Human Performance and Rehabilitation Centers, Inc.

ACL tears in athletes

“I heard it go ‘pop,’” an athlete says with dread.

That sickening sound and a sudden pain in the knee point to the culprit: an ACL tear. Sports that demand sudden stops and quick lateral movements like football, soccer and basketball are hotbeds for ACL tears. Here’s what an athlete needs to know about recovering from this common sports injury.

About the injury

The anterior cruciate ligament (ACL) is one of four main ligaments in the knee that connect the femur above the knee to the tibia below. Injuries to the ACL can happen to anyone, but they are common among competitive athletes in their late teens to mid- to late twenties. As more young people are participating in sports with higher levels of athleticism, the injury is on the rise. According to the American Academy of Orthopaedic Surgeons, the annual incident rate of ACL injury is about 200,000 with 100,000 ACL reconstructions performed a year.

How it happens       

ACL injuries often occur when an athlete makes a quick stop, plants his or her foot and then changes direction. The abrupt change of speed combined with an abrupt change in direction stresses the ACL, which can tear and make a popping sound. Pain and swelling sets in quickly. Athletes will generally opt for reconstructive surgery of the ligament to maximize their ability to resume competition.

The road to recovery

Orthopedic surgeons thread in a new tendon to replace the torn ACL that is taken from the patient’s hamstring or from a cadaver. A patient will usually be on crutches for the first couple of weeks after surgery. The rehabilitation plan is dependent on the extent of injuries sustained during an ACL tear; it’s not uncommon to also experience damage to the meniscus. Therapy starts with very limited weight-bearing exercises that will slowly increase over time.

Strengthening the quadriceps is the primary goal of first 6 weeks of therapy. This helps provide stability to knee. The physical therapist will then move to short arc exercises, straight leg raises, hip strengthening and some balance exercises.

During the first 6 weeks, the goal is to increase range of motion — helping a patient go from zero to 135 degrees of flexion.

At the 8 to 12-week mark, the healing process is well underway with the reconstructed tendon tightening down as it should. Balance and biomechanics become key therapy priorities. Patients also progress into plyometric training, working their way up to light jogging and mild ladder drills at about the 10-week juncture. After 12-16 weeks, patients get into heavier plyometrics with the intention of soon getting back into their chosen sport. The therapist observes movement and watches for any signs of instability or imbalance.

Listen to your PT

Throughout therapy, it’s critical that a patient stick to the prescribed home exercise program to supplement therapy sessions. It’s also important a patient understand that the adage “no pain, no gain” does not apply to ACL recovery.  Take it slow and allow the ligament to fully heal in place. Patience goes a long way in preventing future injury.

Ankle Sprain: Here’s how to treat this common injury

Ankle sprains can happen to anyone. Sure, athletes who spend a lot of time running and jumping are vulnerable, but everyday individuals can experience ankle sprains while carrying out routine activities. Stepping off a curb incorrectly, stumbling while doing yard work, or other occasions when you unexpectedly meet uneven terrain can result in an ankle sprain. The good news is that this injury rarely requires surgery. Patients can recover quickly with the right treatment.

What usually happens when you sprain your ankle is that the ankle rolls inward, tearing the anterior talofibular ligament. Physical therapists classify ankle sprains in one of three categories depending on the level of trauma the ligament sustains.

A Grade 1 sprain is a mild sprain that will heal on its own. You can walk it off, and it exhibits little to no swelling. Ice and rest are recommended to ensure a full recovery, which tends to occur within a week.

A Grade 2 sprain usually exhibits bruising as well as swelling immediately after the injury takes place. A Grade 3 sprain presents a higher degree of swelling and bruising and results in difficulty walking. A physical therapist can determine the extent of the injury through a routine examination of the ankle.

The treatment for a Grade 2 or 3 ankle sprain is first to decrease the swelling through what we call “PRICE,” an acronym that stands for Protect, Rest, Ice, Compression and Elevation. Once the swelling subsides, we focus on restoring movement to the ankle through manual therapy to the ankle joint. We also have patients perform specific isolated exercises that build flexibility. A common exercise is to have patients “draw” the alphabet with the big toe of the affected foot while sitting in a resting position.

As we see improvement in the movement of the ankle, we focus on restoring strength to the area by exercising the surrounding musculature. We also work to restore balance – a very important function of the ankle. Think about it. Your ankles are constantly working to help your body adjust to uneven surfaces as you move throughout the day. We work to restore this sense of balance by having patients perform proprioceptive exercises, or exercises that help the body understand where it is in relation to its environment.

Generally, patients can make a full recovery from an ankle sprain within two to four weeks.

Sit Up Straight: How Workplace Posture Impacts Health

For a growing number of professionals, the cumulative effects of working behind a desk can take their toll. Years of pecking away at a computer and talking on the phone can lead to a variety of issues, including headaches, stiffness, and pain in the shoulders, middle back and neck. There’s hope, though. These issues can be effectively addressed through physical therapy and by making adjustments to your everyday posture.

We see patients routinely who experience pain that we can link directly to the way they sit at work. The modern world has created all sorts of demands that don’t square with our bodies’ natural movements. We are not designed to perch in uncomfortable chairs six to eight hours a day, and as the years go by, our body rebels by expressing pain. Physical therapists address these issues by using interventions that can effectively remove stiffness. We also help patients strengthen muscles in the upper back to provide additional support to the neck and shoulders. And, we make specific recommendations for postural adjustments so that pain does not return.

Improving the way you sit at a desk goes a long way. Here are some recommendations:

  • Your feet should touch the floor completely. For people under 5’5”, this can be a challenge as most desks are made for taller people. Use a box or stool if needed.
  • You should be able to place your forearm on your desk or your elbows on arm rests while typing at a keyboard.
  • Your knees should be at a 90-degree angle when you sit, making sure your knees are in line with your hips.
  • Don’t crane your neck to talk on the phone. Use a headset.
  • Ideally, your computer screen should be at eye level.

One of the most important issues to remember is that the body doesn’t like being stagnant. Set a timer and take a “micro-break” every 20 minutes. I can hear the work-a-haulics groaning, but this doesn’t have to take long – a mere 10-15 seconds is all that’s required to stand up and stretch. It’s a simple strategy that goes a long way in protecting your health and warding off pain.

Treating Achilles Tendonitis

Overview of Achilles tendonitis

Achilles tendonitis is a condition in which the Achilles tendon becomes painful or inflamed because of overuse. It’s often experienced by runners who make an abrupt change in their routine, such as an increase in mileage, hills or speed work without building up adequately. Weekend athletes who are sedentary during the week can also experience the condition. It’s easy to assume that Achilles tendonitis will improve on its own, but that’s usually not the case. Untreated, it almost always gets worse.

How to recognize Achilles tendonitis

Achilles tendonitis comes on slowly. Overuse causes the tendon to become tight and inflamed. Pain and swelling can occur anywhere along the Achilles tendon, which spans from the heel bone to the calf. When the condition first appears, the patient might notice some discomfort above the heel when running, walking, getting out of bed or standing for long periods. The pain and stiffness will usually worsen over time.

How physical therapy can help

Reducing inflammation in the Achilles tendon is the main goal of therapy. Depending on the patient’s level of mobility, treatment can include modalities like therapeutic ultrasound, dry needling and Astym. These modalities reduce inflammation and decrease the chances of the tendonitis from returning.

  • Therapeutic ultrasound is a highly effective treatment for Achilles tendonitis. It is used in conjunction with an anti-inflammatory gel applied to the surface of the skin. The ultrasonic waves help the gel to penetrate the tissue faster and bring relief to the inflamed area.
  • Dry needling is a form of manual therapy in which small needles are inserted into “knots” or trigger points. In Achilles tendonitis patients, it is used to address the referred pain that a patient can experience in the calf muscles. Dry needles are applied in a relatively painless manner and coax the muscle to release tension and “reset.”
  • Astym is a soft tissue therapy in which a clinician performs certain protocols of manual therapy using a small hard plastic instrument. This is an effective strategy for breaking down scar tissue and stimulating the growth of healthy soft tissue.

Patients with Achilles tendonitis usually see good results between 8-12 weeks.

Speech Therapy After Stroke

Stroke Overview

Strokes are caused either by a blockage of the blood vessels in the brain or by bleeding in or around the brain, and they can happen to anyone of any age at any time. Patients have the best shot at recovering from the effects of a stroke when they are evaluated quickly and thoroughly by a team of medical professionals, including a Speech-Language Pathologist (SLP). A stroke can cause cognitive communication and swallowing deficits, and an SLP will diagnose and treat these specific conditions.

Speech Therapy After Stroke

An SLP creates a tailored treatment plan for each patient that focuses on improving the skills that the stroke has diminished. The brain is organized such that an injury to one side of the brain affects the opposite side of the body. Depending on what areas are affected, an SLP will deploy certain therapies and strategies. The SLP’s goal is to:

    • Improve the patient’s ability to understand and/or produce language;
    • Improve speech production if there is difficulty due to weakness or motor planning;
    • Determine whether there is a need for an alternative/augmentative device to supplement a patient’s verbal communication;
    • Increase awareness of deficits in order to help self-monitoring in the hospital, home and community;
    • Implement compensatory strategies or modify the patients work/school environment to meet their needs;
    • Make recommendations that involve positioning issues, feeding techniques, specific therapeutic techniques and diet consistency changes; and,
    • Educate the patient, their family members or caregivers about the therapy path forward.

The recovery and rehabilitation process is different for each patient. An SLP will work with a team of other health care professionals to help a patient transition back into the community and to reclaim the skills to live as independently as possible. Everyone’s common goal should be restoring a patient’s quality of life.

Remember, there is life after stroke, and early therapy increases the chance that life will be as fulfilling as possible.

Additional resources:

National Stroke Association – www.stroke.org
American Speech Language Hearing Association (ASHA) – www.asha.org
National Institute of Health – www.stroke.nih.gov

As the World Turns: Using Therapy to Resolve Vertigo

Overview

The sensation of spinning, or vertigo, can be a common problem especially among older adults. Vertigo is usually a condition called Benign Paroxysmal Positional Vertigo, (BPPV), an inner ear malfunction treated in a therapy setting. Vertigo is not detected in an MRI.

BPPV, the most common form of vertigo, is a mechanical failure of the inner ear. Calcium carbonate crystals (otoconia) that are embedded in a part of the ear called the utricle dislodge and float to places where they cause problems. When enough of these crystals settle in the fluid of the ear canals, they trick the brain into thinking the head is moving when it isn’t. That’s where the sensation of spinning comes from.

Treating Vertigo

Our first step is to determine if a patient has BPPV. We do this by performing a Dix-Hallpike Test in which we ask the patient to lie in a supine position while we carefully roll the head until it triggers vertigo. If a patient has BPPV, a bout of vertigo will create a detectable “error message” in the eye movement. Both eyes will turn rapidly in a torsional fashion which also intensifies the sensation of spinning.

Ultimately, the eye movements are the key to a BPPV diagnosis and helps us pinpoint exactly where the crystals have migrated. Our next step is to gently maneuver the head using specific protocols. Your therapist should be well-trained in this intervention, which uses gravity to naturally guide the crystals from their offending location back to the utricle. The most common type of maneuver is called an Epley Maneuver, and it can take less than five minutes to perform. Many patients will feel instant relief, and others will see progress in a day or two.

Patients who suffer from BPPV have often spent months or years trying to get a clear diagnosis. Seeing a therapist first can bring an end to both frustration and discomfort.

Front of knee pain: How to treat Patellofemoral Pain Syndrome

If you’ve experienced pain in the front of your knee around the kneecap, it’s probably a condition called Patellofemoral Pain Syndrome. Known also as “runner’s knee” or “jumper’s knee,” this condition can occur at any age, but it’s most common in teenagers, young adults, athletes and those who have recently hit puberty.

Patellofemoral Pain Syndrome is typically not caused by trauma; instead, it can seem to just appear. Because no single incident is the culprit, a person experiencing it may be inclined to work through the pain, or keep participating in sports or activities. When the pain doesn’t resolve, and, in fact, it gets worse, everyday knee flexion and extension can become intolerable.

Younger athletes are particularly vulnerable to Patellofemoral Pain Syndrome. During puberty, a young person’s bones grow fast –  outpacing the growth rate of ligaments, tendons and muscles and putting more stress on the joints. In addition, females have wider hips compared to their male counterparts and this can change the alignment of the knee and impact the patella’s movement in the trochlear groove. Athletes who engage in running, soccer, volleyball, cheerleading and dancing could experience this kind of knee pain.

Other causes for Patellofemoral Pain Syndrome include muscle weakness, stiffness, fatigue, improper shoe wear and poor movement patterns. Other contributing factors include overtraining or poor training techniques. And, prolonged sitting behind a desk during the week coupled with extreme “weekend warrior” activities can create an opening for Patellofemoral Pain Syndrome.

Patients should avoid irritable activities and apply ice two-to-three times daily to decrease inflammation. Physical therapy plays a big part in getting back to normal. In PT sessions, we work with patients on improving flexibility, stretching the hamstrings and strengthening the quads and hips by using very specific exercises. I usually like to see patients with this condition twice a week for four to six weeks.

Because of the multitude of contributing factors for each individual experiencing Patellofemoral Pain Syndrome, it’s important to let an experienced PT evaluate your case and develop a therapy plan that fits.

Achilles Tendon Injury

The Achilles tendon is an essential part of daily life. Spanning from your heel bone to your calf muscle, this band of tissue allows you to participate in everything from competitive sports to recreational activities, or just simply getting around. While the Achilles is the strongest and thickest tendon in the body, it can also be vulnerable to injury.

How Achilles tendon injuries happen

Athletes certainly experience their fair share of Achilles tendon injuries, but so can the average person. A variety of issues can cause the tendon to partially tear or even rupture. These include an abrupt and incorrect stepping down movement, wearing high-heeled shoes over the long-term, contact injuries or overuse. A tear can occur anywhere along the tendon from the heel to the calf. Injuries are more common in middle-aged individuals, and generally effect men more often than women.

How to recognize a tear

Partial tears, which are vertically or horizontally oriented along the tendon, are much more common than ruptures, or complete tears. You can usually feel a tear when it happens. It will cause the area around the Achilles to feel sore, tender and it may cause swelling. When a patient experiences a complete tear, normal walking is instantly compromised since the tendon is severed and essentially rolls up like a Roman shade. A rupture will require surgery and follow-up physical therapy.

Treating a partial tear or a post-op rupture

A full recovery from an Achilles injury demands patience. Rest is key. If surgery is not indicated, some patients benefit from wearing a boot to keep the tendon in a neutral position. If surgery is indicated, the patient will be referred to physical therapy typically around the 6th post-operative week, but will remain in a boot until 12 weeks post-op, on average.

During therapy sessions, a PT will manually stretch the tendon to bolster blood flow and to improve the relationship between the tendon and the heel bone and/or the calf muscle. The PT will also issue home exercises to encourage healing while minimizing inflammation. When the patient is ready, the PT will introduce gentle exercises like seated calf raises and exercises using therapy bands to increase blood flow. Next, the therapist will guide the patient through a progression of walking activities and dynamic stretching like lunges and standing calf raises with the goal of an eventual return to the individual’s desired level of activity. Another important part of therapy is restoring – or improving – a patient’s sense of balance, so a therapist may also deploy exercises that improve biomechanics. As the patient builds strength and flexibility, it will be possible to once again run and jump.

Continued maintenance

A home exercise program is a key part of helping a torn Achilles tendon heal throughout therapy. Wearing proper footwear is also important. While active adults are always eager to jump back into their former routines, it’s crucial that they practice patience and allow the Achilles tendon to heal fully to prevent re-injury.

Cupping and Taping: Not Just for Elite Athletes

The 2016 Summer Olympics in Rio made folks aware of a couple of different physical therapy techniques popular among elite athletes. Remember the round bruises around the shoulders of five-time Olympian Michael Phelps? Those were from a process called “cupping.” And beach volleyball guru Kerri Walsh Jennings routinely competed with a pattern of tape on her shoulder. Not just for elite athletes, cupping and kinesio-taping are effective strategies for everyday PT patients experiencing a range of issues. Here’s what you need to know.

Cupping

This is an aggressive manual therapy technique meant to enhance range of motion and optimize muscle function. A physical therapist places a special plastic suction cup on the surface of the skin to effectively pull skin and fascial tissue away from the muscle. This releases adhesions that may have formed from a collagen fiber build-up. Over years of use and stress, a patient can develop scar tissue and adhesions within the muscle that limit range of motion, making the muscle feel tight and sometimes causing pain.

Cups come in different sizes for use on different areas of the body. A therapist will identify the proper placement of the cup by examining the skin for tautness and testing the muscle’s range of motion. While the process leaves a circular bruise, it actually invites more blood flow to the area and helps trigger healing. Avoid any kind of cupping that also includes skin laceration techniques because this can introduce infection. Cupping should not be used on patients with blood clots or those taking blood thinners.

Taping

The kind of tape you’ve seen on elite athletes is different from the common tape or bandage that holds a sprained ankle in place. Instead, this is a special type of stretchy tape meant to promote muscle function and guide the muscle into proper movement. A physical therapist places the tape in a deliberate pattern. As it guides the joint through motion, it sparks kinesthetic and proprioceptive feedback. In other words, it’s coaxing better function out of a muscle or joint because it’s showing it how to move correctly. This provides stability and helps prevent injury or re-injury. It also helps teach the muscles to contract properly.

Because they both show good results, cupping and taping are becoming popular therapy techniques for treating everyday patients.

My aching back: Using physical therapy to address low back pain

If you’ve experienced low back pain, you’re not alone. According to the National Institute of Neurological Disorders and Strokes, about 80% of American adults – both men and women – will experience low back pain at some point in their lives. For many patients, physical therapy is an effective tool in improving low back pain and restoring strength and function.

The low back, or lumbar region, is an incredibly important part of the body. Comprised of five vertebrae, the low back supports the weight of the upper body as we go about our daily lives. Multiple components have to work together for the low back to function properly. Soft cushions or discs between the vertebrae act like shock absorbers as we walk, lift, run and jump. Ligaments hold the vertebrae in place. Tendons attach the muscles to the spinal column. Finally, dozens of pairs of nerves are embedded in the spinal cord. Each of these parts works in tandem, so when something is compromised, we feel pain.

No two patients experiencing lower back pain are built exactly the same, which is why a physical therapy setting can be so effective in addressing a patient’s issues and body mechanics. Our goal is to restore normal physiological motion in the low back through tested hands-on therapy techniques that zero in on each joint. In many cases, this mechanical approach is a much more effective – and certainly less invasive – than surgery.

Some of the patients we see experience pain due to spinal stenosis, or the narrowing of spaces in the spine. This is usually caused by age, normal wear-and-tear or arthritis. As joints grow harder and more narrow over time, they can encroach on the nerves that are rooted there. When that happens, the nerves become compressed. We use techniques including traction modalities, manual therapy, joint manipulations and extension exercises both in the clinic and at home.  These therapies help give the nerves more room to function and can help reduce pain in our patients.