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.Categories: Physical Therapy
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 dorasaVi 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.
By: Brian Brewer, CPT, is a strength and conditioning specialist for NovaCare Rehabilitation in Annapolis, Maryland.
Posted on 8/23/2018 by Marge Krengel, OTR/L, CHT
Summer activities often mean more upper extremity injuries associated with overuse, poor posture and unconditioned muscles. In the summer, everyone is excited to get outside and work on gardening, lawn improvement and home repair projects. Others are going back to the gym or taking up sports like tennis and golf.
The terms “wear and tear,” overuse injuries, osteoarthritis and degenerative joint disease have been used in the past to describe these types of injuries. More recently, terms such as repetitive motion injury, repetitive strain injury and cumulative trauma disorder (CTD) are used to define and diagnosis musculoskeletal impairments caused by overuse.
An overuse injury can happen when you try to take on too much physical activity too quickly or when you are causing repetitive trauma to a muscle or joint. For example, if you use poor form as you perform strength training exercises or throw a baseball, you may overload certain muscles and cause an overuse injury.
Certified hand therapists are specifically trained in job and activity analysis and to address CTDs. We have many methods to decrease pain, inflammation and recondition the injured area to tolerate normal use again. In addition to eliminating pain, therapists can educate individuals on different ways to perform the same activities and lower re-injury. Our goal is to return patients to the level of activity they are accustomed to.
Here are few ideas shared by the American Society of Hand Therapists for preventative treatment:
A therapist can assess your work, leisure or home repair activities by simulating these in the center or looking at photos or videos of you performing an activity. If you are having problems at work, in some instances the therapist can visit your job site.
Sometimes different tools are needed. If you find you are adding padding or modifying how you are doing something, then the tools being used should be re-evaluated for their effectiveness. Ergonomically designed tools are available.
Take 30-second breaks every 15 to 30 minutes when performing repetitive activities. Use this time to stretch the muscles in the opposite direction from your working pattern.
If possible, break up your day with different activities to avoid over-repetition with one activity.
In addition to these tips, a therapist can design exercises specific to your unique needs to address your upper extremity condition.
Speak with your physician before starting any new activity or ramping up your current routine and contact a hand therapist if you are experiencing pain in your hand, wrist, elbow, arm or shoulder. Regardless of the activity you want to enjoy, make sure you can reach your optimal performance and avoid unnecessary injuries.
Enjoy the remaining weeks of summer and remember to see a certified hand therapist if you need help reaching your goals!
By: Marge Krengel, OTR/L, CHT. Marge is an occupational and certified hand therapist for Emory Rehabilitation Outpatient Center in Marietta, GA.
Emory Rehabilitation, NovaCare and NovaCare Rehabilitation are part of the Select Medical Outpatient Division family of brands.
Posted on 7/10/2018 by Nicole Tombers, P.T., DPT
In a culture dominated by cell phones, table stand computers, neck pain and headaches are becoming more and more common. Studies show that up to 45 percent of today’s workforce will experience problematic neck pain at some point.1, 2 As a physical therapist, I often find that these problems are associated with muscle tightness and weakness brought on by poor posture. It can be difficult to maintain perfectly straight posture all day, especially when your thoughts are focused on other things, such as the work project you need to finish this week, the heavy traffic on the roads around you or the emails you are answering from your tablet in the evening.
Here are a few tips and tricks that will set you up for success when it comes to maintaining good posture and reducing the strain on your neck in everyday situations.
Set your car mirror
Many people spend up to an hour or more in their car every day – driving to and from work, running errands and shuttling the kids to their many activities. Having poor posture in the car can place extra stress on the joints and muscles of your back and neck. Leave yourself a little reminder to keep good posture by adjusting your rearview mirror.
When you first get in your car, sit in a tall but comfortable posture; not leaning on the door or console, and not slouched low in your seat. Once you are in a good position, adjust your rearview mirror appropriately. Then, as you are driving, if you look in your mirror and realize you do not have the full view, it will be a reminder that you need to adjust your posture back to that good starting position.
Adjust your workspace
If you are one of the millions of people who spend their work day sitting at a desk, it can be a major source of strain on your neck and back. Modifying your workspace may help keep you in a good posture while you work. Here are a few key things to pay attention to:
When sitting, your hips and knees should be at 90 degree angle with your feet flat on the floor or stool.
Your arms should be comfortably supported on armrests with shoulders relaxed and elbows at a 90 degree angle. The keyboard and mouse should be positioned comfortably under your hands; you should not be reaching forward for the keyboard, nor should you be actively holding your shoulders up near your ears.
The monitor should be directly in front of you (if you work with more than one monitor, try to keep them centralized in your field of vision as much as possible) and the top of the monitor should be at your eye level.
Keep work off of your lap
Sitting on a couch or chair with your laptop, tablet or other papers on your lap tends to lead to a hunchbacked posture. Ideally, you should bring your work up to eye level (as discussed above) to reduce strain on your neck. If you must work from the sofa, try to raise it up a little by placing a pillow or folded blanket on your lap and working from that elevated surface.
Set a posture timer
If you know you are going to be focused on a project for a long period of time, try setting a timer on your computer or cell phone to go off every 20 to 30 minutes as a reminder to be conscious of your posture and readjust as needed.
Use a pillow roll
Ideally, you want to have a neutral spine while you sleep so that you can wake up feeling refreshed rather than cramped and stiff. Stomach sleeping is not good for your neck as it requires you to have your head turned to one side for a prolonged period. Back or side sleeping is preferred.
You want to have your head in line with your body and your neck fully supported. You can accomplish this by rolling a hand towel lengthwise and placing it inside your pillow case so that when you lay down it fills and supports the curve of your neck.
Do some self−massage
Place two tennis balls or racquet balls about one inch apart in a tube sock or nylon. You can hold the ends and place one ball on either side of your spine to give the muscles at the base or your head a nice massage.
Take stretch breaks
When you sit at a desk all day, your body grows stiff and your mind grows tired. Take a short break every hour or so. Stand up, look around, go for a short walk, take some nice deep breaths and do a few stretches. Here are a few options that can easily be done at your workstation:
Segmental rolling: Start with a nice tall posture (either sitting or standing) and focus on slowly bringing your chin to your chest one vertebra at a time until your neck and upper back are rounded forward. Hold at the bottom for a few seconds, then slowly return to upright posture one vertebra at a time.
Cat stretch: This is a popular yoga-style stretch that can be done sitting, standin, or on hands and knees. With arms stretched out in front of you, gently round your back, tuck your chin and pull your shoulder blades apart. Hold this pose for five to 10 seconds.
Upper trapezius stretch: Sitting up tall with hands resting in your lap, gently tip your head to one side and turn chin into shoulder until a stretch is felt in your neck. Hold this pose for 30 seconds and repeat on the other side.
Upper trap stretch
Chin tuck: With ears directly over your shoulders, gently tuck your chin as if trying to make a double chin. You should feel a gentle stretch at the base of your skull.
Scapular squeeze: sitting or standing tall with ears directly over your shoulders, gently squeeze your shoulder blades together without pushing your chin forward or raising your shoulders up. Hold this pose for five seconds, relax and repeat five to 10 times.
For persistent neck pain, please consult with your physician or contact one of our outpatient physical therapy centers conveniently located near you to speak with a licensed clinician today. Our highly trained physical therapists will help to alleviate your pain and get you back to work, athletics and daily life!
By: Nicole Tombers, P.T., DPT. Nicole is a physical therapist for NovaCare in Eagle River, AK. She treats a variety of conditions, but specializes in post-surgical rehabilitation and treatment of dizziness and vertigo. Nicole loves helping people improve and providing them with the education they need to have power over their circumstances.
Posted on 6/18/2018 by Erica Zettlemoyer, P.T., DPT
Multiple Sclerosis (MS) is a progressive disease in which the body’s immune system attacks the central nervous system (CNS). The CNS is composed of the brain, spinal cord and optic nerves. Our nerves are surrounded by a fatty substance called myelin, which allows electrical messages to be delivered quickly from the brain to the correct muscle. In MS, the myelin is damaged, scars are formed and the electrical message from our brain is disrupted. This creates a less efficient movement pattern, as well as pain, weakness, heat sensitivity, fatigue, numbness, vision changes and other impairments.
Multiple Sclerosis and Exercise – Though researchers are making significant advances in treating MS, there is still not a cure. However, there are various treatments which focus on slowing the progression of the disease and managing symptoms. Exercise is considered one of these treatments. In a published study, people with MS who participated in 15 weeks of three 40-minute training sessions per week were shown to demonstrate improved cardiovascular fitness, strength and overall health.¹
Multiple Sclerosis and Physical Therapy – Due to the complexity of MS, it is important to work with a physical therapist who will create a specialized exercise program based on one’s progression and severity of symptoms. Treatments will focus on general conditioning, strengthening, flexibility and balance as well as postural education, positioning and respiratory function. In more severe cases, a therapist will assist in the utilization of equipment, such as bracing, wheelchairs, standing frames. Several of the challenges that must be considered include:
Heat Sensitivity: Many patients with MS report a sensitivity to heat. A rise in core body temperature of as little as 0.5ᵒ C can intensify symptoms. A physical therapist can guide patients through several ideas that will assist in controlling body temperature while exercising. Using a fan, drinking cold water prior, during and after activity as well as utilizing cooling vests and wrist bands are helpful in controlling body temperature. Other ideas include placing a cooler in the car with cold drinks and starting the air conditioning in the car 10 minutes prior to leaving.
Lassitude: Fatigue affects 74 to 89 percent of those diagnosed with MS.² It is the initial symptom for almost half of those diagnosed, even predating diagnosis by as much as 10 years.³ A physical therapist can help patients address modifiable factors that increase fatigue, such as activity, respiratory weakness, thermosensitivity, pain, deconditioning and movement compensation.
Bone Density Loss: When exercising, it is important to focus on strengthening with resistance. Those diagnosed with MS may suffer from bone density loss due to Vitamin D deficiency and increased use of steroids. Participating in a weekly strengthening program while utilizing weights may improve bone health. A physical therapist can guide patients in safely incorporating resistance into an exercise program.
Examples of Appropriate Exercises – It is helpful to know that when exercising with MS, we should look at the total amount of exercise minutes for the day. For example, if someone can participate in riding a stationary bike for five minutes in the morning, five minutes in the afternoon and five minutes in the evening, that will give them 15 minutes of total cardio exercise for the day. Walking on a treadmill, walking inside or standing activities are other examples of exercises that can be modified to one’s functional and physical capabilities.
Strengthening exercises can include bridges, clams, heel raises, sit-to-stand transitions squats, step-ups and rows. Wall push-ups and triceps dips are especially important for fall recovery training. I recommend working on eight to 15 repetitions while using an appropriate resistance level.
Stretching is important and should focus on calf muscles, hamstrings, hip flexors and pectorals. When incorporating balance activities, vary the surface you are practicing on, whether seated or standing. For example, sitting on a wobble board or standing on foam will maximize training.
Beginning an exercise program does not have to be overwhelming or intimidating. Each patient with MS will tolerate exercise differently and a physical therapist can individualize each program to meet the needs of that individual. The MS Society and Multiple Sclerosis Association of America are also valuable resources for those who are seeking information on exercise.
For more information regarding physical therapy for MS, please contact a center near you today!
Petajan J, Gappmaier E, White A, Spencer M, Mino L, Hicks R. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Annals of Neurology. April 1996 39(4):432-41
Murray TJ. Amantadine therapy for multiple sclerosis. Can J Neurol Sci 1985; 12:251-254
Krupp L, Alvarez L, LaRocca N, et al. Arch Neurol. 1988 45(4):435-437
White L, Dressendorfer R. Fitness testing in multiple sclerosis: a case report. Med Sci Sports Exerc 2003;35 (5): S314
By: Erica Zettlemoyer, P.T., DPT, is a licensed physical therapist at Baylor Scott and White Institute for Rehabilitation. She received a doctorate of physical therapy in 2010 from Texas Woman’s University and is a Certified Multiple Sclerosis Specialist.