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Do Inversion Tables Work?

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?

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.

 

 

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.

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. https://www.ncbi.nlm.nih.gov/pubmed/18802266

Traction for low back pain. http://www.cochrane.org/CD003010/BACK_traction-for-low-back-pain

Effects of Gravity-Facilitated Traction on Intervertebral Dimensions of the Lumbar Spine. https://www.researchgate.net/publication/23267651_Effects_of_Gravity-Facilitated_Traction_on_Intervertebral_Dimensions_of_the_Lumbar_Spine

The effect of inversion traction on pain sensation, lumbar flexibility and trunk muscles strength in patients with chronic low back pain. https://www.researchgate.net/publication/264742284_The_effect_of_inversion_traction_on_pain_sensation_lumbar_flexibility_and_trunk_muscles_strength_in_patients_with_chronic_low_back_pain

Inverted Spinal Traction. https://www.ncbi.nlm.nih.gov/pubmed/687049

The Efficacy of Traction for Back Pain: A Systematic Review of Randomized Controlled Trials. https://www.researchgate.net/publication/9033349_The_Efficacy_of_Traction_for_Back_Pain_A_Systematic_Review_of_Randomized_Controlled_Trials

A comparison of inverted spinal traction and conventional traction in the treatment of lumbar disc herniations. https://www.researchgate.net/publication/232054773_A_comparison_of_inverted_spinal_traction_and_conventional_traction_in_the_treatment_of_lumbar_disc_herniations

Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome. https://www.researchgate.net/publication/7677298_Effectiveness_of_lumbar_traction_with_routine_conservative_treatment_in_acute_herniated_disc_syndrome

Analysis of electromyographic activities of the lumbar erector spinae caused by inversion traction. https://www.researchgate.net/publication/301708034_Analysis_of_electromyographic_activities_of_the_lumbar_erector_spinae_caused_by_inversion_traction

How to Squat Properly

Learn How to Squat Correctly

If there was one exercise that all people need to perfect is the squat – athletes or not.  We’re not necessarily talking about putting a bar on your back and doing maximal effort squats.  We’re alluding to simply performing sit to stand from a chair, or getting on/off the toilet with proper squat technique.  That said, so many compensatory patterns and muscle substitutions take place from the ankle to the trunk.  This is one of the first things we look at during a physical therapy evaluation, and you may not even know it, but we’re looking the minute we see you in the waiting room.  Watching you get up from the chair is the first clue as to how you are performing this activity.  We almost immediately have an opportunity to help you or your loved one before we’ve even talked!  There are many reasons that poor squat form can occur – lack of mobility in the hips, knees, or ankles or lack of stability in the core region. Figures 1 and 2 show some poor squat form because of these areas.  Figure 1 shows the subject leaning forward, and Figure 2 shows the heels elevated.  In figure 3, the subjects knees are collapsed in and the feet are turned out.  You may have one or all of these regions causing you to not perform a proper squat.   We can help you determine which areas are the sources of your dysfunction.  The purpose of this blog post is to talk about some ways to perform a proper squat movement to not only help improve function, young or old, but for the active patient, provide a foundation for more advanced leg strengthening.  The squat is not only a basic tenet of movement in general, but also part of a strengthening program.  The body weight squat should be perfected prior to adding external resistance.

 

 

Figure 1:  Poor squat form, trunk leaned forward

 

Figure 2: Poor squat, heels off ground

Figure 3: Knees collapsed inward, toes pointed out

Reasons for Poor Squat Form

Are you Figure 1?  If you look more like figure 1 with a forward trunk lean and not so great depth, more than likely you have tight hips and/or core and hip weakness.  Both are easy fixes!

Are you Figure 2? You may have both of Figure 1 deficits, but if your heels are coming up, you may have tight calves or an ankle mobility restriction.  Perhaps you had a previous ankle/foot surgery and your mobility has been affected?  We can figure that out in an evaluation.

 

Are you Figure 3?  If you’re figure 3, more than likely you have some or all of the deficits in figures 1 and 2!

Key Aspects of a Proper Squat

First of all, see Figure 4 for good squat form.  The feet are slightly more than shoulder width apart, the trunk is leaned forward, the head is up, the trunk is parallel with the “shin” bones.  The curve in the low back is maintained.  Many people struggle with achieving these basic points.   Sometimes it’s a MOBILITY problem why we can’t get there.  Perhaps with arthritic aging joints or tightness in muscles from sitting in front of a computer all day, you may not be able to get in that position.  Conversely, you may have a STABILITY problem.  We know this by watching you squat by yourself, then having you repeat it while we hold your hands, supporting you.  If you increase your depth and your form improves, we know that you’re using us for stability.  Therefore, we know our targeted interventions here will focus on hip and core stability training.

Figure 4: Proper Squat Form

 

Exercises to Improve Your Squat

In figure 5, you’ll see the subject holding on to a cable attached to a weighted stack.  Basically, what this provides the subject is some stability as they descend.  Usually, people stop their descent with the squat because any lower, they will fall back.  You can confirm this by getting to the bottom of the squat and then letting go of the cable – if you fall backward, you are the ideal person to need this!  As you get better at this, you can release one hand, try and hold on less, or get to the bottom and pause without holding on.  If you don’t have a cable or are teaching this to a relative at home, any immovable object that the person can hold on to will work.  Exercises to strengthen your core and hip muscles should compliment this activity however.  One of our physical therapists can show you a comprehensive program to address this. Maintaining proper form and posture is paramount when you do this though.

Figure 5: Assisted squat, using a cable

In figure 6, you’ll see the subject’s feet are elevated.   This is actually a way to help someone squat with tight calves or lack of ankle mobility from joint or soft tissue restrictions.  Again, these issues can be addressed in physical therapy.   However, this method is also good because by virtue of shifting weight to the toes, the hips have to go backward – equal and opposite reaction.  As you improve, you can either lower the height your heels are elevated or use nothing at all.  The elevation of the heels effectively acts as a “buffer” or “buys you time” until ankle or soft tissue mobility is restored in physical therapy.  We don’t let people cheat, but this is a way to let you cheat until you have the mobility and control you need.

Figure 6: Assisted squat, heels elevated

Hopefully, these tips help you perform a proper squat.  You can use these tips to teach a child or an elderly relative how to perform a proper squat.  It would be a privilege to partner with you in your care.  Remember, you can see a physical therapist in Kansas without a physician referral.  Give us call!  We have locations in Overland Park and Prairie Village to serve you.

 

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!

 

 

Salvador Perez: Intercostal Strain

Salvador Perez Injury: Intercostal Strain

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

What are the Intercostals?

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

How are they injured?

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

Why are intercostal strains a problem?

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

What’s the rehab of intercostal strains look like?

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

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

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

 

Golf after Rotator Cuff Repair

When Can You Golf After Rotator Cuff Repair?

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

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

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

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

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

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

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

Figure 3. Horizontal adduction.

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

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

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

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

So when can I play again?

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

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

Household Items That Sub for Weights

No Weights at Home? Household Items Work!

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

Household items that sub for weights

One Pound

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

Two Pounds

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

Three Pounds

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

Four Pounds

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

Five Pounds

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

Seven-Eight Pounds

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

Other Household Item Substitutes

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

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

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

The One Thing All Patients Expect

One Thing that Matters to Most Patients

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

 

Why Consistency Matters

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

How do you know this is so important?

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

The SSOR Approach

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

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

Stiff Knees from Knee Arthritis?

Battling Knee Arthritis? Try These 6 Things to Help

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

Why are my knees stiff?

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

Knee arthritis? You may have a dry sponge.

Tips for Knee Arthritis

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

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

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

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

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

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

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

Torn Rotator Cuff: Should You Fix It?

Is Surgery Necessary for a Torn Rotator Cuff?

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

Role of the rotator cuff

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

How are they torn?

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

So should I fix my torn rotator cuff?

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

Torn Rotator Cuff: Summary

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

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

Which Desk Chair is Best for You?

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

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

Desk Chair: Things to Consider

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

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

Does Type of Desk Chair Affect Overall Health?

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

Summary on Desk Chairs

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

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