Do You Need Surgery for a Torn ACL?

Torn ACL: I Gotta Get it Fixed, Right?

We have an active population here at SSOR and we have a host of patients who tear their knee anterior cruciate ligament (ACL).  ACL tears are well-documented in sports and most of us probably know someone that tore their ACL, either playing sports or sometimes doing rather benign activities.  It’s a painful injury and one that can limit activity and even bother you with daily life.  Certainly there are volumes of studies showing success after ACL reconstruction, but many of our patients assume that surgery is necessary.  So does a torn ACL inevitably lead to surgery?

What’s the ACL?

The ACL is a ligament on the inside of the knee that helps limit the tibia or “shin bone” from moving too far forward when you jump or plant and cut.  It also helps limit “twisting” of the knee.

How is it torn?

ACL tears are about 75% non-contact.  Most of the time, people tear their ACL with planting and cutting, landing from a jump, or any kind of quick deceleration.  Sometimes, their torn with a combination of the above on a “straight knee.”  The picture below shows a typical mechanism where the knee “buckles” inward.

Do I need surgery for a torn ACL?

You may be surprised, but there is evidence showing that a knee can stabilize over time, particularly in non-athletes.  Research has shown here, here, and here that surgery may not be necessary, particularly if you are not playing cutting/pivoting sports.  Heck, there are even pro athletes that played with no ACL!

This is a question you should discuss with your doctor.  That said, here’s three things you should consider:

Is your knee giving out?  Instability in the knee is the main reason to get it fixed.  If you’re just walking along and your knee gives out or buckles, that’s not a great sign.  You might be a stay-at-home mom that just does some basic aerobics classes, but if you have young kids and you’re carrying them around and your knee gives out, that could hurt the both of you.  This is just one example, but hopefully you get the point – instability is not good.   That is the principle reason to get ACL reconstruction.

Are you in a lot of pain?  Sometimes people have a lot of pain after this injury.  While it’s not the chief reason to have surgery, it’s something you should think about.

Do you plan on leading an active lifestyle with cutting/pivoting sports?  If you’re just a recreational jogger, a swimmer, a cyclist, or well, just not that active, you should consider rehab on your knee.

How do you rehab a torn ACL if I go the non-operative route?

Basically, there are four central tenets to non-operative ACL rehabilitation.  The first is restoration of quadriceps strength.  After this injury, the quadriceps or “thigh” muscles, lose their strength and mass.  It’s important to get that back.  Secondly, you need particular emphasis on hamstring strengthening.  The hamstrings are the best friend to the ACL.  They help prevent that tibia from moving forward because they attach on the back of it.  Think about reins pulling back on a horse.  With good hamstring strength, they will protect your knee should you get back to sports activities again.  Third, you need perturbation training.  You might think of this as balance training, but perturbation training is a little different.  Perturbation training involves adding activities that challenge your stability of your knee from an outside influence, either standing on a wobble board  with someone causing it to tip quickly or being able to sustain a push from someone without your knee buckling.  A qualified sports physical therapist or licensed athletic trainer can work with you on this.  Finally, movement re-training is necessary to help you avoid the movement patterns that may have caused the torn ACL in the first place.  So, learning to land properly from jumps or changing direction more efficiently are two things that might be addressed.  Hopefully, your sports physical therapist will objectively measure how these things are improving and then progress you with running and jumping activities to see how you respond. Understand though that even in the best of circumstances, you may need to have ACL reconstruction for your torn ACL should any of the indications above (instability, pain, desired activity level) surface.

Our team of qualified, dedicated sports physical therapists are passionate about helping our patients get back to the activities they enjoy.  We are well-versed in treating torn ACL’s, either operative or non-operative.  It would be a privilege to serve you and partner with you in your care.  We have locations in Overland Park and Prairie Village to serve you.

Stay Fit While Recovering From Injury

How Do You Stay Fit After Injury?

We have a results-oriented population here at SSOR.  Our team of physical therapists see people that lead active, healthy lifestyles and have specific goals in mind when they come see us.  Whether they are competitive or recreational athletes or just want to stay in shape, injury and surgery can really cause otherwise healthy, fit people to get out of shape fast.  Particularly if you have surgery, you can’t move your arm or leg much or are unable to weight-bear, so your options are limited.  It’s a vicious cycle potentially – no activity, sit around, snacking a lot, not getting the heart rate up, repeat.  All of a sudden, the pounds add up and you’re panting going up the stairs.  On top of that, some people have a visceral need to exercise, otherwise they can’t sleep or are very moody.  So what can you do do stay fit after injury?

Ways to Stay Fit When You’re Recovering

If you have an upper body injury or surgery, consider stationary recumbent or upright biking.  Biking is a good choice because you don’t really have to move your arms.  Depending on what injury you have, even walking might not be a good idea because your arms sway back and forth during normal gait.  When your arms sway, your shoulder muscles are still contracting some.  If you had a rotator cuff surgery for example, a brisk walk with arm movement may cause pain and be detrimental to your recovery.  Cycling on stationary bikes is a great choice until you can do more.

Take the stairs or park at the far end of the lot.  Depending on your injury, this might be tough to do, but instead of taking the elevator take the stairs.  Stairs can be quite the workout and help you burn a few extra calories.  Similarly, parking at the far end of the parking lot gets you a little longer walk in.

Get in the pool!  We love the pool here.  We suggest pool exercises for patients all the time, whether professional athletes or our older patients.  You are lighter in the water and the circumferential pressure of the water helps with swelling.  If you move fast, the water provides more resistance.  Again, depending on your injury, you can take water aerobics classes or do deep water running.  Try it sometime, it’s harder than it looks, especially if you move fast!  In the water, you can also use those “water dumbbells” that provide more resistance for you to work through.  If you’re appropriate to be using those, they are a nice option.

If you have a lower body injury and can’t weight-bear/have limited weight-bearing or are in a cast, consider an upper body bike.  “Arm bikes” are a great option.  Try doing the bike in intervals – sprint for a short time, then recover, repeat. Trust us, this will get your heart pumping and get that sweat you desire.  Most fitness facilities have them.

Confined to a wheelchair? No problem! Get on the open road and start pumping!  Similar to the arm bike, working hard on the wheelchair is a great way to get your heart rate up too.  Again, you can try intervals to shake things up a bit.  There are also a number of workouts you can do with bands or dumbbells in a wheelchair.  Give those a shot!

Whether you have an acute injury, had a surgery recently, or have chronic trouble from an injury, our team of physical therapists is ready to help you.  We’re qualified, competent, and will provide an enjoyable atmosphere for you to get back on your feet. It would be a privilege to serve you and partner with you in your care.  Give us a call! Remember, you can see a physical therapist in Kansas without a physician referral.

Sitting Posture Tips

Try These Things to Improve Sitting Posture

We see lots of patients here complaining of back, neck, and shoulder pain and many times, a contributing factor is sitting posture.  It’s affecting people of all ages nowadays though because we’re just a sitting society now.  Everyone is huddled in front of computers or devices for much of the day.  Improving your sitting posture will help you get through your day with less pain and discomfort and hopefully help minimize the risk of having to see one of our physical therapists for treatment.  The following are some guidelines for you to consider if you’re a “desk jockey” to help improve your sitting posture.

Sitting Posture Tips

Make sure your shoulders are relaxed, your wrists are neutral, and your elbows are bent to 90 degrees.  

Stay square to the computer.  Do you have multiple screens going at once? Do you have your screen in front of you but your desk/workspace and/or your phone to your right or left?  Do everything you can to stay square with what you’re working on.  Otherwise, you’ll be rotating your neck and body in suboptimal positions and that can lead to pain.

Keep your monitor no less that 20″ away or an arm’s length from you, slightly below eye level.  Below eye level encourages you to have a more upright head posture rather than the poor forward head position.  Here is a good link that properly shows not only monitor distance but also shoulder and elbow positions that should be encouraged.

On the phone a lot? Get a headset.  A headset will just help you avoid having your head sidebent/tilted one way.  It’s just an awkward position and if done for prolonged periods, can definitely lead to neck pain and headaches.

To change things up, try positioning your knees below your hips or straddle your chair.  This is a big one and may help.  Try it yourself.  Scoot to the edge of your chair and put your knees below your hips or put another way, tuck your feet under you.  You should feel that it immediately helps straighten you out.  Even “perfect” posture showed in the link above can occasionally get uncomfortable.  The pictures below show some positions you might consider.

Knees below hips position.

Straddle the chair.

“Booster seat”. Roll up a pillow and place it under your “sit bones.” This elevates your hips above your knees.

Get a standing desk.  Standing desks are definitely being used more and more and for good reason.  It gets us out of this sitting posture and as stated above, it changes things up for your body.

We hope these tips and tricks help you.  You may also consider trying these 3 things if you sit all day at your desk to help you get through your day.  Should you start having neck, shoulder, or back pain, the physical therapists at SSOR know how 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.


Stretching: Before or After Activity?

When Should You Do Stretching Exercises?

A majority of our patients here are an active bunch.  They lead active, purposeful lives and do a wide array of physical activities.  They’re always asking us about stretching.   Routintely, we get asked how long to hold stretches, when to do them, and which ones to do.  For seemingly years, it has been an accepted dogma that you must stretch before exercise, although no research proves that it’s necessary for injury prevention.  A review by Witvrouw et al (Sports Med, 2004) showed that there is an obscure relationship between stretching and injury prevention.  Thacker et al found in a systematic review of literature that there is no evidence to endorse or discontinue stretching before or after exercise to prevent injury.  Intuitively, it would seem that it can’t be true, but the research has not shown otherwise.  We imagine the reason that it’s always been assumed that we should stretch before exercise because the perception is that if you go into an exercise or competitive session “tight” you are at risk for injury.  Clinical experience and the literature reveals that this argument is partly true.

Different Types of Stretching

First of all, it’s important to understand the different types of stretching.  Static stretching is what we’re most familiar with – placing a muscle or joint on stretch and holding the stretch position.  For example, placing your foot on a chair to stretch your hamstring.  Now, static stretches can be active or passive.  Active is when you do it yourself and determine amount of stretch, or passive when someone does it for you.  Dynamic stretching is basically stretching while moving.  An example of dynamic stretching is doing lunges with exaggerated steps, doing “high knees” while running, etc.  Finally, PNF (proprioceptive neuromuscular facilitation) is the last type.   Here, a muscle is stretched by contracting the opposing muscle.  PNF is used both for flexibility, strengthening, and for rehab.  It is an excellent treatment tool.

Static stretching (place and hold) has been shown to actually decrease acute strength and power.  Winchester and others (J Strength Cond Res, 2008) have found that it impairs sprint performance and Robbins et al (J Strength Cond Res, 2008) found that it adversely affected vertical jump performance.  Other studies have substantiated these conclusions.  The proposed reason that this occurs is basically due to muscle’s length-tension relationship.   Essentially, muscle physiology principle says that the muscles contractile proteins (actin and myosin) are supposed to have an optimal position so maximize muscle function.  It is believed that acute bouts of stretching increases that length and subsequently decreases the ability of the muscle to contract at its best.

All that being said, the trend is shifting in that performing dynamic stretching before exercise is the best way to “stretch” before exercise.  Ce et al (J Strength Cond Res, 2008) and Manoel et al (J Strength Cond Res, 2008) are just two groups of researchers that have recently found that dynamic stretching is the optimal way to increase power prior to sport performance.  First of all, because it’s dynamic, you are moving and you’re likely to work up a sweat.  If you are sweating, there is increased blood flow which has been shown to increase tissue extensibility.  The problem with static stretching is that in order to get benefit, you can’t be “cold”.  By “getting hot”, your tissues are more elastic and ready for activity.  Examples of dynamic stretching are walking lunges, jumping jacks, high knees, butt kickers, and squats just to name a few.  Here’s a link to a clip on some good ideas for dynamic stretching.

Best Approach to Stretching

So, what’s the best way to stretch?  We always prefer a general warm up first.  A bike, a short jog, an elliptical trainer, or stair stepper is just a way to get the heart rate up and work up a sweat.  After a 5-10 minute warm up, we suggest performing a specific or dynamic warm up.  Here, they’ll perform a series of movements in the upper and lower extremities.  Lunges, mountain climbers, jumping rope, and arm circles are just a few examples that would follow for another 5-10 minutes.  We encourage athletes to continue moving and take no rest between these movements to keep the heart rate up.   After this is done, you should be ready to move into your workout.

Once the session is done, a brief stint on a bike or a short jog is a good way to “flush” the body of waste products created during exercise to help minimize delayed onset muscle soreness (DOMS).  We assure you’ve had DOMS if you woke up the morning after an intense workout and could barely walk!  You might consider foam rolling too.  After the cool down period, close with static stretching.  In theory, static stretching should be more productive at this point because the tissues are much warmer and more extensible at this time as opposed to being “cold” prior to any exercise.

How Long Should You Hold Stretches?

Two studies by Bandy and others (Phys Ther, 1997) have shown that holding stretches for 30 seconds is the optimum time frame to hold a stretch for acute increases in flexibility.  The “rub” here is that you aren’t going to sustain the new length unless you consistently stretch.

Summary on Stretching

1.  Warm up with light exercise, like jogging, biking, or the elliptical, followed by dynamic flexibility like lunges, high knees, “butt kickers”, etc.  Do not perform static stretches BEFORE activity.

2. Static stretches AFTER activity.

3. Hold stretches 30 seconds – no more, no less.

It would be a privilege to serve you and partner with you in your care.  Remember, in the state of Kansas, you can see a physical therapist without a physician referral.  Give us a call!  Our team of physical therapists are competent, professional, and will give you specific tasks to achieve your goals.

How to Treat a Pulled Muscle

DIY for a Pulled Muscle

We have an active, results-oriented population here at SSOR.  Our patients are competing in many different activities, whether it’s recreationally, competitively, or just to stay in shape.  Elite athletes pull muscles just like “regular Joe’s” do.  The difference is that many regular Joe’s don’t have their sport as their job!  Most of us are working regular jobs and taking care of our families.  We just don’t have time to get treatment all day to get better after these like the pro athletes do.  So if you pull a muscle, what should you do? There are many misconceptions about how to treat a pulled muscle.  We’re experts in the treatment of pulled muscles here and sports physical therapists should be your first choice in treating them.  There are varying degrees of severity of pulled muscles, so these suggestions have some caveats to them.  Obviously, these should be treated by a professional, but for those of you who insist otherwise, here’s a summary of what you should do.

Signs of a Pulled Muscle

Typically when you pull a muscle, you know it!  Most people report a stretching, tearing, or popping sensation that is painful.  It hurts to stretch and if you try and run, it’s either not possible or very painful to do so.  It’s usually very sore and hurts to do basic things like bend over or get in/out of the car.  If you really did a number on yourself, you may have extensive bruising and be very tender at the site of the pulled muscle.

Bruising along the inner thigh from a groin muscle strain

Why Do Pulled Muscles Happen?

There are many reasons why you pull muscles.  You may have a strength imbalance.  For example, hamstring strains are pretty common.  Many people do exercises to strengthen the quadriceps but don’t also strengthen the hamstrings.  The resulting muscle imbalance may lead to a strain.  Another reason for pulled muscles is lack of flexibility.  While there is some debate about this in the scientific literature, if you ask your muscles to reach their outer limits of flexibility during activity but don’t have the elasticity to get there, you might be at risk for a strain.  If you don’t stretch regularly and try and leg out a triple in that rec league softball game, you might put yourself at risk.  Third, you could be dehydrated.  A good analogy is filet mignon versus beef jerky.  With proper hydration, your muscles are like filet – tender, juicy, and less stiff.  Hydrated muscles are more elastic and flexible.  However, if you’re more dehydrated, your muscles are like beef jerky – they get tough and lose their elasticity.  So, if you drink a ton of coffee without also drinking water or if you maybe are playing sports while drinking beer/s, you’re losing water from sweat and both coffee and alcohol are diuretics – they make you lose more water!  Here’s a good link on proper hydration guidelines.  

Can Pulled Muscles be Prevented?

You can certainly reduce the likelihood of these happening.  If you look at the potential causes above, make sure you stay flexible, make sure you have balance in exercise routines, and make sure your water intake is adequate.  A good warm-up routine to heat up your tissues to make them more “ready” for activity will help too.  Activities like a light jog, jumping jacks, walking lunges, high knees, skipping, “butt kickers,” shuffling/defensive slide, and cariocas are just a few options.  The idea is to “prime the system” before more intense activities take place.  Finally, a great way to prevent pulled muscles is to stay active – it’s a bad idea to sit all all week or be a sedentary person, then ask muscles once in a while to perform at their best.  It’s just not a good idea.

sports injury

Treatment for a Pulled Muscle

The following are general guidelines for a pulled muscle.  Keep in mind, there are different grades of pulled muscles and exercises will be a little different based on what muscle group you pulled.  Additionally, you may have pulled the tendon rather than the muscle.  Tendon strains take longer to heal than muscle strains do.  You probably pulled your tendon if your pain is real close to the joint.  So, if you pulled your hamstring, you got the tendon if it hurts real high near your glutes, or real low by the back of the knee.  All that being said, here’s some things you might try:

  1. Rice, ice, compression the first 3-5 days.  After a pulled muscle, there is a gap at the site of the tear, almost like frayed ends of a rope.  The body will begin the healing process to try and “patch” the damage.  Therefore, rest is critical and ice is as well to manage pain from the inflammatory process.  During this time, there shouldn’t be any stretching, even though it feels tight.  The repair is very weak and “immature” to handle stretch.  Use a compressive wrap of some kind to support the muscle and to help minimize swelling.  The worse the strain, the longer you should rest.
  2. Use a crutch/es if need be.  Sometimes with these muscle pulls, it can cause people to limp.  If that is the case, the scar tissue won’t lie down appropriately and will actually cause the muscle to shorten further.  Use a crutch or a cane on the opposite side of the injury until walking is normal.
  3. Ride an exercise bike after the first 3-5 days.  A good guideline to start is that it’s not tender to touch and you are able to walk normally.  Riding an exercise bike not only helps move fluid out of the area but also gets the muscles contracting/relaxing in a non-impact, low intensity manner to help minimize further declines in function.  No need to ride aggressively or for a long time – an easy 10-15 minute ride will suffice.
  4. Start stretching about day 5 after the injury.  Stretches should be gentle and not painful.  Hold stretches for 30 seconds and repeat 3-4 times per day.  Stretching can start when walking is normal.
  5. Once range of motion is pain free, begin light resistance exercises.  Depending on the muscle group, this could mean a multitude of exercises.  Regardless, resistance should be light enough to allow full range of motion and limited pain.  Repetitions should initially be high (20-30) and reduce as resistance increases.  Consider doing step ups, lunges, and squats in a pain free range as well.
  6. Once resistance exercises are pain free, consider dynamic warm up activities.  High knees, “butt kickers,” shuffling, cariocas, and jogging are all activities that you can attempt.  Speed should gradually increase from 25%, then to 50%, then to 75%, and finally 100% effort gradually over the course of the next 2-3 weeks.
  7. Increase the speed of your exercises.  To better replicate running and sprinting, your resistance exercises should also be performed quickly.  This is only after the strength is restored.  Do not sacrifice form, but go with lighter weight and perform repetitions fast.
  8. Once you get back to playing sports, dynamic stretch before, static stretch after.  Research is supporting more activities like walking lunges, skipping, jumping jacks, and shuffling before activity to break a sweat, then do “place and hold” stretching afterwards.
  9. Consider wearing compressive shorts once you get back to playing.
  10. Ice after activity.
  11. Stay hydrated!  If you are dehydrated, a muscle is more prone to pulls.

If you get a pulled muscle, look no further than the sports physical therapists here at SSOR to get you back to the activities you love to do.  We have a competent and professional team of physical therapists to help you.  It would be a privilege to serve you and partner with you in your care.  Give us a call! Remember, you can see a PT in Kansas without a physician referral, so don’t delay getting better!

Spencer Ware Injury Rehabilitation

Chiefs RB Spencer Ware Injury – PCL and LCL

The Chiefs had a tough start to their season last week when they lost running back Spencer Ware to a significant knee injury.  We always hear about the dreaded ACL injury, but Spencer Ware actually tore his posterior cruciate ligament (PCL) and his lateral collateral ligament (LCL).  There are four ligaments in the knee and he tore two of them!  This is a really tough injury and there’s a long road ahead for him.  We’re going to explore this injury in this blog.

What is the PCL?

The PCL is inside the knee joint behind the more commonly known ACL.  “Cruciate” means “cross” and these two ligaments form an “X” inside the knee.  It is typically torn from a posteriorly-directed blow to the tibia (“shin bone”) or during hyperflexion.  Think landing directly on the knee or possibly during a high-velocity car accident where the dashboard pushes the knee backward.  Certainly, the PCL can be torn during hyperextension or during rotational movements too.  PCL injuries can have varying degrees of disability and some do not require surgery.   As in this case, PCL injuries rarely occur in isolation – there are usually associated injuries with it.  Learn more about the PCL here.


What is the LCL?

The LCL is a ligament on the outside or lateral aspect of the knee that protects the knee from laterally-directed blows from the medial aspect of the knee.  The LCL is also torn with hyperextension injuries.  We’re thinking that Spencer Ware had a hyperextension injury since he got both the PCL and the LCL.  With injuries of this magnitude, it is also possible to injure the postero-lateral corner (PLC).  If this is also injured, this adds to the significance of this injury.  Learn more about the LCL here.

What’s the rehab like?

As stated above, you have 4 ligaments in and around the knee and when you tear half of them, it’s a complicated injury with a long recovery process.  Rehab for this will be relatively slow to allow for proper tissue healing and to protect the PCL and LCL grafts.  Key principles for rehab of this injury include progressive weight-bearing, protection of posterior subluxation of the tibia, and quadriceps strengthening ( LaPrade et al, AJSM 2015).  Like any knee injury, getting range of motion, strength, balance, and normalizing gait are fundamental to the process.  There are some key differences though with PCL reconstructions.  First of all, the period of non-weight bearing or limited weightbearing is a little longer than ACL’s because the graft takes longer to heal (Bellelli et al, Radiol Med 1999; Fanelli, Arthroscopy 2008; Harner & Hoher, Am J Sports Med, 1998).  Range of motion progression is also slower with these injuries than after an ACL reconstruction.   Secondly, it’s important for the knee to get fully straight again, but contrary to ACL injuries, there is a risk of stretching a graft if knee extension is forced or pushed too early with PCL and LCL reconstructions.  Next, while the hamstrings are the best friend to the ACL, with PCL injuries, active contraction of the hamstrings can cause the PCL too much strain.   Therefore, exercises like hamstring curls are delayed for up to 12 weeks.  Provided the tibia is vertical, like with Romanian deadlifts, hamstring exercises can be done prior to that.  Similarly, exercises done on your back, like leg presses where the tibia is in a gravity-dependent position, will put harmful strain on the PCL in the early phases.  Therefore, exercises in standing, like squats and step ups are better choices, or ensuring that the leg press is performed in sitting.  Even exercise bike choice matters – a recumbent bike has the knees extended in front of the patient, creating that posterior sag of the tibia that we want to protect.  The upright bike is a better choice for these patients once the protocol allows them to do so.  Even the basic straight leg raise exercise is performed in the brace to protect the graft.  Other than some of the above considerations, the rehab after theis injury is much like ACL rehab.

How long is the rehab?

We know he’ll have every resource at his disposal to recover to the maximum potential, but this is still easily a 8-12 month injury to recover from.  It’s important that he regains strength, power, rate of force development, and speed in addition to his general conditioning for football.

Should you suffer a knee injury, it would be a privilege to serve you and partner with you in your care.  We have Kansas City’s only knee/shoulder fellowship-trained sports physical therapist.  You can count on an evidence-based, competent physical therapist to guide you through the process.  Give us a call!



Treatment Tips for Headaches

Exercises for Headaches

We have lots of patients come through here with a long history of headaches and often a long history of failed treatments or treatments with transient effectiveness.  Multiple chiropractic treatments, massages, injections, holistic approaches, dietary changes, and who knows what else to get relief.  SSOR has become a resource for numerous practices in the Kansas City metro for those who are battling chronic headaches.   Our approach is simple – get to the root cause of them and address accordingly.  We understand headaches and get results quickly for our patients through the effective use of manual therapy, exercise, posture education, and ergonomic education.  Forget about things like ultrasound and electrical stimulation – no evidence shows they work for headaches and they’re not addressing the cause.  We won’t waste your time on treatments that don’t work – maybe that’s why we so many that failed elsewhere.


What causes headaches?

There are many reasons why headaches occur.  Stress, posture, anxiety, history of concussion/whiplash, recent motor vehicle accidents, and occupational demands are just a few of the reasons we tend to hear.  Regardless of the cause, we can help each other get to the root of it.   Now, we have to say – sometimes serious conditions can cause headaches too that need immediate medical attention.  If you have facial numbness, visual disturbances, dizziness, “pulsatile” headaches, or acute headaches that are worsening – you should see a doctor immediately.  In this post, we’re addressing headaches that truly are mechanical in nature and not due to more serious causes like strokes.


Why has nothing helped my headache, or helped only a little?

Most headache treatments are addressing the symptoms, not the actual cause/s.  People are loaded up with medications that just take the pain away for a while.  Massages feel good, but the reason for the need for massage hasn’t been addressed.  Injections or other aggressive, sometimes invasive treatments, treat the symptoms.  Similarly, chiropractic treatments do the same – they may feel good, but people keep needing to go back for more “adjustments.”  All that said, some people are hurting so much, they’ll do anything to get even a modicum of relief for a short time.  We certainly don’t blame people!  However, we know more can be done and expect better for you.

Treatment for Headaches

While it’s difficult to speculate on the source of the problem, there are a few simple things you can try.  This headache treatment clip from our YouTube channel shows two simple things you might try at the office or at the computer to help get through your day.  You can also try these two stretches below (fig 1 and 2).  Those are good stretches for the upper trapezius and the levator scapulae, both muscles that commonly get “knots” in them.  Lastly, laying on a foam roller to open up your shoulders (Fig 3) and chest will help reverse that slumped posture that often contributes to headache.

Figure 1. Upper Trapezius stretch. Hold for 30 seconds. You should feel a stretch on the side of your neck



Figure 2. Levator stretch. You should feel this in the back of your neck.


Figure 3. Lay on your back on a foam roller. You should feelt a stretch in your shoulders and chest. Try for a few minutes as needed.

It would be a privilege to partner with you in your care to help your headache.  Our approach will get to the root cause and give you long-term solutions that you’ll be able to manage yourself, hopefully with less or without medications or short-term treatments.  We’re confident our approach will get you results.  Give us a call! Remember, you can see a PT in Kansas without a physician referral!


Salvador Perez: Intercostal Strain

Salvador Perez Injury: Intercostal Strain

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

What are the Intercostals?

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

How are they injured?

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

Why are intercostal strains a problem?

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

What’s the rehab of intercostal strains look like?

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

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

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


Golf after Rotator Cuff Repair

When Can You Golf After Rotator Cuff Repair?

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

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

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

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

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

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

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

Figure 3. Horizontal adduction.

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

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

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

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

So when can I play again?

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

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

Household Items That Sub for Weights

No Weights at Home? Household Items Work!

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

Household items that sub for weights

One Pound

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

Two Pounds

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

Three Pounds

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

Four Pounds

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

Five Pounds

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

Seven-Eight Pounds

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

Other Household Item Substitutes

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

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

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