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Physical Therapy for Parkinson’s disease

April is Parkinson’s disease awareness month!!  Did you know that one million individuals in the United States are living with this disease?  Physical Therapy has always been a component of care for individuals with Parkinson’s. The past twenty years of rehabilitative research has revealed several important findings which physical therapists who specialize with this patient population would like patients to know.  The earlier care is initiated, the better the outcomes.  It used to be that persons were not referred for therapy until much disability had occurred or if someone was experiencing falls.  Now, there are proven interventions to address the disease early so that patients can be empowered to know what exercises and habits can help them even in the earliest stages.  Being involved in activity and movement is very important.  Rigidity (a form of muscle tightness) of the axial (spinal) muscles can be present even in the early stages and learning to improve mobility in this body region can carry over to being able to maintain long term functional capabilities.  There is also a sensory/motor disconnect whereby patients feel they are moving as big as they can when in fact they are not.  This change is very subtle over time and the patient is often unaware of it until someone else points it out to them.  Aerobic conditioning is very important to maintain at all stages of the disease and patients can benefit from guidance on how to incorporate this into their lives.   Postural changes can also be a subtle progression with this disease and can be improved with exercise and patient education.  Tremor remains resistant to...

Avoiding Tech Overload that can cause Tech-induced Injuries

Just as the words Facebook, Twitter, Xbox, cell phone, tablet, laptop and Snapchat have made their way into our everyday life and vocabulary, new medical conditions are surfacing due to how we are physically interfacing with all the great new technologies available to us. TEXT NECK For example, could you be using your cell phone, laptop, electronic book or other digital device in a way that may cause the condition known as “Text Neck”? Your head weighs an average of 10 to 12 pounds and places this weight onto your spine. However, if you bend your neck forward and look down, the weight on the cervical spine begins to increase. Take a look at how a normal 10-12 pound load on the neck changes with the angle at which you are holding your head on your neck: 15 degree bend: 27 pounds 30 degree bend: 40 pounds 45 degree bend: 49 pounds 60 degree bend: 60 pounds That amounts to a great deal of unnecessary wear and tear on the joints of the neck! Think about how often you are looking at a device in this way. If you have high school or college age students, the amount of time they do this may exceed many of us. When tissues of the spine are placed in these positions of stress repeatedly and for prolonged periods of time day in and day out, it can lead to tissue inflammation, muscle strain, pinched nerves, herniated discs, and headaches. Medical experts are growing increasingly concerned with the amount of people and particularly young people who require spine care. To avoid this poor...

Unexpected Sources of Pain

Here are some strange but true sources of pain that may not be obvious. If you are suffering from discomfort but just cannot seem to pinpoint what is causing it, consider some of these potential culprits. Our choice of wardrobe: Paying attention to what we choose to wear can have an influence on how we feel. Let’s think about shoes first. Most women can attest to the fact that high heels are known to be uncomfortable but flip-flops/sandals can be problematic too. This type of footwear offers no arch support and can lead to conditions like plantar fasciitis, ankle and knee pain. Save this type of footwear for the beach or in limited time frames. It really is best to have some arch support for everyday use. Watch that wallet-where you keep it that is. Most men like to keep their wallet in one of their back pants pockets. This location however can contribute to back or leg pain. From a seated position, the wallet placement can place unnecessary pressure on the sciatic nerve which can lead to sciatica. The easiest solution is to remove the wallet while driving – especially long distances- or when taking a seat. Tight fitting pants or belts, wearing a phone in a front hip pocket or taking a long bike trip while bent over the handle bars for a long period of time can cause pain in the front and side of the upper thigh. This can sometimes be mistaken for a back nerve root problem but it is actually a sensory nerve impingement syndrome. Monitor anything that may be constricting where your...

“Do This Not That” to avoid Back Strain, Pain and possible Injury

There is a popular book on the market right now entitled Eat This Not That which helps persons make better nutritional choices for their health and well being by comparing various food choices side by side with photos. It makes a compelling case for empowering a person’s knowledge on what are the most healthy food choices. This article would like to borrow that concept and apply it to teaching you a similar thought process to help you be empowered to know how to do some everyday tasks while avoiding dangerous back positions or movements that can contribute to back problems and pain. Your spine is a complex beautifully constructed structure composed of 24 bones/vertebrae which are separated by flexible and cushy discs, layers of muscles and ligaments and dozens of joint surfaces. The spine protects your spinal cord and nerves that travel out of the spinal cord through joint surfaces between the vertebrae in order to carry signals from the brain to the rest of the body. These nerves enable you to generate movement and feel sensation. Injury can occur at any of these component parts of this structure. Extreme trauma can cause devastating injuries. Microtrauma (small amounts of injury which can accumulate over time) can also wear and tear at the component parts of the spine leading to such things as: herniated discs which press on nerves and lead to weakness, pain and altered sensation, spinal arthritic changes in the joint surfaces which create narrowing of nerve passageways, pain and nerve compression, and muscular strain or changes in muscular integrity to support the spine (certain muscles become over...

Barefoot and Minimalist Running

Barefoot and Minimalist Running Barefoot running was initiated as an observation of many long distance runners from Kenya performed well in competition and trained barefoot. Their lifestyle involved them being barefoot much of their lives and the bottom of their feet became adapted to this over many years and thus the skin was thought to be much thicker and tougher than those who grew up wearing shoes on a daily basis. It did not take long for runners who tried barefoot running to notice that their feet had thin and sensitive soles and cuts, blisters, skin breakdown and pain limited their running. We have all experienced what stepping on a small rock while barefoot feels like. Now try it at a running pace. Thus minimalist shoes were created that fit like a very short sock and have a rubber-like bottom to protect the sole of the foot. Barefoot running and running in minimalist shoes have been a “buzz” over the past 5 years. It is estimated that 25-30% of runners have tried running in minimalist footwear on a regular basis and only 2% run barefoot routinely. Approximately 20% of people surveyed reported trying to run barefoot. People who promote barefoot/minimalist-shoe running suggest that it changes the biomechanics of the running style and thus strengthens the foot muscles and changes the forces of impact on the legs. They feel this can reduce certain injuries. An article in March 2014 in the British Journal of Sports Medicine analyzed current research regarding barefoot running and concluded, “running injuries are the result of many factors and running without your shoes is least likely...

Avoiding Bike Fit Related Injuries

Avoiding Bike Fit-Related Injuries Bicycle riding is a great form of exercise. The longer you ride, the more forces are placed on your body which can lead to pain, numbness, and tingling. Eventually, if these symptoms are intense or persistent many people quit riding. Our goal is to keep you active and healthy so we are providing some tips to keep you on your bike. • Try to maintain a straight spine posture even though your trunk will be inclined forward. A prolonged spine position of a forward curve (flexed) puts the same unhealthy forces on your back as if you sat slouched in a chair for a long time period. Adjusting the handle bars and seat tilt can help align the spine better. • Set the seat height to position your knees in a slightly bent angle at the bottom of the pedal stroke. If your knees are fully straight at the bottom pedal position, you will be reaching with your leg causing your hips and pelvis to tilt and placing unwanted forces on the hips, pelvis and low back. If the knee is too bent at the bottom pedal stroke especially combined with pedaling more forcefully like in a harder gear or up hills, harmful forces will be placed on the patellofemoral joint (knee cap) resulting in front of the knee pain. Too much forward tilt of the bike’s seat will result in extra body weight on the arms and hands. • Change the handle bar position occasionally on longer rides to alter the forces on your arms, neck and upper back. Keep a light to moderate...

Medial Tibial Stress Syndromes -Shin Splints

Medial Tibial Stress Syndromes – Shin Splints “Shin splints” is a general term that is used to describe pain often accompanied by tenderness along the front of the lower leg. The tibia is the larger of the lower leg bones and runs from the knee to the ankle. It can be felt running along the front of your shin. Many muscles attach to the tibia and the bone is covered by periosteum which has a good blood and nerve supply. Medial tibial stress syndromes are commonly caused by prolonged running or walking or repetitive jumping. Shin pain is most commonly diagnosed as a stress fracture of the tibia or an overuse syndrome of the muscles and their attachment to the periosteum. The difficulty in diagnosing between these two conditions is that stress fractures are often missed on X-ray because the hairline fracture is typically not seen until after about 3 weeks when the new bone growth becomes visible. A bone scan or MRI would better detect a stress fracture but are not typically ordered early after pain onset due to the cost. We rely on clinical signs and symptoms to guide the diagnosis if radiographic tests are not conclusive or have not been taken. Typically, stress fractures have more localized area of pain and tenderness to palpation and muscular inflammatory problems tend to have a larger area of pain and tenderness. Stress fractures tend to be painful during the running, walking or jumping and the pain resolves shortly after the activity is finished. Muscular inflammatory injuries tend to hurt early in the morning, and progress in intensity with the...

The Cultural Trend of Sports Specialization in Youth: What You Should Know

The Cultural Trend of Sports Specialization in Youth:  What You Should Know   There is no doubt that organized sports can be a very positive experience for young people offering fitness benefits (greater cardiovascular health, bone mass, strength, prevention of obesity and type II diabetes), improved coordination and athletic skills, self esteem and social interaction skills in addition to just being a healthy outlet for fun!  Youth participation in sports has changed dramatically in the past 3 decades.  Participation has increased by more than sixfold.  Girls have become more involved in athletics and there has been significant study of the female athlete’s vulnerability to specific injuries.   Including both genders between the ages of 5 and 14, sports related injuries have increased to estimated numbers of 3.5 million a year.  Within this great increase of participation in youth sports, has grown a trend of “sports specialization” occurring in younger and younger age groups.  This phenomenon is when young athletes “self select” to focus on a year round single sport participation.  Children and adolescents who choose one specific sport face increasing quantity and specificity of stresses on their growing bodies due to the constant exposure of that one sport or training required for that one sport.  As professionals in the medical field and specialists in the sports medicine arena, we are noting that we have within our community two large populations of children:  Ones who are inactive and face the threat of obesity and another growing large group of increasingly specializing sport youth who are at risk of developing injury due to overuse in a skeletally immature body.  Did you know...

Important Information for Concussion Recovery

Important Information for Concussion Recovery Concussions have become a very common event in sports participation and have been frequently reported in the news media over the past couple of years. This increase in press makes it sound like a relatively new “buzz” in medicine. Unfortunately, concussions have occurred for many years prior to this new focus on them. This is an area of medicine that has made great strides over the past 10 years focusing on the proper recognition, realization on the level of severity and potential future effects and the best treatment options. Physicians, physical therapists, athletic trainers and coaches now receive better education in the recognition and treatment of concussions. It is important that people utilize medical professionals in handling concussions and listen to their advice. We see a number of youth, adolescent and adult recreational and competitive athletes as well as non-athletes in our clinic that unfortunately have sustained a concussion. The goal of this blog is to educate you as the concussion recipient or as a care giver of someone who has sustained a concussion with some information that may lessen the symptoms of a concussion and expedite the brain’s healing process. Many of the grade school through high school students that we treat after a concussion have had to modify their school attendance and receive homework and / or tutoring at home because the hypersensitivity to light and noise and intolerance of sustained activities that require concentration. These patients must try to minimize excessive stimulation of the brain to allow it to heal. Activities such as watching television and playing video games are not...

Physical Therapy for Pediatrics and Adolescents: The Science and Art of Treating Developing Framework

Physical Therapy for Pediatrics and Adolescents: The Science and Art of treating developing body framework Children and adolescents are not “little adults”. Their bodies are still in development as their musculoskeletal and neurological systems are in the process of maturing. The injury patterns that occur in this age group are different than adults in both physical and physiological ways. Most notable is the fact that children and adolescents have open growth plates and their ligaments (tissues that hold bone to bone) are stronger than the bony attachment sites where they serve as connectors. Growth can occur quickly at the growth plate resulting in a rapid change in skeletal length producing longer bones but soft tissues (muscles, tendons, ligaments) that do not grow as fast. With each new body configuration that results from rapid growth, the child/adolescent may experience postural change and a period of incoordination (because the full musculoskeletal system such as muscles and tendons are “catching up” to the new longer bones and the body’s neurological system is relearning to “make internal sense” of the new body for movement and sports participation). This age group also experiences a vulnerability to musculoskeletal injury at these times of development due to the physical activities that they may participate in which stresses the young body system. Physical Therapy treatment of these conditions require specialized consideration and intervention philosophies keeping the growing skeletal system in mind while returning the youth to physical activity and sport. The growth plate portion of bones in this population is vulnerable to injury and growth plate fractures may be more common than a ligament sprain at these...