on a firm surface on your side with your shoulder under you and your arm extended out; bend the extended arm up into a 90° angle with your fist in the air; use the other arm to push the bent arm down (forearm towards the floor) and stop pressing down when you feel a stretch in the back of your shoulder; hold this position for 30 seconds, then relax your arm for 30 seconds; repeat 4 times, 3x/day
  • Other
    • Use proper form: athletes involved in overhead sports should learn and utilize proper form at all times to reduce the strain on their shoulders
    • Listen to your body: if certain activities cause you immediate pain, try to avoid them as best you can to curb the progression of pain

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.