Physical Therapy Information, Educational Information, Glossary
Coordination in Athletic activities
My Knee Hurts and I'm having arthroscopic surgery!
There is nothing to fear! Depending on the injury and severity of the damage, recovery should be fairly speedy. One of the best reasons to have arthroscopic repair is when a piece of cartilage floats in the joint space leading to impaired arthrokinematics (joint movement).
Physical Therapy prior to surgery and immediately after can hasten recovery and maintain muscle strength to aid in weightbearing quickly.
This is a painful, scary condition that can lead to buckling, locking, swelling, pain and instability. Many people wear an immobilizer or knee brace specially designed to prevent further damage to the joint. This is helpful in the short term but is only a minor quick fix to a manageable problem.
Having partially torn both of my ACL's and helping others recover from tears and preventing surgery, I can tell you two things:
1. ACL surgery is not always necessary, sometimes it's not even ideal.
2. Physical Therapy can drastically help- regardless of surgical intervention.
A focused program of physical therapy can help to minimize pain and decondtioning before surgery and decrease swelling quickly after the initial injury.
In research studies performed in the past 10 years, a significant percentage of athletes sustaining ACL tears and having surgical intervention decide not to return to sports which leads many to wonder if they are appropriate and necessary, particularly when the injury is acute and inflamed.
Recovery after ACL surgery can last from 2-4 months of intense physical therapy during which even small amounts of walking can be challenging and fatiguing. I have bilateral tears in my ACL, leading me to have 10-15 degrees of knee hyperextension in both knees but I am still able to run, ski and squat without difficulty.
I routinely help athletes in NYC check the integrity of their ACL using movement testing and static ligament testing. Many times, these findings will support the need for focused physical therapy to improve function.
While many people train heavily, recreationally or competitively, overtraining can occur very easily.
Five signs that you are Overtraining
1. Fatigue, even after long bouts of sleeping.
2. Increased frequency of colds/ sickness.
3. Diffuse pain throughout the body.
4. Painful Joints
5. Poor performance and new intolerance for the sport/ activity.
What you can do:
Take a break from the activity. Cross-training can help you to stay in shape and not lose strength while allowing your mind and body a chance to rest and recover. Even with sufficient rest, it can take weeks to fully recover from overtraining.
Barefoot Running- Fad or Future?
Many people are tossing their heavily cushioned and supportive running trainers and opting for shoes which are minimally cushioned or choosing to run barefoot (at least indoors, in my experience). Biomechanically speaking, there is less shock transmitted to the spine by running barefoot and landing on the heel. Running seems to require less effort but it can be problematic for those with a history of ankle sprains, plantar fasciitis or achilles tendonitis. While it may be difficult to attempt this on NYC streets, many people report a drastic change in their energy levels and pain after running.
Leg/ Calf Cramps and What they Mean
Lately, many people have reported frequent leg cramping after activity, Often, this can indicate one of two things:
1. A drastic increase in activity you are unaccustomed to.
2. A drastic decrease in activity recently (i.e. an Olympian after competing and in deconditioning).
Use of judgment is helpful with leg cramps and determining what the offending activity is will help decrease the likelihood of it occurring again. Stretching and progressive physical therapy can help with the pain of frequent cramping.
The reason for motion sickness
If you have ever suffered an attack of vertigo or experienced motion sickness, you are aware of how extremely debilitating and disruptive to daily life it can be. I like to use motion sickness as an example of how adaptable our inner ear/ brain are to change.
The main reason for motion sickness is a conflict of information from the inner ear (which acts like a level) and the eyes. If you are reading while rocking on a swing, the information your brain receives from your eyes tells you that you are still but the conflict is revealed when the inner ear send information that it is detecting movement and acceleration. The result is that you begin to feel dizzy or nauseous, which is your bodies way of telling you to STOP.
While motion sickness is not pleasant, it can be treated by using a principle similar to how vaccines are effective in inoculation. By lightly triggering some of the symptoms of nausea and dizziness, the brain becomes accustomed to the activity and more tolerant of it, leading to sustain the activity longer without feeling dizzy or nauseous. The brain learns to process the information differently and it is not regarded as harmful each ensuing time you attempt it. This is what we focus on in physical therapy treatments to assist with decreasing the discomfort of vertigo and increasing the ability of one to function without experiencing fear when going outside.
The same way our brain is able to learn new activities, process memories and allow us to dream is the same way we can learn to adapt to new and somewhat uncomfortable activities.
Due to the bent forward posture and the repetitive swinging, the lower back may become irritated. Combined with faulty postural habits, muscle weakness, limited flexibility and poor fitting equipment, the spine may become extremely irritated and lead to difficulty with regular movements of daily life.
Rest, physical therapy and a gradual return to exercise (often with assistance) is usually indicated. Proper fitting equipment and mechanics are crucial.
We often help analyze movements and suggest training with a Medicus swing trainer to achieve a more efficient swing.
Surprisingly, it affects more players than “golfer’s elbow”. Characterized by pain with gripping or moving the wrist and hand, it is brought on by absorbing too much shock or vibration through the hand, most commonly with swinging a club and initiating impact on the ball. The area of the elbow affected is very fibrous and does not have a good blood supply, leading injuries to stay inflamed for prolonged periods of time. Stiffness accompanies the pain and a gradual return to activity is necessary to avoid further injury. Physical Therapy can dramatically speed the recovery time and get you back playing at the top of your game!
Rotator Cuff Injuries and Tears
When people injure their shoulder and suddenly notice they cannot move, they often experience fear, panic and a fair amount of pain. Usually, once the inflammation eases, pain decreases and movement can be restored.
Upon visiting a specialist and having imaging studies, many people express concern when hearing they have a rotator cuff tear. This is not always cause for alarm; a partial tear of the rotator cuff is more akin to fraying of a rope, weakening the integrity and thickness of the tendon. As long as painful movements and inflammation is controlled, the tendon will heal and can be strengthened with physical therapy.
A complete or full thickness rotator cuff tear presents with an inability to raise the arm initially, especially slowly, without the use of momentum or substituting muscle groups.
One of the most damaging injuries is one in which the dominant arm is affected and the person does work which involves overhead movements. This can lead to further damage at the shoulder joint and force the shoulder to move in a compromising manner, leading to pain at the neck and upper back.
Tips for avoiding chronic injury at the shoulder- A Physical Therapist's perspective
Locate any tender spots at the shoulder. You can contact us to help you distinguish all the tendons and where they can be palpated to accurately check for inflammation or tenderness.
Prevent injury before it happens. Be careful when exercising and avoid combined movements in which your elbow rises above the level of your shoulder. Exercises which do this may lead to impingement and rotator cuff damage.
Maintain adequate flexibility. By keeping an almost circular freedom of movement at the shoulder, you maintain the ability to reach overhead, to the side and rotate freely which what the shoulder is designed to do. If you are limited, you should seek help in order to avoid pain and further damage to the joint and the delicate balance of the rotator cuff function.
Three important things to do after an ankle sprain
1. Apply ice and rest- typically ice for 10-15 minutes will help to relieve inflammation and prevent further damage to the anterior talofibular ligaments or other supporting structures.
2. Try to remember the offending cause- was it a twist while walking on the sidewalk? Were you wearing high heels? Any information is useful in aiding in prevention.
3. See a specialist- Typically, you do not need to see an orthopedist for this problem, a physical therapist should be able to decrease the inflammation, increase range of motion and strength.
Ankle sprains are not self-limiting by nature, they will not recover fully on their own and will recur if you do not undergo adequate physical therapy or care to regain the muscular control necessary to maintain stability of the ankle.
With the advent of physical & contact sports such as mixed martial arts, kickboxing and Brazilian jiu-jitsu, many more recreational injuries are being reported to health care professionals. Below are 3 common injuries to watch out for when participating in these sports.
Hip bursitis/ inflammation
This is often reported in those who kick forcibly to the front, especially in Tae Kwon Do and the athletic kicking martial arts such as kickboxing. If you experience pain at the front of the hip, you should try to rest it and apply ice for ~10 minutes until the area is a bit numb. Repeated kicking should be avoided until pain is relieved.
Shin injuries
Most common in Muay Thai and when training, people often injure their shins (front of tibia) by training and kicking hard objects in order to toughen the point of impact on their lower legs. To relieve these painful areas, you should try to avoid kicking hard objects or wait until it is not extremely tender to the touch before you begin training anew. Ice applied to the shin
ACL tears
Mostly due to planting the foot and pivoting over it or by being kicked while only standing on one leg, this can be debilitating and traumatic. Unfortunately, I have seen many individuals continue training or fighting once this occurs, causing more damage and eventually requiring surgery. Proper protection of the standing or supporting leg is crucial to avoiding injury along with enough kinesthetic awareness to avoid a locked knee posture.
Reflex Sympathetic Dystrophy & Complex Regional Pain Syndrome
May be due to an altered firing pattern, or function, of the nerves in the affected extremity. Many people report tingling or numbness that varies throughout the day, often making activity excruciating to bear.
The most important stage to arrest and prevent RSD from setting in is in the early phase. Skin inspection and movement (if allowed) are crucial to prevent it
RSD & its role with pain
Reflex Sympthatetic Dystrophy (RSD) can be a debilitating condition, affecting many individuals post-operatively or those not undergoing surgery. Often characterized by swelling of the affected extremity, extreme tenderness to touch, impaired sensation and changes in skin texture.
While RSD is still poorly understood, the advent of spinal cord stimulators has proved beneficial to some individuals while others benefit from physical therapy addressing limitations in strength and flexibility.
Often, the pain can be unbearable to the point that clothing cannot be on the affected body part, due to an increase in pain. Medication may help to temporarily alleviate this pain and contrast baths, consisting of alternate heat and cold applications may stimulate the body part to decrease pain.
This is a very difficult condition to deal with, as it affects all aspects of life. We help those experiencing difficulty with this condition using an integrated approach of different specialties to minimize the pain and increase function.
Extreme Coordination & what it means for You
We are always astonished at the feats skilled athletes perform and marvel at their seemingly superhuman abilities. However, we often remember these feats are learned skills, practiced almost endlessly so they become routine in nature. For any skilled athlete, mistakes such as falling, twisting ankles, tripping, dropping a football or missing a shot lead to a change in the nervous system and its function.
Our bodies neuromuscular feedback mechanism is constantly adapting to the input provided when engaging in a high level athletic activity. The same level of neuromuscular activity is exhibited when someone has a difficult time with walking, going up stairs or controlling speed when walking down a ramp. The problem arises when there isn’t enough muscular strength to perform the activity or not enough ability to summon the strength efficiently (what I like to think of as coordination).
Train Like A Pro
We can train ourselves the same way athletes do, even if it is at a lower level of activity. If you are having a difficult time with walking, the best thing to do is attempt to analyze why the walking is difficult. Breaking down the difficult task into component motions can make it easier to assess performance and deficiencies within them.