November 16, 2020

Physical Therapy Guide to Spondylolysis and Spondylolisthesis (Fracture of the Lumbar Spine and Slipped Vertebra)→

November 16, 2020/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Spondylolysis (spon-dee-low-lye-sis), or lumbar stress fracture, is a stress fracture of a section of the lumbar spine. The area of the fifth lumbar vertebra is most often affected. The injury can occur on the left or right of the vertebra. Lumbar stress fractures occur in up to 11.5% of the general population in the United States. It is a common cause of low back pain in older children and youth, most often young males. It is a common cause of low back pain in older children and youth. It most often occurs in young males, but also can occur in girls. Highly active teens who engage in activities like lifting heavy loads, repeated backward bending, or twisting of the trunk, are most at risk. Activities like football, hockey, gymnastics, or dance put athletes at higher risk. Only a small percentage of cases require surgery. The majority (85% to 90%) of young patients recover in three to six months with proper treatment. Recovery time can be longer and is different for each person.

Spondylolisthesis (spon-dee-low-lis-thee-sis), or slipped vertebra, is a condition that involves the forward slippage of one vertebra over the one under it. If a crack or stress fracture occurs on both sides of the vertebra it is called spondylolisthesis.

Lumbar stress fracture and slipped vertebra are often described together because they are similar in:

The mode of injury.
Age of the patient.
Symptoms.
Treatment.

What Are Stress Fracture and Slipped Vertebra of the Lumbar Spine?

Lumbar stress fracture is a fracture of the part of the bony ring that connects the front part of the spinal column to the back part. The fracture occurs between the part of the bone that sticks out of the back of the spine and the part that sticks out of the side of the spine. Doctors sometimes refer to this condition as a "pars defect." Strain on the lumbar spine due to repeated activities in a growing child can cause this type of injury. It results in low back pain.

Slipped vertebra is the forward slip of a defective, unstable vertebra. There are five grades of slips, with grade I being the smallest amount of slippage and grade V being a slippage of 100%. With milder slippage, and a defect on just one side of the vertebra, physical therapy treatment is effective. Young athletes whose teenage growth spurt has not yet occurred are at greater risk for continued slippage. These athletes and are monitored until they are fully grown.

Key points to understand about lumbar stress fracture and slipped vertebra:

Early detection and proper diagnosis of these conditions are important. With early diagnosis and treatment, people with these conditions can safely return to sport or an active lifestyle. If symptoms last a long time and you wait to get help, healing may take much longer.
The majority of symptoms can resolve with rest and the help of a physical therapist.
Surgery may be needed when treatment of more than six months fails, and symptoms persist.
Both of these conditions need to be ruled out in a young athlete who is has low back pain that lasts for more than a few weeks. Active young athletes in sports such as football, hockey, gymnastics, and dance are at the greatest risk. This is especially true while the athlete is still growing.
If an X-ray does not show a fracture, but a clinical exam suggests a high likelihood of lumbar stress fracture, your doctor may order an MRI to rule it out.
These conditions are not a major cause of low back pain in adults. It can, however, occur high-level adult athletes who take part in high-risk sports.

Signs and Symptoms

Lumbar stress fracture or slipped vertebra may be present if you experience:

Low back pain with or without buttock or leg pain. If leg pain is present, it is felt into the thigh, but generally not below the knee.
Muscle spasms in your low back, buttocks, and thighs.
Difficulty or pain with walking or standing for long periods.
Symptoms that are relieved by sitting, slouching, or bending forward.
Pain with sports or manual labor.
Pain with bending backward, twisting the spine, or with throwing.
Decreased flexibility of the leg muscles.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes questions about your health history. Their goal is to assess the degree of your injury and to determine the cause and contributing factors. Your physical therapist also may gather information from forms you fill out before your first session. Their questions may include:

How did your injury occur? Was there a single episode or did your condition become worse over time?
How have you taken care of your condition? Have you seen other health care providers? Have you had imaging (e.g., X-ray, MRI) or other tests, and do you have the results of those tests?
How long have you had pain? Did it come on suddenly or gradually?
Does your pain occur with activity, at rest, or during the day or night?
What activities or positions make your pain better or worse?
Do you take part in activities like football, hockey, gymnastics, or competitive dance?
Can you point with one finger to the area on your back that is painful?
Do you have any other symptoms, such as fever, chills, or night sweats?
Do you have trouble with bowel and bladder control?

After your physical therapist learns the specifics of your condition they will conduct a physical exam.

The physical exam most often will begin with watching some of the movements that were discussed in the interview. It will include the area of your main symptoms as well as other areas that may be involved, such as your hip. Your physical therapist may:

Watch you walk.
Have you bend forward to try to touch your toes, and bend back as far as you can.
Ask you to stand on one leg and bend back.
Ask you to turn your trunk from side to side.

Your physical therapist uses these tests to assess your leg and spine flexibility as well as your core strength. They may ask you if the testing changes your symptoms. They may gently but skillfully press specific areas of your low back and pelvis to see if they are painful. This information helps your physical therapist determine the cause of your pain, exactly where your pain is, and the best treatment to resolve your symptoms.

After the interview and physical exam, your physical therapist will discuss the findings with you. If your physical therapist suspects a stress fracture, they may refer you to an orthopedic or sports medicine doctor familiar with back injuries. The doctor may order imaging tests (X-ray, MRI) to confirm a diagnosis and rule out other conditions.

How Can a Physical Therapist Help?

Spondylolisis and listhesisGettyImages-1139743540.jpg

Your physical therapist will design a targeted treatment program based on your condition and goals. It will be designed to safely return you to sport or daily activities. Your treatment plan may include:

Patient education. Your physical therapist will work with you to identify and change any external factors causing your pain. These factors can include the type and amount of exercise you do, your athletic activities, footwear, or the surfaces on which you practice and play. They may recommend changes in your daily activities.

Pain management. Your physical therapist will design a program to address your pain. This may include applying ice to the affected area. Applying heat also is helpful in some cases. Electrical stimulation gently targets nerve fibers that send pain signals to the brain. It also may be used together with ice to help relieve your pain. Your physical therapist also may recommend decreasing some activities that cause pain. Physical therapists are experts in prescribing pain-management techniques that reduce or avoid the need for medicines, including opioids.

Body mechanics. How you move and use your body for work and other activities can contribute to lumbar spine problems and pain. Your physical therapist will teach you how to improve your movements or body mechanics based on your daily activities. They also may make recommendations to improve the way you do certain activities, such as lifting and carrying objects.

Manual therapy. Often, manual therapy for lumbar stress fracture and slipped vertebra includes "soft tissue release" or massage for tight and sore muscle groups. These hands-on techniques may be used to correct tightness of muscles to promote normal movement.

Stretching exercises. Stretching exercises can help improve the flexibility of tight muscles. They also may help to improve movement in the spine and lower extremities and help decrease stress on the lumbar spine during daily activities.

Strengthening exercises. Strengthening helps to make the lumbar spine, pelvis, and hip joints more stable. This, in turn, helps to reduce strain on tissues, and pain. These movements are focused on weak muscles, including the lower abdominal, pelvic floor, and buttocks muscles.

Functional training. Once your pain, strength, and motion improve you will need to safely move back into more demanding activities. To lessen your risk of repeated injury, it is important to learn safe, controlled movements. Based on your unique movement assessment and goals, your physical therapist will create a series of activities to help you use and move your body more correctly and safely for years to come.

Can This Injury or Condition Be Prevented?

Lumbar stress fracture and some types of slipped vertebra may be preventable by educating individuals who are at higher risk of injury.

For the growing young athlete, it is necessary to manage how much, how intensely, and how often you exercise. Parents and coaches should:

Limit a child’s participation to one high-risk sport at a time during a season.
Limit participation to only one team at a time during a season.
Require and enforce one to two days of rest from training per week.
Gradually increase training volume, intensity, and frequency when a person is starting a new sport or activity.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat lumbar stress fracture and slipped vertebra. However, you may want to consider:

A physical therapist who is experienced in treating people with spine injuries and/or athletes. Some physical therapists have a practice with an orthopaedic or sports physical therapy focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedic and/or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

General tips when you are looking for a physical therapist (or any other health care provider):

Get recommendations from family, friends, or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who are athletes or active individuals with lumbar stress fracture.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

6 Tips to Prevent New Parenting Injuries→

August 17, 2020/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

The months following the birth of a child are some of the most rewarding for new parents—and the most challenging to a new parent’s body. Lifting and carrying a child, picking up toys off of the floor, and pushing a stroller are normal daily tasks for moms and dads.

Here are some tips on how using proper body mechanics to help ease the strains and stresses of parenting:

1. Lifting Your Child From the Floor
When picking up your child from the floor, you should use a half-kneel lift:

First, stand close to your child on the floor. While keeping your back straight, place one foot slightly forward of the other foot, and bend your hips and knees to lower yourself onto one knee. Once down on the floor, grasp your child with both arms and hold him or her close to your body. Tighten your stomach muscles, push with your legs, and slowly return to the standing position.

To place your child onto the floor, the same half-kneel technique should be performed.

2. Carrying/Holding Your Child
When holding or carrying your child, you should always hold him or her close to your body and balanced in the center of your body. Avoid holding your child in one arm and balanced on your hip. When using a child carrier, be sure to keep your back straight and your shoulders back to avoid straining your back and neck.

3. Picking up Toys From the Floor
While straightening up and picking items off the floor, keep your head and back straight, and while bending at your waist, extend one leg off the floor straight behind you. You can also use the half-kneel technique discussed above, if several toys are within the same space.

4. Lifting Your Child Out of the Crib
As you lift your child out of the crib, keep your feet shoulder-width apart and knees slightly bent. Arch your low back and, while keeping your head up, bend at your hips. With both arms, grasp your child and hold him or her close to your chest. Straighten your hips so you are in an upright position, and then extend your knees to return to a full stand. To return your child to the crib, use the same technique and always remember to keep your child close to your chest.

5. The Stroller
When you are lifting your child from a stroller, stand directly in front of the child to avoid twisting your back. It is important to bend from your hips rather than from your lower back, much like rising from a squatting position.

When walking your child in a stroller, you will want to stay as close to the stroller as possible, allowing your back to remain straight and your shoulders back. The force to push the stroller should come from your entire body, not just your arms. Avoid pushing the stroller too far ahead of you because this will cause you to hunch your back and round your shoulders forward.

6. The Changing Table
Before placing the baby on the changing table, it is essential to keep him or her at the center of your body. The table should be at the appropriate height for parental use. When changing your baby's diaper, the best table placement and height is directly in front of and slightly below the elbows. This helps avoid the type of bending and twisting that can cause injury.

Other tips:

Place all diaper-changing materials within arm’s reach—for instance, in wide-set drawers directly below the changing area.
You may wish to place one leg on a stool when you are using the changing table. This can help take strain off your back and neck.

April 29, 2019

Patellofemoral Knee Pain→

April 29, 2019/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap (patella). PFPS is one of the most common types of knee pain experienced in the United States, particularly among athletes, active teenagers, older adults, and people who perform physical labor. Patellofemoral pain affects more women than men and accounts for 20% to 25% of all reported knee pain. Physical therapists design exercise and treatment programs for people experiencing PFPS to help them reduce their pain, restore normal movement, and avoid future injury.

Current research indicates that PFPS is an "overuse syndrome," which means that it may result from repetitive or excessive use of the knee. Other contributing factors may include:

Weakness, tightness, or stiffness in the muscles around the knee and hip
An abnormality in the way the lower leg lines up with the hip, knee, and foot
Improper tracking of the kneecap

These conditions can interfere with the ability of the kneecap to glide smoothly on the femur (the bone that connects the knee to the thigh) in the femoral groove (situated along the thigh bone) during movement. The friction between the undersurface of the kneecap and the femur causes the pain and irritation commonly seen in PFPS. The kneecap also may fail to track properly in the femoral groove when the quadriceps muscle on the inside front of the thigh is weak, and the hip muscles on the outside of the thigh are tight. The kneecap gets pulled in the direction of the tight hip muscles and can track or tilt to the side, which irritates the tissues around the kneecap.

PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, such as running, stair climbing, squatting, or repeated carrying of heavy loads. Older adults may experience age-related changes that cause the cartilage on the undersurface of the kneecap to wear out, resulting in pain and difficulty completing daily tasks without pain.

How Does it Feel?

People with PFPS may experience:

Pain when walking up or down stairs or hills
Pain when walking on uneven surfaces
Pain that increases with activity and improves with rest
Pain that develops after sitting for long periods of time with the knee bent
A "crack" or "pop" when bending or straightening the knee

How Is It Diagnosed?

Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Your physical therapist also will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee.

Generally, X-rays are not needed to diagnose PFPS. Your physical therapist may consult with an orthopedic physician who may order an X-ray to rule out other conditions.

How Can a Physical Therapist Help?

After a comprehensive evaluation, your physical therapist will analyze the findings and, if PFPS is present, your therapist will prescribe an exercise and rehabilitation program just for you. Your program may include:

Strengthening exercises. Your physical therapist will teach you exercises targeted at the hip (specifically, the muscles of the buttock and thigh), the knee (specifically, the quadriceps muscle located on the front of your thigh that straightens your knee), and the ankle. Strengthening these muscles will help relieve pressure on the knee, as you perform your daily activities.

Stretching exercises. Your physical therapist also will choose exercises to gently stretch the muscles of the hip, knee, and ankle. Increasing the flexibility of these muscles will help reduce any abnormal forces on the knee and kneecap.

Positional training. Based on your activity level, your physical therapist may teach you proper form and positioning when performing activities, such as rising from a chair to a standing position, stair climbing, squatting, or lunging, to minimize excessive forces on the kneecap. This type of training is particularly effective for athletes.

Cross-training guidance. PFPS is often caused by overuse and repetitive activities. Athletes and active individuals can benefit from a physical therapist’s guidance about proper cross-training techniques to minimize stress on the knees.

Taping or bracing. Your physical therapist may choose to tape the kneecap to reduce your pain and retrain your muscles to work efficiently. There are many forms of knee taping, including some types of tape that help align the kneecap and some that just provide mild support to irritated tissues around it. In some cases, a brace may be required to hold the knee in the best position to ensure proper healing.

Electrical stimulation. Your physical therapist may prescribe treatments with gentle electrical stimulation to reduce pain and support the healing process.

Activity-based exercises. If you are having difficulty performing specific daily activities, or are an athlete who wants to return to a specific sport, your physical therapist will design individualized exercises to rebuild your strength and performance levels.

Fitting for an orthosis. If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by low or high arches.

Can this Injury or Condition be Prevented?

PFPS is much easier to treat if it is caught early. Timely treatment by a physical therapist may help stop any underlying problems before they become worse. If you are experiencing knee pain, contact a physical therapist immediately.

Your physical therapist can show you how to adjust your daily activities to safeguard your knees, and teach you exercises to do at home to strengthen your muscles and bones—and help prevent PFPS.

Physical therapists can assess athletic footwear and recommend proper choices for runners and daily walkers alike. Wearing the correct type of shoes for your activity and changing them when they are no longer supportive is essential to injury prevention.

Real Life Experiences

Amelia is a 25-year-old office assistant who loves to start her day with a 5-mile run. Over the past 6 months, she has been training for her first marathon. She began by training on very flat ground and has just moved to a hilly area.

Last week, Amelia began feeling pain in the front of her left knee when running downhill. Today, she had to stop running after 3 miles because of her knee pain. She called her physical therapist.

Amelia's physical therapist completes a comprehensive evaluation, including a screening for other possible conditions that might be causing her pain. He uses special tests to measure her strength and finds that she has weak hip muscles and tenderness around the kneecap. He determines that she has developed PFPS. Amelia is shocked to learn that she also has flat feet, and she’s not wearing the right supportive running shoes.

To begin her treatments, Amelia’s physical therapist applies special tape to the front of her knee to help reduce her pain, and instructs her in the use of ice to decrease her symptoms. He performs gentle movements of her kneecap and the surrounding tissues to help increase mobility and decrease pain. He teaches her special exercises to gently strengthen the weak muscles that support the knee.

He also designs a specific home-exercise program for Amelia to perform between sessions. He provides information about proper shoe choices for her foot and body type, and advises her to purchase shoes that will give her feet the right type of support. He also recommends that she try deep-water running or swimming for a week instead of her regular running program, until her condition improves.

After her first week of physical therapy, Amelia notices a decrease in her pain and an increased ability to walk up and down stairs without pain. Her physical therapist approves her new footwear, and adds more challenging exercises to her session and her home program. He gives her the go-ahead to race-walk. She applies ice only when she has pain.

After 2 weeks, Amelia reports she is feeling even less pain. Her physical therapist continues to increase the intensity of her exercises, and she starts to run again—but only on flat surfaces and short distances combined with longer walk intervals.

After a few more weeks of therapy, Amelia occasionally feels only slight twinges of pain and gradually resumes her prior level of training. Her physical therapist recommends continuation of her stretching and strengthening exercises, and discharges her from physical therapy.

A few months later, Amelia completes her first marathon pain free. She is thrilled to learn that her time was a personal best!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.
A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic physical therapy and has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with patellofemoral pain syndrome.

During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

De Quervain’s Tendinitis→

February 10, 2019/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

De Quervain's (dih-kwer-VAINS) tendinitis is a condition that causes pain and tenderness at the thumb side of the wrist, at the base of the thumb and forearm. Pain is worsened with grasping or extending the thumb (pulling it back like "thumbing a ride"). People of all ages can develop this condition, which usually happens when the tendons are strained by prolonged or repetitive use of the hand, rapid or forceful hand use, or use of the hand or arm in an awkward position. Tendons at the wrist become irritated and thickened, resulting in pain when moving the thumb and grasping objects. Common forms of treatment for De Quervain’s include splinting and range-of-motion exercises. Injection for cortisone by a doctor is common treatment. Persistent cases may require surgery.

What is De Quervain’s Tendinitis?

De Quervain's tendinitis is a common condition involving tendons of the wrist. Tendons are tough cords or bands of connective tissue that attach muscles to a bone. The thumb and wrist extensor tendons (Abductor Pollicus Longus and Extensor Pollicus Brevis) are encased in a "sheath" or a tunnel at the wrist, which keeps the tendons in place. De Quervain's tendinitis can occur gradually or suddenly, when the tendons become inflamed or thickened from overload or repetitive use, and have difficulty sliding through the extensor tunnel.

Risk factors for developing De Quervain's tendinitis include:

Chronic overuse of the hand.
Excessive use of the thumb from texting and gaming.
Being female (women are 8 to 10 times more likely to develop this condition than men).
Pregnancy.
Using the hand or arm in a position that feels awkward.
Participation in sports that stress the hand and wrist, such as golf and tennis.
Age greater than 40 years.
Race; members of the black community may be more likely to experience this problem.

How Does it Feel?

A person who has De Quervain's tendinitis may:

Feel localized tenderness, pain, and, swelling at the wrist near where the thumb is attached to the forearm.
Have difficulty pinching or grasping with the thumb or hand.
Feel pain when moving the wrist from side to side or twisting it.
Experience limited motion and feeling of weakness in the thumb.
Have difficulty flexing the thumb.
Notice a "catching" or "snapping" sensation with movement of the thumb (a less common symptom).

Active use of the hand with activities, such as writing, opening jars, lifting a child, hammering, sports, and any workplace or home activity that involves pinching or grasping with the thumb, can provoke the symptoms of pain, stiffness, and weakness.

Note: Other conditions of the wrist and hand can cause symptoms similar to those stated here. Your physical therapist will help to identify any underlying problems of your joints, tissues, or nerves that may be causing similar symptoms.

How Is It Diagnosed?

Your physical therapist will ask you how and when you first experienced symptoms, and what it feels like at the present time. Your therapist will perform a physical exam that will include feeling for tender spots, measuring the flexibility and range of motion of the thumb and wrist, and testing the strength of the thumb muscles and grip. Your physical therapist will also perform a Finkelstein test, which gently stretches the tendons on the thumb side of the wrist through the extensor tunnel. Pain during this test is common with De Quervain’s tendinitis.

Your physical therapist will also perform other tests to rule out any underlying conditions that may mimic De Quervain's symptoms.

How Can a Physical Therapist Help?

If your physical therapist confirms De Quervain’s Tendinitis from an evaluation, they will work with you to develop an individualized plan with you for this condition.

Your physical therapist will review and evaluate how you use your hand and wrist for functional activity. The review will include your daily activities, work, and sports activities. The physical therapist will try to help you identify what activities or positions that you use that may contribute to the problem. They will instruct you how to make changes in your function to help healing and reduce risk of the problem in the future.

Specific instructions may include avoiding repetitive thumb and/or wrist movements, avoid flexing the thumb, and avoid moving the hand toward the pinkie finger as much as possible. You should also avoid forceful hand movements, and any movements or activities that increase pain.

The therapist may provide a wrist splint to position your wrist and thumb for rest, and to provide compression to help pain and swelling.

Your therapist may also work with you to reduce pain and inflammation.

Ultrasound therapy may be applied to improve pain. This treatment uses ultrasonic sound waves applied over the involved area to improve circulation, reduce swelling, and aide healing of the tissues and tendons.

Iontophoresis is another option to reduce swelling and pain. Iontophoresis is a type of electrical stimulation that is used to administer medication to the problem area through your skin.

Ice or heat may be recommended for short term pain relief. Your therapist will advise you for what is best for your condition.

Exercise is prescribed to improve range of motion and prevent stiffness. Early on, exercise is restricted to avoid aggravating the condition. As the condition improves, exercises will be progressed to improve strength for functional activity, as well as improve active range of motion of the thumb and wrist.

If your symptoms do not respond to conservative care, your physical therapist will refer you to a physician who will determine if you need medication, injection, or surgical care for further recovery.

How Can a Physical Therapist Help Before & After Surgery?

If your De Quervain's problem does require surgery, your physical therapist may fit a splint to your hand and wrist after the procedure. Your physical therapist will help you to control any swelling, maintain and improve your hand and wrist flexibility, build your strength, and improve your range of motion, allowing you to safely return to your preinjury activity levels.

Can this Injury or Condition be Prevented?

It may be possible to prevent De Quervain's tendinitis. Some risk factors cannot be controlled, such as gender, race, or age; however, physical therapists recommend that you:

Avoid chronic overuse of the hand.
Avoid or restrict overly forceful use of the wrist.
Avoid excessive use of the thumbs for texting and gaming.
Avoid putting the wrist and hand in awkward positions while using the hand or arm.
Train and condition in sports, such as golf and tennis to minimize wrist and thumb strain.

Your physical therapist can teach you correct and safe hand and wrist positions to maintain during your daily home, work, and sport activities.

Real Life Experiences

Janet is a mother of a 2-year-old boy, and is expecting her second child in 3 months. Her part-time job as a secretary requires her to spend 90% of her work day typing on a keyboard. Recently, Janet noticed her right wrist near her thumb was starting to feel sore after work. When she got home, she had trouble picking up her child because of the pain she felt on the thumb side of her wrist. On a recent weekend, Janet spent a lot of time painting to get her new nursery ready. On Monday morning she felt a constant pain in her wrist and forearm that was worse with grasping. She could hardly pick up her coffee cup. She was unable to work. She called her physical therapist.

Janet's physical therapist performed an evaluation of her wrist and hand. He found swelling and tenderness of the thumb extensor tendons. Gently bending the wrist to the "pinkie side" and flexing the thumb increased her pain. The Finkelstein test confirmed De Quervain’s tendinitis. He also noticed her hand and wrist movements were limited.

Janet's physical therapist treated the area with ultrasound to reduce the pain and swelling, and fitted her with a wrist-thumb spica splint to limit use of the affected tendons, and to provide compression. He showed her how to perform gentle movements of the thumb for stiffness in a way that did not increase her symptoms. He cautioned her to avoid lifting and typing as much as possible for 2 weeks. He also recommended ice to the area for 10 minutes, 2 to 3 times a day, to reduce pain and swelling.

Janet felt improvement after her first treatment. She returned for treatment 2 times a week for ultrasound, soft-tissue massage, and modified exercises.

Two weeks later, Janet reported that her pain was no longer constant, and when present, it felt 50% better. She still experienced pain when lifting her child and using the keyboard for longer than 30 minutes. At her physical therapist's suggestion, Janet modified her work habits; for example, she began using a voice dictation program to reduce the amount of time she spent typing. She was happy to note that holding her coffee cup, and similar activities of daily living were no longer painful.

Janet kept using her splint daily with activity throughout her rehabilitation, and continued to restrict any activities that created or increased her pain symptoms. She also made changes to her workspace as recommended by her physical therapist, and changed the position of her hands to reduce joint stress at her wrist and hand during work.

Four weeks after her initial visit with the physical therapist, Janet's pain was minimal and only occurred with movements that stressed the thumb side of the wrist, such as holding a gallon of milk. She continues her home exercise program for strengthening her wrist, thumb, and grip. She continues to use her splint intermittently with activity. She feels stronger and more confident lifting her child, and is gradually returning to her full activity levels.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat De Quervain's tendinitis. However, you may want to consider:

A physical therapist who is experienced in treating people with hand conditions, sports injuries, or repetitive stress injuries of the upper limb.
Physical therapists who have a practice with a focus on hand rehabilitation.
A physical therapist who is a board-certified clinical specialist, or who has completed a residency or fellowship in Orthopedic or hand therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have De Quervain's tendinitis.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

3 Ways a Physical Therapist Can Help Manage Headaches→

February 05, 2019/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Headaches affect 47% of the global population and are described by the type and location of pain in the head. Many headaches are harmless and resolve gradually. However, more frequent moderate to severe headaches can impact your ability to do daily activities and quality of life.

Different types of headaches include:

Tension
Cervicogenic or neck muscle-related
Migraine
Secondary headaches from an underlying condition, such as fever, infectious disease, sinus disorder, or in rare cases, a tumor or more serious illness
Unspecified headaches

A physical therapist will perform a clinical examination to diagnose the type of headache and develop an effective treatment plan. Physical therapy has been proven to:

Decrease or resolve the intensity, frequency, and duration of headache
Decrease medication use
Improve function and mobility
Improve ease of motion in neck
Improve quality of life

A physical therapist treatment plan may include:

Manual therapy: Proven hands-on techniques are designed to alleviate joint and muscle stiffness, increase mobility of the head and neck, decrease muscle tension and spasms, and improve muscle performance.

Exercise: Research has shown that various types of specific exercises will decrease pain, improve endurance, decrease inflammation, and promote overall healing. In addition to individualized prescribed exercises, customized home-exercise programs are an essential part of the treatment plan.

Education: Educational strategies have been found helpful at lessening severity and/or frequency of headaches. These strategies include identifying highly individualized triggers (ie, dietary, sleep, movement/postural habits, stressors, hydration). Effective strategies to alleviate symptoms also include a wide variety of relaxation techniques.

Resources

Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. J Orthop Sports Phys Ther. 2017;47(7):A1–A83. Free Article.

Ferracini G, Florencio LL, Dach F, et al. Myofascial trigger points and migraine-related disability in women with episodic and chronic migraine. Clin J Pain. 2017;33(2):109–115. Article Summary in PubMed.

Bevilaqua-Grossi D, Goncalves MC, Carvalho GF, et al. Additional effects of a physical therapy protocol on headache frequency, pressure pain threshold, and improvement perception in patients with migraine and associated neck pain: a randomized clinical trial. Arch Phys Med Rehabil. 2016;97(6):866–874. Free Article.

Fernandez-de-las-Penas C, Cuadrado ML Physical therapy for headaches. Cephalalgia. 2016;36(12):1134–1142. Article Summary in PubMed.

Irby MB, Bond DS, Lipton RB, Nicklas B, Houle TT, Penzien DB. Aerobic exercise for reducing migraine burden: mechanisms, markers, and models of change processes. Headache. 2016;56(2):357–369. Free Article.

Louw A, Puentedura EJ, Zimney K, Schmidt S. Know pain, know gain? A perspective on pain neuroscience education in physical therapy. J Orthop Sports Phys Ther. 2016;46(3):131–134. Free Article.

Fernandez-de-las-Penas C, Courtney CA. Clinical reasoning for manual therapy management of tension type and cervicogenic headache. J Man Manip Ther. 2014;22(1):45–50. Free Article.

Page P. Cervicgogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011;6(3):254–266. Free Article.

Zito G, Jull G, Story I. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Man Ther. 2006;11(12):118–129. Article Summary in PubMed.

Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headaches. Spine (Phila Pa 1976). 2002;27(17):1835-1843. Article Summary in PubMed.  

Authored by Denise Schneider, PT.

January 20, 2019

Frozen Shoulder (Adhesive Capsulitis)→

January 20, 2019/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Often called a stiff or “frozen shoulder,” adhesive capsulitis occurs in about 2% to 5% of the American population. It affects women more than men and is typically diagnosed in people over the age of 45. Of the people who have had adhesive capsulitis in 1 shoulder, it is estimated that 20% to 30% will get it in the other shoulder as well. Physical therapists help people with adhesive capsulitis address pain and stiffness, and restore shoulder movement in the safest and most effective way possible.

What is Frozen Shoulder (Adhesive Capsulitis)?

Adhesive capsulitis is the stiffening of the shoulder due to scar tissue, which results in painful movement and loss of motion. The actual cause of adhesive capsulitis is a matter for debate. Some believe it is caused by inflammation, such as when the lining of a joint becomes inflamed (synovitis), or by autoimmune reactions, where the body launches an "attack" against its own substances and tissues. Other possible causes include:

Reactions after an injury or surgery
Pain from other conditions, such as arthritis, a rotator cuff tear, bursitis, or tendinitis, that has caused a person to stop moving the shoulder
Immobilization of the arm, such as in a sling, after surgery or fracture

Often, however, there is no clear reason why adhesive capsulitis develops.

How Does it Feel?

Most people with adhesive capsulitis have worsening pain and a loss of movement. Adhesive capsulitis can be broken down into 4 stages; your physical therapist can help determine what stage you are in.

Stage 1: "Prefreezing"

During stage 1 of its development, it may be difficult to identify your problem as adhesive capsulitis. You've had symptoms for 1 to 3 months, and they're getting worse. Movement of the shoulder causes pain. It usually aches when you're not using it, but the pain increases and becomes "sharp" with movement. You'll begin to limit shoulder motion during this period and protect the shoulder by using it less. The movement loss is most noticeable in "external rotation" (this is when you rotate your arm away from your body), but you might start to lose motion when you raise your arm or reach behind your back. Pain is the hallmark feature of this stage; you may experience pain during the day and at night.

Stage 2: "Freezing"

By this stage, you've had symptoms for 3 to 9 months, most likely with a progressive loss of shoulder movement and an increase in pain (especially at night). The shoulder still has some range of movement, but it is limited by both pain and stiffness.

Stage 3: "Frozen"

Your symptoms have persisted for 9 to 14 months, and you have a greatly decreased range of shoulder movement. During the early part of this stage, there is still a substantial amount of pain. Toward the end of this stage, however, pain decreases, with the pain usually occurring only when you move your shoulder as far you can move it.

Stage 4: "Thawing"

You've had symptoms for 12 to 15 months, and there is a big decrease in pain, especially at night. You still have a limited range of movement, but your ability to complete your daily activities involving overhead motion is improving at a rapid rate.

How Is It Diagnosed?

Often, physical therapists don't see patients with adhesive capsulitis until well into the freezing phase or early in the frozen phase. Sometimes, people are being treated for other shoulder conditions when their physical therapist notices the signs and symptoms of adhesive capsulitis. Your physical therapist will perform a thorough evaluation, including an extensive health history, to rule out other diagnoses. Your physical therapist will look for a specific pattern in your decreased range of motion called a "capsular pattern" that is typical with adhesive capsulitis. In addition, your physical therapist will consider other conditions you might have, such as diabetes, thyroid disorders, and autoimmune disorders, that are associated with adhesive capsulitis.

How Can a Physical Therapist Help?

Your physical therapist's overall goal is to restore your movement, so you can perform your daily activities. Once the evaluation process has identified the stage of your condition, your physical therapist will create an individualized exercise program tailored to your specific needs. Exercise has been found to be most effective for those who are in stage 2 or higher. Your treatment may include:

Stages 1 and 2

Exercises and manual therapy. Your physical therapist will help you maintain as much range of motion as possible and will help reduce your pain. Your therapist may use a combination of range-of-motion exercises and manual therapy (hands-on) techniques to maintain shoulder movement.

Modalities. Your physical therapist may use heat and ice treatments (modalities) to help relax the muscles prior to other forms of treatment.

Home-exercise program. Your physical therapist will give you a gentle home-exercise program designed to help reduce your loss of motion. Your therapist will warn you that being overly aggressive with stretching in this stage may make your shoulder pain worse.

Your physical therapist will match your treatment activities and intensity to your symptoms, and educate you on appropriate use of the affected arm. Your therapist will carefully monitor your progress to ensure a safe healing procedure is followed.

Pain medication. Sometimes, conservative care cannot reduce the pain of adhesive capsulitis. In that case, your physical therapist may refer you for an injection of a safe anti-inflammatory and pain-relieving medication. Research has shown that although these injections don’t provide longer-term benefits for range of motion and don’t shorten the duration of the condition, they do offer short-term pain reduction.

Stage 3

The focus of treatment during phase 3 is on the return of motion. Treatment may include:

Stretching techniques. Your physical therapist may introduce more intense stretching techniques to encourage greater movement and flexibility.

Manual therapy. Your physical therapist may take your manual therapy to a higher level, encouraging the muscles and tissues to loosen up.

Strengthening exercises. You may begin strengthening exercises targeting the shoulder area as well as your core muscles. Your home-exercise program will change to include these exercises.

Stage 4

In the final stage, your physical therapist will focus on the return of "normal" shoulder body mechanics and your return to normal, everyday, pain-free activities. Your treatment may include:

Stretching techniques. The stretching techniques in this stage will be similar to previous ones you’ve learned, but will focus on the specific directions and positions that are limited for you.

Manual therapy. Your physical therapist may perform manual therapy techniques in very specific positions and ranges that are problematic for you. They will focus on eliminating the last of your limitations.

Strength training. Your physical therapist will prescribe specific strengthening exercises related to any weakness that you may have to help you perform your work or recreational tasks.

Return to work or sport. Your physical therapist will address movements and tasks that are required in your daily and recreational life.

Can this Injury or Condition be Prevented?

The cause of adhesive capsulitis is debatable, with no definitive cause. Therefore, to date, there is no known method of prevention. The onset of the condition is usually gradual, with the disease process needing to "run its course." However, the sooner you contact your physical therapist, the sooner you will receive appropriate information on how to most effectively address your symptoms.

Real Life Experiences

Cheryl is 47-year-old office manager who swims and hikes on the weekends. A few months ago, Cheryl began having pain in her left shoulder when she reached up to file archived reports at work. At first she ignored it, but then noticed her shoulder was aching after work and sometimes at night. She began to limit her movement due to pain. Just this week, she chose not to visit her local pool for her regular swim. She decided to contact a physical therapist.

Cheryl’s physical therapist took her health history, and asked her to describe when the pain began, and how her current symptoms are affecting her. Cheryl reports no accident or trauma, and that the pain has slowly increased over the past few months. She notes that she has to make adjustments at work because she can’t lift her arm above shoulder level, and that the pain is now affecting her sleep. Her physical therapist conducts a thorough physical examination and diagnoses stage 2 frozen shoulder (adhesive capsulitis).

He begins Cheryl’s rehabilitation with heat treatments to relax her muscles, and designs an individualized home-exercise program to address her symptoms and help stall any loss of motion. He encourages Cheryl to perform her home exercises every day.

Cheryl’s treatments during this phase consist of gentle movements performed by her physical therapist (manual therapy), to help maintain the shoulder joint’s current range of motion. At this point, he focuses treatment not on increasing the shoulder’s range of motion, but on mobilizing the joint to reduce pain and reduce the amount of movement that is lost.

When Cheryl progresses into stage 3 ("frozen") adhesive capsulitis, her visits to the physical therapist are increased. He uses stretching and manual therapy techniques to improve her range of motion. He updates Cheryl’s home-exercise program to match her current limitations and function.

After a few more weeks of treatment, Cheryl reports minimal pain, and her range of motion is beginning to increase. Her treatment is reduced to weekly visits, and then to twice monthly visits. She begins to slowly return to swimming; her physical therapist prescribes a safe and appropriate program to follow, as she resumes her activities.

After 2 more months of treatment, Cheryl’s range of motion is normal, and her pain has stopped. She has happily returned to her regular swimming schedule, and feels stronger than she has in years! Cheryl's physical therapist credits her excellent recovery to her full participation in her treatment and home-exercise programs.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have frozen shoulder, or adhesive capsulitis. You may want to consider:

A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedic physical therapy, manual physical therapy, or specializes in the treatment of the upper extremity. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

General tips when you're looking for a physical therapist:

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with frozen shoulder.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Degenerative Disk Disease→

September 09, 2018/ Pro Dynamic Physical Therapy/ Travis Tanasse

What Is Degenerative Disk Disease?

Your spine is made up of 33 vertebrae that are stacked on top of one another. Between each of these vertebrae is a rubbery piece of cartilage called an "intervertebral disk." (See images: Degenerative Disk Disease - Cervical | Lumbar.) Imagine the disk as a tire, with gelatin filling the hole in the tire. The tire is called the "annulus," and the gelatin is called the "nucleus." When we're young—under 30 years of age—the disk is made mostly of gelatin. As we age, and sometimes with injury, we start to lose some of that gelatin and the volume of the disk decreases, resulting in less space between the vertebrae. The disk becomes flatter and less flexible, leaving less space between each set of vertebrae. Sometimes bone spurs form in response to this degeneration of the disk, which could make the spine stiff. Often, this flattening and additional stiffness to the spine is not at all painful. However, in some cases, when the rough surfaces of the vertebral joints rub together, pain and inflammation may result. The nerve root, the point where a spinal nerve exits the spine and extends to other parts of the body, may become irritated or compressed.

Disk degeneration may occur throughout several regions of the spine, or it may be limited to 1 disk. Degeneration does not always lead to pain. For some people, however, it can cause a great deal of pain and disability.

You are more likely to develop DDD if you:

Smoke
Are obese
Do heavy physical work
Don't get very much exercise

How Does it Feel?

With DDD, you may experience mild to intense neck and back pain—or no pain at all:

A degenerative disk in the neck may cause pain in the arm, shoulder, or neck.
A degenerative disk in the low back may cause pain in the back, buttocks, or legs.

The pain is often made worse by sitting, bending, and reaching. It may be worse first thing in the morning and after staying in any one position for a long time.

In severe cases, when DDD results in pressure on the nerve root, it can lead to numbness, tingling, and even weakness in the arms or legs.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation that includes a review of your medical history, and will use screening tools to determine the likelihood of DDD. For example, your physical therapist may:

Ask you very specific questions about the location and behavior of your pain, weakness, and other symptoms
Ask you to fill out a body diagram to indicate specific areas of pain, numbness, and tingling
Perform tests of muscle strength and sensation to determine the presence of pressure on the nerve
Examine your posture and observe how you walk and perform other activities
Measure the range of motion of your spine and your arms and legs
Use manual (hands-on) therapy to evaluate the mobility of the joints and muscles in your spine
Test the strength of important muscle groups

If you have muscle weakness, loss of sensation, or severe pain, diagnostic tests, such as an X-ray or MRI, may be needed. However, X-ray evidence of wearing in the joints of the spine is found in people with back pain as well as in many who have never experienced back pain. Studies have shown that disc degeneration is present in 40% of individuals under the age of 30 and present in over 90% of those aged 50 to 55 years. Do not panic if your X-ray or MRI shows “problems” with your discs; these are normal changes that happen from the age of 20 years and onward. Physical therapists work closely with physicians and other health care providers to make certain that an accurate diagnosis is made and the appropriate treatment is provided.

Research shows that in all but the most extreme cases (usually involving muscle weakness or high levels of pain), conservative care, such as physical therapy, has better results than surgery. Research also shows that results from conservative care and surgery are the same after 18 months post operatively.

After the evaluation, if your physical therapist suspects you have DDD and there are no major medical problems, treatment can begin right away.

How Can a Physical Therapist Help?

Your physical therapist's overall purpose is to help you continue to participate in your daily activities and life roles. Your physical therapist will design a treatment program based on both the findings of the evaluation and your personal goals. The treatment program may include:

Stretching and flexibility exercises. Your physical therapist will teach you specific exercises to improve movement in the joints and muscles of your spine, arms, and legs. Improving motion in a joint is often the key to pain relief.

Strengthening exercises. Strong trunk muscles provide support for your spinal joints, and strong arm and leg muscles help take some of the workload off your spinal joints.

Aerobic exercise. Regular aerobic exercise, such as walking, swimming, or taking a low-impact aerobics class, has been shown to help relieve pain, promote a healthy body weight, and improve overall strength and mobility—all important factors in managing DDD.

This might sound like a lot of exercise, but don't worry, research shows that the more exercise you can handle, the quicker you'll get rid of your pain and other symptoms.

Your treatment program may also include:

Manual therapy. Your physical therapist may apply manual (hands-on) therapy, such as massage, to improve movement in stiff joints and tight muscles that may be contributing to your symptoms.

Posture and body mechanics education. Your physical therapist may show you how to make small changes in how you sit, stand, bend, and lift—even in how you sleep—to help relieve your pain and help you manage your condition on your own.

Note: Studies show that recurrence of neck and low back pain is common when a condition such as DDD is not properly treated. Regular performance of the exercises your physical therapist chooses for you is extremely important to make sure your pain does not return.

Can this Injury or Condition be Prevented?

DDD is a natural result of aging. However, you can make choices that lessen its impact on your life and slow its progression. Your local physical therapy clinic can offer you advice on staying strong and fit. Some physical therapy clinics conduct regular educational seminars to help people in the community learn to take care of their backs and necks. Your physical therapist can help you develop a fitness program that takes into account your DDD. There are some exercises that are better than others for people with DDD, and your physical therapist will choose the right ones for you. For instance:

Exercising in water can often be a great way to stay physically active when other forms of exercise are painful.
Exercises involving repetitive twisting and bending need to be performed with some caution. If you start to notice some aching or pain after exercising, consult with a health care professional, such as a physical therapist, who can improve the way you move—and help reduce or eliminate your back or neck symptoms.
Weight-training exercises, though important, need to be done with proper form to avoid stress to the back and neck. Your physical therapist will work with you to ensure your weight training is safe and effective.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have DDD. You may want to consider:

A physical therapist who is experienced in treating people with pain, orthopedic, or musculoskeletal, diagnoses.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist:

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with DDD.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Thoracic Outlet Syndrome→

August 29, 2018/ Pro Dynamic Physical Therapy/ Travis Tanasse

Thoracic Outlet Syndrome (TOS) is a potentially painful and disabling condition of the upper extremity. It results from the compression of structures in the thoracic outlet, a space just above the first rib, and behind the clavicle (collar bone). Due to the range of signs and symptoms that can lead to a diagnosis of TOS, the incidence rates of the condition currently are unknown. Physical therapists work with individuals who have TOS to ease their symptoms and restore their upper-body function.

How Does it Feel?

Because TOS generally is classified based upon the type of structures compressed, the symptoms experienced may vary. However, more than 90% of TOS cases are thought to be neurogenic (nerve compression) in nature (categories 3 and 4 below).

Arterial TOS

Pain in the hand; rarely in shoulder or neck
Coldness or cold intolerance
Numbness and tingling

Venous TOS

Pain in the arm
Swelling in the arm
Change in arm coloration (appears bluish)
Feeling of heaviness in the arm
Numbness and tingling in fingers and hands

True Neurogenic TOS

Pain, numbness, and tingling in the hand, arm, shoulder, and often the neck
Headaches
Numbness and tingling of the arm, often waking the individual up at night
Hand clumsiness
Intolerance to cold
Hand coldness and color changes

Disputed Neurogenic TOS

Pain, numbness and tingling in the hand, arm, shoulder and often the neck
Headaches
Numbness and tingling of the arm, often waking the individual up at night
Hand clumsiness
Intolerance to cold
Hand coldness and color changes
Symptoms greater at night vs day
Tests may come back normal (hence, the term "disputed").

How Is It Diagnosed?

Diagnosis of TOS begins with a thorough health history and clinical examination.

Your physical therapist will likely check for color changes in the affected area, and gently attempt to provoke symptoms by moving the affected limb in different directions.

You also may be referred for diagnostic testing, such as a Doppler ultrasound, which can confirm arterial and venous TOS, or nerve conduction velocity testing to help confirm a true neurogenic TOS.

Your physical therapist may be the first to recognize an onset of TOS, because of its effects on your physical function. Your physical therapist may ask you:

When did you begin experiencing these symptoms, and when are they the worst?
Have you noticed any change in your symptoms when the temperature changes?
Have you noticed any significant changes in your ability to perform physical tasks that require hand movements?
Have you noticed any changes in the appearance of your arm or hand?

In addition, your physical therapist will rule out other conditions, which may mimic this disorder. Your therapist may ask you to fill out a questionnaire in order to better understand your physical state, and to screen for the presence of other conditions.

How Can a Physical Therapist Help?

Once you have received a diagnosis of TOS, your physical therapist will work with you to develop a treatment plan to help ease the discomfort, and improve your ability to perform daily activities. Most research on this condition recommends a treatment plan that involves physical therapy to help ease your symptoms and improve function.

Physical therapy treatments may include:

Manual Therapy. Manual (hands-on) therapy may be applied to manipulate or mobilize the nerves of the arm to help reduce symptoms, such as pain and numbness/tingling. Your physical therapist also may attempt to gently mobilize your first rib and/or collar bone.

Movement and Strengthening Exercises. Your physical therapist will teach you muscle-strengthening exercises to improve movement and strength in the affected area.

Education. Your physical therapist will teach you strategies that can help minimize your symptoms while performing your daily functional activities.

Activity modification and postural strategies: Your physical therapist will teach you positions and strategies to place less stress on the structures involved with TOS.

Can this Injury or Condition be Prevented?

While some cases of TOS cannot be prevented, such as those due to anatomical variations, congenital conditions, trauma, or space-occupying lesions, others may be avoidable. Understanding risk factors that could make you more likely to develop this condition is the first step in prevention.

Your physical therapist will work with you to develop strategies to help you better understand and manage your risk factors and symptoms. As with many conditions, education is key. Understanding strategies, such as methods of reducing symptoms while performing activities, can help you live a full and functional life after the onset of TOS.

Real Life Experiences

George is a 45-year-old used-car salesman who takes potential customers on test drives in a crowded city area. Recently on a test drive, his customer ran a red light and the vehicle was struck by another motorist on the passenger side, where George was sitting. George was shaken up, although the police assured him the actual collision was minor.

George was taken to the emergency room following the accident, and received an X-ray, which was negative for a fracture of his clavicle. Fearing that he may be having a heart attack, he also followed up with his primary care physician, who was able to rule that out as well.

Over the next few days, George felt pain on his right side, and numbness and tingling down his right arm. His symptoms seemed to be worse at night. He called in sick to work, fearing he could be injured further on the job. He called his physical therapist.

George's physical therapist conducted a full physical examination. During the exam, George reported that he felt very anxious about the recent event, and wasn’t sure he'd be able to trust taking customers on test drives anymore.

George's physical therapist noticed the presence of a rounded shoulder and forward-head posture, as she examined him. She was able to provoke George’s symptoms by gently placing his arm in particular positions, and gently pressing in the region of George’s first rib. She carefully checked for any other conditions that could be causing his symptoms. She told George that she suspected neurogenic TOS.

She developed a strategy for physical therapy that was best for him, consisting of activities and exercises to increase his strength, confidence, and function, while also easing his pain. She showed him postural activities to reduce compressive forces on his nerves. She also helped him with "nerve gliding" activities (encouraging his nerves to glide normally as his joints moved) to improve the function of the affected nerves.

Despite the complexity of the condition, George did well with his personalized course of physical therapy. Following several weeks of treatment and exercise, he was able to return to work without symptoms, and with a new-found confidence that he could ride in a car with customers again. With his physical therapist's ongoing help, George has returned to his normal activities of daily living.

This story highlights an individualized experience of TOS. Your case may be different. Your physical therapist will tailor a treatment program to your specific needs.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:

A physical therapist who is experienced in treating people with TOS.

A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.

When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with TOS.

During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible. Keeping a journal highlighting when you experience pain will help the physical therapist identify the best treatment approach.

Blog

What Are Stress Fracture and Slipped Vertebra of the Lumbar Spine?

Signs and Symptoms

How Is It Diagnosed?

How Can a Physical Therapist Help?

Can This Injury or Condition Be Prevented?

What Kind of Physical Therapist Do I Need?

Further Reading

How Does it Feel?

How Is It Diagnosed?

How Can a Physical Therapist Help?

Can this Injury or Condition be Prevented?

Real Life Experiences

What Kind of Physical Therapist Do I Need?

Further Reading

What is De Quervain’s Tendinitis?

How Does it Feel?

How Is It Diagnosed?

How Can a Physical Therapist Help?

How Can a Physical Therapist Help Before & After Surgery?

Can this Injury or Condition be Prevented?

Real Life Experiences

What Kind of Physical Therapist Do I Need?

Further Reading

What is Frozen Shoulder (Adhesive Capsulitis)?

How Does it Feel?

Stage 1: "Prefreezing"

Stage 2: "Freezing"

Stage 3: "Frozen"

Stage 4: "Thawing"

How Is It Diagnosed?

How Can a Physical Therapist Help?

Stages 1 and 2

Stage 3

Stage 4

Can this Injury or Condition be Prevented?

Real Life Experiences

What Kind of Physical Therapist Do I Need?

Further Reading

What Is Degenerative Disk Disease?

How Does it Feel?

How Is It Diagnosed?

How Can a Physical Therapist Help?

Can this Injury or Condition be Prevented?

What Kind of Physical Therapist Do I Need?

Further Reading

How Does it Feel?

How Is It Diagnosed?

How Can a Physical Therapist Help?

Can this Injury or Condition be Prevented?

Real Life Experiences

What Kind of Physical Therapist Do I Need?

Further Reading

Pro Dynamic Physical Therapy Inc.