Salvador Perez: Intercostal Strain

Salvador Perez Injury: Intercostal Strain

Royals All-Star catcher and fan favorite Salvador Perez recently went on the disabled list for an “intercostal strain.”  As of now, he’s on the 10-day disabled list.  At first glance, you might be thinking, “C’mon Salvy, it’s a rib muscle! How serious can it be?”  So what’s the deal with intercostal strains?

What are the Intercostals?

Quite simply, the intercostals are muscles that run between the ribs and act to elevate the ribs during normal breathing.  When they expand and relax, they move the chest wall to allow the lungs to expand.

How are they injured?

These can be injured in many ways.  Sometimes, a violent cough or sneeze can do it!  However, it sounds like Salvador Perez swung on a strikeout and caused the injury.  Certainly, an awkward throw or twist could cause the muscle to strain.  Heck, he could easily strain the intercostals during one of his infamous “Salvy Splashes” lifting those coolers!

Why are intercostal strains a problem?

The reason why these are a problem are twofold.  One, they are painful.  These muscles can’t rest!  They are moving with every breath you take.  Intercostals are not like the hamstrings or a hip flexor that you might strain.   You can support them with wrapping and avoid running or aggravating activities.  However, we can’t put a cast or supportive wrapping on the ribs – you’ll suffocate!  The second reason is that these just take time to heal.  Like rib injuries and abdominal oblique injuries, these just need time that athletes often don’t have.

What’s the rehab of intercostal strains look like?

For the most part, rehab is just watching the clock.  Pain is managed with medications, possibly a steroid injection to take the edge off.  Things like heat, cold, ultrasound, laser, and electrical stimulation won’t do much here either.  With intercostal strains, you just have to rest until the pain subsides, then you can get back at it as tolerated.

We’re sure Salvy will be back soon to finish out the race for the division title and hopefully much more than that.

While there’s not much we can do at SSOR to treat intercostal strains, we’re experts at figuring out what you have going on if you come see us for an injury.  Make no mistake, if you need to see a doctor, we’ll make sure we make that happen for you.  It would be a privilege to serve you and partner with you in your care.  Give us a call!

 

Golf after Rotator Cuff Repair

When Can You Golf After Rotator Cuff Repair?

We have a results-oriented population here at SSOR and our clientele expect to be as functional or better than they were prior to surgery.  Our patients are active and want to live an active lifestyle when formal rehab is complete.  Rotator cuff repairs are a common procedure we see around here and we have many people that want to play golf again when it’s all said and done.  Inevitably we get asked, “When can I play golf again?”  Unfortunately, there are no controlled studies that look at this question.  The decision is largely based on what the orthopedic surgeon feels is appropriate and hopefully, after consultation with the physical therapist.  Hopefully, this post will help answer some questions.

What’s the big deal? The tear is “repaired” right?

It’s a little more complicated than that.  First of all, your physician needs to give you the “green light” to play.  Your age matters too.  Typically, the older you are, the more the tissue is less elastic and well, there’s some “tread on the tires” so to speak.  The size of your tear and the quality of the tissue also matter.  If you have a small tear and good tissue, you’ll likely be able to play sooner.  However, if you have a massive tear, are older, and the tissue that was repaired isn’t good quality, you’ll probably wait much longer to play.  Truthfully, something to consider too is how good a golfer you are.  If you don’t play much and don’t have a very good swing, you may for example, strike the ground in your downswing which could hurt your surgically repaired rotator cuff.  Experienced golfers typically have a better, more efficient swing which will help minimize the risk of re-injury.  Lastly, your medical history matters too.  If this is a revision rotator cuff repair, you’re likely to have a much more conservative post-operative course and a longer time before you can golf again.

What should I be able to do before I can play golf?

Range of motion is critical after your rotator cuff repair.  The pictures below show a few examples of some things you should be able to do.  First of all, you should be able to flatten your back against the wall and raise both arms overhead in Figure 1 (like you’re saying “Touchdown!”).  If that doesn’t feel symmetrical or very close to it, you don’t have enough flexion range of motion.  Another is a “wall angel” (Figure 2).  Here, you put your arms at 90° and try and raise your arms, keeping them on the wall.  Painful? Can’t get there? Well, there’s some mobility restrictions there that you’ll need to keep addressing.  Lastly, because your arms have to go across your body, you should be able to do that without “hiking” your shoulder to get there or without pain (Figure 3).  Lastly, you have good strength of your rotator cuff, and the only way to really know that is testing from your physical therapist.

Figure 1. With your back against the wall, you should be able to get your arms against the wall

Figure 2. Wall Angel. Place your arms on the wall as pictured, and keeping your arms against the wall, raise your arms till they’re straight overhead

Figure 3. Horizontal adduction.

What should I work on to maximize results for my golf game?

Obviously, range of motion and strength in the shoulder are critical.  The “genie stretch” pictured below can help increase posterior shoulder mobility so you can bring your arm across your body.  Another very important component is thoracic rotation, pictured below.  Thoracic rotation is important for two reasons.  First of all, the more your spine can rotate, the less strain on your shoulder.  Without thoracic rotation, your shoulder will have to compensate or “overcorrect” for the lack of spine rotation, which could damage your recently repaired rotator cuff.  Secondly, your swing is more efficient with better rotation.  Think of winding up a toy – the more it’s wound up, the farther it goes/faster it moves.  Well, the more you can rotate, the more you can “coil” and “uncoil,” effectively using your body’s own elastic energy.  Of course, mobility in your hips matters too.  As we age, we lose mobility there too.  Without hip and thoracic spine mobility, you’ll be needing us for physical therapy for low back pain.

Genie Stretch. Lay on your affected side and lift your arm off the ground. You should feel a stretch in back of the shoulder

Seated thoracic rotation. Place a ball between your knees and make sure your feet are flat on the floor. Rotate each direction.

So when can I play again?

We have to define what “play golf” means.  Full, unrestricted release to playing golf is much longer time frame than say, putting and working on chipping.  Again, provided your doctor gives you the OK, you can start putting around weeks 6-8 or so once you’re out of the sling.  Chipping and working around the greens is the next step and usually you can start that somewhere between 12-16 weeks post-op.  From there, a progressive return to golf program starts with working on irons and of course, hitting off the tee is last.  Most people are back on the course playing with no restrictions anywhere from 4-6 months after surgery.  Again, all of that depends on factors mentioned above – age, size of tear, quality of tissue, experience playing golf, other medical history that may affect your swing.

If you had rotator cuff repair, look no further than the expert staff at SSOR to help you restore your function and your way of life.  Athlete or not, we understand what is done surgically and what has to be done long-term for you to maximize your outcome.  If you love to play golf, this is the place to be – we know what it takes to not only get your shoulder right, but make sure you’re at your best when you get back on the links again.  It would be a privilege to serve you and partner with you in your care.  Give us a call!

Household Items That Sub for Weights

No Weights at Home? Household Items Work!

Home exercise programs are essential and an integral part of each and every patient that walks through the door here.  Whether it’s stretching, mobility exercises, strengthening, daily activity modifications, or any combination of the above, our ideal patients take ownership of their problem and look to us to give them the guidance.  Sometimes, our patients need weights at home in order to improve their strength, but many don’t have weights immediately accessible.  Sets of dumbbells or cuff weights can take up a lot of space too, but options are available for a “set of weights in one.”  Certainly some patients head right to the sports store after their appointment, but other people would rather just use what’s at home, can’t afford to buy weights, or don’t want to buy them because they’ll eventually collect dust.  So what household items can be used as an alternative to dumbbells or cuff weights?

Household items that sub for weights

One Pound

First of all, one pound is 16 oz.  So, if you can do some math in your head or use that trusty cell phone, you can figure out what you need.  That being said, substitutes for 1 lb weights include cans of soup, bottles of salad dressing, and a bunch of kitchen utensils like forks, spoons, and knives held together by a rubber band.

Two Pounds

Household items that are two pounds are basically a carton of milk, but you can also get a sock or a plastic bag with two cans of soup for example to get you 2 lbs of weight.

Three Pounds

A standard bag of onions or oranges is about 3 lbs.  Again, the same strategy for 2 lbs can be used with cans.

Four Pounds

Big bottles of ketchup (64 oz) are 4 lbs and so are many small bags of cat food.

Five Pounds

Bags of flour, sugar, and rice often come in 5 lb bags.  You can put those in a plastic shopping bag or a reusable shopping bag. Many of these products come in 10 lb bags as well and can be used for heavier weights.

Seven-Eight Pounds

A gallon of milk is about 7-8 pounds.  This all depends on the carton materials, but that’s about right.

Other Household Item Substitutes

Lots of other things can be used to hold weights.  Plastic water bottles can be filled to get the desired weight.  Similarly, used soda bottles can be filled with water, sand, rice, or pet food to reach the desired weight.  Socks can be filled with the same materials mentioned above.  Lastly, your kids make great weights for push-ups and squats – make your rehab a family activity.

Sure, lots of these things seem like more work than just buying weights on one click somewhere.  You can go to the store and just buy weights, but hey, if you’re strapped for cash, have limited transportation options, or don’t want to buy weights you’ll never use again, these household items will suffice.  Many people also progress and after a few weeks, don’t need those lighter weights.  Now, you have weights that are just taking up space.  Therefore, household items make great substitutes.

When you come to SSOR, you can count on a personalized home program designed to fit your needs.  We get it – with deductibles, co-pays, and well, just expenses from life, rehab can get costly!  If you don’t have anything at home, hopefully this gives you some ideas how you can be creative.  It would be a privilege to serve you should the need for physical therapy arise.  We hope to partner with you in your care.

The One Thing All Patients Expect

One Thing that Matters to Most Patients

People have lots of reasons why they make the decisions they do – cost, location, past experience, word of mouth, convenience, just to name a few.  When choosing a physical therapist, patients of course expect results, competence, convenient location and scheduling, affordability, and a likable treating physical therapist.  The topic of things that matter to patients has even been highlighted in this blog.  All of those are great things to keep in mind when choosing a physical therapist.  However, one thing that our patients have told us consistently over the years is not often what is found in many physical therapy facilities, but rest assured, you get it here at SSOR – you stay with who you start with and you don’t get passed around between physical therapists.

 

Why Consistency Matters

Think about why you like going to your favorite burger place, hairdresser/barber, or car mechanic – they know you, you know them, you like them, you trust them, and you get consistent results.  Physical therapy is no different.  The physical therapist you start with understands your history, why and how you got here, and what makes you tick.  When you say your pain is a 6/10, they know what your “6” is better than another PT that hasn’t worked with you.  You get comfortable with how they talk to you, their exercises, their hands-on techniques, and the rapport that you’ve developed with them.  When some physical therapy clinics pass you around for whatever reason, it’s like starting all over each time.  You have to tell them your whole story.  Maybe their mannerisms are different.  Maybe you just don’t “click” with them.  Perhaps they told you something totally different than your initial physical therapist. Maybe their manual techniques are a little different (they may get the same results, but they’re still not the same!).  Maybe you tell them that your pain is a 4/10 today but that might not mean a lot because your initial physical therapist knows that you started at a 6/10.  Hopefully, you get the picture here.  It is very important that you build a level of trust, rapport, and confidence in your physical therapist. That’s why this “one thing” really matters to a majority of our patients.

How do you know this is so important?

We know this one thing is important for a number of reasons.  First and foremost, patients tell us that’s why they like us or why they left “the other place.”  We know this because if one of our physical therapists works at both locations, their patients follow them wherever they go.  We know this because the cancellation rate spikes when a physical therapist is on vacation or out of town or patients just don’t schedule when “their PT” is out.  We know this when they call back with a new PT problem and they only want “their PT” even if that PT isn’t immediately available to get them evaluated.  We know this because they tell their friends that their guy/gal is the best and this is the only person to see. Finally, we learn this from our discharge surveys when patients tell us what they liked most about us – they stayed with who they started with.

The SSOR Approach

So, it’s pretty clear that this is hallmark of how we do things here at SSOR.  We work very hard to make sure you “stay with who you start with.”  Of course though, we have a plan in place just in case schedules don’t match, your PT is too busy at your requested time, or your PT is out of town on vacation for a week.  In those instances, our physical therapists will introduce you to the “new” PT and give them the run down – why you’re visiting us, relevant history, your restrictions, what you like/don’t like, what the treatment plan is, and what to work on.  Immediately, your confidence increases that this visit won’t be a waste of time and that your “new” PT knows everything they need to know to make sure you have a meaningful visit while “your” PT is out.  If your PT is out for an extended time, like a full week for vacation, each PT writes out a brief summary for each patient that’ll be seen by other physical therapists.  Nothing worse than opening a chart and seeing a treatment log for a patient you know nothing about and they know nothing about you.

We not only care about our outcomes and our approach, but we also care about the “little things” that are “big things” to our patients.  No question, the one thing that is non-negotiable to most patients is consistency.  Patients deserve to have the person they are comfortable with – someone that knows them best, and vice versa.  It would be a privilege to serve you and partner with you in your care.  Give us a call! We’re confident you will be pleased.

Soreness After Exercise

“Soreness After Sports/Exercise: Should I Be Worried?”

One of the more important roles we have as physical therapists is to help our patients wade through the ebb and flow of pain and discomfort and the proverbial “soreness” after activity, whether it’s work or sport.  Not all pain is “bad” and not all pain means pathology is present.  Sometimes soreness and pain just results from the body adapting to the stress we put on it.  For example, many patients complain of pain after ankle surgery once they go back to work and are on their feet all day for the first time.  They come in worried that something bad happened or they did damage because they’re limping, swollen, or sore.  Our main job at physical therapists in this situation is to calm their anxiety by helping them understand that it was a big step for their ankle today to work an 8-10 hour day after being off work for several weeks and they’ll be fine – the ankle is just having a temper tantrum right now.  Here’s what we do to make that better.  In a short time, the work day is a “piece of cake” then they jog for the first time and the process repeats itself.

However, there are other times when our patients are completing a return to sport progression in say, swimming or baseball, and after motoring along for a few weeks, they have significant soreness that lasts maybe a couple of days.  Again, after asking some pointed and detailed questions, we’re able to determine better if this is “bad” pain or just pain from the body adapting.

All that being said, how can you determine if your pain is just from soreness or if there is something more concerning going on?

Soreness, muscle soreness, pain after activity

Considerations about pain and soreness

It is important to understand that pain isn’t always what it seems.  For example, many patients get an MRI on their lumbar spine and the report comes back that they have signs of pathology but are asymptomatic.  Well, we know now that up to 40% of people have positive findings on MRI but are asymptomatic.  Conversely, many patients have an MRI report that says one thing, but their symptoms say another.  Therefore, diagnostic studies don’t always match with what your complaints are.  Secondly, pain and how our body interprets it can be from multiple sources.  Stress, anxiety, lack of fear, past experience with pain, and previous injury can all have an affect on how we perceive the pain we’re experiencing.  Certainly, pain can match the injury – you roll your ankle you now have a swollen ankle that is tender and causes you to limp.  However, it is important to understand that our activity level and any spike in it, even if it’s only going from part-time to full-time work, can cause soreness.  Finally, sharp pain is different than dull, achy pain.  “Knife-like,” sharp pain may be indicative of more serious pathology.  On the contrary, dull achy pain that is more diffuse after activity that surfaces after exercise and lasts up to 24 hours later isn’t as concerning.

The Soreness Rules

The University of Delaware have developed a “Soreness Rules” guideline that helps us to help our patients understand their pain and soreness and what to do about it.  They look like this:

If you have soreness during warm-up that continues, take a couple of days off and drop down a step in your exercise routine or training.  For example, if you have pain during warm-up after jogging a mile yesterday, you might consider jogging a half mile in two days.

If you have soreness during warm-up that goes away, stay at that level that lead to the soreness, then increase to the next step once the warm-up is soreness-free.

If you have soreness that is present during warm-up that goes away again later , then surfaces again – take a couple of days off and again, drop down a step.

For throwing athletes, here are the general rules:

If sore more than I hour after throwing, or the next day, take I day off and repeat the most recent throwing program workout.

If sore during warm-up but soreness is gone within the first 15 throws, repeat the previous workout. If shoulder becomes sore during this workout, stop and take 2 days off. Upon return to throwing, drop down one step.

If sore during warm-up and soreness continues through the first 15 throws, stop throwing and take 2 days off. Upon return to throwing, drop down one step. If no soreness, advance one step every throwing day.

Ways to avoid soreness

There are many things you can do to control soreness.  Graded progression of activity and exercise is arguably the most important factor.  “Too much, too soon” is the kiss of death for soreness.  So, don’t train for that marathon and run 5 miles one day and then run 10 the next.  If your son plays baseball, don’t go from throwing 50 throws 90 feet to 100 pitches off the mound at full speed in the span of a couple of days.  There are numerous interval sport programs available for many different sports and can easily be found online that will provide specific guidelines on what to do.  Another way is to make sure you have discussed your intentions with your physician and/or your physical therapist.  They can provide guidance on what to do and how to avoid soreness.  Next, make sure you have the appropriate mechanics and technique of the activity.  Along those same lines, ensure you have proper mobility and strength to return to activity safely.  A physical therapist can help you to determine if you are physically ready.  Finally, consider things like icing, massage, proper cool down activities, and anti-inflammatory medications to manage soreness.

The physical therapists at SSOR are accustomed to treating results-oriented patients.  We know how to help our patients progress safely through their rehabilitation and eventually their return to activity, whatever that may be.  We don’t freak out when you’re sore and we’ll make sure you don’t either!  Rest assured though, if something’s amiss, we’ll help get you to the right providers.  It would be a privilege to serve you and partner with you in your care. Give us a call!

Oblique Strain for Danny Duffy

Danny Duffy Injury Rehab: Oblique Strain

Royals fans got some bad news over the weekend that ace pitcher Danny Duffy is going to be out for 6-8 weeks with an oblique strain.  That is definitely a blow to their pitching staff because Duffy has been consistent all year.  So what’s the deal with this oblique strain?

Royals pitcher Danny Duffy

What are the obliques?

 

The obliques are abdominal muscles that are involved primarily in rotation of the trunk.  There are internal and external obliques.  The external obliques are closer to the surface, while the internal oblique is deep to that.  The right oblique actually rotates the trunk to the left and vice versa for the left oblique.  Obviously, that’s a big deal for a pitcher since he has to rotate his trunk with so much velocity to both accelerate to the plate and to decelerate through the hips and trunk after delivery of the pitch.  According to Johnson (Curr Sports Med Rep, 2006), the abdominal muscles are injured by direct blows or by sudden or repetitive trunk movement, either rotation or flexion/extension.  Sounds like he strained it covering first on a play there, so it could have been reaching his trunk too high or twisting awkwardly.

Is Danny Duffy’s Injury common?

There is actually one study from the American Journal of Sports Medicine in 2012 by Conte et al that looked at abdominal strains in professional baseball over a 20 year period.  They found that abdominal strains accounted for 5% of all baseball injuries, and a whopping 92% of those were of the internal or external obliques.  Interestingly, there was an upward trend (20%) of these injuries in the 2000’s, especially in early season.   Clearly, Danny Duffy fits this description.  It makes sense that these injuries are on the rise too – athletes are just more explosive today than they were 20 years ago.  That said, this doesn’t sound like it was from an explosive mechanism.

Why is he out so long?

 

Like any muscle injury, whether it’s a hamstring or groin strain or an oblique strain, not only is there time required for the soft tissue to heal, but the athlete has to get the strength back and then get the velocity of contraction back too.  Collectively, these phases take time.  Obviously, Duffy has to generate a lot of power through his trunk to pitch.  It takes time for the muscle to tolerate the loading and speed of contraction that is required of it so he can do his job.  What makes any abdominal strain, and any rib/intercostal muscle injury a challenge is that it’s hard to rest these muscles.   The abdominal and oblique muscles contract when you roll over or sit up in bed and when you sneeze.  It’s hard to give these muscles rest!  Compared to a hamstring, we can easily rest those muscles – we just don’t run!

 

What’s the rehab look like?

 

First step is to get his pain under control.  Given he’s out 6-8 weeks, it sounds like it could be a nasty injury.  Given that he’s their ace and need him for the long haul, they might just be taking extra precautions, especially considering the high re-injury rate.  Nonetheless, once his pain is under control, he’ll begin a steady program of core and hip strengthening exercises.  He’ll likely start with “static” abdominal contractions (think  bracing yourself before taking a punch) while he pushes and pulls bands/tubing, squats, lunges, and similar exercises that keep the muscle active, but ones that don’t involve rotation.  As these exercises are tolerated well, he’ll begin more trunk flexion exercises and introduce rotary movements at slower speeds first.  As he is pain free with these movements, he’ll increase speed of contraction doing medicine ball chop patterns and likely get back on the field jogging and progress from there.  It’s a relatively uneventful rehab.  Just need time and gradual progression of exercises.  Of course, he’ll have things like the pool to compliment his exercises.  From a modality standpoint, other than some soft tissue work, not much else will help this injury.

We hope Danny Duffy is back on the bump soon mowing down opposing hitters!  We know he’s in good hands with the Royals training staff, so we won’t be surprised if he’s back before 6-8 weeks.

If you strain a muscle, we’re your first choice for rehab in Kansas City.  We have locations in Overland Park and Prairie Village to serve you.  Remember, you can see a PT in Kansas without a physician referral.  Give us a call!

Stretching for Pitchers

Two Stretches All Pitchers Should Do

We see lots of general position players and pitchers here at SSOR for various injuries.  According to data from the STOP Sports Injuries organization, there has been a fivefold increase in shoulder and elbow surgeries since the year 2000 and the American Sports Medicine Institute has presented some sobering statistics on injuries in pitchers.  We find ourselves showing the same things to many of these athletes because well, many of them have the exact same deficits.

Why these stretches for pitchers?

We’re in an age now of lots of sitting in front of computers, cell phones, and other electronic devices (and young boys are hooked on video games too!).  As a result, their front shoulder muscles, like their pectorals, get short and tight and cause those shoulders to round forward.  The rounded shoulder posture is not optimal for pitchers because they have to be able to “open” their upper body to get their arm in the “cocked” position for pitching.  If they are tight, they’ll have to overcome the tightness to get the arm in the right position.  Compensations can result and can change timing and direction.   Therefore, stretching the front of the shoulder is very important.  The anterior shoulder stretch is highlighted in this video as well as a commonly done stretch that is actually contraindicated in pitchers.

With repetitive throwing, the muscles in back of the shoulder act as the “brakes” for the throwing motion. Because pitchers are throwing at high velocities, these muscles can tighten up over time from repetitive throwing.  Tightness in back of the shoulder can lead to a myriad of problems in pitchers, so it’s important they get stretched too.  The “Genie Stretch” (like the old TV show “I Dream of Jeannie”) is an effective stretch that any athlete can do for the back of the shoulder.  Laying on the ground “fixes” the scapula or “shoulder blade” in place to allow a more effective stretch.

Genie Stretch. Lay on your throwing side and place the non-throwing arm on top. Lift the arm off the ground. You should feel a stretch in back of the shoulder

How long should pitchers hold the stretch? How many should they do?

Each stretch should be done 2-3 times after throwing and do 30 second holds.  Repeat as needed.

If you’re a pitcher or have a son that plays baseball and has nagging shoulder or elbow trouble, it’s important you get them in to see someone like the sports PT’s at SSOR before a minor problem becomes a more severe one.  We have a great team of therapists for baseball players here and will ensure that you get an individualized program catered to help address your deficits.

It would be a privilege to serve you and partner with you in your care.  Give us a call!  We have locations in Overland Park and Prarie Village to serve you.

Heel Pain on the Inside of the Foot?

Heel Pain: Plantar Fasciitis Spikes During Warm Weather

Warm weather brings a spike in patients complaining of medial heel pain from plantar fasciitis.  As sure as the seasons change, so too does this aggravating condition that makes every step hurt.  The increased use of flip-flops and sandals leads to the spike in heel pain and it makes those hot summer days painful and limits your ability to fully enjoy the summer weather.  So what’s the problem and what can you do about it?

What’s causing my heel pain?

The plantar fascia is a band of tissue that acts as a “truss” between your heel and toes.  It’s not a muscle really, but more of an elastic ligamentous spring.  Some people get this pain from either high arches or flat feet, but summer months lead to an increase in heel pain because when people wear sandals and flip-flops, the heel isn’t stable.  When the heel isn’t stable, that plantar fascia tugs on the inside of the heel, almost like a child continuously pulling on your shirt for attention.  Over time with each step, the plantar fascia gets inflamed and leads to the heel pain.  Couple that with a mix of other causes of heel pain, like being overweight, wearing high heels, and having poor running mechanics – you have yourself a painful day!

What can I do about the heel pain?

Well, there’s a few things you can do.  First of all, consider wearing a supportive shoe with the heel covered when you’re not at the beach or out to dinner.  Sure, we get it – it’s summer, you want to wear sandals and show off your new pedicure.  That’s great, but chronic sandal or flip-flop use causes that heel to roll around unchecked and over time, causes some inflammation.  So maybe if you’re making a few errands, wear gym shoes instead.  Just at the office sitting at your desk but have a big meeting later in the day?  Cool, take those heels off, put “regular” shoes on, and put the heels or sandals on later.

Three Easy Treatments for Heel Pain

So what to do about it if you’re still having pain even if you took our advice?  Well, here’s three quick “home remedies to try.

  1. Self-massage and stretch the plantar fascia.  Take a lacrosse ball and roll it back and forth along the bottom of your foot.  It will loosen up that tissue a little and may help reduce the tension and lessen your pain.  You could also try a plantar fascia stretch pictured below.

    Roll back and forth for a few minutes as needed

    Stand up straight and put your toes against the wall and lean in for stretch. You should feel this on the bottom of your foot.

  2. Stretch your ankle.  Without getting too technical, if you have tight calves or a stiff ankle, that will cause that heel to collapse and increase the tension on your plantar fascia.  The limitation in ankle dorsiflexion is an often missed contributing factor.  See the picture below.  Put your big toe about an inch from the wall and move your knee towards the wall without letting your heel come off the ground.  Move back about an inch at a time until you feel stretch and/or until the heel wants to come off the ground.  Don’t cheat by moving your hips or anything – take what your ankle gives you.  When you get that stretch, hold for 30 seconds and repeat as needed.  For what it’s worth, “normal” is about 4 inches from the wall.  Did you achieve that?

    Ankle dorsiflexion stretch

  3. Strengthen your arch.  While there are lots of ways to do this, “towel curls” pictured below are great and easy to do.  Lay a towel on the floor, and if needed, put a small weight at the end.  Then just “curl” the towel up with your toes, then spread back out and repeat.  Do this while you’re watching TV or reading your book at night to wind down.  Without strong muscles to support the arch, it will collapse more and make that fascia more irritable.  

 

If you’re still having heel pain, we see it a lot around here and you can be confident we’ll get you in and out of here fast with great results.  Give us a call! It would be a privilege to serve you.

 

Things to Consider Before ACL Surgery

5 Questions To Answer Before ACL Surgery

We have a results-oriented population here at SSOR so because of that, we see tons of patients here that tore their anterior cruciate ligament (ACL) in their knee.  We’ve heard just about every possible reason why people tear their ACL, some benign, others the results of sports activities.  In athletes, most of them are non-contact injuries, making up about 75% of ACL tears.  ACL tears affect kids, adolescents, high schoolers, college kids, working class, and even folks in their 50’s and 60’s.  Interestingly though, not all people need to have ACL surgery to get it reconstructed.  Unfortunately, our patients have been lead to believe, for whatever reason, that if you tear your ACL, you have to have surgery.  Many people “cope” with an ACL tear and do quite well.  Others make the decision to reduce the activities that caused the tear in the first place.  In those folks, we gently say that they have to live their life and can tear their ACL walking down the stairs in the house, so “avoidance” isn’t always the best policy.  All that being said, here’s five questions you should ask before you decide to have ACL surgery.

The 5 Questions

1. Do I need it? The primary indication for ACL surgery is instability in the knee.  If your knee is buckling and “giving way” a lot, you might be a good candidate for surgery.  The caveat though is that if you’re thinking you don’t want to have ACL surgery, then you should make sure you give physical therapy a shot for at least 6 weeks to see if you can get it stronger and more stable to avoid instability episodes.

2.  Am I willing to wait? If your ACL rehab is done correctly, it will be criteria-based, not time-based.  Additionally, a competent and evidence-based physical therapist will progress you based on your graft type as well as being mindful of the unique deficits that accompany each graft type.   Everyone has the idea of “6 months” in their head, but very few are actually ready for full release to all activities by 6 months.  Most people, to do it really right, are 8-12 months.  You may not get to run till 4 months, while you see people on the internet or hear people at the office or at your kids’ game say they started at 3 months.  Will the pressure get to you, or will you trust the experts?

3.  Am I going to fully commit to rehab? You have to be “all in” after ACL surgery.  You have to do your home program regularly.  You have to follow up regularly with your physical therapist and do what is instructed of you.  You have to be in this for the long haul, no matter how burned out, bored, or sick of rehab you get (coincidentally, that doesn’t happen at SSOR – you will have definitive tasks to achieve, variety of exercises to do, clear progressions, and yeah, you’ll laugh along the way a lot too – we have fun here!).  You will have to stay the course even when you think you’re ready but our testing reveals you are not there yet.

4.  What is my end game? Are you really active and want to stay active? Do you normally engage in the high-risk activities that contributed to your tear (say, motocross or skiing moguls)?  Were the circumstances of your tear a “freak accident” and you otherwise lead a sedentary lifestyle?  All things you should consider.  If you just work out a little at the gym, are a swimmer, take Pilates and/or yoga classes only – you might be able to get away without ACL surgery.  Lots to consider here for sure.  If you plan on engaging in cutting/pivoting activities like basketball and soccer, it’s worth giving surgery strong consideration.

5.  Can I afford it? ACL surgery, beginning to end, is pricey. X-rays, doctor visits, the MRI, surgery, the hospital stay, and then months of rehab. Now, you might meet your deductible from surgery and ancillary care surrounding that, but see #3 above – would be a crying shame to go through all of that and not “finish the job.” Any good surgeon will tell you a great surgery can be ruined by bad rehab (yes, sometimes bad PT happens), but patients can be responsible for not committing to the rehab.  What’s your co-pay?  Co-insurance? Do you have a visit limit? If PT runs out, does my PT place have a “gym program” so I can continue my rehab (like we do here at SSOR)?

Hopefully, we gave you some things to think about and you should seriously consider each before going under the knife for ACL surgery.  Regardless of what you decide, we are confident that we’re the destination of choice for ACL rehab in Kansas City.  It would be a privilege to serve you and partner with you in your care.

Non-Negotiable Qualities of Good PT

3 Things Great Physical Therapy (PT) Will Give You

Like any other business, there are lots of choices out there and the way we choose is unique to each individual person.  Some people choose a service because it’s close to home or work.  Some people choose a service because of a friend’s recommendation or from online reviews.  Others pick a service because of positive past experiences, or conversely, try another place from a previously poor experience somewhere else.  In health care, one of the first questions we get asked when patients call us for PT is “Do you take my insurance?”  Definitely a valid question given the price of healthcare, rising deductibles and co-pays, and more cost-shifting to the consumer.  That being said, we’ve had patients drive over an hour one-way to see us because they heard we were worth it, while some people only choose because another place is a half a mile closer to their home or work, even if the other place really isn’t a fit for them.  Patients choose us because of recommendations from friends and/or family or from online reviews, while others just go with what their doctor tells them to do.  No question there are lots of choices for physical therapy, and like any other business, no two are the same.  So what should a good physical therapy facility offer you?

Must-Haves PT

3 Must-Haves for Physical Therapy

  1.  You stay with the physical therapist you start with.  One of the hallmarks of SSOR comes from years of experience hearing patients coming from other places because they were passed around from therapist to therapist.  Patients love continuity of care and they get comfortable with who they start with.  PT’s may largely do things similarly, but it’s not the same.  You need someone that knows you well and knows your pain and how you respond to your treatment.  This is a really important factor and you should consider looking elsewhere if you’re not getting it.
  2. Results quickly.  Nothing drives us more crazy than when we hear patients say they went somewhere for months on end and they’re no better.  If you have a competent physical therapist, they will diagnose your condition, explain what’s going on, and how the treatment plan will work.  If they’re on target, you should see substantive changes within a few weeks and as you improve, your visits should taper down.  PT can get expensive fast and your therapist should be mindful of that.
  3. Specific tasks to achieve your goals.  This one relates to #2.  Your therapist shouldn’t be throwing darts at calendar to tell you when you can get back to activities you enjoy.  From your first visit, regardless of what you’re being seen for, they should tell you what the expectations are for you and milestones you need to achieve for each step and what is required prior to discharge.  If you have no idea what you’re doing and why, it might be time to choose another physical therapist.

No shock, but you can count on these 3 things to happen when you come for PT at SSOR.  They are foundational principles for us because we’ve listened to our patients over the years and consistently, these things are important to them.  Therefore, it’s the framework in which we practice.  It would be a privilege to serve you and partner with you in your care.  Give us a call!