Rehabilitation

Achilles Tendinitis

Achilles tendinitis is an overuse injury of the Achilles tendon. The Achilles tendon is the thick band of tissue that connects your calf muscles to your heel bone. Types of overuse includes increasing speed or running long distances too quickly, suddenly adding hills or stair climbing to an exercise routine, stressing the calf muscle too soon after taking time off from exercising, or putting stress on the calf muscles when they are not yet ready for stress.

Achilles tendinitis can be common in all ages but is more common in older adult men due to the fact that the tendon weakens as we age, and also in young athletes due to repetitive stress and strain from intensive training. Other risk factors include poor flexibility, lack of range of motion, inverted foot structure, obesity/diabetes, poor exercise training program, poor footwear, or increased use of corticosteroids. There are two types of Achilles tendonitis:

  • Insertional Achilles tendonitis which affects the lower portion of your tendon where it attaches to your heel bone.
  • Noninsertional Achilles tendonitis which involves fibers in the middle portion of the tendon and tends to affect younger people who are active.

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after increased activity. Stiffness and tenderness can also occur with decreased use of the extremity. For example, an individual may experience stiffness with weight bearing when getting out of bed due to inactivity. People may also have difficulty wearing shoes due to increased swelling around the tendon site.

The most common treatment for acute tendinitis would be supportive care with rest and ice. This means stopping the activities that make pain worse and placing ice on the area that is inflamed and painful multiple times a day. Ankle taping to support the tendon has also been shown to be a helpful at home remedy. If pain persists and lingers, another option would be non-steroidal anti-inflammatory medication to assist with reducing pain and swelling. Physical therapy is a common route to take with both acute and chronic cases of Achilles tendinitis. Soft tissue mobilization and calf stretching are common treatments in physical therapy. There are also methods that have been proven helpful like cupping and dry needling. These can be performed on the tendon site if other conservative methods haven’t done the job.

Extracorporeal shockwave therapy can be used to stimulate healing. This is not a very common procedure and it has not shown consistent results. This is normally implemented on chronic cases of tendonitis when all conservative methods listed above have failed. ESWT uses high energy shockwave impulses to stimulate the healing process in damaged tendon tissue. It is a non-invasive procedure and is occasionally tried before surgery is considered.

If pain persists for more than 6 months after all conservative treatments, then surgery should be considered. The specific type of surgery will depend on the location of the tendinitis and the amount of damage to the tendon. Physical therapy is recommended after an Achilles tendon surgery and is an important part of recovery. Many patients require a year of rehab from start to finish before they are pain free.

Prevention of Achilles tendinitis can be taken in many ways. First, by wearing proper footwear that allows cushioning and arch support. Second, by slowly increasing activities and easing into new routines. And lastly, making it a priority to stretch and strengthen your calf muscles daily to improve agility and make the tendon less prone to injury.

Achilles Tendinitis2020-11-04T22:03:59+00:00

Scoliosis

Scoliosis is an abnormal curvature of the spine (backbone). The curvature can either be S shaped or C shaped. Currently there is no cure or cause for scoliosis. The curvature can either be right, which is most common in the thoracic region or left most common in the lumbar region.

Scoliosis is categorized into groups known as idiopathic or unknown cause (80% of all cases). Osteopathic is a bony spinal disease or abnormality cause. Myopathic is related to a disease causing muscle weakness.  Neuropathic is the result of CNS or central nervous system causing the scoliosis. Age of scoliosis diagnosis varies from infant to adulthood because the curvature can be very mild and not progress for years.

Scoliosis can be diagnosed using plain radiography and using the Cobb method to measure the degree of scoliosis (Goodman & Fuller). Also, an Adams test or forward bend test can be used with or without scoliometer (Goodman & Fuller). Having a base line degree of curvature can help monitor the progression and rate of change.

Scoliosis treatment in most cases involves strengthening, stretching and posture awareness to prevent progressive and severe spinal deformity. Further treatment might involve the Schroth method that uses exercises specific to each patient to return the curved spine to a more straight alignment. The exercise intent is to de-rotate, elongate and stabilize the spine (Gerard).

In cases that are more severe, spinal braces might be used and possibly even surgery using a rod to correct the spinal curve. Our clinic diagnosis scoliosis and provides individualized exercise programs to restore strength, improve alignment and reduce pain.

References

Gerard, A. (2020, April/May). When Life Throws You Curves. PI in Motion, 4.

Goodman, C. C., & Fuller, K. S. (2009). Pathology Implications for the Physical Therapist.

Scoliosis. (2020, April 29). MedlinePlus – Health Information from the National Library of Medicine. https://medlineplus.gov/scoliosis.html#

Scoliosis2020-11-04T21:55:07+00:00

Pre-habilitation

Pre-habilitation is a program specifically designed by therapists to meet the individual needs of a patient prior to a surgery or a medical procedure .This practice is often used for  orthopedic surgeries  for both acute and chronic injuries and helps to promote optimal outcomes and success.

These can range from an ACL rupture to an osteoarthritic knee waiting for replacement. “Pre-hab” provides patients with pain relieving techniques, stretches, and strengthening exercises needed in order to obtain a smooth and speedy recovery.

The goals of a pre-operative rehabilitation program include mentally preparing for surgery, reducing pain and inflammation, maximizing range of motion and muscular control, education of expectations post-surgery, and improving overall wellbeing and fitness.

The surgeon is only responsible for 50% of outcome success after a surgery or procedure. The other 50% is due to a patient’s commitment to recovery. Patients will feel better about their recovery process if they are able to get out of bed, go to the restroom, and walk around the house independently.

Outpatient therapy provides their patients with exercise programs to perform at home, making patients more comfortable and familiar with the types of intervention they will encounter post-surgery. Our clinic provides a wide range of knowledge and we would love to help you decide what type of care is best for you or your family members.

References

Ries, E. (2016). Better Sooner and Later: Prehabilitation. PT in Motion, 1-12. Retrieved from

http://www.apta.org/PTinMotion/2016/2/Prehabilitation/

What You Need to Know About Prehabilitation. (2014, July 1). Burke Rehabilitation Hospital. https://www.burke.org/blog/2014/7/what-you-need-to-know-about-prehabilitation/19

 

Pre-habilitation2020-03-04T20:39:10+00:00

Total Knee Replacement

A total knee replacement is the substitution of weight bearing surfaces in your knee with artificial joints commonly made from mixes of plastic, ceramic, and metal. Knee replacements are commonly prescribed to those who suffer from arthritis which results in painful wear-and-tear in the knees when doing normal daily activities.

After Surgery Care

Following total knee replacement, there are three major factors that need to be monitored by a medical professional:

1)    Wound healing

2)    Blood clot prevention

3)    Muscle strengthening

  • Proper wound care speeds up the healing process by preventing infection and leaving minimal scarring. The healthier the wound, the higher the potential for you to have the best function of your knee.
  • Blood clots can be very a dangerous complication and those who have had major surgery, such as total knee replacement, can be at risk. However, through proper care and exercise, blood clots can be prevented if treated and monitored diligently. You should inform your doctor if you experience any pain, tightness or swelling in your knee unrelated to your incision.
  • Muscle strengthening is vital to the functionality of your knee following surgery. Proper range of motion exercises, joint mobilizations, and other modalities can all be used to improve knee function following surgery.
  • A total knee replacement may seem like a scary process, but can be very simple and beneficial when in the right hands. Post-surgery rehabilitation is key to a successful total knee replacement, and all of the above services can be provided here at Yukon Wound Care and Rehab.

 

 

 

Total Knee Replacement2019-11-06T21:18:40+00:00

TMJ – Temporomandibular Joint

Temporomandibular Joint

Temporomandibular joint aka TMJ is pain in and around the ear where the mandible attaches to the skull. The temporomandibular (TMJ) joint allows you to open and close your mouth for chewing, talking and yawning. Dysfunction of this joint causes jaw pain, headaches, swelling, numbness, radiating pain, stiffness, jaw locking, clicking and popping.

Occasionally acute TMJ pain will improve without treatment using home remedies such as soft food, heat, ice and NSAID’s. However, TMJ can develop into chronic pain and need physical therapy help to resolve pain and restore joint function. Our out-patient clinic uses manual techniques to relax the surrounding joint muscles, integrative dry needling, ultrasound, joint tapping, electrical stimulation, heat and ice to resolve pain and restore function.References

Temporomandibular Joint Dysfunction. (2017, January 2).

Retrieved from https://www.nidcr.nih.gov/sites/default/files/2017-09/less-is-best-tmj.pdf

TMJ – Temporomandibular Joint2019-07-15T14:48:58+00:00

Breathe Easy

Chest Physical Therapy

Chest physical therapy (Chest PT) is a manual physical therapy technique used for airway passage clearance. It consist of percussion, vibration, deep breathing and coughing. The technique is used to create a productive cough to clear mucus and fluid from the five lobes of the lungs. Chest PT can be used for various diagnosis such as flu, cold, asthma, pneumonia, bronchitis, chronic obstruction pulmonary disease (COPD), neurological disorders, or bed bound persons.

The two main techniques are percussion and vibration. Percussion is done by slightly cupping the hand and clapping against the chest wall. Having the hand cupped provides comfort and less of a slapping sensation. Vibration is performed by gently shaking the chest wall with a flattened hand to loosen the mucus from the lungs. Person is placed in various positions to allow postural drainage to assist with the production of mucus. Each technique is then followed by attempting a productive cough to expel the mucus.

Our clinic provides manual chest therapy for all ages and we highly recommend this treatment for cold and flu season to prevent pneumonia and other complications from congestion.

Cystic Fibrosis Foundation. Chest Physical Therapy. Retrieved from https://www.cff.org/Life-With-CF/Treatments-and-Therapies/Airway-Clearance/Chest-Physical-Therapy/

Breathe Easy2019-08-27T15:26:29+00:00

Adhesive capsulitis

Adhesive capsulitis or commonly known as “frozen shoulder” is the tightness, lack of use and the pain associated within the shoulder joint. Frozen shoulder can be caused by an injury or arthritis that then results in lack of use and loss of function. Injuries such as stroke, fractures, falls, or prolonged immobility after a shoulder surgery are examples of common causes. People over 40, particularly women, are more susceptible to adhesive capsulitis.

Physical therapy is the most common prescribed tool for improving adhesive capsulitis. Joint mobilizations, aggressive stretching, and range of motion exercise are techniques used during each session. Physicians may prescribe steroids or an injection into the joint for relief. In some cases, an orthopedic consult may be needed. An orthopedic surgeon would surgically clean the inside of the joint to remove arthritis, scar tissues, or tears and free the capsular space.

Preventive exercise can be beneficial. Contacting an experienced physical therapist is key. Physical therapy will guide the person through appropriate care. If suspicion of a frozen shoulder is occurring, range of motion exercise and joint mobilizations will be used.

Mayo Clinic Staff. (2018, July 20 2018). Frozen Shoulder. Retrieved from https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684

Adhesive capsulitis2019-08-27T15:29:53+00:00

Knee Rehab

Knee Rehabilitation is important for daily life!

Rehabilitation can consist of strengthening, plyometrics, stretching, K-Taping, and/or manual therapies. Strong pain-free knees make work and daily routines effortless! Immediate openings available. #YWCR #kneetherapy #kneerehab #bestronger

Knee Rehab2019-01-22T19:42:29+00:00

Shoulder Pain

Many American’s suffer with shoulder pain for several different reasons. Shoulder pain can be the result of rotator cuff tear, bursitis, tendonitis, labrum tear, frozen shoulder, osteoarthritis and impingement. Physical therapy is usually the first line of care and the gold standard in treating shoulder pain. Physical therapy can restore active range of motion, reduce inflammation, pain and restore stability and strength.

Rotator cuff tear is either incomplete (partial) or complete tears (full thickness) (McKinnis, 2014). The cause of rotator cuff tear could be from traumatic injury or from progressive tendon tearing during overhead repetitive activities (McKinnis, 2014). The rotator cuff is made up of 4 muscles, subscapularis, supraspinatus, infraspinatus and teres minor. The most common tendon tear is the supraspinatus muscle. Imaging to diagnose a rotator cuff tear is MRI or US.

Shoulder bursitis is usually a gradual onset of pain caused by repetitive activities resulting in inflamed bursa. Shoulder pain is usually worse lying on affected side. The most cost effective and useful imaging modality to diagnose shoulder bursitis is US (McKinnis, 2014). Shoulder tendonitis also known as shoulder impingement is caused by repetitive overhead activities or trauma. Pain is usually gradual and worse with resistance. At initial injury (RICE) rest, ice, compression and elevation is useful in pain relief. Again US is the least expensive imaging modality to use to diagnosis shoulder tendonitis and / or impingement (McKinnis, 2014).

Labrum tear is usually from shoulder trauma injury causing pain with overhead activities, and instability. There are two types of labrum tears SLAP involving the superior labrum and Bankart involving the inferior labrum. Treatment is usually NSAID’s and RICE rest, ice, compression and elevation. If pain persist and shoulder is increasingly unstable surgery may be needed to restore stability. Imaging to diagnosis shoulder labrum tear is MRI (McKinnis, 2014). Frozen shoulder is a gradual increase in pain that cause loss of joint movement and can occur after shoulder injury or lifting something heavy. Physical therapy is the first and best treatment for pain and restoring joint mobility. Imaging for diagnosis is usually plain radiography and MRI (McKinnis,2014).

Osteoarthritis is the most common reason for shoulder pain in glenohumeral joint and acromioclavicular joint. Osteoarthritis of shoulder generally is gradual onset of pain and loss of mobility and responds to NSAID’s and physical therapy to resolve pain and  immobility. Imaging to diagnosis shoulder OA is plain radiography which is the least expensive, then MRI followed by CT (McKinnis, 2014). Shoulder pain is extremely common in both men and women of all ages. Surgery is usually the last resort and should be avoided if possible. Physical therapy is the gold standard of care and most effective treatment to restore range of motion, strength, function and resolve pain.

References
McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging.

 

Shoulder Pain2019-01-22T19:42:29+00:00

Lymphedema

The Function of a Physical Therapist Treating Lymphedema

Lymphedema is progressive chronic swelling usually in extremities, but can occur in the chest, stomach and groin regions. Currently there is no cure for lymphedema, but treatment from a physical therapist is extremely helpful to prevent immobilizing side effects and possible dangerous complications (APTA.org, 2009).

Prompt discovery of limb and / breast lymphedema is key to managing and preventing complication (APTA.org, 2009). In our practice we work closely with physicians and patients to treat lymphedema quickly with minimal to no pain. We use manual lymphatic drainage therapy and begin immediate compression for long term management.  Other physical therapy terms used to describe lymphedema treatment are decompression therapy, complete decongestive therapy and complex physical therapy (APTA, org,2009). Complex physical therapy for lymphedema is the gold standard of care and includes: manual lymphatic drainage, compression garments, exercise and education about skin and nail care (APTA.org, 2009). In most cases patients who receive lymphedema therapy see an 80% improvement in just one to two weeks.

Evidence based research has proven success in lymphedema treatment and management using patient education, exercise, compression and lymphedema therapy can stop lymphedema from returning (APTA.org, 2009). Early onset of lymphedema improves outcomes and reduces complications. Patients with breast cancer should be aware of the risk factors and warning signs that include:

Risks

  • Overweight or increasing weight during and throughout cancer treatment.
  • Lymph node removal
  • Radiation therapy
  • Infection or blood clot in affected extremity.

Warnings

  • Pain and fullness in affected limb
  • Tightness in affected limb
  • Noticeable swelling in affected limb
  • Numbness and tingling in affected limb (APTA.org, 2009).

In conclusion, the role of physical therapist treating patients with lymphedema is to help patients identify lymphedema early to prevent lasting side effects and possible dangerous complications. Currently there is no cure for lymphedema. However, treatment from a physical therapist is highly successful in eliminating lymphedema and preventing reoccurrences.

Sincerely, Sherri Boos, PT, DPT

References
Physical Therapist Play Integral Role in Lymyphedema Prevention, Treatment. (2009). Retrieved from APTA.org, 2009
Role of Physical Therapist in the treatment of Lymphedema. (2009). Retrieved from http://APTA.org

 

 

Lymphedema2019-01-22T19:42:32+00:00