November 18, 2018

Plantar Fasciitis→

November 18, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Plantar fasciitis is a condition causing heel pain. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear. You experience pain when you put weight on your foot—particularly when taking your first steps in the morning. The pain can be felt at the heel, or along the arch and the ball of the foot.

Plantar fasciitis is a common foot condition. It occurs in as many as 2 million Americans per year and 10% of the population over their lifetimes.

Factors that contribute to the development of plantar fasciitis include:

Age (over 40 years)
A job, sport, or hobby that involves prolonged standing or other weight-bearing activity
Rapid increases in length or levels of activity, such as beginning a new running program or changing to a job that requires a lot more standing or walking than you are accustomed to
Decreased calf muscle flexibility
Increased body weight (Body Mass Index greater than 30)
Tendency to have a flat foot (pronation)

Plantar fasciitis affects people of all ages, both athletes and non-athletes. Men and women have an equal chance of developing the condition.

Treatment generally reduces pain and restores your ability to put weight on your foot again.

What is Plantar Fasciitis?

Plantar fasciitis is a condition causing heel pain. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear. The condition develops when repeated weight-bearing activities put a strain on the plantar fascia. People who are diagnosed with plantar fasciitis also may have heel spurs, a bony growth that forms on the heel bone. However, people with heel spurs may not experience pain.

Plantar fasciitis occurs most frequently in people in their 40s but can occur in all age groups.

The condition can develop in athletes who run a great deal and in non-athletes who are on their feet most of the day, such as police officers, cashiers, or restaurant workers.

Signs and Symptoms

The onset of symptoms of plantar fasciitis frequently occurs with a sudden increase in activity. You might feel a stabbing pain on the underside of your heel, and a sensation of tightness and/or tenderness along your arch.

People with plantar fasciitis may experience pain:

In the morning, when stepping out of bed and taking the first steps of the day
With prolonged standing
When standing up after sitting for awhile
After an intense weight-bearing activity such as running
When climbing stairs
When walking barefoot or in shoes with poor support

As your body warms up, your pain may actually decrease during the day but then worsen again toward the end of the day because of extended walking. Severe symptoms may cause you to limp.

How Is It Diagnosed?

The physical therapist’s diagnosis is based on your health and activity history and a clinical evaluation. Your therapist also will take a medical history to make sure that you do not have other possible conditions that may be causing the pain. Sharing information about the relationship of your symptoms to your work and recreation, and reporting any lifestyle changes, will help the physical therapist diagnose your condition and tailor a treatment program for your specific needs.

To diagnose plantar fasciitis, your therapist may conduct the following physical tests to see if symptoms occur:

Massaging and pressing on the heel area (palpation)
Gently stretching the ankle to bend the top of the foot toward the leg (dorsiflexion)
Gently pressing the toes toward the ankle

How Can a Physical Therapist Help?

Physical therapists are trained to evaluate and treat plantar fasciitis.

When you are diagnosed with plantar fasciitis, your physical therapist will work with you to develop a program to decrease your symptoms that may include:

Stretching exercises to improve the flexibility of your ankle and the plantar fascia
Use of a night splint to maintain correct ankle and toe positions
Selection of supportive footwear and/or shoe inserts that minimize foot pronation and reduce stress to the plantar fascia
Application of ice to decrease pain and inflammation
Iontophoresis (a gentle way to deliver medication through the skin)
Taping of the foot to provide short-term relief

Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely required.

Can this Injury or Condition be Prevented?

Guidelines for the prevention or management of plantar fasciitis include:

Choosing shoes with good arch support
Replacing your shoes regularly, so that they offer arch support and provide shock absorption to your feet
Using a thick mat if you must stand in one place for much of the day
Applying good principles to your exercise program, such as including a warm-up and gradually building up the intensity and duration of your exercises to avoid straining the plantar fascia
Stretching your calves and feet before and after running or walking
Maintaining a healthy body weight

Real Life Experiences

Jason has worked as a cook in a restaurant kitchen for 5 years. He has gradually gained about 25 pounds over those years. He began to develop pain in both his heels about 2 months ago. He does not exercise.

Jason asks a friend who has received physical therapy for advice. His friend suggests he see a physical therapist to find the cause of his heel pain.

Jason's physical therapist conducts a detailed history, asking questions about his health, lifestyle, and work, and performs a thorough evaluation. Jason says that his heel pain is worst when he gets up in the morning. After a shower and walking around for a while, his pain diminishes. However, when he is cooking at the restaurant during the evening shift, his heel pain returns, extending to the balls of his feet. Due to food debris in the restaurant kitchen, Jason says he wears old beat-up sneakers to work.

After conducting a physical examination, Jason's therapist diagnoses plantar fasciitis. She teaches Jason several stretches to perform twice a day and designs a home exercise program that will fit his goals and lifestyle. The therapist recommends he choose a shoe with a good arch support and replace them when they are worn out. She also suggests an orthotic (shoe insert) to place into his new shoes. She instructs him to apply ice to the bottom of his feet several times throughout the day. The therapist does not prescribe a night splint at this time, because Jason has had symptoms for less than 3 months. The therapist recommends that for his general health, Jason begin a low-impact exercise program, including swimming and using an exercise bike. This will help him lose the excess weight he has gained without further aggravating his plantar fasciitis.

Jason follows the advice of his physical therapist. He purchases new footwear for work and performs the stretching exercises and icing as instructed. After 2 weeks, he is 90% pain-free. Jason keeps his follow-up visit with his physical therapist 1 month later to review his condition and adjust his home program.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat plantar fasciitis. However, you may want to consider:

A physical therapist who is experienced in treating people with orthopedic and sports injuries, particularly those with experience working with the ankle and foot
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy, meaning that 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 (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 heel pain.
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.

Hip Impingement →

October 29, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Hip impingement involves a change in the shape of the surface of the hip joint that predisposes it to damage, resulting in stiffness and pain. Hip impingement is a process that may precede hip osteoarthritis. It most often occurs in young, active people. A recent study found that 87% of teens and adults with hip pain showed evidence of hip impingement on diagnostic images taken of their hip joints. To treat hip impingement, physical therapists prescribe stretches and strengthening exercises to better balance the muscles around the hip to protect it, and use manual therapies to help restore range of motion and increase comfort.

What is Hip Impingement?

There are 2 types of hip impingement; they may occur alone or together.

Pincer-Type Impingement

In pincer-type impingement, the hip socket (acetabulum), which is usually angled forward, may be angled toward the back, or protruding bone may be present on the pelvis side of the hip joint making the socket a deeper recess that covers more of the ball or head of the femur bone.
The overgrown bone or incorrect angle of the socket causes the labrum, a rim of connective tissue around the edge of the hip socket, to be pinched. Over time, this extra pressure to the labrum when flexing (moving the leg forward) leads to wear and tear that can cause inflammation and could result in a tear. If this condition persists, eventually the cartilage that lines the hip joint can become worn and form holes.
This condition affects men and women equally; symptoms often begin early, appearing at any time between 15 to 50 years of age.

Cam-Type Impingement

In cam-type impingement, the shape of the bone around the head of the femur—the ball at the top of the bone in the thigh—is misshapen. It can vary from the normal round ball shape, or have overgrown bone formed at the top and front. The nickname “pistol grip” deformity is given to the appearance of the bony overgrowth on x-rays.
The overgrown or misshapen bone contacts the cartilage that lines the hip socket, and can cause it to peel away from the bone in the socket. The labrum can become worn, frayed, or torn as well.
This condition affects men to women at a ratio of 3 to 1; symptoms often manifest during the teen years and 20s.

Signs and Symptoms

Hip impingement may cause you to experience:

Stiffness or deep aching pain in the front or side of the hip or front of the upper thigh while resting.
Sharp, stabbing pain when standing up from a chair, squatting, rising from a squat, running, "cutting," jumping, twisting, pivoting, or making lateral motions.
Hip pain described in a specific location by making a "C" with the thumb and hand and placing it on the fold at the front and side of the hip, known as the "C-sign."
Pain that most often starts gradually, but can also remain after another injury resolves.
Pain that increases with prolonged sitting or forward leaning.
Feeling less flexible at the hips, including a decreased ability to turn your thigh inward on the painful side.

How Is It Diagnosed?

Your physical therapist will evaluate the range of motion (movement) of the hip and surrounding joints, and test the strength of the muscles in that area. Your therapist will feel the hip joint and surrounding muscles to evaluate their condition. The examination will include observing how you move, standing from a sitting position, walking, running, or squatting, as appropriate. Your physical therapist may perform special tests to help determine whether the hip is the source of your symptoms. For instance, the therapist may gently roll your leg in and out (the “log roll” test), or bend your hip up and in while turning the lower leg out to the side (the "FADDIR" test) to assess your condition.

If further diagnosis is needed, your doctor may order diagnostic tests to help identify any joint changes, including x-rays, magnetic resonance imaging (MRI), or diagnostic injections. Hip impingement can occur at the same time as low back, buttock, or pelvic pain, or from conditions such as bursitis or groin strain. The final diagnosis of hip impingement may take some time, especially when other conditions are present.

How Can a Physical Therapist Help?

Without Surgery

When an active person develops hip pain, but does not have severe symptoms or joint damage, the recommended treatment is physical therapy. The following interventions can help decrease pain, improve movement, and avoid the progression of hip impingement and the need for surgery:

Improving the strength of your hips and trunk. Strengthening of the hips and trunk can reduce abnormal forces on the already injured joint and help with strategies to compensate.
Improving hip muscle flexibility and joint mobility. Stretching tight muscles can reduce abnormal forces that cause pain with motion. Joint mobilization may help ease pain from the hip joint; however, these treatments do not always help range of motion, especially if the shape of the bone at the hip joint has changed.
Improving tolerance of daily activities. Your physical therapist can consider your job and recreational activities and offer advice regarding maintaining postures that are healthier for your hip and activity modification. Often this involves limiting the amount of bending at the hip to avoid further hip damage.

Following Surgery

Surgery for hip impingement is performed with arthroscopy. This is a minimally invasive type of surgery, where the surgeon makes small incisions in the skin and inserts pencil-sized instruments into the joint to repair damage. The surgeon may perform 1 or several techniques during your procedure as needed. The surgeon may remove or reshape the bone on the pelvis or femur side of the joint, and repair or remove the damaged labrum or cartilage of the hip joint.

Postsurgical physical therapy varies based on the procedure performed. It may include:

Ensuring your safety as you heal. Your physical therapist may recommend that you limit the amount of weight you put on the operated leg if there was a repair of the labrum. You may wear a brace to help limit the amount of bending at the hip. You might also use crutches to avoid overloading the leg if the bone on the femur was reshaped.
Improving your range of motion, strength, and balance. Your physical therapist will guide you through safe range-of-motion, strengthening, and balance activities to improve your movement as quickly as possible while allowing the surgical site to heal properly.
Instructions on returning to an active lifestyle. Most people return to normal daily activities about 3 months after surgery, and to high-level activities and sports 4 to 6 months after surgery. Your physical therapist will recommend a gradual return to activity based on your condition—research shows that 60% to 90% of athletes return to their previous playing ability depending on the surgical procedure performed and the sport.

Can this Injury or Condition be Prevented?

Currently there are no recommendations to prevent hip impingement. Despite a major increase in research to learn more about hip impingement, there is a great deal that is unknown. For instance, many active young people whose x-rays show hips as being abnormal do not have pain despite continuing to live active lives and participate in sports.

However, there is evidence that physical therapy interventions along with anti-inflammatory drugs can decrease pain, slow joint damage, and improve function. This is particularly important in those with mild hip impingement, those who are attempting to avoid surgery, and those who are not candidates for surgery.

Real Life Experiences

Lindsay is an active high school senior who plays shortstop for her school's softball team. Over the last several months, she has had progressively worsening pain on the front and side of her left hip. It started as an occasional sharp pain when she fielded ground balls at practice, and it eventually developed into aching and stiffness of the hip while resting. Lindsay occasionally develops hip pain while sitting in class or at the movies. In the past couple of weeks, she has found it hard to lean forward to tie her shoes. Her mom has been worrying about her pain and takes Lindsay to her physical therapist.

At the evaluation, the physical therapist finds that Lindsay has weakness around her hip and trunk muscles, decreased hip mobility, pain when flexing the hip, pain returning to a standing position after squatting, and decreased balance when standing on her affected leg. Her physical therapist diagnoses mild hip impingement in her left hip. Lindsay sees her physical therapist 1-2 times a week for the next 6 weeks.

Her treatments focus on developing a home program for strengthening her hips and trunk, and the therapist uses manual therapy for the hip to improve her comfort and allow her to perform more activities. The therapist works with Lindsay to change how she moves when standing from a seated position, and also to modify how she moves when playing the infield in softball. Lindsay also spends less time in the positions that bother her hip in the weight room and on the practice field, following recommendations from her physical therapist. After 3 weeks, the majority of her pain has subsided, and by 6 weeks, she is playing in games pain-free.

Lindsay meets her goal of finishing her senior year with the softball team. However, she is considering other ways to stay active after she graduates that don’t involve bending forward as much.

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 patients who have hip impingement. You may want to consider:

A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with a sports or orthopaedic focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in sports or orthopaedic 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 hip impingement.
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.

Tarsal Tunnel Syndrome→

October 11, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

What is Tarsal Tunnel Syndrome?

Often described as the carpal tunnel syndrome of the lower extremity, tarsal tunnel syndrome is a condition that results from the compression of the posterior tibial nerve as it runs through the tarsal tunnel (a structure made up of bone and tissue (retinaculum) on the inside of the ankle). As it passes through the tarsal tunnel, the tibial nerve divides into 3 branches that provide sensation for the heel and bottom of the foot, and aid in the foot's function. When this structure becomes compressed, symptoms, such as pain, numbness, and/or tingling may occur and radiate into the lower leg, foot, and toes. Individuals may also experience muscle weakness in the area.

How Does it Feel?

The most common symptoms of TTS result from irritation of the tibial nerve and its branches. People with TTS may experience:

Pain, numbness, or tingling in the foot or ankle, which may radiate into the lower leg, foot, and toes
Weakness in the muscles of the lower leg and foot
Weakness of the big toe
Foot swelling
Symptoms that increase with prolonged standing or walking
Symptoms that decrease with rest
Altered temperatures of the foot and ankle
Pain that disrupts sleep

How Is It Diagnosed?

There are several tests that can help a clinician determine if TTS is present. Your physical therapist and/or physician will first take a comprehensive health history, and inquire about your current symptoms. Then your physical therapist may conduct tests, such as:

Gently tapping over the posterior tibial nerve in an attempt to reproduce your symptoms.
Tensing of the posterior tibial nerve, a maneuver that looks and feels like a "stretch," in an attempt to reproduce your symptoms.
Conducting a nerve condition study—a diagnostic test to determine the speed at which a nerve conducts information.
Ruling out other conditions, such as plantarfasciitis (inflammation of the tissue that runs along the bottom of the foot).

How Can a Physical Therapist Help?

Physical therapists play a vital role in helping people experiencing TTS to improve and maintain their daily function and activities. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals.

Because the signs and symptoms of TTS can vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:

Nerve Gliding Activities. Gentle exercises that move and "glide" the nerves may help reduce symptoms and improve function.

Muscle Strengthening Exercises. Strengthening activities for any muscles affected by TTS, such as the tibialis posterior muscle in the back of your lower leg.

Balance and Coordination Activities. Work to improve your balance and coordination, which are often affected by TTS.

Orthotics/Taping/Bracing. Apply ankle taping, a custom orthotic, or bracing to position the foot to decrease stress on the posterior tibial nerve.

As with many conditions, education is key. Understanding the underlying mechanisms of TTS, and learning to recognize early signs and symptoms of stress may help you better manage the condition.

Can this Injury or Condition be Prevented?

Although there are no proven strategies for preventing TTS, there are ways to minimize stress to the foot and ankle, such as choosing appropriate footwear, wearing custom orthotics, minimizing the amount of time spent standing on hard surfaces, and improving and maintaining strength in the muscles of your legs, ankles, and feet. These strategies can be discussed further with your physical therapist.

In addition, early detection of the signs and symptoms of TTS will help you and your medical providers begin appropriate management of the condition, which may enhance your long-term well-being.

Real Life Experiences

Kim is a 46-year-old woman who works on an automobile assembly line. Her job involves standing on hard surfaces for prolonged periods of time. Kim recently noticed an onset of pain in her inner ankle after working a few hours, as well as an occasional shooting pain in her big toe. Now, her pain gets progressively worse throughout the day, and often interrupts her sleep. She is afraid of losing her job if she mentions her symptoms to her boss, and really can't afford to miss work. Kim decides to call her physical therapist.

Kim's physical therapist asks about her medical history, and learns that Kim has been diagnosed with high blood pressure and high cholesterol. They discuss Kim’s current symptoms.

He examines Kim’s ankle motion and strength, and gently performs procedures to provoke her symptoms. He also observes how she walks, and assesses her balance. Based on these signs and symptoms, he diagnoses tarsal tunnel syndrome.

Over the next several weeks, Kim works with her physical therapist to reduce her pain and improve her function. Her treatments include:

Application of a custom orthotic to better support her foot/ankle.
Nerve-gliding activities to improve the mobility of the posterior tibial nerve.
Balance exercises.
Manual therapy to ease her pain and improve her ankle mobility.
Strengthening exercises for her affected muscles.
Education about modifying her work positioning and activities.

After 4 weeks of physical therapy, Kim reports a significant reduction in her symptoms. She says she no longer fears going to work, and believes that she has taken control of her current situation. She continues to perform the home-based exercises her physical therapist taught her, and is amazed at how comfortable her feet feel throughout the workday—in her new shoes with custom orthotic inserts.

This story highlights an individualized experience of TTS. 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 experience to treat conditions, such as TTS. However, when seeking a provider, you may want to consider:

A physical therapist who is a board-certified clinical specialist, or who has completed a residency or fellowship in physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
A physical therapist who is well-versed in the treatment of TTS or other neuropathic disorders.

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 painful conditions
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 way of approaching care.

Rotator Cuff Tear→

October 04, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

What is a Rotator Cuff Tear?

The "rotator cuff" is a group of 4 muscles and their tendons (tissues that attach muscles to bones), which connects the upper arm bone, or humerus, to the shoulder blade. The important job of the rotator cuff is to keep the shoulder joint stable. Sometimes, the rotator cuff becomes inflamed or irritated due to heavy lifting, repetitive arm movements, or trauma such as a fall. A rotator cuff tear occurs when injuries to the muscles or tendons cause tissue damage or disruption.

Rotator cuff tears are called either "full thickness" or partial thickness," depending on how severe they are.

Full-thickness tears extend from the top to the bottom of a rotator cuff muscle/tendon.
Partial-thickness tears affect at least some portion of a rotator cuff muscle/tendon, but do not extend all the way through.

Tears often develop as a result of either a traumatic event or long-term overuse of the shoulder. These conditions are commonly called “acute” or “chronic.”

Acute rotator cuff tears are those that occur suddenly, often due to traumas, such as a fall or lifting of a heavy object.
Chronic rotator cuff tears are much slower to develop. These tears are often the result of repeated actions with the arms working above shoulder level, such as with ball-throwing sports or certain work activities.

People with chronic rotator cuff injuries often have a history of rotator cuff tendon irritation that causes shoulder pain with movement. This condition is known as shoulder impingement syndrome.

Rotator cuff tears also may occur in combination with injuries or irritation of the biceps tendon at the shoulder, or with labral tears (to the ring of cartilage at the shoulder joint). Your physical therapist will explain the particular details of your rotator cuff tear.

How Does it Feel?

People with rotator cuff tears can experience:

Pain over the top of the shoulder or down the outside of the arm
Shoulder weakness
Loss of shoulder motion
A feeling of weakness or heaviness in the arm
Inability to lift the arm to reach up, or reach behind the back
Inability to perform common daily activities due to pain and limited motion

How Is It Diagnosed?

To help pinpoint the cause of your shoulder pain, your physical therapist will complete a thorough examination that will include learning details of your symptoms, assessing your ability to move your arm, identifying weakness, and performing special tests that may indicate a rotator cuff tear. For instance, your physical therapist may raise your arm, move your arm out to the side, or raise your arm and ask you to resist a force, all at specific angles of elevation.

In some cases, the results of these tests might indicate the need for a referral to an orthopedist or other professional for imaging tests, such as ultrasound imaging, magnetic resonance imaging (MRI), or a computed tomography (CT) scan.

How Can a Physical Therapist Help?

Once a rotator cuff tear has been diagnosed, you will work with your orthopedist and physical therapist to decide if you should have surgery or if you can try to manage your recovery without surgery.

If you don't need surgery, your physical therapist will work with you to restore your range of motion, muscle strength, and coordination, so that you can return to your regular activities. In some cases, you may learn to modify your physical activity so that you put less stress on your shoulder.

If you decide to have surgery, your physical therapist can help you both before and after the procedure.

Regardless of which treatment you have—physical therapy only, or surgery and physical therapy—early treatment can help you speed the healing process and avoid permanent damage.

If You Have an Acute Injury

If a rotator cuff tear is suspected following a trauma, seek the attention of a physical therapist or other health care provider to rule out the possibility of serious life- or limb-threatening conditions. Once serious injury is ruled out, your physical therapist will help you manage your pain and will prepare you for the best course of treatment.

If You Have a Chronic Injury

A physical therapist can help manage the symptoms of chronic rotator cuff tears as well as improve how your shoulder works. For large rotator cuff tears that can't be fully repaired, physical therapists can teach special strategies to improve shoulder movement. However, if physical therapy and conservative treatment alone do not improve your function, surgical options may exist.

If You Have Surgery

If your condition is severe, you may require surgery to restore use of the shoulder; physical therapy will be an important part of your recovery process. The repaired rotator cuff is vulnerable to reinjury following shoulder surgery; working with a physical therapist is crucial to safely regaining full use of the injured arm. After the surgical repair, you will need to wear a sling to keep your shoulder and arm protected as the repair heals. Your physical therapist will apply treatments during this phase of your recovery to reduce pain and gently begin to restore movement. Once you are able to remove the sling for exercise, your physical therapist will begin your full rehabilitation program.

Your physical therapist will design a treatment program based on both the findings of the evaluation and your personal goals. Your physical therapist will guide you through your postsurgical rehabilitation, which will progress from gentle range-of-motion and strengthening exercises to activity- or sport-specific exercises.

Your treatment program most likely will include a combination of exercises to strengthen the rotator cuff and other muscles that support the shoulder joint. The time line for your recovery will vary depending on the surgical procedure and your general state of health, but return to sports, heavy lifting, and other strenuous activities might not begin until 4 months after surgery and full return may not occur until 9 months to 1 year after surgery. Following surgery, your shoulder will be susceptible to reinjury. It is extremely important to follow the postoperative instructions provided by your surgeon and physical therapist.

Your rehabilitation will typically be divided into 4 phases:

Phase I (maximal protection). Phase 1 of treatment lasts for the first few weeks after your surgery, when your shoulder is at the greatest risk of reinjury. During this phase, your arm will be in a sling. You will likely need assistance or need strategies to accomplish everyday tasks, such as bathing and dressing. Your physical therapist will teach you gentle range-of-motion and isometric strengthening exercises, provide hands-on treatments (manual therapy), such as gentle massage, offer advice on reducing your pain, and may use techniques such as cold compression and electrical stimulation to relieve pain.
Phase II (moderate protection). This next phase has the goal of restoring mobility to the shoulder. You will reduce the use of your sling, and your range-of-motion and strengthening exercises will become more challenging. Exercises will be added to strengthen the "core" muscles of your trunk and shoulder blade (scapula), and the rotator-cuff muscles that provide additional support and stability to your shoulder. You will be able to begin using your arm for daily activities, but will still avoid heavy lifting. Your physical therapist may use special hands-on mobilization techniques during this phase to help restore your shoulder's range of motion.
Phase III (return to activity). This phase has the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities, but you will still be unable to participate in activities such as sports, yard work, or physically strenuous work-related tasks. Your physical therapist will advance the difficulty of your exercises by adding weight or by having you use more challenging movement patterns. A modified weight-lifting/gym-based program may also be started during this phase.
Phase IV (return to occupation/sport). This phase will help you return to work, sports, and other higher-level activities. During this phase, your physical therapist will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. For others, it may include practice in lifting heavier items onto shelves, or instruction in proper positioning for everyday tasks such as raking, shoveling, or doing housework.

Can this Injury or Condition be Prevented?

A physical therapist can help you reduce the worsening of the symptoms of a rotator cuff tear and may decrease your risk of worsening a tear, especially if you seek assistance at the first sign of shoulder pain or discomfort. To avoid developing a rotator cuff tear from an existing shoulder problem, it is imperative to stop performing actions that could make it worse. Your physical therapist can help you strengthen your rotator cuff muscles, train you to avoid potentially harmful positions, and determine when it is appropriate for you to return to your normal activities.

To maintain shoulder health and prevent rotator cuff tears, physical therapists recommend that you:

Avoid repeated overhead arm positions that may cause shoulder pain. If your job requires such movements, seek out the advice of a physical therapist to learn arm positions that may be used with less risk.
Apply rotator-cuff muscle and shoulder-blade strengthening exercises into your normal exercise routine. The strength of the rotator cuff is just as important as the strength of any other muscle group. To avoid potential harm to the rotator cuff, general strengthening and fitness programs may improve shoulder health.
Practice good posture. A forward position of the head and shoulders has been shown to alter shoulder-blade position and create shoulder impingement syndrome.
Avoid sleeping on your side with your arm stretched overhead, or lying on your shoulder. These positions can begin the process that causes rotator cuff damage and may be associated with increasing your pain level.
Avoid smoking; it can decrease the blood flow to your rotator cuff.
Consult a physical therapist at the first sign of symptoms.

Real Life Experiences

Jonathan is a 55-year-old professor who leads a relatively sedentary lifestyle. Recently, with the help of a colleague, he decided to repaint his house. Over the past 3 weeks, he has spent hours a day on a ladder, reaching overhead to scrape old paint and apply new coats. Starting 2 weeks ago, Jonathan began to feel pain in his shoulder after working an hour or so each day. Now, every time he raises his right arm overhead, he feels a sharp pain in his shoulder area. He admits that the pain has been steadily getting worse, and now his arm feels weak. He decides to stop his painting project and call a physical therapist.

Jonathan’s physical therapist takes his health history, noting his lack of daily exercise, and has him describe his symptoms, when they started, and what they now prevent him from doing. He examines Jonathan’s shoulder and arm using the procedures described above. Based on the findings from the examination, Jonathan’s physical therapist suspects that he may have a rotator cuff tear. He advises Jonathan to avoid all activities that require reaching overhead, and to protect the irritated muscles and tendons by performing actions, such as resting his elbow on an armrest when sitting. He refers Jonathan to a physician for an MRI. The test results confirm a diagnosis of a partial-thickness rotator cuff tear.

Jonathan’s physical therapist begins his treatment by teaching him gentle movement and strengthening exercises, and shows him how to apply ice to the shoulder at home to help decrease any irritation and pain. During phase 1 of treatment, he teaches Jonathan specific exercises to help restore pain free range-of-motion and activation of the rotator cuff muscles.

During phase 2 of Jonathan’s rehabilitation, his physical therapist prescribes exercises to strengthen his rotator cuff and shoulder blade muscles, and addresses any remaining limitations in motion with manual therapy (hands-on treatment) techniques. He teaches Jonathan new movements to improve his posture and his ability to raise his arm without making his symptoms worse.

As Jonathan progresses, his physical therapist adds shoulder exercises that are performed in various positions, functional activities for the arm, and core strengthening exercises. He encourages Jonathan to start taking daily walks and explore other gym-based activities.

Six weeks after starting physical therapy, Jonathan has restored his ability to raise his arm over his head and feels stronger and more fit than he has in years. He has returned to his house painting, with the guidance of his physical therapist. He limits the time spent reaching overhead, adjusts his movements to protect his shoulder at all times, takes daily walks, and performs strengthening exercises to maintain his new-found fitness.

Just this week, a few of Jonathan’s students surprise him by showing up to complete his house-painting project themselves! Jonathan invites them to join him for regular “walk and talk” sessions, where they discuss current class topics while improving their overall fitness.

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 patients who have a rotator cuff tear, but you may want to consider:

A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with an orthopedic focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy 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 labral tears.
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.

Medial Collateral Ligament (MCL) Injury→

September 30, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

The medial collateral ligament (MCL) is the most commonly damaged ligament in the knee. The MCL can be sprained or torn as a result of a blow to the outer side of the knee, by twisting the knee, or by quickly changing directions while walking or running. MCL injury most often occurs in athletes, although nonathletes can also be affected. A physical therapist treats an MCL sprain or tear to reduce pain, swelling, stiffness, and any associated weakness in the knee or lower extremity.

What is an MCL Injury?

The MCL is a small, thick band of tissue on the inner side of the knee joint. It connects two bones—the thighbone and the shin bone—preventing the knee from bending inward toward the other knee. When the knee is hit on the outer side of the leg (eg, the left side of the left leg), or if the knee is twisted violently, the MCL can overstretch resulting in a partial or complete tear. MCL injuries commonly occur in football players who get "clipped" or hit on the outer side of the knee. Other causes may include twisting and turning while skiing, blows received on the soccer field, trauma experienced in a car accident, or simply turning the knee sharply while the foot is planted on the ground. Healing times vary from a couple of weeks to a couple of months, depending on the severity of the injury.

How Does it Feel?

When you experience an MCL injury, you may feel:

Pain on the inner side of the knee
Swelling and bruising at the inner side of the knee
Swelling that spreads to the rest of the knee joint in 1 or 2 days following injury
Stiffness in the knee
Difficulty or pain when trying to bend or straighten the knee
An unstable feeling, as though the knee may give out or buckle
Pain or difficulty walking, sitting down, rising from a chair, or climbing stairs

Signs and Symptoms

With an MCL injury, you may experience

A "popping" sound as the injury occurs
Pain and swelling in your knee
Difficulty moving your knee
Difficulty bearing weight on your leg for walking or getting up from a chair

How Is It Diagnosed?

If you see your physical therapist first, the therapist will conduct a thorough evaluation that includes taking your health history. Your therapist will also ask you detailed questions about your injury, such as:

Did you feel pain or hear a "pop" when you injured your leg?
Did you turn your leg with your foot planted on the ground?
Did you change direction quickly while running?
Did you receive a direct hit to the leg while your foot was planted on the ground?
Did you see swelling around the knee in the first 2 to 3 hours following the injury?
Does your knee feel like buckling or giving way when you try to use it?

Your physical therapist also will perform special tests to help determine the likelihood that you have an MCL injury. Your therapist will gently press on the outside of your knee while it is slightly bent as well as when it is fully straight to test the strength of the ligament. The therapist will also check the inner side of your knee for tenderness and swelling and measure for swelling with a tape measure. The therapist may use additional tests to determine if other parts of your knee are injured, and will also observe how you are walking.

To provide a definitive diagnosis, your therapist may collaborate with an orthopedic physician or other health care provider. The orthopedic physician may order further tests, such as magnetic resonance imaging (MRI), to confirm the diagnosis and to rule out other damage to the knee. It also helps to determine whether surgery is required. MRI is not required in all cases but may be ordered. Your therapist or doctor may recommend a knee brace, a knee immobilizer, or crutches to reduce pain if the MCL injury is severe.

How Can a Physical Therapist Help?

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments you can do at home. Physical therapy will help you return to your normal lifestyle and activities.

The First 24-48 Hours

Your physical therapist may advise you to:

Rest the area by avoiding walking or any activity that causes pain. Crutches and a knee brace may be recommended to reduce further strain on the MCL when walking.
Apply ice packs to the area for 15-20 minutes every 2 hours.
Compress the area with an elastic bandage wrap.
Consult with a physician for further services such as medication or diagnostic tests.

Reduce Pain

Your physical therapist may use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and hands-on therapy such as massage.

Improve Motion

Your physical therapist will choose specific activities and treatments to help restore normal movement in the knee and leg. These might begin with passive motions that the therapist performs for you to gently move your leg and knee joint, and progress to active exercises and stretches that you do yourself.

Improve Strength

Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to steadily restore your strength and agility. These may include using cuff weights, stretchy bands, weight-lifting equipment, and cardio-exercise equipment such as treadmills or stationary bicycles.

Improve Balance

Regaining your sense of balance is important after an injury. Your physical therapist will teach you exercises to improve your balance skills.

Speed Recovery Time

Normal healing of time is a few weeks to a few months, depending on which tissues are injured and how severely they are injured. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

Return to Activities

Your physical therapist will discuss your goals with you and use them to set your work, sport, and homelife recovery goals. The therapist will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will apply hands-on therapy, such as massage, and teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Prevent Future Injury

Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your knee, upper leg, and abdomen to help prevent future injury. These may include strength and flexibility exercises for the leg, knee, and core muscles.

If Surgery Is Necessary

Surgery is rarely necessary in the case of an MCL injury. If surgery is needed, you will follow a recovery program over several weeks guided by your physical therapist, who will help you minimize pain, regain motion, strength, and return to normal activities as quickly as possible after surgery.

Can this Injury or Condition be Prevented?

To help prevent a recurrence of the injury, your physical therapist may advise you to:

Learn how to not let your knees collapse in toward each other when jumping, running, or turning quickly
Practice balance and agility exercises and drills
Always warm up before starting a sport or heavy physical activity
Follow a consistent strength and flexibility exercise program to maintain good physical conditioning, even in a sport's off-season
Wear shoes that are in good condition and fit well

Real Life Experiences

Mark is a 35-year-old accountant who is an avid bowler on the weekends. He lives with his 100-lb Rottweiler dog. One morning, as Mark was quickly turning a corner into the kitchen to grab a ringing phone, his dog ran the other way and accidentally hit Mark’s knee on the outer side of his right leg. Mark lost his balance and fell sideways. His right foot got caught underneath the dog as his body fell to the right, forcing the outer side of the knee to buckle and the inner side of the knee to overstretch. Mark felt a sharp pain on the inner side of his knee, and fell to the ground. Mark felt immediate tenderness on the inner side of his knee, and he could not straighten or bend it.

Mark was able to see his physical therapist that day. The physical therapist performed special tests on the ligaments and cartilage in the knee. She found that just the MCL was injured, and that it was a mild sprain. She immediately applied ice and electrical stimulation to the area for 20 minutes. She wrapped Mark’s knee with a compressive wrap and instructed him to keep it elevated when he was sitting or lying down. She gave Mark crutches and taught him how to use them.

When Mark returned for his next visit, the physical therapist began gently moving the knee to reduce the stiffness. She taught Mark some exercises he could do at home to start improving his muscle strength. She helped him use equipment in the clinic to gently move, stretch, and strengthen his knee and leg.

Mark received physical therapy treatments for 2 weeks, after which he was able to walk and climb stairs with only a little discomfort. His therapist taught him a variety of balance and endurance exercises. By the third week, he was able to return to bowling, and walk around sharp corners in his house, while keeping a watchful eye on his energetic dog!

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 MCL injury. However, you may want to consider:

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

You can find physical therapists that have these and other credentials by using Find a PT, the online tool developed 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 (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 your type of injury.
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.

Female Athlete Triad→

September 25, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Female athlete triad (triad) is a syndrome that can manifest across a broad spectrum, but involves the interrelationship between 3 measurable factors: (1) how much energy a woman has available to use for activity (energy availability), (2) the quality and strength of her bones (bone mineral density), and (3) her menstrual cycle. Clinically, imbalances in any one of these areas can lead to eating problems, osteopenia/osteoporosis, and/or menstrual dysfunction. The prevalence of all 3 components of female athlete triad among high school, collegiate, and elite athletes in the United States can be as high as 16%; the prevalence of any one component of the triad in this population can be as high as 60%.

What is Female Athlete Triad?

Female athlete triad is a syndrome that can involve both the physical and mental aspects of health. It develops in female athletes based on 3 factors: energy availability, bone mineral density, and the menstrual cycle.

Energy availability is calculated by how much energy you gain from dietary sources, minus the amount of energy you expend during activity. Typically, with triad poor energy availability is the driving force behind abnormal bone density and menstrual dysfunction. Poor energy availability is caused by poor nutrition; it can occur with or without the presence of an eating disorder. Nutrients act to provide the necessary source of fuel for bones and muscles. Poor nutrition also can have a negative effect on the part of the brain that controls hormones that regulate the menstrual cycle. Optimal energy availability supports bone health specifically by maintaining estrogen levels. Estrogen is an important hormone that has a protective effect on bone by supporting the balance between bone building and bone loss. Therefore, lack of estrogen can impact bone density and may increase the risk of bone stress injuries.

Bone mineral density (BMD) defines 1 aspect of bone health. When your bones are not supplied with necessary nutrients or are stressed too much through overexercising, they may begin to weaken. This weakening can lead to osteopenia (lower than normal BMD) and further, osteoporosis (a loss of bone strength that predisposes a person to increased risk of fractures). When a person has low BMD, she may be at an increased long-term risk of bone mineral loss and fracture as she ages.

Menstrual dysfunction refers to abnormal menstrual periods. This spectrum can range from oligomenorrhea (inconsistent menstrual cycles) to amenorrhea (absence of a menstrual period) in females who are of a reproductive age.

Female athletes are at an increased risk of developing triad due to the high demand that athletics place on the female body physically, as well as the increasing societal pressures for performance and image. For example, a female runner may feel that altering or restricting caloric intake will make her a faster runner, therefore gaining an edge on the competition and earning greater success in her sport. Triad can be present in any female athlete, from the elite athlete striving to reach high-performance goals, to the adolescent female whose body is going through normal changes related to puberty. In any case, there are physical and psychological aspects of this syndrome that affect its extent, impact, and treatment.

How Does it Feel?

Female athlete triad is not caused by a sudden traumatic injury; therefore, no immediate symptoms typically appear. Instead, symptoms related to the 3 components of triad may develop over time, ranging from months to years.

A female athlete may begin experiencing the following symptoms, conditions, or changes (separately or together) that may indicate she is developing female athlete triad:

Low energy during school, work, or exercise
Irregular or absent menstrual cycles
Stress-related bone injuries (stress reactions or fractures)
Difficulty concentrating
An unexplained drop in performance
Changes in eating habits
Altered sleeping patterns
An unusually high focus on performance or image
Experiencing high levels of stress

How Is It Diagnosed?

A multidisciplinary team of medical providers typically diagnoses female athlete triad. The team may include medical doctors, nutritionists, physical therapists, certified athletic trainers, and psychologists. However, nonmedical individuals, such as parents, friends, coaches, teammates, teachers, and work colleagues can also be resources to help identify female athletes who demonstrate signs of triad, as these are all people who spend time with the athlete. Often, the athlete does not realize that she has low energy availability or any of the symptoms of triad; therefore, it often becomes the responsibility of a health care professional to educate a patient and her parents and coaches.

If it is suspected that an athlete may be demonstrating 1 or more components of triad, a proper screening interview can help identify the components, including questions about menstrual status and history, history of stress or bone injury, and eating disorder tendencies. These questions may include:

Have you ever had a stress fracture?
Do you have menstrual periods?
Are you trying to or has anyone recommended that you gain or lose weight?
Are you on a special diet?
Have you ever been diagnosed with an eating disorder?

To diagnose triad, a number of medical and psychological tests and consultations may be recommended, including:

Diagnostic imaging of bone health (ie, X-ray, bone density scan [DEXA])
Referral to a nutritionist for dietary assessment
Referral to a primary care or family medical doctor for monitoring of menstrual function or related medical tests (eg, blood tests, assessment of the natural stages of development, such as the onset of puberty)
Referral to a physical therapist for functional assessment (ie, motion, strength, movement quality)

Because triad involves multiple components of health, an athlete who is able to receive care from all relevant health care practitioners has the best chance of developing a comprehensive plan to return to good health and athletic participation/performance.

How Can a Physical Therapist Help?

Physical therapists are trained to identify signs and symptoms of female athlete triad and initiate multidisciplinary care as appropriate and needed. The physical therapist can assist with prevention and the promotion of health, wellness, and fitness, in addition to providing rehabilitation following an injury. Primary prevention includes proper screening of any female athlete for triad, asking questions such as those stated above, and referring the athlete to other appropriate health care professionals.

Physical therapists are also trained to understand the implications that triad may have on exercise prescription. For example, an athlete with a stress fracture due to low BMD should not perform jumping and running movements. Once an athlete's symptoms are resolved, her physical therapist can design an individualized return-to-activity program that encourages a safe, progressive level of activity. A physical therapist also can identify if an athlete is at an increased risk of overuse injury or abnormal loading of the bone or a joint.

Physical therapists are trained to educate athletes and their families about triad, and work with athletes to prevent or resolve the condition—guiding them back to safe, optimal performance levels. In many cases, this attention to and care for a female athlete's overall health can improve her performance in athletics and in school as well, and boost her overall self-esteem. Many athletes report that they are more confident, stronger, and better equipped to achieve their goals when they feel they have strong support and a plan for sustained health.

Can this Injury or Condition be Prevented?

The Female Athlete Triad is a very preventable condition.

The most effective approach to prevention is education. As both the level of female participation in competitive sports and the incidence of the Triad have risen over the last 2 decades, a stronger emphasis has been put on educating athletes, parents, and coaches on strategies to prevent the development of causal factors for the Triad. It is important to begin educating young female athletes as early as middle-school age on topics such as healthy eating, smart physical training, recovery and rest, and taking care of their bodies.

Coaches should monitor training and its impact on the overall health of the athlete by encouraging pain-free participation in sports; they may also track training and performance in order to notice any abnormal health or behavioral signs. Individuals involved in the life of a female athlete should promote an open, honest, and safe environment for the athlete so that she feels comfortable discussing challenges or issues she may be facing without the risk of external pressure or judgment.

Real Life Experiences

Jenna is a 17-year-old junior in high school who runs cross-country and track, and swims on a competitive, year-round swim team. Jenna is a very talented athlete. She has been swimming since age 5; last year, with encouragement of her coaches, she decided to start running to improve her fitness for swimming. She immediately ranked in the top 5 runners on the school’s cross-country team. Jenna recently started receiving phone calls from college swim coaches. It has been her dream to earn a scholarship to swim in college, and as she begins to feel like it may be a real possibility, she commits to training harder than ever for both running and swimming.

For several weeks, Jenna practices both sports every day, rushing from the track to the pool with no time to rest or grab a snack. The junior year is the hardest academic year at her school; she has been swamped with homework and only gets around 5 hours of sleep each night.

After finishing in the top 10 at the state cross-country meet in November, Jenna started 2-a-day swim practices without taking any time off. During her weight-room sessions, she began to notice her shin was growing very sore with each workout, and that she wasn’t able to increase her weights like she did last season. Her shin didn’t bother her in the pool, but she had a hard time completing workouts and hitting her running times. She just felt tired all the time, and began to grow discouraged and unmotivated. Her mom took her to see a physical therapist.

Jenna's physical therapist asked her specific questions about her training. Jenna felt comfortable being honest with her. Jenna mentioned that she had started skipping lunch so that she wouldn’t feel lethargic for practice, and rarely had time to eat a full dinner because of her homework load. She told her physical therapist that she was beginning to feel like her chances of getting a college scholarship were slipping away.

Jenna and her physical therapist had a long discussion about the best plan to help her return to good health and achieve her goals. Her physical therapist helped her see that her desire to perform at a high level had become out of balance with her ability to take care of her body. She encouraged Jenna not to feel guilty, but to feel positive about her opportunity to address her challenges. She told Jenna that she may have to rest for a few weeks to begin to restore her full strength. Jenna was frustrated by the situation, but excited to work toward returning to full health. They discussed the plan with her coaches and parents, and everyone was on board.

Jenna's physical therapist referred her to an orthopedic physician for evaluation of her bone health, as well as to a nutritionist to evaluate her diet and come up with a proper fueling plan that met the high physical demands of swimming and running. After resting for several weeks, Jenna began her physical therapy. Her physical therapist designed an individualized program to restore and enhance her strength, endurance, and movement quality. She and her coaches worked on a training plan that would allow adequate rest and recovery.

By the national swim meet that March, Jenna was in the best shape of her life and placed first in her event, setting a new personal-best time. That summer, the college of her choice called with a scholarship offer. Jenna felt happy and healthy entering her senior year, excited for the adventures ahead!

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 identify female athlete triad. However, you may want to consider:

A physical therapist who is experienced in working with people who have female athlete triad. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical 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 female athlete triad.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible.

Shoulder Labral Tear→

September 20, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

An unstable shoulder joint can be the cause or the result of a labral tear. "Labral" refers to the ring of cartilage (glenoid labrum) that surrounds the base of the shoulder joint. Injuries to the labrum are common, can cause a great deal of pain, and may make it hard to move your arm. A labral tear can occur from a fall or from repetitive work activities or sports that require you to use your arms raised above your head. Some labral tears can be managed with physical therapy; in severe cases, surgery may be required to repair the torn labrum.

The ring of cartilage called the glenoid labrum provides extra support for the shoulder joint, helping to keep it in place. A shoulder labral tear occurs when part of this ring is disrupted, frayed, or torn. Tears may lead to shoulder pain, an unstable shoulder joint, and, in severe cases, dislocation of the shoulder. Likewise, a shoulder dislocation can result in labral tears.

When you think of the shoulder joint, picture a golf ball (the head of the upper-arm bone, or humerus) resting on a golf tee (the glenoid fossa, a shallow cavity or socket located on the shoulder blade, or scapula). The labrum provides a rim for the socket (golf tee) so that the humerus (golf ball) does not easily fall off. If the labrum is torn, it is harder for the humerus to stay in the socket. The end result is that the shoulder joint becomes unstable and prone to injury.

Because the biceps tendon attaches to the shoulder blade through the labrum, labral tears can occur when you put extra strain on the biceps muscle, such as when you throw a ball. Tears also can result from pinching or compressing the shoulder joint, when the arm is raised overhead.

There are 2 types of labral tears:

Traumatic labral tears usually occur because of a single incident, such as a shoulder dislocation or an injury from heavy lifting. People who use their arms raised over their heads—such as weight lifters, gymnasts, and construction workers—are more likely to experience traumatic labral tears. Activities where the force occurs at a distance from the shoulder, such as striking a hammer or swinging a racquet, can cause a traumatic labral tear. Falling on an outstretched arm also can cause this type of tear.

Nontraumatic labral tears most often occur because of muscle weakness or shoulder joint instability. When the muscles that stabilize the shoulder joint are weak, more stress is put on the labrum, leading to a tear. People with nontraumatic tears tend to have more "looseness" or greater mobility throughout all their joints, which might be a factor in the development of a tear.

How Does it Feel?

A shoulder labral tear may cause you to feel:

Pain over the top of your shoulder
"Popping," "clunking," or "catching" with shoulder movement, because the torn labrum has "loose ends" that are flipped or rolled within the shoulder joint during arm movement, and may even become trapped between the upper arm and shoulder blade
Shoulder weakness, often on one side
A sensation that your shoulder joint will pop out of place

How Is It Diagnosed?

Not all shoulder labral tears cause symptoms. In fact, when tears are small, many people function without any symptoms. However, healing may be difficult due to the lack of blood supply available to a torn labrum. The shoulder with a labral tear may pop or click without being painful, but if the tear progresses, it is likely to lead to pain and weakness.

If your physical therapist suspects that you have a labral tear, your physical therapist will review your health history and perform an examination that is designed to test the condition of the glenoid labrum. The tests will place your shoulder in positions that may recreate some of your symptoms, such as "popping," "clicking," or mild pain, to help your physical therapist determine whether your shoulder joint is unstable. Magnetic resonance imaging (MRI) also may be used to complete the diagnosis. Some labral tears may be difficult to diagnose with certainty without arthroscopic surgery. Your physical therapist may consult with an orthopedic surgeon if necessary.

How Can a Physical Therapist Help?

When shoulder labral tears cause minor symptoms but don’t cause shoulder instability, they usually are treated with physical therapy. Your physical therapist will educate you about positions and activities to avoid, and tailor a treatment plan for your recovery. Your treatment may include:

Manual therapy. Your physical therapist may provide gentle manual (hands-on) therapy to decrease your pain and begin to restore movement in the shoulder area.

Strengthening exercises. Improving the strength of the muscles of the shoulder will help you decrease the stresses placed on the torn labrum and allow for better healing. Your physical therapist may design rotation exercises that target the muscles of the shoulder joint, and shoulder-blade (scapular) exercises to provide stability to the shoulder joint itself.

Stretching exercises. An imbalance in the muscles or a decrease in flexibility can result in poor posture or excessive stress within the shoulder joint. Your physical therapist may prescribe stretching exercises—such as gentle stretches of the chest (pectoralis) muscles—to improve the function of the muscles surrounding the shoulder. Your physical therapist also may introduce middle-back (thoracic) stretches to allow your body to rotate or twist to the side, so the shoulder joint doesn’t have to stretch further to perform tasks, such as swinging a racquet or golf club.

Postural exercises. Your physical therapist will assess your posture, and teach you specific exercises to ensure your shoulders are positioned properly for daily tasks. A forward-head and rounded-shoulder posture puts the shoulders at risk for injury.

Education. Education is an important part of any physical therapy treatment plan. Your physical therapist will help you understand your injury, the reasons for modifying your activities, and the importance of doing your exercises to decrease your risk of future injury.

Home-exercise program. A home-exercise program is an important companion to treatment in the physical therapy clinic. Your physical therapist will identify the stretching and strengthening exercises that will help you steadily improve your shoulder function and meet your work, home, and activity goals.

Following Surgery

In more severe cases, when conservative treatments are unable to completely relieve the symptoms of a labral tear, surgery may be required to reattach the torn labrum. Following surgery, your physical therapist will design a treatment program based on your specific needs and goals, and work with you to help you safely return to your daily activities.

A surgically repaired labrum takes 9 to 12 months to completely heal. Immediately following surgery, your physical therapist will teach you ways to avoid putting excessive stress or strain on the repaired labrum.

As the labrum heals, your physical therapist will introduce resistance and strengthening exercises, such as those listed above, to your treatment plan, to address your specific needs, and help you slowly and safely return to performing daily tasks that require force or lifting. Your physical therapist is trained to gradually introduce movements in a safe manner to allow you to return to your usual activities without re-injuring the repaired tissues.

Can this Injury or Condition be Prevented?

Forceful activities performed with the arms raised overhead may increase the likelihood of developing a labral tear. To avoid putting excessive stress on the labrum, you need to develop strength in the muscles that surround the shoulder and scapula. Your physical therapist can:

Design exercises to help you strengthen your shoulder and shoulder blade muscles
Show you how to avoid potentially harmful positions
Train you to properly control your shoulder movement and modify your activities to reduce your risk of sustaining a labral injury
Provide posture education to help you avoid placing unnecessary forces on the shoulder
Help you increase your shoulder and middle-back flexibility

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat patients who have a shoulder labral tear, but you may want to consider:

A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with an orthopedic focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedics physical therapy 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 labral tears.
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.

Achilles Tendinopathy→

August 21, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Achilles tendinopathy is an irritation of the Achilles tendon. Achilles tendon pain is one of the most common types of pain felt behind the heel and up the back of the ankle when walking or running. Although Achilles tendinopathy affects both active and inactive individuals, 24% of athletes develop the condition, and an estimated 50% of runners will experience Achilles tendon pain in their running careers. In all individuals, Achilles tendinopathy can result in a limited ability to walk, climb stairs, or participate in recreational activities. Physical therapists help people with Achilles tendinopathy reduce pain in the affected area, and restore strength, flexibility, and mobility to the injured tendon and eliminate swelling when present.

Achilles Tendinopathy

Achilles tendinopathy is an irritation of the Achilles tendon, a thick band of tissue along the back of the lower leg that connects the calf muscles to the heel. The term “tendinopathy” refers to any problem with a tendon, either short- or long-term. The Achilles tendon transmits force from the calf muscles down to the foot when a person pushes the foot off the ground (eg, runs or jumps), and helps control the position of the ankle when the foot touches back down on the ground (eg, lands). Achilles tendinopathy results when the demand placed on the Achilles tendon is greater than its ability to function. The condition can occur after a single incident (acute injury) or after repetitive irritation or "microtrauma" (chronic injury). Most often, Achilles tendon pain is the result of repetitive trauma to the tendon that can result in chronic Achilles tendinopathy—a gradual breakdown of the tissue—and is most often treated with physical therapy.

Achilles tendinopathy is linked to several different factors, including:

Calf muscle tightness
Calf muscle weakness
Abnormal foot structure
Abnormal foot mechanics
Improper footwear
A change in an exercise routine or sport activity
Obesity

Pain can be present at any point along the tendon; the most common area to feel tenderness is just above the heel (known as midportion Achilles tendinopathy), although it may also be present where the tendon meets the heel (known as insertional Achilles tendinopathy).

How Does it Feel?

With Achilles tendinopathy, you may experience:

Tenderness in the heel or higher up in the Achilles tendon with manually applied pressure
Pain and stiffness with walking, at its worst with the first several steps
Tightness in the calf
Swelling in the back of the ankle

How Is It Diagnosed?

Your physical therapist will review your medical history and complete a thorough examination of your heel, ankle, and calf. Your physical therapist will assess your foot posture, strength, flexibility, and movement. This process may include watching you stand in a relaxed stance, walk, squat, step onto a stair, or do a heel raise. The motion and strength in other parts of your leg also will be assessed.

Your physical therapist may also ask questions regarding your daily activities, exercise regimens, and footwear, to identify other contributing factors to your condition.

Imaging techniques, such as X-ray or MRI, are often not needed to diagnose Achilles tendinopathy. Although it is unlikely that your condition will ultimately require surgery, your physical therapist will consult with other medical professionals, such as an orthopedist, to determine the best plan of treatment for your specific condition if it does not respond to conservative care.

How Can a Physical Therapist Help?

Physical therapy promotes recovery from Achilles tendinopathy by addressing issues such as pain or swelling of the affected area, and any lack of strength, flexibility, or body control. You and your physical therapist will work together to develop an individualized treatment program to help you achieve your specific goals in the safest and most effective way possible. Your treatment may include:

Education. Your physical therapist will work with you to identify any possible external factors causing your pain, such as faulty footwear or inappropriate movements or exercises. Your physical therapist will assess your footwear and recommend improvements, and develop a personalized exercise program to help ensure a pain-free return to your desired activities.

Pain management. Many pain-relief strategies may be implemented, such as applying ice to the area, putting the affected leg in a brace, using heel lifts, or using therapies such as iontophoresis (a medicated patch placed on the skin that is electrically charged and used to decrease pain and inflammation), or therapeutic ultrasound. These strategies can reduce the need for pain medication, including opioids.

Manual therapy. Your physical therapist may apply hands-on treatments to gently move your muscles and joints in order to improve their motion and function. These techniques often address areas that are difficult to treat on your own.

Range-of-motion treatments. Your ankle, foot, or knee joint may be moving improperly, causing increased strain on the Achilles tendon. Self-stretching and manual therapy techniques (massage and movement) applied to the lower body to help restore and normalize motion in the foot, ankle, knee, and hip can decrease this tension and restore full range of motion.

Gentle exercise. Loading of the tendon (applying weight or resistance to it) through exercise is beneficial for recovery from Achilles tendinopathy. You may begin by performing gentle strengthening exercises in a seated position (eg, pushing and pulling on a resistive band with your foot). You then may advance to exercises in a standing position (eg, standing heel raises).

Muscle-strengthening exercises. Muscle weakness or imbalance can result in excessive strain on the Achilles tendon. Based on your specific condition, your physical therapist will design an individualized, progressive, lower-extremity resistance program for you to help correct any weakness-associated movement errors that may be contributing to your pain.

Functional training. Once your pain eases and your strength and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension placed on the Achilles tendon and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your goals and movement assessment, your physical therapist will create a series of activities that will help you learn how to use and move your body correctly to safely perform the tasks required to achieve your goals.

If additional interventions are needed, such as injections, minimally invasive tendon procedures, or surgery, your physical therapist will work with you after your procedure to help you regain motion, strength, and function.

Can this Injury or Condition be Prevented?

Maintaining appropriate lower-extremity mobility and muscular strength, and paying particular attention to your exercise routine—especially changes in an exercise surface, the volume of exercises performed, and your footwear—are the best methods for preventing Achilles tendinopathy.

When you have experienced an injury, your physical therapist will help guide you through a process that will progressively reintegrate more demanding activities into your routine without aggravating your Achilles tendon. Keep in mind that returning to high-level activities too soon after injury can lead to another episode of pain.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat Achilles tendinopathy. However, you may want to consider:

A physical therapist who is experienced in treating people with Achilles tendinopathy. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
A physical therapist who is a board-certified orthopaedic clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical 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 Achilles tendinopathy.
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.

What is Pitcher's Elbow?→

August 14, 2018/ Pro Dynamic Physical Therapy/ Travis Tanasse

Pitcher's elbow, also known as medial epicondyle apophysitis, is a common injury that occurs among young baseball players. Caused by "overuse" and "repetitive motion," pitcher's elbow causes pain and swelling inside of the elbow, can limit one's ran… — Pitcher's elbow, also known as medial epicondyle apophysitis, is a common injury that occurs among young baseball players. Caused by "overuse" and "repetitive motion," pitcher's elbow causes pain and swelling inside of the elbow, can limit one's range of motion, and will limit or prevent the ability to throw a ball.
Causes
The forceful and repetitive nature of overhand throwing for baseball players (pitchers in particular) can cause inflammation of the growth plate inside the throwing elbow, resulting in pitcher's elbow. Adolescent baseball players are most likely to experience this injury because their elbow structure (ie, bones, growth plates, and ligaments) is not fully mature or developed.
The following risk factors contribute to pitcher's elbow:
**Age.** Young baseball players (particularly those between the ages of 9 and 14 years) are at greater risk because their elbow joints are not fully developed. Less mature bones, looseness of the ligaments, open growth plates, and undeveloped musculature are common in youth pitchers and predispose them to overuse injuries.
**Pitching too many games.** The number of games pitched should be carefully monitored and the league's pitch count rules followed. Research has proven that overuse in baseball contributes to injuries such as pitcher's elbow. Specifically, there is evidence it can occur over the course of a game (pitching more than than 75 pitches per game), per season (pitching more than 1,000 pitches per season), or per year (pitching more than 3,000 pitches per year. Also, it is advised that pitching not occur for greater than 8 months of the year. If pain occurs before the pitch count limit is reached, the player should stop immediately. Additionally, pitching should be halted if fatigue is experienced during the game. Rotating pitchers within games is a good idea to ensure each pitcher gets adequate rest.
**Curveballs and breaking pitches.** Likely due to poor pitch mechanics, both of these types of pitches appear to put more stress on the growth plate than other pitches. These should be limited, especially in players between the ages of 9 and 14 years.
**Improper mechanics.** Improper throwing mechanics can put undue force on the elbow joint. Proper throwing mechanics can help a young player avoid unnecessary injury and develop proper technique that improves their game. Your coach or other qualified instructors can be used as a resource to ensure you have learned proper mechanics.
More about pitch count
**No multiple pitching appearances in a single game.** Your child should not make more than 1 pitching appearance in 1 game (ie, pitch, change positions, then pitch again).
**No circumventing pitch count rules by pitching in multiple leagues.** Most youths now play in multiple leagues and the number of pitches can only be tracked for each individual league. It is important to avoid violating the pitch count restrictions by pitching in multiple leagues.
**No pitching at home after having pitched in a game.** To limit the number and amount of overall pitches thrown, players are advised not to pitch at home after having pitched in a game.
**Get appropriate rest between pitching performances**. See recommended pitch count rules.
How a Physical Therapist Can Help
Physical therapists are experts in restoring and improving mobility and motion in people's lives, and eliminating pain. For young baseball players, this means a physical therapist will work with you to help prevent pitcher's elbow, and recover safely if it does occur.
In addition to following the guidelines for pitch counts and recommendations for rest, a physical therapist will help baseball players prevent the occurrence of pitcher's elbow by teaching them stretching and strengthening exercises that are individualized to their specific needs. Everybody is different, which means pitcher's elbow may occur for different reasons for each person. A physical therapist will help a player recover by designing an individualized treatment plan to regain range of motion, flexibility, and strength.
Bibliography
MomsTeam.com. Protecting Young Pitching Arms. The Little League pitch count regulation guide for parents, coaches, and league officials. Updated February 27, 2017. Accessed March 7, 2018.
Fleisig GS, Andrews JR, Cutter GR, et al. Risk of serious injury for young baseball pitchers: a 10-year prospective study. *Am J Sports Med*. 2011;39(2):253–257. Free Article.
Nissen CW, Westwell M, Ounpuu S, Patel M, Solomito M, Tate J. A biomechanical comparison of the fastball and curveball in adolescent baseball pitchers. *Am J Sports Med*. 2009;37(8):1492–1498. Free Article.
Dun S, Loftice J. Fleisig GS, Kingsley D, and Andrews JR. A biomechanical comparison of youth baseball pitches: is the curveball potentially harmful? Am J Sports Med. 2008;36(4):686–692. Free Article.
Olsen SJ Jr, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34(6):905–912. Free Article.
USA Baseball Medical & Safety Advisory Committee. Position statement on youth baseball injuries. Updated May 2006. Accessed March 7, 2018.
Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30(4):463 –468. Free Article.
Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc. 2001;33(11):1803–1810. Free Article.
Andrews JR, Fleisig GS. Preventing throwing injuries [editorial]. J Orthop Sports Phys Ther. 1998;27(3):187–188. Free Article.
Ireland ML, Hutchinson MR. Upper extremity injuries in young athletes. Clin Sports Med. 1995;14(3):533–569. Article Summary in PubMed.

August 05, 2018

Guide to Calf Strain→

August 05, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

What is a Calf Strain?

The “calf muscle” consists of 9 different muscles. The gastrocnemius, soleus, and plantaris muscles attach onto the heel bone, and work together to produce the downward motion of the foot. The other 6 muscles cause knee, toe, and foot movements in different directions; these muscles are the popliteus, flexor digitorum longus, flexor hallucis longus, tibialis posterior, and the fibularis (or peroneal) longus and brevis. They extend from the lower leg bones around the sides of the ankle and attach to various parts of the foot and toes. Injuries to these 6 muscles are sometimes wrongly attributed to the first 3 muscles mentioned here, as the pain is felt in similar areas of the calf.

A calf strain is caused by overstretching or tearing any of the 9 muscles of the calf. Calf strains can occur suddenly or slowly over time, and activities, such as walking, climbing stairs, or running can be painful, difficult, or impossible.

A muscle strain is graded according to the amount of muscle damage that has occurred:

Grade 1. A mild or partial stretch or tearing of a few muscle fibers. The muscle is tender and painful, but maintains its normal strength. Use of the leg is not impaired, and walking is normal.
Grade 2. A moderate stretch or tearing of a greater percentage of the muscle fibers. A snapping or pulling sensation may occur at the time of the injury and after the injury. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. Use of the leg is visibly impaired, and limping when walking is common.
Grade 3. A severe tear of the muscle fibers, sometimes a complete muscle tear. A “popping” sound may be heard or felt when the injury occurs. Bruising is apparent, and sometimes a “dent” in the muscle where it is torn is visible beneath the skin. Use of the leg is extremely difficult, and putting weight on the leg is very painful.

When muscles are strained or torn, muscle fibers and other cells are disrupted and bleeding occurs, which causes bruising. Within a few hours of the injury, swelling can occur, causing the injured area to expand and feel tight and stiff.

After a severe calf strain, bruising may also be seen around the ankle or foot, as gravity pulls the escaped blood toward the lower part of the leg.

How Does it Feel?

If you strain your calf muscles, you may feel:

Sharp pain or weakness in the back of the lower leg. The pain can quickly resolve, or can persist.
A throbbing pain at rest with sharp stabs of pain occurring when you try to stand or walk.
A feeling of tightness or weakness in the calf area.
Spasms (a gripping or severe tightening feeling in the calf muscle).
Sharp pain in the back of the lower leg, when trying to stretch or move the ankle or knee.
A “pop” or hear a “pop” sound at the time of injury (with a Grade 3 calf strain).

Signs and Symptoms

With a calf strain, you may experience:

A snap or pull felt or heard at the time of injury (with a Grade 1 and 2 calf strain). A "pop" may be felt or heard at the time of injury of a Grade 3 calf strain.
Pain and weakness in the calf area.
Swelling in the area.
Tightness in the area.
Bruising.
Weakness in the calf when trying to walk, climb stairs, or stand.
Limping when walking.
Difficulty performing daily activities that require standing and walking.
An inability to run or jump on the affected leg.

How Is It Diagnosed?

If you see your physical therapist first, your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will ask you:

What were you doing when you first felt pain?
Where did you feel the pain?
Did you hear or feel a "pop" when it occurred?
Did you receive a direct hit to your calf area?
Did you see severe swelling in the first 2 to 3 hours following the injury?
Do you feel pain when moving your ankle or knee, standing, or walking?

Your physical therapist will perform special tests to help determine whether you have a calf strain, such as:

Watch how you walk, and see if you can bear weight on the injured leg.
Test the different calf muscles for weakness.
Look for swelling or bruising.
Gently feel parts of the muscle to determine the specific location of the injury (palpation).

Your physical therapist may use additional tests to assess possible damage to specific muscles of the lower leg.

In certain cases, your physical therapist may collaborate with an orthopedist or other health care provider. The orthopedist may order further tests, such as an x-ray or magnetic resonance imaging (MRI), to confirm the diagnosis and to rule out other potential damage. These tests, however, are not commonly required for a calf strain.

How Can a Physical Therapist Help?

Your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments that you can do at home to help you return to your normal lifestyle and activities.

The First 24 to 48 Hours

Your physical therapist may advise you to:

Rest the area by avoiding walking or any activity that causes pain. Crutches or a brace may be recommended to reduce further strain on the muscles when walking.
Apply ice packs to the area for 15 to 20 minutes every 2 hours.
Compress the area with an elastic bandage wrap.
Insert heel lift pads into both of your shoes.
Consult with another health care provider for further services, such as medication or diagnostic tests.

Treatment Plan

Your physical therapist will provide treatments to:

Reduce Pain. Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electricity, taping, exercises, heel lifts, and hands-on therapy, such as massage.

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the knee and ankle. These might begin with "passive" motions that the physical therapist performs for you to gently move your knee and ankle, and progress to active exercises and stretches that you perform yourself to increase muscle flexibility.

Improve Strength. Certain exercises will benefit healing at each stage of recovery; your physical therapist will choose the appropriate exercises, and teach you how to safely and steadily restore your strength and agility. These may include using cuff weights, stretchy bands, weight-lifting equipment, and cardio exercise equipment, such as treadmills or stationary bicycles.

Speed Recovery Time. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

Return to Activities. Your physical therapist will collaborate with you to decide on your recovery goals, including your return to work or sport, and will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will apply hands-on therapy, such as massage, and teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Prevent Future Reinjury. Your physical therapist can recommend a home-exercise program to strengthen and stretch the muscles around your ankle and knee to help prevent future reinjury of your calf. These may include strength and flexibility exercises for the calf, toe, knee, and ankle muscles.

If Surgery Is Necessary

Surgery is rarely necessary in the case of calf strain, but if a calf muscle fully tears and requires surgical repair, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the safest and speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

Calf strains can be prevented by:

Increasing the intensity of any activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
Always warming up before starting a sport or heavy physical activity.
Following a consistent strength and flexibility/stretching exercise program to maintain good physical conditioning, even in a sport's off-season.
Wearing shoes that are in good condition and fit well.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat calf strains. However, you may want to consider:

A physical therapist who is experienced in treating people with calf strains.
A physical therapist whose practice focus is in orthopedics or sports rehabilitation.
A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in sports 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 who have calf strains.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and describe what makes your symptoms worse.

Authored by Andrea Avruskin, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.

August 02, 2018

Physical Therapist's Guide to Iliotibial Band Syndrome (ITBS or "IT Band Syndrome")→

August 02, 2018/ Pro Dynamic Physical Therapy/ Travis Tanasse

Iliotibial band syndrome (ITBS) is one of the most common causes of knee pain, particularly in individuals involved in endurance sports. It accounts for up to 12% of running injuries and up to 24% of cycling injuries. ITBS is typically managed conservatively through physical therapy and temporary activity modification.

What is Iliotibial Band Syndrome (ITBS)?

Iliotibial band syndrome (ITBS) occurs when excessive irritation causes pain at the outside (or lateral) part of the knee. The iliotibial band (ITB), often referred to as the "IT band" is a type of soft tissue that runs along the side of the thigh from the pelvis to the knee. As it approaches the knee, its shape thickens as it crosses a prominent area of the thigh (femur) bone, called the lateral femoral condyle. Near the pelvis, it attaches to 2 important hip muscles, the tensor fascia latae (TFL) and the gluteus maximus.

Irritation and inflammation arise from friction between the ITB and underlying structures when an individual moves through repetitive straightening (extension) and bending (flexion) of the knee. Typically, ITBS pain occurs with overuse during activities such as running and cycling.

ITBS involves many lower extremity structures, including muscles, bones, and other soft tissues. Usually discomfort arises from:

Abnormal contact between the ITB and thigh (femur) bone
Poor alignment and/or muscular control of the lower body
Prolonged pinching (compression) or rubbing (shearing) forces during repetitive activities

The common structures involved in ITBS are:

Iliotibial band
Bursa (fluid-filled sack that sits between bones and soft tissues to limit friction)
Hip muscles

ITBS can occur in:

Athletes performing repetitive activities, such as squatting, and endurance sports such as running and cycling
Individuals who spend long periods of time in prolonged positions, such as sitting or standing for a long workday, climbing or squatting, or kneeling
Individuals who quickly start a new exercise regimen without proper warm-up or preparation

Signs and Symptoms

With ITBS, you may experience:

Stabbing or stinging pain along the outside of the knee
A feeling of the ITB “snapping” over the knee as it bends and straightens
Swelling near the outside of your knee
Occasionally, tightness and pain at the outside of the hip
Continuous pain following activity, particularly with walking, climbing, or descending stairs, or moving from a sitting to standing position

Pain is usually most intense when the knee is in a slightly bent position, either right before or right after the foot strikes the ground. This is the point where the ITB rubs the most over the femur.

How Is It Diagnosed?

Your physical therapist will ask you questions about your medical history and activity regimen. A physical examination will be performed so that your physical therapist can collect movement (range of motion), strength, and flexibility measurements at the hip, knee, and ankle.

When dealing with ITBS, it is also common for a physical therapist to use special tests and complete a movement analysis, which will provide information on the way that you move and how it might contribute to your injury. This could include assessment of walking/running mechanics, foot structure, and balance. Your therapist may have you repeat the activity that causes your pain to see firsthand how your body moves when you feel pain. If you are an athlete, your therapist might also ask you about your chosen sport, shoes, training routes, and exercise routine.

Typically, medical imaging tests, such as x-ray and MRI, are not needed to diagnosis ITBS.

How Can a Physical Therapist Help?

Your physical therapist will use treatment strategies to focus on:

Range of motion

Often, abnormal motion of the hip and knee and foot joint can cause ITBS because of how the band attaches to hip muscles. Your therapist will assess the motion of your injury leg compared with expected normal motion and the motion of the hip on your uninvolved leg.

Muscle strength

Hip and core weakness can contribute to ITBS. The "core" refers to the muscles of the abdomen, low back, and pelvis. Core strength is important, as a strong midsection will allow greater stability through the body as the arms and legs go through various motions. For athletes performing endurance sports, it is important to have a strong core to stabilize the hip and knee joints during repetitive leg motions. Your physical therapist will be able to determine which muscles are weak and provide specific exercises to target these areas.

Manual therapy

Many physical therapists are trained in manual therapy, which means they use their hands to move and manipulate muscles and joints to improve motion and strength. These techniques can target areas that are difficult to treat on your own.

Functional training

Even when an individual has normal motion and strength, it is important to teach the body how to perform controlled and coordinated movements so there is no longer excessive stress at the previously injured structures. Your physical therapist will develop a functional training program specific to your desired activity. This means creating exercises that will replicate your activities and challenge your body to learn the correct way to move.

Your physical therapist will also work with you to develop an individualized treatment program specific to your personal goals. He or she will offer tips to help you prevent your injury from reoccurring.

Can this Injury or Condition be Prevented?

Maintaining core and lower extremity strength and flexibility and monitoring your activity best prevents ITBS. It is important to modify your activity and contact your physical therapist soon after first feeling pain. Research indicates that when soft tissues are irritated and the offending activity is continued, the body does not have time to repair the injured area. This often leads to persistent pain, and the condition becomes more difficult to resolve.

Once you are involved in a rehabilitation program, your physical therapist will help you determine when you are ready to progress back to your previous activity level. He or she will make sure that your body is ready to handle the demands of your activities so that your injury does not return. You will also receive a program to perform at home that will help you maintain the improvements that you gained during rehabilitation.

Real Life Experiences

Sarah is a 31-year-old mother training for her first triathlon. With a young child at home, she has to squeeze in her training sessions early in the morning. She rarely has time to cool down or stretch after riding her bike or running because she has to get home before her child wakes up.

Sarah signs up for her first race and begins to increase her cycling and running in preparation. One day during the middle of a long run, she feels a sharp pain at the outside of her knee. It starts hurting with every step, and doesn't go away, even after she stops and stretches. Far from home, she has to finish her run despite the nagging pain. When she gets home, she puts ice on it, but for the rest of the day she has trouble going up and down stairs, or squatting to pick up her son, and feels pain when standing up after driving the car. The next day, she tries to ride her bike, but the knee pain is still there and feels worse.

Wisely, Sarah stops running and cycling and contacts her physical therapist.

Sarah's physical therapist conducts a comprehensive evaluation of her hip and knee motion, strength, balance, and running mechanics. She uses special tests and measures to determine if Sarah’s pain is related to her iliotibial band or if there are other problems occurring simultaneously. She talks with Sarah about her training routine, including equipment (shoes, position on the bike, etc), the routes she runs and their surfaces, and her stretching program. The therapist diagnoses Sarah with iliotibial band syndrome. She guides Sarah through specific exercises in the clinic, including manual stretching of the hip joint by the therapist, sidelying leg raises for hip strengthening, and single leg squats to promote integrated core, hip, knee, and ankle function. Sarah will also perform these exercises at home as a part of her daily exercise routine to maximize improvement and help ensure her sustainable success.

Sarah's physical therapist helps her develop strategies for training, taking into consideration her lifestyle as a busy mother, to help her stay injury-free. Together, they outline a 6-week rehabilitation program for iliotibial band syndrome. Sarah will come to the clinic 1-2 times each week, where her therapist will assess her progress, perform manual therapy techniques, and advance her exercise program as appropriate. Sarah will also have a daily exercise routine to perform independently at home, including stretching and strengthening activities.

In 6 weeks, Sarah has met all of her physical therapy goals and completes her rehabilitation in the clinic. After building her training gradually over the next month, she is able to train and successfully crosses the finish line just as planned!

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 orthopedic, or musculoskeletal, injuries.
A physical therapist who is a board-certified specialist or who has completed a residency in orthopedic or sports physical therapy, as he or she will have advanced knowledge, experience, and skills that apply to an athletic population.

You can find physical therapists that 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 (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 ITBS.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.

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