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!

Kevin Durant Injury

Rehab for Kevin Durant Knee Injury: Grade II MCL Sprain

Golden State Warriors superstar Kevin Durant sustained a knee injury recently and the concern was that he tore the dreaded ACL.  Fortunately for him, his team, and his fans, he just has an MCL or medial collateral ligament injury.  He’ll be out about a month or so.  A general “athletic training room rule” for MCL injuries is about 2 weeks out for each grade of strain.  He’s got a Grade II according to reports, so that is about right.   So what’s with the MCL and why will Kevin Durant be out a month?

What’s the MCL?

The MCL is a ligament along the medial aspect of the knee.  It’s more of a thickening of the joint capsule, more “sheet-like.”  It is also an extra-articular ligament, or outside the joint.  On the contrary, the infamous anterior cruciate ligament (ACL) is intra-articular, or inside the knee and is more “rope-like.”  There are four knee ligaments that contribute to knee stability, and the MCL helps prevent the knee from “buckling” to the inside.  Here is a comprehensive link on MCL anatomy and function.

Knee anatomy for a right knee.

How is it injured?

Most of the time, the MCL is injured from a blow to the outside or lateral aspect of the knee which causes the knee to buckle inward.  However, the MCL can also be torn from an awkward cut or land from a jump, which is something Kevin Durant does constantly in basketball.  It can be injured in the mid-substance over the joint line, or off of its bony attachments on the tibia or the femur.

Cutting, crossovers, and change of direction happen regularly in basketball and leave players at risk for MCL injury

How long do they usually take to heal?

In pro sports, medical staffs must have the clearest crystal ball of any other professional.  Before the injury is accurately diagnosed, a host of stakeholders have to know how long they’ll be out- coach, general manager, agents, etc.  A general rule in sports medicine with MCL injuries is that it is about two weeks of time loss for each grade of tear.  Therefore, with a Grade I tear, expect two weeks out, Grade II four weeks, Grade III tear would be approximately 6 weeks out.  Certainly, this rule is not an absolute as athletes may require more or less time.  Proximal, or femoral attachment MCL sprains, tend to heal a little faster but can stiffen up.  On the contrary, distal or tibial attachment tears tend to heal slower, but typically aren’t as stiff.  All that said, injury history, concomitant injuries, time of season, level of play, and athlete confidence are just a few of several other considerations that affect return to play.

Why is an MCL sprain a big deal?

As a professional basketball player, Kevin Durant is frequently cutting and changing direction as well as jumping and landing on that knee.  Given that the MCL provides medial stability to the knee and helps prevent “buckling” of the knee, it’s critical for him that this ligament is doing its job.  Not only is it painful, but without proper healing, the ligament can not only heal in a lengthened state but will also have poor quality tissue in the healing process (think straight lines which are preferred, versus criss-crossing fibers).  You don’t want the ligament to continue the cycle of healing and re-injury.  The ligament will be weaker and heal in an elongated state, thereby making it insufficient.  So if Kevin Durant doesn’t do this right, this could haunt him for a long time.

Physical Therapy for MCL Sprains

The rehab for MCL sprains depends of course on severity of the sprain.  The more serious the sprain, the slower the process.  With an acute, severe sprain, the athlete is likely to need crutches, a brace, and graded range of motion progression.  Progressing range of motion too fast with this injury may cause more pain and impede optimal healing of the ligament.  In general though, here’s a rehab outline:

  1. Control pain.Icing, compressive wrapping, a knee brace, and use of a crutch or crutches will all help reduce pain and promote healing of the ligament.  Another “training room trick” is to put a medial heel wedge in the shoe of the affected knee.  Effectively, the medial wedge decreases strain on the healing ligament by compressing the medial joint line, even if only a little.  It’s one of those interventions that is by no means a game-changer, but can help.
  2. Low-intensity pulsed ultrasound (LIPUS).There was a time when ultrasound was used for everything. Therefore, its effectiveness has continually been debated and questioned.  Unfortunately, it has been discarded as a useful modality and this is actually one injury where it may help.  However, there are some good studies supporting the use of LIPUS for MCL healing herehere, and here  Laser therapy is also an option and can be effective for these capsular ligaments near the surface.
  3. Restore range of motion.The use of a bike, pool, or heel slides are all ways that can help an athlete restore their range.  The optimum stimulus for regeneration of ligaments is modified tension in the line of stress, and tons of repetitions at that.  That is precisely why cycling is a great modality for these injuries.  With more severe sprains, a graded range of motion progression may be done to help prevent over-straining of weakened, painful tissue.  Therefore, an athlete may have 30-90° for a couple of days, then open 10° in each direction every day or two after until full range is restored.  In more chronic cases with pain in specific ranges of motion, instrument assisted soft tissue mobilization can help break up scar tissue and facilitate healing.  There is one study using these instruments for this injury from the Journal of Orthopedic and Sports Physical Therapy that supports use of these tools to facilitate healing.  Just because of pain, it is not recommended to use the instruments acutely.  They’re best suited for chronic injuries/chronic phases of healing.

    Tools for instrument assisted soft tissue mobilization.

  4. Strengthening of the lower extremity. All sagittal movements (moving forward) should be painless prior to initiation of lateral and rotational movements.  Lunges, step ups, squats, and leg press are just a few exercises that can be utilized. Of course, strengthening the hips should be a part of a comprehensive program for this injury.  One word of caution – hamstring curls can be painful with this injury.  Proceed carefully.  Once straight-ahead movements are tolerated, progressing to lateral and rotational movements should follow.
  5. Graded progression of return to sports activities. Forward jogging can commence once range of motion is restored and the athlete has passed strength testing.  Speed will be gradually increased.  45° cuts, shuffling, and 90° cuts would follow, then the athlete would progress to more field-based sport-specific drills.  For soccer, this injury can be particularly challenging because of kicking, especially with the “push” kick/pass.  The rotation of the lower leg can stretch the MCL and cause pain.  A good progression is non-contact individual drills non-contact team drills, contact drills, then full release to activities.

Once sports activities are painless and the athlete’s confidence is restored, return to play should be considered.  Regarding bracing with these injuries, it’s really a personal preference of the athlete.  Offensive/defensive linemen might consider wearing it due to bodies crashing into each other and lots of lateral, contact movements.  Unfortunately, these braces sometimes make athletes a target for insidious actions by opponents.

No question, this could have been a much worse injury for Kevin Durant.  He got away with one evidently.  We’re sure he’ll recover from this and be back to his normal self again.

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

Stiff Knees from Knee Arthritis?

Battling Knee Arthritis? Try These 6 Things to Help

We see lots of people here at SSOR who are battling knee arthritis.  They want to be and stay active, but knee stiffness and pain either limit their activities or make them dread what they’ll feel like afterwards.  So they limp around for a few days until they feel good again, then they get back at it and repeat the same cycle.  As knee arthritis progresses, the pain and dysfunction tend to get worse.  While there are pharmacological interventions like steroid shots as well as lubricating injections, those things really are just helping with pain relief and well, probably buying you time before you have a total knee replacement.  All that being said, there are some things you can do to help manage your pain from knee arthritis when exercising.  Make no mistake, exercise is good for your knees, and a recent paper even showed that it helped women with knee arthritis.  So how do you manage that pain then?

Why are my knees stiff?

Basically as we age, the ends of our knees have cartilage on them that wears out.  A good analogy is thinking of a snow-capped mountain.  The more we age, the more snow we lose and you get down to bone.  The cartilage on the ends of bone serves as a shock absorber and lubricant to the knee.  Put another way, think of the cartilage as a really wet sponge imbibed with water.  Now imagine the sponge without water and dried up.  That’s kind of what knee arthritis is like and why you’re stiff.

Knee arthritis? You may have a dry sponge.

Tips for Knee Arthritis

Show up early.  Love playing tennis?  Great!  Get to the facility about 20 minutes early and ride the exercise bike, foam roll your legs, and do dynamic warm-up activities like skipping, high knees, “butt kickers,” shuffling, cariocas/”grapevines”, and other activities to get your knees warmed up.  We like to tell our patients “motion is lotion.”  The more your knee is warmed up, the better you’ll feel when it comes time to play.

Wear a knee sleeve.  Yep, just grab a neoprene sleeve from any sporting goods store and wear one of those.  The compression feels good and it will keep the knee “hot” while you workout.  If you have arthritis, you know that when your knee is warmed up, it feels best.

Do “unloading” workouts.  You love to play rec league basketball, but your knees pay for it.  We don’t like to tell people to stop activities they enjoy, but typically, they need to calm the knee down after activities that aggravate it.  Therefore, we suggest people get in the pool or cycle in the days that follow.  You may find that playing basketball four days a week makes your knees hurt like crazy, but two days is tolerable and you don’t pay for it for a week with pain and limping around.

Consider ointments/linaments.  Lots of products are out there with cold and heat creams.  We don’t really have a favorite, but for what it’s worth, Biofreeze actually has a couple of papers here and here showing it decreases subcutaneous blood flow a bit and was even a little better than ice in regards to perceived pain (we have no financial interest in Biofreeze!).  Usually these products just mask the pain a bit, but hey, if it gets you through your activity, that’s a good thing.

Keep your weight down.  This is pretty simple. If you weigh less, it’s less stress on your joints.  “But my knees hurt and I can’t workout.”  Fair point, but there are options like cycling or swimming.  Perhaps it’s just what you’re eating.  Consider a visit with a dietitian to see if you need to make some adjustments.

Glucosamine/Chondroitin Sulfate? NSAID’s?  Maybe.  The research isn’t too high on supplementing with glucosamine/chondroitin sulfate, but that doesn’t mean it won’t help you.  There is some evidence showing the combination of the two can help in those with moderate to severe knee arthritis.  We’re not big fans of taking anti-inflammatory medications like candy, but after a tough workout, it can help your pain.

If you’re battling knee arthritis, look to the expert physical therapists at SSOR to help you. It would be a privilege to partner with you in your care, give us a call!  Remember, you can see a PT in Kansas without a physician referral.  Take advantage, we can get you on the road to recovery faster!

Torn Rotator Cuff: Should You Fix It?

Is Surgery Necessary for a Torn Rotator Cuff?

Many of our patients come see us here with a rotator cuff tear.  Rotator cuff tears do not discriminate – they are in men, women, active and non-active.  A 2009 paper in the Journal of Shoulder and Elbow Surgery found that roughly 21% of the general population has a rotator cuff tear and another paper showed that by the age of 60, 30% of people have at least a partial rotator cuff tear.  Rotator cuff tears in athletes have been reported to be anywhere from 13-37% with throwers having up to 40% rotator cuff tear incidence.  Given that the revision rate with rotator cuff tears has been found to be as high as 50+%, it begs the question, should you get your torn rotator cuff repaired?

Role of the rotator cuff

Intuitively, most folks say that the rotator cuff’s role is to “rotate” the arm.  While that is true, the two main goals of the rotator cuff are to compress the humeral head and depress the humeral head.  Effectively, it “steers” the shoulder. If you think of a golf ball spinning on a tee, that is similar to what the rotator cuff does – it keeps the ball of the shoulder (humeral head) on the tee (glenoid fossa).  A torn rotator cuff will not allow normal mechanics to occur which usually leads to pain and dysfunction.

How are they torn?

There are basically three mechanisms as to how rotator cuffs tear.  The first is through trauma.  Falling on an outstretched hand or landing directly on the shoulder are just two examples of how trauma can cause a tear.  The second is from repetitive activity – years of throwing or overhead sports and lifting weights for example – lead to a tear.  Finally, rotator cuff tears are degenerative.  In essense, this is just “tread on the tires.”  From years of repetitive use, the rotator cuff just starts to break down.

So should I fix my torn rotator cuff?

There are many factors to consider when deciding if you should fix your torn rotator cuff.  First and foremost, pain and function should be considered.  If you’re having a fair amount of pain and can’t use your shoulder for much, you might consider a rotator cuff repair after talking with an orthopedic surgeon.  Certainly a steroid shot is an option, but it’s not likely a long-term solution – it may help your pain, but it’s not going to “fix” the tear.  If you aren’t able to do the things you enjoy due to shoulder pain or lack of mobility and/or strength, you’re potentially a good candidate for surgery.  That being said though, prior to even thinking about surgery, you should give rehab a fair shot.  You may be saying “of course, you’re PT’s so you want me to try rehab first.”  Well, why not give rehab a dedicated 4-6 weeks of work before making your decision?  Why get cut when you may not have to?  If you don’t lead a very active lifestyle and just want to do your job and do light to moderate housework, you may do fine with rehab.  Second, consider if it’s your dominant or non-dominant arm.  If your cuff tear is in your non-dominant arm and you’re not in too much pain but more occasional discomfort, you might consider going the non-operative route.  Next, you should think about if your shoulder has other pathology in it.  Years of wear and tear from just living life may lead to a shoulder with arthritic or other degenerative changes in it.  Adding repair to those pathologies to a rotator cuff tear may prolong rehab and may not get you the outcome you desire.  Fourth, you should think about if you’ll have enough time to devote to the rehabilitation after surgery.  The first 6 weeks after repair are critical for healing to take place, and even 12 weeks after surgery, the rotator cuff is only 50% of its tensile strength.  Rehab can take anywhere from 6 months to a year to do it right.  Are you willing to put off golf for the summer? Are you going to listen to the post-operative restrictions and not get back in the swimming pool or tennis court too fast?  Does your job allow you modifications or desk work until you are able to resume normal work activities?  All of those things should be considered because if you don’t fully commit to the rehab, it will fail.  Next, you should think about if there are any activity modifications you can make.  For example, let’s say you play tennis 3-4 days a week.  Maybe it’s just the volume of tennis that makes you hurt, not the tennis itself.  Let’s face it, you’re older body isn’t what it was in your college years.  So, what if you only played two days a week and cross-trained with another activity?  By taking this approach, you’re “meeting your body where it’s at.”  In our experience as physical therapists, this has been very effective to find that “sweet spot” of being able to scratch the itch playing the sport you love, but not being miserable all week either after doing so.  The last thing to think about is the size of the tear and the quality of the tissue.  You would have to find that out from your doctor though.  A really small tear with good quality tissue may do quite well with rehab.  However, a large tear with might be better off with a repair if you also have high pain and dysfunction.

Torn Rotator Cuff: Summary

All things being considered above, the decision fix versus not to fix really comes down to pain levels and shoulder function as well as your desired activity level.  A discussion with a physical therapist as well as an orthopedic surgeon should help you make the most informed decision.

If you have a torn rotator cuff, look no further than the physical therapists at SSOR to help you.  We see these regularly and know exactly what needs to be done to reduce pain and improve your function.  Plus, we won’t waste your time – if we see that rehab just isn’t working after a few visits, we’ll send you to the doctor to consider surgery or other interventions.  It would be a privilege to partner with you in your care.  Give us a call!