Posted on 9/11/2018 by Brian Brewer, CPT
School is back in session and fall sports are underway! From the gridiron to the soccer field to the volleyball court, athletes of all levels are hitting the field. With increased play, however, there is also an increased risk for injury.
Did you know that there are movement assessments designed to assess ACL injury risk? Within Select Medical’s Outpatient Division*, we provide movement assessments using dorsaVi wireless wearable sensors to measure exactly how individuals move. This technology allows our highly trained clinical team objectively analyze body movement and muscle activation, utilizing a test called the Athletic Movement Index, or AMI. With this testing, we are able to accurately determine an athlete’s ability to safely perform higher level movements, such as cutting, pivoting and deceleration, all of which can lead to ACL injury if not performed efficiently.
The ACL is one of four ligaments in the knee that provide joint stability. Roughly 70 percent of ACL injuries during high-risk sports are non-contact injuries, meaning no collision occurred when the ACL tore. As an athlete begins to tire throughout the course of a game or event, their efficiency in movement begins to suffer, their mechanics become faulty and their risk for injury is heightened. If we can recreate these conditions during movement assessments, we are more able to determine an athletes risk for ACL injury. The AMI is a test that simulates the fatigue factor that plays a role in ACL injuries.
The AMI runs the athlete through a battery of movements, designed to assess core strength and stability, hip strength and mobility and efficiency moving through single-leg movements, such as a single-leg squat and a single-leg hop. The single-leg movements analyze the movement of the knee, whether it is collapsing inward or outward past neutral and the degree of loading, or depth, that the participant is able to go to, both of which are important indicators in assessing ACL injury risk. If the knee is not staying neutral during single-leg movements, then there is weakness in the hip, specifically the gluteus medius muscle, which is leading to inefficient movement. The higher the speed that the knee is moving out of neutral, the higher the risk of ACL injury there is. Similarly, if the athlete is not loading deep enough, and that is coupled with a high speed of displacement, then their risk is increased even more. Through strengthening the hips and core effectively and deliberately, based on the test results, clinicians can help reduce an athlete’s risk of injury dramatically.
Our exclusive ACL Play it Safe Program is an ACL prevention program, designed specifically to go hand-in-hand with the AMI and address the faulty mechanics that lead to ACL injuries. The program consists of a mobile application, with pre- and post-practice exercises and drills to be performed. Additionally, there is an ACL Play it Safe Kit that consists of equipment designed to improve strength and conditioning of the muscles responsible for controlling mechanics during dynamic movements that can cause injuries.
The pre-practice exercises are dynamic warm-ups that should be used to increase flexibility and mobility in the hips, knees and ankles:
High knee with calf raise
These pre-practice exercises should be performed for 15 yards down and back, two times each. This will help to warm-up the hips and knees, and prime them for efficient movement.
The post-practice exercises utilize the TheraBand CLX, TheraBand Ankle Cuff and TheraBand Stability Trainer. These should be done after practice when the athlete is tired. If an athlete can strengthen and train with proper mechanics while they are tired, then it will be that much easier for them to perform efficiently on the field when they reach the same level of fatigue. There is a multitude of post-practice exercises, with some listed below:
CLX spiral technique
TB cuff side stepping with kicks
Single leg toss on stability trainer
CLX plank with kicks
All of the post-practice exercises are designed to help strengthen the core and gluteus medius muscle and prevent a displacement of the knee during dynamic movements. Of course, as with any exercise routine, static stretching and/or foam rolling should also be performed following the completion of the program.
Through objective analysis of muscle activation and subjective observations of movement, clinicians are able to determine ACL injury risk with high accuracy. If we can address poor mechanics of movement through assessment prior to when an athlete takes the field and introduce them to ACL Programs designed to addressed these poor mechanics, we can start to minimize lost time on the field, see an increase in performance and help athletes be more confident in their sport.
*NovaCare Rehabilitation and NovaCare are part of the Select Medial Outpatient Division family of brands.Categories: Physical Therapy
By: Brian Brewer, CPT, is a strength and conditioning specialist for NovaCare Rehabilitation in Annapolis, Maryland.
Posted on 9/26/2018 by Anne Marie Muto, OTR/L, CHT
Now that students have a few weeks of school under their belts, their backpacks – which were relatively light from a few school supplies – are now filling up. Not only are children feeling the weight of nightly homework, but also the weight of their book, binder and electronic-filled backpacks.
Aside from considering the right cartoon character/super-hero, color and cool factor, the backpack should also be the right fit. In honor of National School Backpack Awareness Day, here are few things to keep in mind when picking out a backpack:
The width should be about the same size as the student; the length should be no longer than the torso (trunk or central part of the body) and not hang more than four inches below the waist. Remember to check the bag each year, especially for younger children who are experiencing growth spurts.
Select a backpack that has a padded back, two padded shoulder straps and a waist strap to help evenly distribute the weight from the shoulders to the body’s core and hips. The extra padding will help protect students’ neck and shoulders which are rich in blood vessels and nerves and when constricted can cause pain and tingling in the neck, arms, and hands.
Finally, choose a backpack that is light-weight and has multiple compartments which can help distribute the weight more evenly. It’s also a good idea to think about picking a backpack with reflective material or adding reflective tape for younger students.
After picking out the perfect backpack, students should also be reminded on how to properly wear and pack their “shoulder shadow.”
Always wear both shoulder straps to distribute the weight evenly. Using one only shoulder strap can cause too much leaning and threaten to curve the spine.
Adjust the shoulder straps so the pack fits snugly across their back. When possible, pack lightly and carry only items that are required for the day.
Never allow a student to carry more than 15 percent of their body weight. For example, if a child weighs 100 pounds, the backpack should not weight more than 15 pounds.
When organizing the content of the backpack, distribute the weight evenly by packing the heaviest items toward to the center and lower portion of the bag to keep the weight off their shoulders.
Finally, here are a few tips to keep in mind to help lighten the load:
Ask if textbooks are available digitally, or if extra books are available to leave at home.
Consider having a “homework box” at home that contains schools supplies (pens, pencils, ruler, markers, highlighters, etc.) to reduce the amount of unwanted weight in a backpack.
Encourage kids to use their locker or desk frequently throughout the day instead of carrying an entire day’s worth of books. Only bring home the books which are truly required for homework or studying each night.
Pick up the backpack using proper lifting techniques, encouraging students to bend at their knees and use both of their hands when lifting the bag to their shoulders. It may not be a bad idea for students to participate in back-strengthening exercises to assist in building up muscles required to carry a backpack.
We hope you have a fun and healthy year at school! Happy learning!
By: Anne Marie Muto, OTR/L, CHT, from NovaCare Rehabilitation’s Broomall and Boothwyn, PA centers. Anne treats patients dealing with upper extremity injuries and is a preferred provider for the Graston Technique.
NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.
Posted on 6/12/2017 by Heather N. Wnorowski, P.T., DPT, OCS
Across the country, baseball and softball season is in full swing. Whether it’s at a backyard barbecue or an official game, athletes of all skill levels are taking part in America’s favorite pastime.
Over the past few years, a large emphasis has been on the youth athlete and overuse injuries in pitchers. We have learned to monitor pitch counts, plan structured rest and encourage multi-sport participation with athletes.
But what about outfielders, catchers and the weekend warriors who enjoy playing in their neighborhood league?
Common injuries aside from the shoulder and elbow exist in youth and adult baseball/softball athletes, such as back pain, knee pain and Achilles injury. Many overhead athletes have concurrent complaints of back pain or contralateral knee pain (knee pain opposite of their throwing arm). Why?
When you think about baseball and softball, a player is doing rotational movements that require the entire body. Unless they switch hit, these rotational patterns are always to the same side. What then happens is they may overdevelop certain muscular groups on one side in comparison to the other. In doing so, this can cause overuse injuries of these groups or we may injure or strain ourselves doing normal daily activities due to this imbalance.
The easiest way to avoid injury at practice or during a game is to develop a proper warm-up routine. An adequate warm-up usually involves a little bit of sweat, which can be hard to get in the dugout. Try performing some of these full body movements to warm-up quickly and efficiently:
Overhead walking lunge
Heather Overhead Lunge
Split squat with one foot on the dugout bench
Heather Split Squat
Lunge with trunk and arm rotation
Heather Lunge Rotation
Shoulder rotation with banded pull aparts
Heather Band Rotation
PNF diagonal pattern with banded pull aparts
Heather PNF Bands
Incorporating a low back and abdominal strengthening routine into your normal strengthening routine is also recommended. To be most efficient, you need a good transfer of force between the upper half and lower half during throwing or batting. Without a solid core, athletes with lose force and become less effective. Abdominal exercises that require rotation in both directions, isometric holds (planks, side planks), and lumbar extension strengthening should all be incorporated into your programming.
Heather Stretch 1 Heather Stretch 2
Having a good balance of strength (right and left sides comparable) and a solid warm up routine will help to prevent injury and enhance performance. Hopefully these tips prepare you for your season and keep you healthy on the field. Best of luck in your upcoming season!
By: Heather N. Wnorowski, P.T., DPT, OCS. Heather is a staff physical therapist at our NovaCare Rehabilitation center in Sewell, NJ. She earned a doctorate of physical therapy from Widener University and is dedicated to developing efficient avenues of treatment to influence superior patient outcomes.
Posted on 5/26/2017 by Aileen Lysaught, M.S., CCC-SLP
Join NovaCare Rehabilitation and NovaCare as we shine a light on Better Hearing and Speech Month (BHSM)! BHSM is hosted each May by the American Speech-Language-Hearing Association which works to make effective communication accessible and achievable for all.
Being a first time mother, you don’t really know what to expect after your child is born. My son Rowan was born unexpectedly at 35 weeks. While I was in labor, the nurses warned me of all the complications that may occur with a premature baby. The neonatologist was present for the delivery, and my son was quickly whisked away before I could hold him. While he was being examined by the doctors, I couldn’t wait to hold him for the first time. I could hear him crying as well as the nurse saying, “It looks like he has a tongue tie; my grandson had one, too.”
It seemed slightly ironic, being a Speech-Language Pathologist (SLP), that my son would have a tongue tie; however, I was too overjoyed with his birth to worry about the consequences of this during our first moments together.
When I looked in Rowan’s mouth, I could see he had what’s called a Class 1 tongue tie (the small fold of membrane that normally extends from the floor of the mouth to the midline of the bottom of the tongue attaches all the way at the tip of the tongue). This would significantly impact his ability to move his tongue for feeding.
Our first attempt at breastfeeding was when things became difficult. Being a preemie, he had some difficulty feeding as the sucking pads are not developed in babies born prior to 37 weeks. The tongue tie also made it difficult for him to coordinate the movements necessary for breast or bottle feeding. So, being an experienced SLP, I knew to ask, “When can we have the ear, nose and throat (ENT) doctor come do the frenectomy?”
A frenectomy is a procedure for children struggling with speech or feeding difficulties related to tongue tie. This procedure would help my son improve his feeding skills and get the adequate nutrition needed. The next day, the ENT arrived and quickly performed the procedure. By our first pediatrician appointment the following week, he was back up to his birth weight and then some.
As time went on, I noticed some symptoms in my son that led me to believe he still had tongue restriction and a potential lip tie. He suffered from reflux, which caused him to arch his back and become fussy after feedings. He was gassy and didn’t sleep very well.
Aileen and RowanI began to research as much as I could about tongue tie in babies and children. I took courses and joined support groups for other parents with tongue tie babies and groups in which SLPs would discuss their experiences with tongue ties. I found that some of the other symptoms my son was experiencing could be related to his tongue tie. I also found that many physicians or dentists who are not specially trained in tongue tie may not perform complete revisions, which may result in the need for a second procedure. By this time my son was six months old.
After a lot of research and careful consideration, I went to see a pediatric dentist who was highly recommended and performed successful frenectomy procedures on many of my patients with great outcomes. I was worried, but I couldn’t help but think about how many times I have recommended a family to have the procedure done. The pediatric dentist we saw was extremely knowledgeable.
After he examined my son, the dentist said Rowan’s initial frenectomy was likely incomplete and he would have to use a laser to perform another revision on Rowan’s tongue as well as revise his lip tie. I trusted his recommendation and the procedure took less than five minutes.
I knew the importance of aftercare procedures, including stretching 10 times per day for 10 days and oral motor exercises to improve Rowan’s tongue’s strength and range of motion. I noticed significant improvements in his feeding abilities, ability to babble and gross motor development. Now that Rowan is a little over a year old, has well over 20 words in his vocabulary and is beginning to eat a variety of foods, I couldn’t be happier that he is able to move his tongue freely.
My situation was quite unique being a practicing pediatric SLP with experience in this area. Many mothers struggle and have to give up their attempts at breastfeeding before they discover what may be impacting their child. Many babies have difficulty with weight gain, suffer from reflux or are diagnosed as colicky when the issue lies in their tongue’s ability to function correctly. Parents may not realize their child has a tongue restriction until they have been diagnosed with a speech delay or struggle with a toddler who refuses to eat.
Tongue ties impact many areas of speech and feeding development, and it is important to find knowledgeable professionals to help with the process. It is essential to work with a SLP who can evaluate and identify if a tongue restriction exists and treat the symptoms (speech and feeding difficulties). It is also important to get referrals to an ENT or pediatric dentist to determine if a frenectomy is advised.
Having experienced these issues first hand, I feel that it not only makes me a better mother, but a better SLP. I am dedicated to helping other families overcome these difficulties so their child’s quality of daily life can improve.
Aileen LysaughtBy: Aileen Lysaught, M.S., CCC-SLP. Aileen is a pediatric SLP and the assistant center manager at NovaCare Kids Pediatric Therapy in LaGrange, IL. She has been a practicing SLP since 2010.
Posted on 3/18/2019 by Martin Ryan, C.P., CFO, FAAOP | Comments
How does a prostheses attach? Great question and one that has a number of possible styles for the below the knee patient.
Suspension systems in prosthetics come in a number of configurations. One system common today is the mechanical pin lock system. A pin is attached to the distal liner and inserted to a lock mechanism that provides the interface for suspension. The system is clinically referred to as the Below Knee Prosthesis with a Pin Locking Liner.
Pin lock suspension can be used with patella tendon bearing (PTB), total surface bearing or hydrostatic socket design. With pin lock liners, a silicone liner is rolled onto the residual limb creating a seal between the skin and the liner. The liner has a pin on the end that locks into the bottom of the prosthetic socket. A prosthetic sock may be worn over the silicone insert in order to allow for volume fluctuations.
PUTTING ON THE PROSTHESIS:
Turn the liner inside out. Make sure the liner is clean and dry and has no dirt on it that will irritate the skin.
Make sure a good portion of the bottom end of the liner is exposed and place it against the limb. (Figure 1) With light pressure, roll it up and over the limb. Make sure no air pockets exist between the liner and the skin.
Roll the liner up the limb. (Figure 2) Do not pull or tug. Be careful not to tear or puncture it with fingernails or jewelry.
Pay close attention to the placement of the pin. In most cases, it should be in line with the limb. Be careful not to pierce the liner with the pin.
When using a liner without a fabric cover, a lubricant may be necessary. Consult with your prosthetist to determine the best lubricant for your use.
Add the appropriate thickness of prosthetic sock over the liner, if necessary.
Push the residual limb into the prosthetic socket. The pin will insert into the lock and click down as the limb goes into the socket. It should take some effort to put on the prosthesis. If it clicks down easily, a thicker prosthetic sock may be needed. (Figure 3)
REMOVAL OF YOUR PROSTHESIS:
Push and hold the lock button in and lift the limb out of the socket.
CLEANING AND MAINTENANCE:
The prosthetic socks and sheaths should be cleaned according to the manufacturer’s directions. The soft insert and the prosthetic socket may be wiped out with warm, soapy water or alcohol as needed. Clean socks should be worn every day.
TIPS AND PROBLEM SOLVING:
One of the most difficult concepts to master is how to determine the correct sock ply to wear. Wearing the correct amount of socks is critical for comfort and safety. Your prosthetist and physical therapist will supply you with general guidelines in wearing socks, but if you have questions do not hesitate to contact or visit your prosthetist.
OH NO, IT’S STUCK:
It can happen. You get stuck and the pin will not release. Many times, the sock has covered the pin and is providing in ability of the pin to release.
Do not panic. In most instances, some consistent pulling will release the pin and free the lock. Ask someone to assist you in this process if necessary.
In extreme cases, pour soaping water into the liner next to the skin breaking suction and allow it to release from the prostheses and work free.
Contact your prosthetist.
For more information on the Below Knee Prosthesis with a Pin Locking Liner, please contact a NovaCare Prosthetics & Orthotics centers near you.
By: Martin Ryan, C.P., CFO, FAAOP, is prosthetist for NovaCare Prosthetics & Orthotics. Marty is certified in advanced prosthetic designs for adults and pediatrics. He received prosthetic training at Northwestern University and the Rehabilitation Institute of Chicago. Marty is certified in prosthetics by the American Board for Certification and works out of NovaCare P&O’s Fond du Lac center in Wisconsin. NovaCare Prosthetics & Orthotics is part of the Select Medical Outpatient Division family of brands.
Posted on 10/6/2017 by Melissa Bloom, P.T., DPT, NCS
Cooler temperatures, students returning to school and the start of another football season are all the telltale signs of fall. And with football back, reports of concussion will inevitably follow. While advancements continue to be made in regards to concussion prevention and treatment, the long-term effects of head trauma, specifically chronic trauma encephalopathy (CTE), remains a huge concern.
You may have previously heard of CTE from the movie “Concussion,” or even from recent media reports. CTE is a tough topic for me. My trouble with the conversation is that there are a lot of unknowns and uncertainties. With the potential for serious injuries, there is the chance for panic and decisions made on emotions versus science. Moreover, ignoring the conversation leads to misinformation. So, it’s time we talk about CTE; what is it and what it means for the future of football.
What is CTE?
CTE is a progressive neurodegenerative disease associated with repetitive head trauma. CTE involves cellular pathological changes similar, but different, to Alzheimer’s disease. The buildup of Tau protein in the brain causes cell death, atrophy and abnormal functioning. CTE can currently only be diagnosed after death by examining the brain under a microscope.
Symptoms can be physical, involving gait abnormalities and slowness of speech, or psychiatric and behavioral, including personality changes, depression and aggression. Various cognitive and processing deficits are also common with CTE, including difficulty thinking, concentrating and remembering.
One consistent scientific challenge is understanding the extent to which age-related changes, psychiatric or mental illness, alcohol or drug use, coexisting dementia or other unknown factors play a role in developing CTE. Currently, this is largely unknown and has not been accounted for in research. CTE is more common in contact sports, but other factors in these athletes may also lead to the disease.
Recent Study and Media Interviews
Earlier this year, the Journal of American Medical Association released an article on CTE. The study looked at participation in American football along with multiple physical and psychosocial variables, and they compared these factors to diagnosis of CTE. Results of this study travelled across the media quickly, with the overall conclusion that players of American football may be at increased risk for CTE. Of the 202 individuals in the study, they found 177 were diagnosed with CTE. The researchers further concluded that 99 percent of subjects who played in the National Football League (NFL) were diagnosed with CTE. What a headline.
Not to downplay the severity of CTE and valid concerns that exist about it, but I want to discuss some limitations about what we can take from these results. First, they conducted their study with football players whose brains were donated for research of CTE, creating a significant selection bias. It was known that their brains would be studied regarding a possible connection with CTE and their participation in contact sports. Individuals and their families who participated (i.e., donated their brain) may have noticed symptoms consistent with CTE prior to death, which led to their participation.
What trends did they find?
Beyond the expected motor, cognitive and psychological involvement known to accompany CTE, there were other notable trends. Substance abuse was noted in 67 percent of those diagnosed with mild CTE, and 49 percent in those diagnosed with severe CTE.
The presence of co-morbid neurodegenerative diseases was also common, including Alzheimer’s, Lewy Body Dementia (LBD) and other motor neuron diseases. In fact, more than 19 percent of the subjects with CTE presented with LBD alone. The current study was not designed to determine the impact these factors had on the development of CTE.
Even the authors note that caution must be used in interpreting the high frequency of CTE in their sample. Their results do not allow for estimates of prevalence, due to the lack of comparison groups. Additionally, the sample population was not representative of the overall population of former players of American football. The majority of players only play youth or high school levels, but most individuals in this study played at the college or pro level.
Evidence supports an association between long-term cognitive, neurobehavioral and psychiatric problems with participation in contact sports, such as football, boxing, soccer, etc. While it seems plausible there is a connection between CTE and repetitive impacts seen with American football, it is currently not possible to determine the causality or risk factors with any certainty. We need to proceed cautiously and collect additional research. However, concussion screenings and efforts to minimize concussion can improve the current health of players even if the long-term effects are unknown.
There is an inherent risk with contact sports for concussive and sub-concussive impacts. The challenge now is evaluating the risk given uncertain long-term consequences and the many scientific questions we don't have answered. For now, let’s continue to play smart, wear protective gear, get baseline tested for concussion and, should a concussion occur, thoroughly go through the rehabilitation process for safe return-to-play and activity.
Melissa Bloom By: Melissa Bloom, P.T., DPT, NCS. Melissa is a physical therapist with Physiotherapy Associates in Atlanta, GA. Melissa is a board certified neurology specialist. She specializes in vestibular rehabilitation and concussion management and teaches nationally on both topics.
Physio, NovaCare Rehabilitation and NovaCare are part of the Select Medical Outpatient Division family of brands.
Posted on 3/23/2017 by Michael Staino, O.T., CHT, COMT
Negative pressure soft tissue manual therapy, or, in simpler terms
, cupping, is a mobilization technique used to treat pain, stiffness and swelling of the upper and lower extremities, as well as large soft tissue areas such as the shoulder blade or low back.
Cupping is the combination of massage movements and negative pressure with the use of a suction device on the skin. A cup is positioned at the treatment area and a vacuum is created within the cup to draw the skin and underlying tissue into the cup. The produced vacuum creates a suction effect that increases blood and lymphatic circulation, relaxes muscle tissue and support, draws stagnation and toxins out of the body and releases a myriad of pain causing factors.
Cupping for soft tissue stiffness
Following injury, surgery and prolonged immobilization, patients may experience pain, stiffness and swelling that hinder normal movement patterns. There are numerous methods to treat such soft tissue stiffness. Scar tissue can be hypersensitive to touch, restricting a therapist’s ability to mobilize the visible scar and scar tissue deep within a patient’s recovering region. Using cupping, the therapist able to gently lift and mobilize surrounding pain-free tissue and work toward the targeted region without pain and discomfort. The results are immediate and lasting, with patients gaining range of motion and tolerance to exercise with reduced swelling.
Additional cupping benefits include:
Improved muscle performance
Improved scar mobility
How does cupping work?
Cupping tissue liftLotion is applied to the skin to improve suction and contact quality of the silicone cups on the skin. Treatment time can range from a few minutes to 10 to 20 minutes depending on the patient and treatment area. The negative pressure works well in a moving technique as our therapists glide the silicone cups across the skin.
Patients will feel slight pressure during treatment, similar to a massage, and experience little to no pain. Following treatment, small, pin-sized red dots or bruising surrounding the treated area may appear.
Cupping can help to treat:
Tightness, stiffness and swelling following healed fractures
Post-operative carpal tunnel syndrome
Brachial plexopathy (pain, decreased movement and sensation in the arm and shoulder)
Rotator cuff injury
Shoulder pain and stiffness
Low back pain
Neck pain and stiffness
…And much more!
For more information on cupping, please contact a center near you today.
Mike StainoBy: Michael Staino, O.T., CHT, COMT. Michael works in NovaCare Rehabilitation’s South Jersey community and works extensively out of our Manahawkin center. Along with managing hand therapy in his market, Michael specializes in treating patients with hand and upper extremity injuries. He is an occupational therapist, certified hand therapist and certified orthopaedic manual therapist of the upper extremity with more than 24 years of experience.
Posted on 6/4/2019 by Victoria Trueba, MOT, OTR/L, CHT
Finger sprains are very common. They can cause torn ligaments and broken bones even if you don’t see an obvious deformity and are still moving your finger. Earlier treatment allows you to recover faster, identify a more serious injury to your finger and begin the most successful treatment. Whether it’s a basketball player who jammed his middle finger against the ball, an employee late to work who slammed the car door on her finger or a dog leash that became tangled and pulled on a finger, digital trauma is nothing to shake your finger at!Case in point: Mrs. F, a teacher’s aide working with children with special needs. One particular morning as the class was completing an arts and craft project, Mrs. F went to help a student who was becoming increasingly upset. As she was attempting to help the student, he accidentally grabbed Mrs. F’s finger instead of the crayon. Without thought, Mrs. F pulled away and her middle finger got twisted. She recalls the intense pain and immediate swelling she experienced after the injury; however, she thought the pain would go away on its own and that ice would help with the swelling.As the days went on, Mrs. F’s middle finger was not improving. It remained swollen, tender to the touch and she noticed bending and straightening became more limited. Her grip had been affected, and daily tasks such as grabbing the steering wheel and writing became challenging. Mrs. F remembers thinking, “But it was just a finger sprain!”Our fingers contain three joints, with the most commonly sprained joint being the middle knuckle. Our joints also have many ligaments, which serve as a type of checks and balance system that allows both mobility and stability. When Mrs. F was finally evaluated by an orthopaedic physician four weeks after her injury took place, she was diagnosed with a grade 1 injury to a ligament on the side of her joint – the culprit of her limited mobility. Grade 1 ligament injury is detected when there is localized pain and tenderness over the involved joint, noticeable swelling and possible bruising.Depending on the grade of the strain, different treatment options are available. In Mrs. F’s case, a grade 1 injury is less severe on the scale of 1 to 3. As the severity increases to grade 2 and grade 3, the integrity of the ligament is further injured, which results in a less stable joint and a need for prolonged immobilization. In some cases, these injuries may require surgery.We were able to treat Mrs. F’s grade 1 injury with 7-10 days of immobilization in a custom removable splint for eight weeks. This allowed the swelling to go down and the ligament to begin healing. Afterward, she wore fabric buddy tapes around her index and middle fingers to protect the middle finger from a sideways force. Needless to say, don’t be fooled by a ‘simple’ finger injury! Although Mrs. F had a grade 1 injury, she was still significantly affected in her ability to complete daily activities. By the time she began therapy, she had lost a considerable amount of motion in her finger and had begun finding ways to grip without using her middle finger. Even a low grade strain may require therapy due to stiffness, weakness, swelling and hypersensitivity to touch. Make sure to have an injury evaluated in a timely manner and get the appropriate treatment to avoid deficits in doing the things you love most.
By: Victoria Trueba, MOT, OTR/L, CHT. Vicky is an occupational therapist and certified hand therapist with NovaCare in Trinity, FL.
Posted on 7/20/2017 by NovaCare Rehabilitation and NovaCare
The dog days of summer are upon us, but you don’t have to stop exercising outside just because of the warmer temperatures. NovaCare Rehabilitation’s Paul Hansen, ATC, from our Minnesota community, and NovaCare’s Andy Prishack, P.T., ATC/L, center manager, from the Fair Oaks, VA center, explain how to keep safe while enjoying some of your favorite summer activities.
• Avoid exercising between the hours of 11 a.m. to 3 p.m. as that is considered the hottest part of the day. Limit high intensity workouts to either early morning or early evening hours when the sun’s radiation is minimal.
• Stay hydrated by drinking a glass or two of water before you head outside. If possible, carry a bottle of water or even a hydration pack and take a drink every 15 minutes even if you’re not thirsty. The easiest thing to do is pay attention to the color of your urine. Pale and clear means you’re well hydrated; if it’s dark you need to drink more fluids.
• Wear clothing that’s light in color, lightweight and has vents or mesh. Microfiber polyesters and cotton blends are good examples. The lighter colors will help reflect heat and the cotton material will help with the evaporation of sweat.
• Feeling nauseous, dizzy or exhausted, along with moist and flushed skin are symptoms of heat exhaustion. Stop what you’re doing and get out of the heat. Remove or loosen any tight clothing and apply cool, wet cloths. Slowly drink a half-glass of cool water to rehydrate yourself and continue doing so every 15 minutes until you feel better.
With the temperature rising, many are also headed to the nearest body of water with kayaks, surf and paddle boards. Water sports are an excellent way to get in exercise and challenge our upper body strength and balance. Heather Wnorowski, P.T., from NovaCare Rehabilitation’s Sewell, NJ center, has a few tips to keep in mind for the water sports novice and seasoned pro.
• Always get in an adequate warm-up. While the temperatures may be warm, it doesn’t mean our muscles are. Dynamic stretching is a great way to get your blood circulating and muscles warm before hitting the water.
• Since water sports are heavily dependent on our shoulders, it’s important to strengthen your postural and rotator cuff muscles in order to avoid repetitive stresses and impingements of the shoulder.
• Don’t forget the rotational mobility of your mid-back! Kayaking and other paddle sports involve a lot of thoracic spine rotation in order to propel you forward. Make sure you’re able to twist from side to side without pain before heading out for a day on the water.
• Last but not least is balance! Balance is an important part of maintaining an upright position while on the water. Practice standing on one leg at home. Once you’ve mastered that, try standing on a foam cushion and closing your eyes. Make sure you have someone or something nearby to hold onto in case you lose your balance.
Have a great summer and be sure to stay safe out in the heat!
Posted on 8/23/2017 by Colleen Boucher, P.T., DPT
Wearing proper clothing, getting the right amount of sleep and practicing proper stretching techniques are vital to an athlete’s success. But, just as is important is eating the right foods. A proper diet will allow athletes to remain active, maximize function and minimize risk for injury. Eating the right foods will also address factors that may limit performance such as fatigue, which can cause deterioration in skill or concentration during an event.
Using guidelines from the American College of Sports Medicine, we believe practicing these tips will help athletes remain active in their favorite sport. What and when you eat prior to physical activity makes a big difference in the way you perform and recover.
Eat three to four hours before your workout and make sure you’re eating food that not only contains adequate amounts of proteins and carbohydrates, but also provides sustainable energy, speeds recovery time and boosts performance. Early fatigue caused by malnutrition can result in improper mechanics, creating predisposition to injury.
Athletes should eat a diet that gets the bulk of its calories from carbohydrates, an athlete’s main fuel. Eating foods such as breads, cereals, pasta, fruit and vegetables will help to achieve maximum carbohydrate storage.
Re-fueling after exercise is just as important. Eating protein, carbohydrates and a small amount of fat after activity prevents the breakdown of muscles and can lead to better next-day performance. While protein doesn’t provide energy, it is needed to maintain muscles. Focus on incorporating foods with high-quality protein, such as fish, poultry, nuts, beans, eggs and milk.
Practicing proper hydration is equally important in reaching your optimal level of success. Athletes, especially those participating in high-intensity sports, should drink fluids early and often. An easy way to ensure you’re properly hydrated is focusing on the color of your urine. A pale yellow means you’re getting enough fluids, while a bright yellow or dark color means you need to drink more. We encourage athletes to:
Drink 17 to 20 ounces of water two to three hours prior practice.
Drink 7 to 10 ounces every 10 to 20 minutes during activity.
Drink 7 to 10 ounces of water after practice for every two pounds of body weight lost.
Drinking the right liquids is also a key factor in an athlete’s diet. Milk is preferred by many athletes as it provides a good balance of protein and carbohydrates. Sports drinks are great for replenishing electrolytes, which are lost when you sweat. If you’re losing a lot of fluid as you sweat, it’s a good idea to dilute sports drinks with equal amounts of water to ensure you’re getting the right balance of fluid and electrolytes. If possible, drink chilled fluids, which are more easily absorbed than room-temperature liquids and can help to cool your body.
Finally, avoid extreme diets as they increase the risk of micro-nutrient deficiencies. Vitamin and mineral supplements aren’t necessary if your diet includes a variety of nutrient-dense foods. Often, these supplements require supervision and monitoring for safety and effectiveness.
By: Colleen Boucher, P.T., DPT, center manager from NovaCare Rehabilitation’s Sicklerville, NJ center. Colleen has been a part of the NovaCare team since 2001 and enjoys treating all types of patients. She has a strong interest in vestibular rehabilitation and concussion management.