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Common Treatments

 

Oh, My Aching Feet - Treating Plantar Fascitis

How many times have we run into the patient who complains of plantar heel pain upon bearing weight first thing in the morning? This symptom may be a sign of plantar fascitis, an inflammatory condition involving the broad tendon sheath which runs longitudinally along the bottom of the foot. Symptoms may present either gradually or suddenly without no apparent cause.

Plantar Fascitis is an overuse syndrome which occurs when the fascia is placed under abnormal stress, which commonly occurs with hyper or hypo pronation. Symptoms usually develop around the origin of the fascia, with point tenderness found on the plantar anteriomedial aspect of the calcaneus.

Physical therapy modalities such as ice, ultrasound, iontophoresis and cross friction massage may help reduce acute symptoms. The patient is instructed to pre form stretching exercises of the calf group and plantar fascia, while ladies are asked to avoid heeled shoes.

The Permanent Cure

Having worked with many of these patients over the years, i have found that the most effective and long lasting results are found with the wearing of customized orthotics which help to balance abnormal forces on the plantar fascia. With the correct device inserted into the show, symptoms will resolve within the first week of wear.




Treating the Patient with lower back pain - A common sense approach

We've all heard the statistics telling us that lower back pain is the most common ailment among the adult population, costing industry billions of dollars in medical bills and lost man hours. Early intervention in any injury is crucial to preventing a chronic disability, and the lower back is no exception. Physical therapy which includes specific patient instruction on how to prevent further injury can be of significant value when treating these individuals. From one therapists perspective, here are some answers to commonly asked questions.

What is the most important role of Physical Therapy in treating LBP?

Teaching the patient how they can prevent further injury and designing an exercise program which is appropriate for their specific back dysfunction is the most important role of a physical therapist. Modalities are used to relieve local inflammation and reduce muscle spasms, but without a sound home program for which the patient can follow, recovery may be delayed or incomplete. Areas such as lifting techniques, sitting postures and ergonomics, transitional movements, along with flexibility and strengthening exercises are all important components of a home program. Some patients may only need a good home program in order to make a quick full recovery.

Which protocol is best, McKenzie Williams, Back School, or a combination of all three?

Here's where the common sense approach really takes over. A thorough evaluation will usually steer the therapist in a direction which will frequently use a combination of techniques which were spawned by different philosophies. Many think of McKenzie as extension and Williams as flexion exercises, but those who follow the McKenzie protocols know that flexion is often as important component in treating LBP. As we age our intervertebral discs tend to lose their water content and hence their height, which may lead to facet joint over-riding. this may be one reason why elderly patients usually respond better to williams flexion as opposed to extension protocol, especially when radicular symptoms are present. Dynamic stabilization exercises are important in reconditioning muscles's and improving joint proprioception, while the spine is maintained in a neutral position. Abdominal and paraspinal strengthening are often critical in preventing the re-occurrence of lower back symptoms.

What other areas of the body may attribute to Lower Back Pain?

Many times we'll find that other areas of the body may be the primary cause of LBP. Leg length discrepancies, hip pathology, and foot abnormalities may all lead to lower back compensation and eventual pain and stiffness. correction of abnormal bimechanics will often resolve lower back symptoms.

Summary

We find that an eclectic, common sense approach with good home instruction leads to excellent long term results.




Effective Long Term Treatment of Fibromyalgia

Fibromyalgia is a condition that affects the muscular system and connective tissue of the body. The exact cause of fibromyalgia is unknown but the symptoms are real and can be debilitating. Severity can range from occasional symptoms that affect one area of the body such as the neck and upper back to constant severe pain throughout the entire body. Characteristics of the symptoms include muscle pain, body aches, fatigue, difficulty sleeping, headaches, muscle spasm, decreased strength and joint motion, and difficulty relaxing to name a few. More women than men are affected by by fibromyalgia, but the condition can affect nearly all age groups.

Treatment for fibromyagia includes but is not limited to prescription medication, proper exercise for range of motion and strength, which is often best treated in an aquatic environment. At Maumee Physical Therapy and Aquatics Center we instruct the patient in light strengthening and stretching exercises which increses blood flow to the muscles resulting in improved function and decreased pain. Relaxation and breathing techniques are also extremely effective for decreasing muscle spasms, pain and improving sleep in this population. Patients learn techniques to help them throughout the day to manage stress, improve posture and enhance body awareness.

A maintenance program of exercises is recommended for those with fibromyalgia to help keep symptoms under control. An example may include relaxation exercises, attending a yoga class for fibromyalgia, gentle strengthening exercises, stretching, water aerobics, and stress management. Listening to your body and learning what works best for you can often be a challenge. Improving body awareness through physical exercise and yoga therapy has shown to be an effective way to manage FMS long term in many individuals.




Patellofemoral Syndrome or Runners Knee

Disabilities involving the knee and more specifically the patella (knee cap) are common in all age groups. Many causes can be blamed on these problems including direct trauma such as falls and auto accidents, biomechanical deficiencies, and training errors in runners. Over time these problems can lead to a wearing of the cartilage which covers the underside of the patella, leading to osteoarthritis characterized by joint noises and pain. Activities such as stair climbing, stooping, and kneeling can often aggravate these symptoms.

Depending on the cause of the problem and the severity of the condition, physical therapy may be prescribed as a conservative treatment option. An exercise program designed to strengthen the quadriceps (upper thigh) muscles without irritating the patellofemoral joint can help to realign the patella and reduce frictional forces. Tightness in the hamstring and lateral (outside) hip muscles must also be addressed. Ice application after exercise is often used to prevent joint inflammation. A good home program includes appropriate exercise and instruction of activities to avoid such as excessive stooping and stairclimbing.

Joggers should do their best to avoid compression forces on the knee joint by avoiding hard surfaces such as cement while wearing proper running shoes. Running on sloped surfaces such as the side of a road may also aggravate symptoms. Proper stretching prior to jogging should include the quadriceps, hamstrings, calves, and lateral hip muscles.

External supports may be used to help align the patella. Knee sleeves and foot orthotics both can both be helpful in reducing abnormal joint friction.

Patellofemoral dysfunction is a common problem we treat at Maumee Physical Therapy and Aquatics Center. With proper treatment and a good maintenance program, symptoms are often abolished and the patient can return to a normal, active lifestyle.




Shoulder Injuries Common and Sometimes Complex

If we look at the anatomy of the shoulder we find a very unstable joint which allows a large amount of motion. In fact it's estimated that only 80% of the ball (head of the humerus) sits in the socket (glenoid of the scapula), which is stabilized by ligaments and a group of four muscles, namely the rotator cuff. This joint is prone to many injuries due to overuse, trauma and simple wear and tear over the years. Shoulder injuries are quite common in a physical therapy orthopedic clinic.

Excessive movement is necessary in our daily activities such as reaching, donning clothes, and grooming. Many athletic events require complex shoulder movements which sometimes lead to overuse injuries, such as tendonitis and bursitis. Referred to as an impingement syndrome, such injuries can be quite annoying, causing pain with overhead and twisting movements. Rotator cuff weakness or tightness in the posterior (back) aspect of the joint is also thought to contribute to these types of injuries. Baseball pitchers, tennis players, and swimmers commonly suffer from this type of injury due to repetitive movements, causing stress on the rotator cuff tendons and bursa. Treatment principles of these types of injury include early ice and rest, gentle painfree movement to promote blood flow and specific strengthening of the rotator cuff and scapular musculature without irritating the injured tissues. Teaching the patient the importance of avoiding activities which reproduce symptoms will quicken the healing process.

Sometimes excessive wear and tear over many years or a traumatic event such as a fall or lifting/catching a heavy object can lead to rotator cuff tears. Patients present with significant pain and weakness with active movements, especially when attempting to reach overhead. Severe rotator cuff tears usually require surgery by an orthopedic surgeon, followed by several weeks of physical therapy. Speed of recovery is aided by motivated patients who comply to a home program designed to first return range of motion to the joint along with progressive strengthening once the surgical repair is healed enough to handle the stress of weight training.

If a person tends to over protect their shoulder after an injury by avoiding normal movement, it may have a tendency to stiffen or freeze. A frozen shoulder is one of the more challenging conditions we work with in our clinic, one that requires graduated stretching not only by the therapist but also by the patient when not in therapy. Normal range of motion returns gradually, and the patient is guided in a home program which challenges the extremes of movement. In a small percentage of cases, therapy may prove unsuccessful in returning normal range of motion. A procedure known as a closed manipulation is sometimes performed by an orthopedic surgeon, where under general anesthetic the patient's shoulder is guided through full range of motion, breaking loose adhesions which form over time. These patients usually require physical therapy immediately following a manipulation in order to maintain their increased range of motion.

We enjoy working with shoulder patients at Maumee Physical Therapy and Aquatics Center. Our goal oriented programs are designed specifically for each individual to return them to their normal daily activities, whether professional or recreational, quickly and safely.




What is Tennis Elbow?

Tennis elbow is a common overuse injury treated at Maumee Physical Therapy and Aquatics Center. Otherwise known as lateral epicondylitis, the condition is actually a tendinitis of the common extensor tendon of the wrist where the muscles attach to the outside of the elbow. Tennis elbow patients present with complaints of localized pain of the lateral (outside aspect) elbow which is aggravated with activities involving gripping, twisting and lifting. Although commonly regarded as a tennis related condition, tennis elbow affects those who perform activities that require repetitive movements of the wrist. Carpenters, painters, and auto mechanics are amongst those who are commonly afflicted with this condition.

Common Treatment

Initial treatment to this or any overuse injury includes rest, ice, and controlled stretching. Tennis elbow straps, worn just below the elbow, are effective at reducing stress to the injured tendon where it inserts onto the humerus (upper arm bone). The patient is asked to eliminate activities which cause pain or produce localized swelling. Once acute symptoms have resolved, the patient is placed on a progressive strengthening program emphasizing low weight, high repetition exercises to increase muscular endurance. Exercises which simulate specific activities of the patients lifestyle can help to prevent reoccurrence of symptoms.

Prevention

Tennis elbow may be prevented by a few common practices:

  • Increasing the size of a tennis racquet, screwdriver, hammer or paintbrush

  • Eliminating repetitive movements of the wrist

  • Maintaining proper flexibility in the wrist extensor musculature thru regular stretching

  • Continuing a progressive strengthening program for the wrist, elbow, and shoulder

  • Using ice as needed

  • Regular use of a tennis elbow strap

Properly managed, acute tennis elbow will usually resolve anywhere from three to six weeks. If you have any questions regarding this or any other condition, please contact us by clicking on our Ask The Therapist link.

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