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!

Which Desk Chair is Best for You?

Desk Chair vs. Sitting Ball vs. Standing Desk vs. Treadmill Desk – Which is best?

We get asked all the time not only about workstation ergomomics and positioning, but also about which desk chair is best.  People just sit these days – a lot – at their jobs and it can lead to a myriad of problems.  Fortunately, there are many options for desk chairs and even more options for alternative work station “chairs” like standing desks or treadmill desks.  Definitely, this is a step in the right direction as many experts have called sitting the “new obesity.”  While it is beyond the purpose of this blog to talk about all the conditions that are affected by prolonged sitting, trust us, sitting all day is a problem!!  That being said, what might be the best desk chair for you?  What does the research say about these options? Hopefully, this post will shed some light on the topic and give some direction about which is best for you and your situation.

Desk Chair: Things to Consider

How long is your work day?  Do you literally sit for 12 hours straight or are there typical breaks in the schedule that get you out of the chair?  Do you have your computer in front of you or is it to your left/right? Do you have multiple monitors that you are looking at?  By no means is this an exhaustive list, but hopefully gives you an idea of what you should be thinking about.  You might need a desk chair that rotates for example, if your monitor is on your left or right.  Ideally, you are looking directly in front of you rather than keeping your head turned one direction.

There is the question of productivity too.  Does the type of desk chair you use affect that, one way or the other? Well, a study in Nature found that desk chair type doesn’t affect productivity.  While it’s only one paper, it does show that it’s probably not a big deal what type of chair you use, unless of course you’re in too much pain to work. In that case, the chair type is not likely your only problem.

Does Type of Desk Chair Affect Overall Health?

It stands to reason that you’ll burn more calories on the job if you have a treadmill desk or a standing desk versus a sitting desk. Even in quiet standing, muscles are working to keep you vertical.  Burning calories of course may lead to weight loss too, so a treadmill desk is a better choice than sitting too and this study showed that a treadmill desk at a speed of 1.1 mph burned 191 kcal/hour than sitting, which burned 72 kcal/hour.  Perhaps the strongest support for a treadmill desk was in this prospective study where people were followed for one year using a treadmill desk.  There was significant weight loss, a decrease in sedentary time, and no change in work performance.  When comparing a stability ball versus a chair, one paper found that the stability ball increased lumbar muscle activation and decreased pelvic tilt, but lead to more discomfort.  Again, it’s only one paper, but something you should consider when thinking about moving to a ball.  There’s even “pedal station” or desk bike products out there now (no financial interest in these), but we aren’t aware of any studies on them yet.  Just another option to consider, but we imagine the results would be positive much like the standing and treadmill desks.

Summary on Desk Chairs

There’s a ton of choices for desk chairs.  They are one piece of the puzzle when it comes to workstation posture to be clear – the best chair won’t help if your workstation ergonomics aren’t right.  This link  has some great tips for setting up your workstation.  All of that said, anything that gets you up and out of your chair is a good thing.  Treadmill desks and standing desks often involve approval from the “higher ups,” but with a letter of need from a medical doctor or physical therapist, sometimes these things get approved.  This is a case where you need to be an advocate for yourself.  If you have the ability, a standing desk or treadmill desk is a better alternative than sitting all day.

If you’re having pain from sitting all day in the neck, shoulders, or low back, the physical therapists at SSOR know how to treat this and get you results quickly.  Give us a call!  It would be a privilege to serve you and partner with you in your care.

Home Remedy for Sciatic Nerve Pain

Do-It-Yourself Home Remedy for Sciatic Nerve Pain

We have lots of people that come see us for hip and glute pain.  Many times, “Dr. Internet” tells them that’s sciatica.  In many cases that is true.  If you experience restless sitting and standing due to leg pain and/or numbness, it may be sciatica or sciatic nerve pain, a pain and/or numbness that typically starts in the glute or back of the hip and radiates down the leg. The pain is typically worse with prolonged sitting or standing and may be described as “burning,” “buzzing,” “tingling,” or “numbness.” Sciatica is more common in older adults. In the younger population, the symptoms are usually from another source such as a potential lumbar disc herniation.

Sciatic nerve, sciatica, gluteal pain

What Causes Sciatic Nerve Pain or Sciatica?

Sciatica is mainly due to a combination of flexibility deficits, postural or ergonomic issues, and often, degenerative changes in the spine that ultimately put strain on the sciatic nerve. It is common in people who either mostly sit at their job or are on their feet all day.  People with sciatica commonly complain of pain while sitting on their wallet, and others complain that it hurts most at heel strike when walking.  Sciatica has also been called “piriformis syndrome,” a term used for all-encompassing gluteal pain. The piriformis is a muscle in the gluteal region that lies on top of the sciatic nerve. Irritation of the piriformis can put pressure on the sciatic nerve and lead to the symptoms described above.  All that said, it’s best to have one of the physical therapists at SSOR do and evaluation on you to make sure that’s actually what you have rather than something more insidious like disc pathology.

Home Remedy for Sciatica

Check out this link for three easy ways you can try treating this yourself.  Give us a call if it doesn’t help for a more thorough evaluation to ensure that you’re doing the right things and your pain is diagnosed correctly.  It would be a privilege to serve you and partner with you in your care.

Teens Athletes & Nutritional Supplements

Should Your Teenager Take Supplements?

We get asked lots of questions from athletes and parents about various products to help their son or daughter improve performance or get a little extra benefit from all their hard work in the weight room.  They think being a little faster or a little stronger will make them a better athlete or get that coveted scholarship.  Furthermore, as a society we’re inundated with ads promising results and endorsements from high profile athletes.  Sadly though, many of the products out there have little scientific evidence supporting their use and the benefits are largely anecdotal.  Therefore, it’s important for us to be honest with our athletes and their parents about these products in regards to their efficacy as well as their safety.  No question, there have been case reports of kids having adverse reactions to supplements, but many times, they were used inappropriately.  That’s why it’s imperative that all the facts are on the table when it comes to this discussion.

A study came out recently in the Journal of Pediatrics and it was highlighted here in an article on CNN’s website.  In summary, many nutritional or supplement stores recommended athletes take supplements, specifically creatine or testosterone boosters, when asked or prompted by the caller.  The American Academy of Pediatrics has discouraged use of these supplements specifically in athletes younger than 18 years old.

So Are These Particular Ones Bad?

There are few points worth making in regards to not only this particular study, but also supplements in general.

  1.  Young athletes should get a balanced diet FIRST.  Many kids are on the run and many kids eat too much fast food and/or junk food.  Lots of youngsters love energy drinks and sugary sodas.  If need be, schedule an appointment with a registered dietitian to talk about diet, snacking, and individual needs for your son/daughter.  Supplements are just that – supplements.  They are no substitute for a balanced diet.  We cannot emphasize that enough.  We advocate that our athletes talk to their doctor as well as a dietitian about appropriateness as well as need for supplements.
  2. True, many supplements just make for an empty bank account and really expensive pee.  Yep, a majority of the supplements out there have no peer-reviewed evidence supporting (or refuting) their use.   Most of it is case study based or anecdotal.  Plus, we really have to make sure we’re “comparing apples to apples.”  A professional bodybuilder, who may be paid to make the claims, is not the same as your teenager.  What’s appropriate for one person may be entirely inappropriate for another.
  3. The FDA doesn’t regulate this industry.  Therefore, you really don’t know what you’re really taking or what’s actually in the pills or powders.  The list of potential adverse reactions that could occur is innumerable.

What about the supplements in the article?

Now, from the article, it’s evident that creatine gets a bad rap.  Even though we’re not advocating teens take creatine, this is actually one supplement with some legitimate science behind it.  Here’s a good summary of what we know on creatine.  Indeed, there are case studies of dehydration and cramping, but many of these side effects are avoided with proper hydration and proper dosing.  Sadly, there have been some deaths that were linked to creatine, but the training methods engaged were of questionable safety.  Therefore, it’s important to look at the evidence, the facts, and each case individually to determine appropriateness.  Education is paramount when it comes to creatine or any other supplement.

Regarding testosterone boosters, we do not support those.  If there is a legitimate, medically-diagnosed hormone deficiency, then hormone therapy administered by a medical doctor is appropriate.  Other than that, we encourage our athletes to avoid these.

Summary on Supplements

Supplements are really expensive.  Many of them have no peer-reviewed science behind them and may have questionable side effects or safety concerns.  Most kids don’t get a balanced diet to start with, and supplements are no substitute for it.  If you are considering supplements for your son/daughter, we strongly advise talking to their physician as well as a dietitian to help decide if a particular supplement is warranted and/or safe for your son/daughter.

KC Chiefs Derrick Johnson Injury

Chiefs All-Pro LB Derrick Johnson Injury: Achilles Rupture, Part 1

Derrick Johnson’s unfortunate recent Achilles injury just two years after having sustained the same injury to his opposite leg has once again brought the devastating blow of this injury to the forefront of the Kansas City sports scene.  Although having already proven the ability to return from this historically devastating injury to an athlete’s career potential, many question his ability to make the same amazing recovery he did at an already seemingly “aged” NFL veteran experience with his first injury two year ago and wonder whether another comeback is possible.  In this blog, we’ll discuss recent developments in the management of these devastating injuries in both professional and weekend warrior athletes that are providing early precedent and hope that recovery and return to play at this elite level may not be so far-fetched.

Chiefs veteran linebacker being assisted off the field after rupturing his Achilles tendon against Oakland

Statistics on Achilles Tendon Rupture

Tears of the Achilles tendon occur most often in middle-aged (30-40 year old) males with a reported rate in the medical literature of 18.2 to 37.3 per 100,000.[1]  While basketball is the most common sporting activity reported by injured patients, football players have certainly not been immune to this devastating injury.   In their internet query review, Parekh et al identified 31 NFL athletes with Achilles rupture injury from 1997 to 2002, and noted only 64% of these athletes being able to return to play and with a 50% drop in performance compared to their pre-injury condition.[2]  Although some recent studies have promoted the use of non-operative treatment for Achilles rupture, due to the risk of re-rupture traditionally operative treatment of these injuries has been the standard treatment for active, healthy individuals.  Despite this, both within the amateur weekend-warrior and professional athlete patient population case reports of disastrous wound complications certainly have placed a cloud of doubt over the operative management of this injury and frequently led to prolonged durations of immobilization and wound protection to avoid this devastating result.

Cutting Edge Treatment for Achilles Tendon Rupture

In response to this, development of minimally invasive/mini-open techniques has been entertained as a means of surgically restoring the muscle-tendon unit while minimizing disruption of the soft tissue envelope of the healing Achilles tendon (i.e., paratenon).  Having gone through various forms over the years, the most recent development of the Percutaneous Achilles Repair System (PARS – Arthrex ®) has shown the most promise.

 

In the first study published with this technique, nine NFL athletes with Achilles rupture were treated with the PARS mini-open technique. [1] All nine athletes were able to return to football play post-operatively, one of which did so at 166 days (5.4 months) which to our knowledge remains the fastest return to football game competition recorded in the medical literature.  Although only 7 of the 9 returned to NFL play, the two athletes who continued professional football in the Arena and Canadian Football League were both undrafted free agents injured in their first season with the team.   Despite the historical concerns with other mini-open techniques, there were no complications of re-rupture, nerve injury or wound issues noted.

 

Following this study, Hsu et al took a much larger amateur patient population of Achilles ruptures and compared the PARS mini-open (101 patients) to standard open repair (169 patients).[3]   Their results noted that 98% of mini-open patients had returned to baseline physical activities at 5 months compared to only 82% of the standard open.  They also demonstrated no issues with nerve irritation, and less risk of wound complications compared to the standard treatment.

 

Having implemented this technique as the mainstay of treatment for all non-insertional Achilles ruptures, this change in patient outcome has been seen not only clinically by myself, but has also changed they way that these patients are managed during their rehabilitation and physical therapy which will be detailed further in the second part of this Achilles blog.

 

With what has been seen both in the professional and amateur athletes alike, mini-open Achilles repair represents a game-changing approach the management and outcome of these devastating injuries for patients.  This is not unlike the change witnessed in the medical community when classical open treatments of shoulder and knee instability injuries traditionally managed with large open dissections and immobilized for weeks at a time transitioned to less invasive means with earlier range of motion once reliable techniques had been developed and tested.

 

As for Derrick Johnson, Kansas City fans can take some consolation in the fact that this road less traveled has been walked before.  Look no further than Terrell Suggs, linebacker for the Baltimore Ravens.  Now 34 years old (and 1 month older than DJ), Terrell sustained his first Achilles injury prior to the start of the 2012 season.  After returning later that season at 5.4 months following his injury and repair, he played two additional seasons prior to rupturing his opposite Achilles in the 2015 campaign.   Having undergone surgical repair, he is now back in full-form for the Baltimore Ravens having started all games during the 2016 season.

 

 

REFERENCES:

 

  • McCullough et al. Mini-Open Repair of Achilles Rupture in the National Football League.  J Surg Orthop Adv 23(4):179-183, 2014.
  • Parekh et al. Epidemiology and outcomes of Achilles tendon injuries in the National Football League.  Foot Ankle Spec. 2(6):283-286, 2009.
  • Hsu et al. Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures.  FAI 36(11):1279-86, 2015.