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Rehab For Patellar Instability

Patellar instability can be a debilitating and frankly, a terrifying condition to deal with because you have no idea when or how the patella will “move out of place.”  When it does, it can be painful and crippling.  Patellar instability encompasses a few different scenarios.  Patellar dislocation is when the patella or “kneecap” moves out of place and stays there.  Sometimes a person can move their knee and it will pop back into place and other times, people need the hands of a skilled medical provider to help it reduce.  Patellar subluxation is when the patella slips out but comes back into place immediately.   Still, others can have patellar instability from a shallow trochlear groove (the groove in the thigh bone that the patella sits in) that enables it to move out of place easily, and some have loose soft tissue around the patella which makes it easy to be unstable.  Patellar instability may be a result of multiple dislocation or subluxation events that over time stretches your tissues to the point that they’re like “Silly Putty.”  At SSOR, we understand how to address this conservatively but also how to help you should you need surgery.

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Picture of Normal, Subluxed, and Dislocated Patella

What are the symptoms of patellar instability?

People with patellar instability typically have a history of an injury where the patella “went out of place.” Once that happens, the tissues around the knee get stretched out and therefore make it easy for this to happen.  Symptoms of patellar instability include but are not limited to: aching in the knee or the feeling of the inability to get comfortable, the feeling of “popping” with activities of daily living, pain squatting/going down stairs, and feelings of apprehension when doing functional activities for fear that it will go out of place.  Sometimes people with patellar instability also have systemic hypermobility, whereby they are “loosey goosey” throughout their body.

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Do I need to have surgery?

Not necessarily.  You should always try conservative measures first, and that starts with physical therapy.  You should try structured physical therapy and home exercises for at least 6 weeks.  The only time you should consider surgery is if rehab failed (but make sure it’s the right rehab! We’ll talk about that below), or if there is gross instability in that it goes out all the time.  For example, people that still dislocate/sublux rolling over in bed, walking, or sitting on the toilet after physical therapy should consider having surgery to stabilize the knee. There are many different procedures that can be done and these should be explored with your orthopedic surgeon.  Most commonly, people have a Buy Zopiclone Tablets Online to help restore stability to the patella.

Will a brace help?

Bracing can help a little for patellar instability, particularly during activity, but it can’t be the only intervention.  We are not aware of any controlled studies saying that these lead to a better outcome.  You should ask for/get a buttress brace or a patellar stabilization orthosis.  There are many different kinds on the market.  Sometimes, braces serve only to give you peace of mind that you have some compression and support around your knee.

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Physical Therapy for Patellar Instability

  1.  First and foremost, a thorough physical examination is required to evaluate you for any anatomical or structural abnormalities that may be exacerbating your condition.  Examples might be excessively flat feet, anteroverted or retroverted hips, or lateral positioning of your tibial tuberosity.  All of these basically change the line of pull of the quadriceps in one way or another and enable the patella to slip out.  You should see an orthopedic surgeon to get X-rays and an MRI to determine extent of bony and soft tissue damage.  Ultimately, this will help predict if physical therapy will be helpful or not.
  2. Strengthening of the quadriceps, gluteals, and hamstrings.  All of these muscles provide structural support to the knee. Whether it’s a first time dislocation or you’ve had multiple episodes, your quadriceps are likely atrophied and very weak.
  3. Balance training.  It is imperative that balance training be done on the lower extremities.  Working on balance training helps keep the knee stabilized during functional activities.  It should start on stable, flat surfaces and progress to more unstable ones.  The idea is that when things happen suddenly during our daily lives, the muscles can respond quickly to stabilize the knee and avoid an episode.
  4. Ice massage for pain.  Works wonders, just try it.
  5. Bracing
  6. Activity modification.  Depending on your recreational interests, they may put you at risk for further complications.   Therefore, you may have to modify or adjust your activities until after physical therapy is complete.  That said, many people are able to play their chosen sport after physical therapy and with the use of a brace.  However, you should be evaluated with functional testing measures, like hop testing, to determine physical readiness for sports.  Testing is of particular importance if you desire to play a cutting/pivoting sport.

If commit to the process of rehab and you’re still having trouble, it’s probably time to go back to your physician and consider surgery.  Fear not, people do quite well following surgery for patellar instability.  Depending on what they have to do in surgery, it may take a little longer to recover fully, but you should be pleased.

Patellar instability doesn’t have to be a continual problem and the reason for your inactivity.  A structured, comprehensive physical therapy program by a sports physical therapy specialist will help you reduce pain and maximize your function after a thorough exam by an orthopedic surgeon.  The experts at SSOR welcome the opportunity to serve you and it would be a privilege to partner with you in your care.

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3 Fitness Mistakes: Are You Guilty?

We see people in physical therapy on a regular basis that get injured when starting well-intentioned fitness programs.  This is a bit of a paradox for us because injured folks are our lifeblood, but so much of these things can be avoided!   The staff at SSOR is committed to helping you help yourself avoid having to come see us, so here’s three avoidable things you might be doing:

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1.  Not getting properly screened before starting.  If you’ve been sedentary for a while or are trying a “couch to 5K” plan, it’s a good idea to see your physician to make sure you’re healthy for activity.  Additionally, you should see one of the physical therapists at SSOR to do a musculoskeletal screen of you to make sure nothing is lurking below the surface that will create problems for you down the road. You should be long, strong, mobile, and stable!

2. Starting too fast/too much too soon.  The hot trend these days is do it fast and do it quickly.  However, without a general fitness base, this will inevitably lead to problems.  If you don’t have appropriate joint mobility or have an injury history that may have caused mobility deficits, you’re asking for trouble.  Without proper work capacity/tolerance, fatigue ensues and with fatigue comes poor technique.  Poor technique almost always leads to injury at some point and a visit to the gang at SSOR.  Ramp things up slowly.

3.  Not listening to your body.  May be you’re working really hard and are really short of breath or light-headed.  Your body is telling you to stop, so you should.  If not, at a minimum, reduce how hard you are working or take a break.  Additionally, if you’re having pain with exercise or things during normal daily living start to hurt, it means you may have a problem on your hands.  If that is the case, give the physical therapists at SSOR a buzz and we’d be glad to help get to the root of the problem.

The physical therapists at SSOR are all about solutions, not stop gaps.  We’ll figure out the problem and get you back to doing the things you enjoy doing as soon as possible.  Give us a call, it would be a privilege to serve you and partner with you in your care.

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Physical Therapy for Sciatica

Sciatica is an all too common condition that we see on a regular basis here at SSOR.  Also known as “piriformis syndrome”, sciatica is a painful, aggravating diagnosis because it limits your ability to stand and walk and requires specific positions of relief, often sitting or lying down.  People with this condition typically have low back and/or hip pain with associated pain and/or numbness, “buzzing,” or burning in the gluteals that can extend down the leg.  The purpose of this post is to educate you on sciatica and of course, what you can do about it.

What is Sciatica?

The piriformis is a muscle deep in your hip, under your gluteals.  Basically, it runs horizontally across your bottom on both sides.  Directly behind the piriformis is the sciatic nerve.  The sciatic nerve is a thick, broad nerve at this location.  Because they are in such close contact, the piriformis can “rub” on the sciatic nerve, which causes the pain and numbness in the hip and possibly the back of the leg.  That’s why sciatica is often discussed interchangeably with piriformis syndrome.

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What Causes Sciatica?

Well, there are a host of potential causes.  If you have a disc bulge or Lorazepam Buying Online, the pressure on the nerve can cause the pain and/or numbness.  Buy Ambien Sleeping Pills Online, or narrowing of the foramen the nerve exits out of, also puts pressure on the nerve in a similar way.  Muscle tightness and hip weakness can also contribute to sciatica because either of them can alter muscle length and strength and the lack of either strength or flexibility can irritate the piriformis muscle.  Finally, there are a host of people that can get sciatica from trauma, like car accidents or stepping awkwardly off a curb for example.

Exercises for Sciatica

There are several potential treatments for this, but it really depends on the reason you are experiencing symptoms.  Here’s a video Buy Klonopin 30 Mg to “home remedies” you can try.  A thorough evaluation by the physical therapists at SSOR will undoubtedly help you find out the true cause of your pain and discomfort.  Activity modification and posture/ergonomics education are two basic but very important parts of treatment.  Often, soft tissue work to the piriformis with a foam roller or lacrosse ball, stretching, and “nerve glides” are three DIY techniques you might try, all shown in the link above.  Manual therapy to loosen a stiff spine and pelvis can be effective as well.  Finally and perhaps most importantly, hip abductor and external rotator strengthening exercises (Figures 1 and 2 below) will help control both the femur and the pelvis to prevent aggravation of the piriformis.  Things like ultrasound and electrical stimulation are completely useless for piriformis syndrome or sciatica, so if your current physical therapist is doing either of them, it’s probably time to find a new physical therapist.

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“Clamshell” exercise for hip external rotator strengthening

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Sidelying leg raise for gluteus medius strengthening. Lay against the wall and while keeping your heel against the wall, raise your leg up and down.

 

The physical therapists at SSOR are experts in biomechanical evaluation and assessment. Sciatica is definitely one condition that requires a thorough evaluation by a skilled, experienced physical therapist to find out the true cause of your symptoms and help you reduce pain.  You shouldn’t live in pain.  We have locations in Overland Park and Prairie Village to serve you.  It would be a privilege to partner with you in your care.

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Arnica Gel/Cream

It seems that we’re hearing more and more people using Arnica for relief of muscle and joint aches and pains.  It’s commonly been used as a homeopathic treatment for inflammation, bruises, and swelling.  The problem with Arnica as with many other herbals and supplements is that the research supporting the use of them is scant at best.  Very few placebo-controlled, double-blind studies support the efficacy of herbals and supplements.  At SSOR, we’re committed to not only using treatment approaches supported by the best available evidence but also to educating our patients about the evidence confirming or refuting use of herbals and supplements.

What is Arnica?

Arnica is a plant extract from the Arnica Montana plant.  The active ingredient is called Thymol which is believed to lead to vasodilation, which is the opening of blood vessels.  More blood flow may contribute to healing of injured tissue.

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Arnica Montana plant

How is it taken?

It is usually used in conjunction with other creams and is normally used topically.  It comes in gel form and can even be taken orally in capsule form.  By itself, it is toxic but it is normally diluted.

What is it used for?

It is used for aches and pains related to arthritis, joint/muscle pain, inflammation, and for bruises and swelling.  It has also been proposed to help with reduction of hematomas.

What does the research say?

A review in the Archives of Surgery in 1995 found that its effectiveness beyond a placebo is not supported in clinical trials.  A more recent Cochrane Database Review, likely the most comprehensive review of the literature for a given topic, found that in people with arthritis, it may help reduce pains from symptoms but no better than normal anti-inflammatories (i.e. Ibuprofen, Aleve) and may have more adverse effects.  A 2010 study in the Annals of Pharmacotherapeutics found Arnica may actually increase muscle pain after intense exercise compared to a placebo, and similar findings were reported in a 2005 study in the Journal of Chiropractic Medicine.  Another study in the Journal of the Royal Society of Medicine in 2003 found it had any advantage over a placebo in post-operative pain, swelling, and bruising in those who had hand surgery.  Also for people with hand arthritis, a 2007 Rheumatology International study found it was no better than anti-inflammatory medications and had more adverse events associated with its use.

Are there any side effects?

It appears there are many.  This Can You Buy Zolpidem In Mexiconicely describes various side effects that have been reported with the use of it.  We suggest you discuss the use of Arnica with your primary care physician prior to taking it, particularly if you are on other medications.

What’s the bottom line?

Much like over-the-counter anti-inflammatories, Arnica is used as an analgesic and anti-inflammatory.  There is little evidence to date supporting its use over OTC medications, but the placebo effect is powerful in the field of medicine.  There are many adverse effects and by itself, Arnica is toxic.  Therefore, it should be something you discuss with your doctor.

All of that said, there is a mountain of evidence supporting physical therapy for the treatment of muscle aches and pains as well as arthritis.  Give us a call at (913) 904-1128 to get you living the life you imagine.

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Rehab Guidelines for MCL Sprains: KU’s Udoka Azubuike

The Big 12 tournament is underway and KU hoops star Udoka Azubuike suffered a knee medial collateral ligament (MCL) injury in practice recently.  Of course, like any in-season sports injury, the timing is not good.  Looks like he’ll miss the Big 12 tournament.  So what’s the deal with these injuries, and everyone wants to know, will he be ready for the NCAA Tournament?

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KU’s Udoka Azubuike

 

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 comprehensiveBuy Valium Melbourneon MCL anatomy and function.

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Illustration of the medial collateral ligament of the 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.  It can be injured in the mid-substance over the joint line, or off of its bony attachments on the tibia or the femur.  In this case, there are a number of reasons why Udoka Azubuike could have sprained his MCL – could be contact or non-contact.

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Possible mechanism for MCL sprains. Here, the knee buckles inward as the athlete makes a cut

How long do they usually take to heal?

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.  Sounds like the injury to Udoka Azubuike wasn’t too bad, so we’re guessing on the lower end of this general rule.

Why is an MCL sprain a big deal?

As an elite basketball player, Udoka Azubuike is frequently jumping, landing, cutting and changing direction, let alone getting hit from opponents on the outside of the 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.  Therefore, he needs stability of the knee during these manuevers.  Without it, he could be at risk for a more serious injury, like an ACL tear.  Typically, you want to avoid surgically repairing an MCL unless it’s part of a more severe injury, like a multiple ligament knee injury.  Even then, surgeons usually elect not to fix it and let it heal over time.  After surgery to repair the MCL, the knee stiffens instantaneously and makes rehab a significant challenge.  Best to rehab these injuries at all costs.

Can’t we just brace his knee and play?

Well, it’s not that simple.  No brace can “prevent” any further injury and if there’s any instability or pain, he’ll still deal with that, even if to a lesser extent than no brace.  Certainly, they can help athletes feel more confident that “something” is there to support the knee, but it’s not much more than a “security blanket.”  Remember too that athletes have to be mentally okay with wearing a brace too.  Some athletes just can’t play their sport with restrictions.  They’re not used to it and it’s “different.”  Because he’s a basketball player and the how the timing of this injury isn’t good, we’re guessing he’ll wear a brace for a little extra protection and support.  It shouldn’t affect his play at all should he choose to wear one.

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.  In the case of Udoka, they’ll likely be a little more aggressive because it’s not a bad sprain and the timing of the injury makes return to play of prime importance.  His rehab will likely be pain relief and modality driven to control his pain and get him back on the court ASAP.  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 may decrease 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 Order Phentermine And Topiramate, Order Green Xanax Bars Online, and Buy Zopiclone UsaLaser 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 Buy Adipex 37.5 Diet Pillsusing 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.

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    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.  In Udoka’s case, they won’t be too worried about how much weight he’s pushing – they’ll just be concerned about his ability to perform on the court.
  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 or court-based sport-specific drills.  A good progression is non-contact individual drills non-contact team drills, contact drills, then full release to activities.  Udoka may have some discomfort as they expedite the healing process, but as long as he can perform on the court, this phase of rehab will be a quick one!!

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.  We’ll see – Udoka might wear a brace for some extra support, especially if he’s still having some discomfort or confidence issues with his knee.  The biggest things to consider are 1) can he protect? and 2) can he perform?

If you suffer an MCL sprain or any other knee injury for that matter, look no further than the expert physical therapists at SSOR to help you.  Remember, you don’t need a physician referral to see a physical therapist in Kansas.  It would be a privilege to serve you and partner with you in your care.  We have locations in Overland Park & Prairie Village to serve you.

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Treatment for Achilles Tendinitis

We have an active, results-oriented population here at SSOR.  As a result, we see many patients who are battling “tendinopathies,” a catch-all term for pathology and pain in tendons.  One of those regions we see a lot that affects people across the lifespan is Achilles tendinopathy.  The general public commonly refers to it as “Achilles tendinitis.”  Achilles tendinitis can be painful, debilitating, and significantly restrict your ability to perform activities of daily living as well as recreational activities.  So what’s the deal with achilles tendinitis?

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What are the causes of Achilles tendinitis?

Like most injuries, there are intrinsic causes that center around your body structure and there are extrinsic causes that center around training methodologies or training environments.  Intrinsically, flat feet can stress the Achilles because it creates an angulation of the heel and alters the pull of the Achilles.  Previous injury can cause Achilles tendinitis from residual strength deficits.  People that are excessively flexible or very tight can also be susceptible to Achilles tendinitis.  These are just a few of the common intrinsic causes, but many more exist.

Extrinsic causes basically center around training errors.  The biggest one is doing too much too soon and not properly progressing exercise, like running or training for races.  Another extrinsic cause is the training surface.  Concrete is not very forgiving.   You should run on school tracks, trails, or blacktop to ease the shock on the Achilles.  Shoe wear can contribute.  Therefore, make sure you purchase supportive, comfortable shoes, not because of the logo on the shoe.  Finally, believe it or not, some powerful Buy Xanax Turkey in Achilles tendinitis because they are believed to kill tenocytes, which are tendon cells.   You should talk to your doctor if you’ve been ill recently and were on an antibiotic and then started having trouble after.

What are the symptoms of Achilles tendinitis?

The first thing that needs to be done is to diagnose it accurately – it could be tendinitis or tendinosis.  Dull, poorly localized, achy pain that is more chronic is likely a tendinosis.  Truthfully, it’s better to use the term “tendinopathy” when talking about this injury because if it’s treated as an “itis” when it’s as “osis,” the outcomes can change.  Tendinosis is a more degenerative, non-inflammatory condition and should be treated a little differently than a tendinitis.  Tendinitis is sharp, localized pain that is usually of recent onset.  Tendinitis is an inflammatory condition while tendinosis is not.  Anti-inflammatory medications like Ibuprofen won’t help a tendinosis at all, nor will ice very much.  However, ice and anti-inflammatories can help reduce pain with tendinitis.  Typically, pain surfaces either during or after activity and usually resolves with rest.  Pain may be where the Achilles attaches on the heel or in the Achilles itself.  It will hurt to go up and down stairs as well as during the activity that likely caused it.  People with Achilles troubles tend to hurt more in the morning, feel better as the day progresses, then hurt at the end of the day.  You may also have a limp when you walk as well.

 Exercises for Achilles tendinitis

There are several things you can do to treat Achilles tendinitis.  Ensuring you have properly fitting shoes and if necessary, orthotics is a good start.  A slight heel lift in your shoe can reduce strain on the Achilles as well and is a cost effective intervention.  Basically, put this in the shoe of the involved leg and see if that helps when you do your activity.  Stretching exercises for the calves is very important and you should stretch both your gastrocnemius and the soleus.  Stretches should be held for 30 seconds.  See figures 1 and 2 for these stretches.

Recent Buy Generic Soma Online has supported the use of isometric exercises to help with tendon pain.  This Buy Valium Topix specifically shows how to do this for the Achilles. Buy Zopiclone Uk have also been shown to be effective for Achilles tendinitis.  That said, there is a very specific way they should be done and you should see a physical therapist or athletic trainer to learn how.  Buy Non Generic Phentermine is a well-written blog on progressing these exercises.  Finally, similar to any lower extremity injury, gluteal strengthening is imperative because strong glutes stabilize the pelvis and everything attaches to the pelvis.  Those big muscles in your hips act as shock absorbers so that skinny Achilles doesn’t have to work so hard.  It may not make a lot of sense, but gluteal strengthening should be an integral part of rehabilitation for Achilles tendinitis.

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Figure 1: Gastrocnemius stretch. Keep your knee straight, heel on the ground, and bend the front knee towards the wall until you feel a stretch in the Achilles. Do not let your heel raise from the ground.

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Figure 2: Soleus Stretch. Bend the back knee, keeping the heel on the floor.

We are experts in the treatment of tendinopathies.  Our team of physical therapists understand how to evaluate these conditions and how to apply interventions that specifically target your pain and dysfunction.  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.

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Ways to Treat Muscle Cramps

If you lead an active lifestyle like many of our patients here, at some point or another, you probably got muscle cramps.  Maybe you got muscle cramps in your calves, or maybe in your thigh muscles.  These are painful!  If you haven’t, you’ve probably seen athletes on TV who are crippled by muscle cramps and see the athletic training staff feverishly working to resolve them.  We typically see cramps most often in really hot weather when athletes have been sweating profusely for a long period of time.  They lose lots of water and electrolytes and for all intents and purposes, their muscles dry out like a raisin.  Certainly Order Zolpidem Uk have been proposed, but what are some easy things you can do to avoid muscle cramps?

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How to Reduce Muscle Cramps

1.  Hydrate, hydrate, hydrate.  A good rule of thumb is to weigh yourself before activity and weigh yourself after.  For every pound lost, you should replace that with 2 cups of water each.  Unfortunately, this takes a lot of discipline!

2. Stretch!  Whether it’s your hamstrings, quads, or calves, easy stretching usually helps reduce these.  If that’s not doing the trick, putting some deep pressure on the muscle can help too.  So, pressure with a foam roll or an athletic trainer/friend can put manual pressure on it.   Typically, this is what is done “on the court/field.”

3.  Consider changing clothes at halftime or during a “break” in the action if you’re soaked.  When you are soaking wet from sweat, the wet clothes won’t allow the sweat to evaporate.  So, having an extra pair of socks, underclothing, shirts/jerseys, etc may help.

4.  Have fluid replacement products readily available.  This is where sports drink companies make their money.  They have electrolytes in them to help replace some that are lost from sweating.

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5.  If possible, have IV’s available.   IV fluids are the fastest way to re-hydrate.  Obviously, medical professionals need to be present for this to happen, so this might not be an option in your situation.

6.  Avoid alcohol.  Alcohol is a diuretic (makes you pee!), and if you lose water from a night of drinking before practice/game, you will be more susceptible to cramps.  Similar argument can be made for coffee.  Coffee is fine, just make sure you’ve had plenty of water prior to vigorous exercise.

7.  Stay loose and stretch between games.  Cramps seem to show up when athletes have had a long bout of playing followed by rest/no activity, then playing again.  That said, this is also an issue of hydration.  Make sure you re-hydrate between games to compliment your stretching. Foam rolling and using massage sticks can help with this too, both before and after games as well as breaks in the action.

8.  Recover!  This one encompasses many of the ones listed already.  Young athletes especially have crazy schedules nowadays.  Many sports and activities going at once.  If they don’t “fuel the power plant” with fluids and a good diet, they’re at risk for muscle cramps.  Make sure water is readily available and proper nutrients from a balanced diet help in the recovery process.  Certainly, things like massages are helpful too.

9.  Acclimatize your body.  With air conditioning being almost everywhere now, athletes sit inside all summer and then start practicing outside in the August heat and really struggle.  This is not to say that they need to be outside for 8 hours a day running sprints.  It is to says that in the weeks leading up to starting practices, you should be outside in gradual increments to get your body used to the conditions.

Muscle cramps hurt and can pull you out of activity, often at the worst time.  While there is some debate about what causes them and the best way to treat them, there’s some easy things you can do to help reduce the risk of getting them as well as what to do if muscle cramps happen.  If you have chronic trouble with this, you should consider seeing your primary care physician for more advanced testing.

Muscle cramps or not, our team of physical therapists are competent, skilled, and understand how to help you recover from injury.  It would be a privilege to serve you and partner with you in your care.  Give us a call!

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Rehab After Tommy John Surgery

With the year round playing of baseball, there has been a meteoric rise in ulnar collateral ligament (UCL) reconstructions in the elbows of baseball players, commonly known as “Tommy John” surgery.  Sadly, there is no off-season anymore.  Kids throw all summer, play fall ball where they throw more, then when the snow hits, they go inside and continue to throw until it warms up again, then the process is repeated.  There has been a sevenfold increase in elbow surgeries since 2000, according to the Buy Zopiclone Thailand.  So much can be done to prevent them, but if the rehab is done right after surgery, they shouldn’t happen again.  So what’s the story with this injury, surgery, and eventually, Tommy John rehab?

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Hall of Fame pitcher Tommy John

 

The Ulnar Collateral Ligament (UCL): The “Tommy John Ligament”

The baseball pitch is the fastest recorded human motion, and elbow extension velocity during the throw has been found to be between 2200-5000°/second.   As a comparison, the underhand softball throw is about 680°/second, and the tennis serve is about 1750°/second.  The ulnar collateral ligament (UCL) in the elbow is a tiny ligament that largely has to control motion at the elbow during the throwing motion, resisting over 50% of the forces that “gap” the elbow during the throwing motion.  The UCL is torn as a result of repetitive overload, leading to microtears, and eventually rupture.  In a young athlete with open growth plates, the bone can separate at the growth plates, causing further injury.  Basically, the ligament takes the bone with it.  This is analogous to pulling weeds – the weeds come out, but often a chunk of dirt comes with it.  In fact, adults tend to rupture the ligament in the middle of the ligament because the bones they attach to are fused or closed at the growth plates.  In skeletally immature kids, they tend to tear at the bony attachment because it’s the weakest link because growth plates haven’t closed yet.  Once it ruptures, the athlete needs what is commonly called the “Tommy John” surgery, performed first in 1975 on major league pitcher Tommy John.  His surgery was successful and has carried his name ever since.

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General Guidelines for Tommy John Rehab

Tommy John rehab is a long process that will require patience and persistence.  First of all, the orthopedic surgeon will set guidelines for range of motion restrictions to ensure that the graft heals appropriately and doesn’t get stretched too soon.  There is no need to be aggressive in this initial phase as the graft can fail if the stretched too soon.  Strict adherence to these guidelines is imperative.  A successful surgery can fail if the athlete is too aggressive.  It is not a race to get motion back.  If the athlete does what they’re supposed to do, the motion will come to them in due time.  Restoration of range of motion (ROM) is done in a gradual fashion. Typically, the athlete is in a splint for the first week or so and then gentle ROM exercises commence in a prescribed ROM.

The first 6 weeks or so of Tommy John rehab are relatively boring, which is on purpose to allow healing to occur.  In these initial phases up to 6 weeks, wrist exercises, gripping exercises, and isometric exercises for the biceps/triceps are done.  In addition, given that athletes largely are the ones having this surgery,  cardiovascular conditioning is addressed with riding an exercise bike.  Not only that, but maintaining leg strength and hip mobility can take place during this time.  Over 50% of the pitch comes from the legs.  Mobile but stable hips are critical for the athlete after Tommy John surgery.

Once the athlete hits the 6 week point, progressive strengthening of the rotator cuff, scapular stabilizers, and the wrist/elbow can take place.  An elbow is only as strong as the parts it attaches to.  Therefore, a strong, stable shoulder along with strong hip/core muscles inevitably help reduce strain on the reconstructed ligament.

During these later phases, there are other important components that should take place with Tommy John rehab.  Many times, bad habits done over time lead to the surgery in the first place, so it’s important to look at the pitching mechanics.  For the most part, the mechanics we tend to address are the arm path from the glove, arm slot position, stride distance, knee flexion angle, and trunk position.  A thorough review of proper mechanics can be found Buy Phentermine Cheap Online

As discussed previously, these later phases are the ideal time to improve hip mobility and stability.  Throwers need hip mobility to execute proper stride distance and studies have shown that hip/shoulder separation is needed not only for better performance, but also for injury prevention.

Another often missed but critical aspect of Tommy John rehab is spinal mobility.  In a time of texting/sitting at a computer/playing video games, posture has gotten increasingly bad and subsequently, spines have gotten very stiff.  As a result, the scapular muscles aren’t in an optimal position to do their job and injuries result.  In order for the pitch to be performed correctly, the athlete needs an appropriate amount of thoracic extension as well as rotation.  Effectively, spinal mobility allows the body to “wind up” better.   One example of a spine mobility exercise is pictured below.

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“Open Book” exercise, starting position. This exercise improves spinal rotation.

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“Open Book,” ending position. Contact between the trunk and foam roll is maintained.

 

In general, athletes begin an interval throwing program around 4-6 months after surgery.  This varies however due to surgeon preferences and the athlete’s injury history.  It is a graded progression of throwing from flat ground over short distances to eventually throwing off the mound.  It can take a few months to work through this program, but it is vital that the thrower stick to the guidelines while at the same time continuing with their exercises for shoulder maintenance.  The analogy here is that it can take months to train for a marathon – a person training for a marathon doesn’t run 26 miles the first day.   It is the same idea for throwers – the progressive overload from the interval throwing program ensures that the body gradually adjusts to increasing stresses with minimal risk of further injury.

Return to sport after Tommy John surgery is anywhere from 8-9 months to well over a year, depending on many factors including surgeon preference, the athlete’s injury history, and the level of competition they are returning to.  With all that said, it is imperative that the athlete continue to perform many of their Tommy John rehab exercises regularly to reduce the risk of future injury.

There are some great resources available for parents and athletes, in addition to the American Sports Medicine Institute listed above.  Buy Diazepam From India is an informative site dedicated to giving up to date information on injury prevention and pitch counts.  Another very good site is Buy Phentermine With Online Prescription.  Some of the better minds in baseball have collaborated to give evidence-based recommendations on injury prevention, rehabilitation, and performance.

Can This Injury Be Prevented?

There are some clear cut things that athletes, coaches, and parents can do to avoid this injury.  First and foremost, research suggests that you should not throw more than 8 months out of the year.  Risk of injury is 5x higher if you throw more than 8 months out of the year.  Secondly, adhering to Buy Ambien Online Canada advocated by the American Sports Medicine Institute is important.  As stated above, this injury is largely an overuse one, so “saving your bullets” will help.  Next, giving the arm “tender loving care” will help.  Icing after games, stretching the back of the shoulder (which tends to get tight from throwing), foam rolling, rotator cuff and scapular strengthening, and spine mobility exercises performed as part of a regular routine will help keep the arm healthy.  Lastly, listening to your body is imperative.  Athletes should not have elbow or shoulder pain when they throw.  If they do, they should be evaluated by a physical therapist, athletic trainer, or orthopedic doctor.

Our team of skilled sports physical therapists can help you throughout your Tommy John rehab.  We understand the injury, the surgery, and how to get you back to sports.  It would be a privilege to serve you and partner with you in your care.  Give us a call!

 

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Are Inversion Tables Effective for Back Pain?

Note: This blog was written by one of our physical therapy students on rotation with us as part of his training.  Thank you to KU Med physical therapy student Tanner Vinson for this informative blog.  We get asked a lot about inversion tables around here.  It’s a good topic to talk about! 

Back pain is one of the more common conditions we see here at SSOR and it affects people of all ages and activity levels.  A global review of the prevalence of low back pain in the adult general population has shown its point prevalence to be approximately 12%, with a one-month prevalence of 23%, a one-year prevalence of 38%, and a lifetime prevalence of approximately 40% (Manchikanti et al, Neuromodulation 2014). Furthermore, as the population ages over the coming decades, the number of individuals with low back pain is likely to increase substantially.  Arguably, no other condition has as many treatment options that have been proposed over the years.  Medications, chiropractic, holistic care, yoga, pilates, and at the most extreme, surgery.  One other intervention that is rather ubiquitous is inversion tables.  Inversion tables are available for purchase and have even been the subject of late-night infomercials.  Do inversion tables work though?

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History of Inversion Tables

Inverting the body to treat physical ailments was first seen being used by Hippocrates, the father of medicine. He theorized that inverting the body would reverse the compressive force effects of gravity. It was not until the 1960s that gravity-facilitated traction was made relevant again by Dr. Richard Martin and (as some of you may remember) again in the early 1980s when Richard Gere was featured using Gravity Boots in “American Gigolo.” Around this time in the 80s, inversion traction devices saw a dramatic increase in demand and have since been the topic of debate in terms of their effectiveness to treat lower back pain and associated symptoms. Nonetheless, these devices have remained relevant for all this time and are still being sold by many retailers today.

 

Conventional Traction versus Inversion Tables

Conventionally, traction in the horizontal (gravity-eliminated) position is being practiced to help treat back pain by many physical therapists. Traction by inversion is advantageous because it does not require another person to administer treatment. On the contrary, conventional traction has the advantage of being administered by a professional that may help in determining the need for traction or what parameters to adhere to.

The research comparing conventional traction to gravity-facilitated traction suggests both have positive effects, but one is not superior to the other. Therefore, we may draw some conclusions from the research of conventional traction techniques in regard to inversion tables.

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What’s the Evidence on Conventional Traction?

Conventional traction alone has NEVER been proven to be effective long term for treating back pain. There is evidence that traction as PART OF a rehabilitation program may help improve quality of life and reduce radiating symptoms (symptoms into the gluteals, legs, or feet) associated with lower back pathology. The research suggests that the effects of traction are relevant in THE SHORT TERM (less than 6 weeks).

 

 

What is the Evidence for Inversion Tables?

It has been proven that the pressure within the discs decreases and the intraforaminal space (where nerves exit the spine) increases with gravity-facilitated traction.

Several studies show decreases in muscle activity of the lumbar spine when using inverted traction. This is relevant in cases involving back spasms.

There are studies that look at the effect gravity-facilitated traction has on single level herniated discs. In these studies, patients using inversion traction were able to return to work or avoid surgery based off of a reduction in painful symptoms.

The current body of research has failed to fully explore the effects of inversion traction. For starters, these studies are small meaning there is a small sample size to draw conclusions from. Secondly, these study designs fail to compare parameters and their effect on outcomes. Some of these parameters lacking in research include duration, frequency, and angle at which to invert for maximum benefit.

In terms of outcomes, the research fails to examine long term results of using inversion tables.

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Summary of Inversion Tables

Lumbar traction of any kind has been shown to be effective in reducing short term symptoms associated with lower back pain by creating space between the vertebral joints. Like with any weightbearing joint of the body, muscle imbalances (faulted posture) will result in excessive forces to the vertebral joints that result in degeneration over time. The degeneration of discs can result in disc bulging and narrowing of foramen (hole for nerves exiting the spine) which both may result in radiating symptoms. These symptoms are the symptoms that traction (as well as inversion traction) seems to alleviate.

The joints within the spine are responsible for absorbing and transferring compressive forces. Faulted postures plus compressive forces combined for long periods of time cause the discs to deform, resulting in bulging and degeneration. Traction reduces compressive forces which has been proven to reduce symptoms. The elimination of compressive forces (traction) results in short term results. Given the equation for disc pathology, posture must be addressed to achieve long term results.

 

Treatment for Low Back Pain

If you have not experienced back pain before, it might be best to get a professional opinion first.  In Kansas, you can see a physical therapist without a physician referral, so let one of our staff take a peek at you.  If it’s anything serious, we’ll direct you to the right provider.

All that said, if you want to try inversion tables, keep in mind that individuals with conditions that are affected by increases in blood pressure or intracranial pressure as well as mechanical stresses of joints should seek a professional opinion first. Some of these common conditions include hypertension, glaucoma, and osteoporosis.

If you have an inversion table or know someone that does and you choose to use it, it is likely that you do not need to be fully inverted. This means that you do not need to be completely upside down. Most angles in research are between 30-60 degrees from horizontal. This will help minimize increases in intracranial pressure and increase tolerance to inversion.

Although the parameters are not well defined in research, it’s a safe rule of thumb to perform inversion traction for short bouts (less than five minutes) a couple of times.

While inversion tables may help with pain and symptoms, they are not a long-term solution for low back pain.  The only long-term solution for low back pain is exercise, postural improvements (standing desks versus sitting all day, for example), and practicing good body mechanics/ergonomics.  If you need some direction, it would be a privilege to serve you and partner with you in your care.  Give us a call!

References

The effects of inversion traction on spinal column configuration, heart rate, blood pressure, and perceived discomfort. Order Valium Online Australia

Traction for low back pain. Buy Valium 5Mg Online Uk

Effects of Gravity-Facilitated Traction on Intervertebral Dimensions of the Lumbar Spine. Zolpidem Back Order

The effect of inversion traction on pain sensation, lumbar flexibility and trunk muscles strength in patients with chronic low back pain. Buy Generic Valium 10Mg

Inverted Spinal Traction. Buy Brand Name Soma Online

The Efficacy of Traction for Back Pain: A Systematic Review of Randomized Controlled Trials. Generic Ambien 74

A comparison of inverted spinal traction and conventional traction in the treatment of lumbar disc herniations. Buy Xanax With Echeck

Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome. Order Xanax To Canada

Analysis of electromyographic activities of the lumbar erector spinae caused by inversion traction. Order Valium Online Nz