Category Archives: Physical Therapy

Posted on

The Truth About Running Injuries

http://marathontrainingacademy.com/truth-running-injuries

Marathon Training Academy

May 3, 2017

In this guest post for Marathon Training Academy, you will learn how to identify the risk factors and potential causes of overuse running injuries so that you can avoid training errors which can result in lost training days, missed races, and unmet goals.

Running is one of the most popular sports and hobbies in recent times.  In the U.S. alone, there are more than 500,000 annual marathon finishers and up to 40 million people who run regularly.

Of those 40 million people, more than 10 million are running at least 100 days a year!

Running can be enjoyed by almost anyone despite age.  Not only is running fun, but it has many health benefits including (although not limited to) the following:  Continue Reading

Posted on

Why You Won’t Heal – Part 6

Risk Factors and Causative Factors are still affecting the Condition

During the recovery process, it’s important to reflect on how the injury or illness occurred.  What were the causative factors that led to the specific injury?  What choices did you make that would have caused this illness?  In order to optimize the healing response, all risk factors and causative factors must be addressed.  In the final Part 6 of the series, Why You Won’t Heal, you will learn how to discern if the risk factors and causative factors that led to the injury and/or illness are still present and affecting your current condition.

You may be getting the best quality care and treatment regime for your specific condition, but if the original causative factors are still present then your ability to recover is significantly impaired.  When possible, always address the root cause of the problem and then determine the appropriate rehabilitation program.

The ultimate goal is to eliminate the leading causative factors and then establish the proper care and treatment.  This includes addressing any potential psychological beliefs associated with the injury as well as insuring that you are consuming quality nutrients and getting enough sleep in order to recover properly.

As a physical therapist, I continue to see countless examples of individuals who may be getting the right treatment, but yet he/she still struggles to heal because the risk factors and causative factors that led to the injury and/or illness are still present and affecting his/her current condition.

The following example illustrates what happened to one of my prior physical therapy clients.

A 30 year old man presents with frequent headache pain and neck pain.  Together we work on restoring proper thoracic and cervical (neck) range of motion as well as proper strength through the cervical and thoracic spine.  He feels much better, but yet he continues to experience intermittent pain and headache symptoms.

His pain levels are worse while at work.  He takes pictures of his office, and a coworker records a short video of him working at his desk.  Upon viewing, I discover that his office set up is incorrect with the keyboard and monitor not properly positioned (poor ergonomics).  He’s working in a slouched posture which causes a forward head and rounded shoulders.

If this is his typical posture throughout a majority of his work day, is there any wonder why his headaches persist?  His posture is causing excessive strain on his neck and upper back every day while at work.

Once his work ergonomics were improved and he was more mindful about his posture, he was pain-free and headache-free.  If the underlying reason for his ongoing pain and headaches hadn’t been correctly addressed, then his recovery would have been less than optimal and his symptoms would have likely persisted or eventually worsened.

The reasons why a person may not recover are vast and complicated.  Your rehabilitation protocol will vary and is dependent on the type of injury or illness you have.  Regardless of the specific injury or illness, it’s critical that the following six categories of common reasons why a person will not fully heal and recover or take an extended time are addressed.

6 Categories of Common Reasons Why You Won’t Heal:

  1. You’re getting the wrong treatment for your condition.
  2. The injury or condition isn’t capable of healing.
  3. Physiological and social conditions are affecting your healing.
  4. Poor nutrition.
  5. Poor sleep quality.
  6. The risk factors and causative factors that led to the disease and injury are still present and affecting the current condition.

The body’s ability to heal and recover is dependent on many things.  To maximize your ability to heal and recover from illness and recovery, it’s important to be proactive and help your body in any way possible.  Getting to the root cause by utilizing these strategies for recovery will insure that you will heal and recover and/or effectively be able to manage your injury or medical condition.

Have you experienced a prolonged recovery or rehabilitation process?  If so, can you share any strategies that helped you to handle it?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

How to Avoid Overtraining Syndrome (OTS)

http://marathontrainingacademy.com/overtraining-syndrome

Marathon Training Academy

April 28, 2017

Don’t let an injury or Overtraining Syndrome (OTS) derail your running plans or affect your performance.  In this guest post for Marathon Training Academy, you will learn which strategies to implement as you self-treat and manage any potential injury safely and quickly.

Nothing can derail your best laid training plans and goals like an injury or suffering from Overtraining Syndrome (OTS).  OTS usually starts with muscle soreness and a feeling of fatigue.  Then it quickly progresses into a case of overtraining syndrome or injury.  Overtraining can occur when the intensity and/or volume of exercise becomes too much for the body to properly recover from.  Many common running injuries are directly associated with OTS.  It’s always best to prevent OTS rather than attempt to recover from it.  Continue Reading

Posted on

Why You Won’t Heal – Part 5

Poor Sleep Quality

The ability of the human body to heal and recover is nothing short of amazing.  The body has an innate way of healing despite our actions.  However, it’s important to realize that what we do and how we treat an injury or illness can significantly affect how well the body is able to heal and recover from it.  In Part 5 of the series, Why You Won’t Heal, I address how poor sleep quality can negatively impact how one heals from an injury or illness.

Although I am not a sleep expert, I have regular discussions with my physical therapy clients regarding sleep quality and hygiene.  Adequate sleep is one of the most important components to a person’s recovery post illness and injury.  On average, a person requires between 7-9 hours of sleep.

Although there are different stages of sleep cycles, a typical sleep cycle lasts between 70-120 minutes.  The actual amount of sleep needed will vary and is dependent on how long your particular cycles are.

It’s interesting to note that if you wake up just as you are coming out of a sleep cycle that you will typically feel more rested and alert.  On the other hand, if you wake at the start or halfway through a cycle, you will probably wake up feeling tired and grumpy (hence the term “waking up on the wrong side of the bed”).  We should probably term this “waking up on the wrong half of the sleep cycle” instead.

Throughout your recovery and rehabilitation, try to sleep and rest more than you typically would.  This shouldn’t be confused with bed rest though.  As a physical therapist, I rarely encourage bed rest, but at times, bed rest can be medically necessary.

Activity and frequent movement is extremely important during your recovery as is getting adequate rest and sleep.  Many important body processes occur while you sleep.  One of the most important aspects of sleep is how it affects your hormonal regulation.  Hormones, such as human growth hormone (HGH), play a critical role in how you will recover from injury.  Adequate rest and sleep is necessary for HGH and other critical hormone systems to be at the optimal level.

Poor sleep or inadequate amounts of sleep not only affect the healing response, but are also a risk factor for many chronic diseases and illnesses including:

  • Metabolic syndrome
  • Diabetes
  • Heart disease
  • Depression
  • Chronic pain
  • Dementia

How to Improve Your Sleep Quality

If your recovery and rehabilitation is starting to slow down or just not progressing like you would expect, taking a look at your sleep quality is an important next step.  In order to insure quality sleep, be proactive about the environment you sleep in and how you prepare to sleep.  This is known as your sleep hygiene.  The following tips can help you to get a better night of rest:

  • Avoid caffeine later in the day.
  • Black out your room.  Darkness sends important hormonal signals to the brain to prepare for sleep.  Even small amounts of light can disrupt sleep patterns, so cover up any potential sources of lights (even those that may be present on smoke detectors or electronic equipment).
  • Avoid any use of electronic equipment for at least two hours before bed as the light (in particular, the blue light) emitted by the screen is very stimulatory to your system.
  • Avoid watching television for at least two hours prior to bed as the light emitted by the screen is also stimulatory.
  • Establish a rule of no electronic equipment in your bedroom.  Many of us feel as though we must have our TV or tablet, but your sleep quality will improve without it.
  • Do not read or watch anything (like the evening news) that would be stimulating or anxiety producing prior to bed.
  • Try supplementing with magnesium prior to bed.  Most people are deficient in the amount of magnesium they consume on a regular basis.  Magnesium can help reduce muscle soreness and improve your quality of sleep.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate can also be beneficial.
  • Get on a schedule.  Your body thrives on a routine, so preparing for bed shouldn’t be any different than your other daily routines.  Try to go to bed at the same time each day.  In order to increase your time sleeping, go to bed a little earlier (like 5-10 minutes) each day versus sleeping in longer in the morning.  Try to gain extra rest at the beginning, not the end, of the sleep cycles.
  • Keep your room cooler.  If your room temperature is too hot, you are likely not to sleep well.  Usually cooler is better than warmer, but not cold.
  • Get regular exercise.  Regular exercise can help to keep you on a good sleep schedule.  Just don’t exercise right before bed.  When recovering from an injury, the type of exercise may vary and is dependent on your specific injury.

An adequate amount of sleep shouldn’t be considered a luxury, but instead as a critical component to proper healing and recovery.  An adequate amount of quality sleep is one of the most critical factors when you’re trying to recover from injury and illness.  It’s also a critical component to avoiding overtraining syndrome.  Don’t underestimate the importance of sleep in your recovery!

Which tip can you implement in order to get a better night of rest?  Do you have any tips to share?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Why You Won’t Heal – Part 4

Poor Nutrition

There are many reasons and factors that affect a person’s ability to heal and recover from an injury or illness.  One of the most common, yet the most basic, reason is poor nutrition.  The healing tissue and the body may not be receiving the proper base components to actually heal.  In Part 4 of the series, Why You Won’t Heal, I address how poor nutrition can negatively impact how one heals from an injury or illness.  Consuming the right foods to provide the proper nutrients for your body is critical in order to fully heal and recover from an injury or illness.

Two Reasons Why Nutrients aren’t getting to the Injured Area:

1. The injured area or tissue just isn’t getting adequate nutritional and growth factors to the actual tissue. 

This is a logistical delivery issue.  For example, the blood supply to the injured area may be compromised.  Without a proper blood supply to the healing tissues, the area will not receive vital nutrients and healing factors which is a critical component of the healing process.

One possible reason for poor blood supply may be due to dysfunction in one’s cardiovascular system (such as heart disease or atherosclerosis, the hardening and narrowing of the arteries).  Another reason may be that the injury is to a tissue that inherently has a poor blood supply such as cartilage tissue.  In the case of lumbar discs, they rely more on movement than blood supply to circulate nutrients.

If it’s not a delivery issue, then there are cases where it may be an absorption issue.  This can occur in the case of a digestive related issue that affects the body’s ability to actually get the needed nutrients from the consumed food into a useable form in the body.  This includes conditions such as Crohn’s disease and leaky gut syndrome.

2. A person’s food choices and lifestyle are not allowing for the body to have the base nutrients needed to actually heal from the injury. 

Sadly even in western societies where food is overly abundant, so is malnutrition.  I work with clients who are obese and have access to an adequate amount of food with plenty of caloric intake to survive, yet they are so nutrient deficient that their rehabilitation potential is very poor.  An abundance of food and calories does not necessarily equal adequate amounts of nutrients and micronutrients to be healthy.  This is the primary problem behind our obesity epidemic including metabolic syndrome, diabetes, and heart disease.

As a physical therapist, I help to educate my clients about a wide variety of strategies from advice on exercise, hands-on techniques (such as myofascial and joint mobilizations), and self-care techniques (such as basic nutrition) because it’s a critical component in how a person can heal and recover from an injury or illness.

Many of my clients have the following conditions which have a nutritional component to them:  osteoporosis; sarcopenia; autoimmune diseases; metabolic syndrome; diabetes; and heart disease.  Even when a client doesn’t have a specific systemic condition, proper nutrition is still a factor on how an injury will heal whether it’s from an ankle sprain or from a knee or a shoulder surgery.

Often times, I will work with a physician, registered dietitian or nutritionist to help educate my client on proper eating habits.  I also commonly refer clients to certain books, such as Dr. Josh Axe’s Eat Dirt: Why Leaky Gut May Be the Root Cause of Your Health Problems and 5 Surprising Steps to Cure It, which can help to educate them on number of different topics.

As a physical therapist, it’s not uncommon for me to see someone who is struggling with healing from an injury.  He/she may be performing the right exercises and receiving the proper treatment, yet he/she is unable to properly heal because his/her body doesn’t have the proper nutrition level to allow the healing to occur.  It is important to remember that poor eating habits not only sabotage your results, but can also lead to severe chronic illnesses.

Focus on your Recovery Nutrition

In order to fully heal and recover from an injury or illness, consuming the right foods to provide the proper nutrients for your body is critical.  The majority of your diet should be from real food.  My personal belief is that food which is minimally processed, organic and/or home grown is likely to have a higher nutrient load and will therefore be healthier for you.  Your body simply cannot heal and recover quickly or adequately when substandard fuel “food” is consumed.

In today’s society, it’s possible to have an overabundance of calories and still be nutritionally deficient and malnourished.  It’s critical to focus on nutrient rich food and avoid “empty” calories.  That includes food which has no nutritional value (junk-food).

Maintaining muscle mass is critical for recovery and rehabilitation as well as for injury prevention.  Initially, focus on macronutrients (fat, protein, and carbohydrates) when it comes to food.  During the rehabilitation process, focus on a diet high in protein from many sources (plant and animal-based), high in fruits and vegetables, and low in processed carbohydrates.

Newer research concludes that as a person ages, his/her protein needs do not actually decrease, but remain elevated as the body’s ability to process protein decreases.  It’s important to have higher amounts of protein available for use.  During recovery, additional protein is often needed to insure healing tissues have the building blocks necessary for recovery.  For more information on protein supplementation, please refer to How Much Protein Do I Really Need?

Each person is different as is the recovery process and one’s prior health status.  The diet should be tailored to your individual needs.  There isn’t just one perfect diet plan—these are only guidelines.  Please discuss your dietary concerns with your medical provider.

Supplementation

The ultimate goal with supplements is to aid your body in improving health and nutritional status.  Try to choose the most natural products as possible and experiment to see what works best for you.  Look for supplements that don’t contain extra fillers, sweeteners or additives.

The following list includes my most common recommended supplements to take during the rehabilitation process:

Protein

Protein is a critical macronutrient that is highly important in maintaining the building blocks needed to support the muscular system (including skin and tissue).  Additional protein is often helpful during the recovery process if you have experienced a muscle or tissue injury.  Additional protein in your diet can stabilize blood sugars and satiate your appetite.

Capraflex

My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra.  It combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently.  I use it to help recover from acute injury.

Magnesium

Magnesium is a critical component of bone health and health in general.  Magnesium helps the body to regulate calcium levels.  This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.

You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.  Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Vitamin D3

Vitamin D3 is critical to the absorption of calcium through the intestinal wall which is important for bone health.  It’s also a critical nutrient in maintaining a healthy immune system.  However, there are potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).

Vitamin K2

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function within the bone.  An osteoclast is a type of bone cell that breaks down bone tissue.  These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream.  Without adequate calcium, many critical cell functions can be affected (including heart function).  Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.  Vitamin K (best found in green leafy vegetables) has anti-coagulation benefits.  If you take blood thinning medications, your physician will need to know how much you consume on a regular basis.

Coconut Oil

In past years, there has been a real push for toward a low fat diet.  However, people have forgotten that fats are a critical macronutrient when consumed at reasonable levels and via real foods (such as coconut oil or avocados).  The nervous system relies on adequate levels of fats and cholesterols to be present.  Insuring the proper amount of fat consumption is critical when healing from a neurologic injury or condition.  It’s also helpful for weight loss because it can satiate your appetite.

Super Greens

Green super foods, such as spirulina algae, chlorella algae, and wheat grass are packed high in antioxidants.  They can have a cleansing and an alkalizing effect which will decrease your inflammation level and aid in recovery.  Super greens boost your immune system and are generally good for you.  I think the argument can be made that algae is the king of “super” foods.  It is likely the most important food/supplement most people are not taking.

I am particularly fond of supplementing with algae as a super food because it addresses many of the most common nutrients needed during rehabilitation.  Algae have high levels of protein as well as magnesium and other critical micronutrients in order to help you recover.

My new favorite way to add greens and protein in general is a supplement called ENERGYbits® and RECOVERYbits®.  They are made from organically grown NON GMO spirulina algae or chlorella algae.  Spirulina algae have a high concentration of plant-based protein (64%).  It also contains 40 vitamins and minerals including iron, nitric oxide, Omega-3, and all of the B vitamins.  Chlorella is high in protein.  It also has detoxing properties and an impressive micronutrient profile.

Because of their overall nutritional profile I now consider spirulina and chlorella algae a top rehabilitation and recovery supplement.  I recommend taking 30-45 of these small tablets per serving.  I recommend swallowing them whole, but you can chew them.

If you want to learn more about algae be sure to listen to Ben Greenfield’s interview with the founder of ENERGYbits®, Catharine Arnston, on the benefits and importance of algae.  Please refer to Is This The Most Dense Source Of Nutrition On The Face Of The Planet?

In full disclosure, I am now an affiliate for ENERGYbits®.  I signed up primarily to get the same 20% discount I can offer you.  You can only purchase them online, so when you check out, just enter discount code PTAdvisor for 20% off all products.

BUY NOW

Adequate nutrition is an important component to the rehabilitation and recovery process.  There is a direct correlation between your nutritional status and your ability to heal.  Each of us has different needs based on our individual health status.

As a physical therapist, I offer general guidelines based on what has worked for my past clients.  However, I recommend that you find a nutritional expert to be part of your rehabilitation team as well.  If you are not healing from your injury, it’s very important to insure that any and all dietary concerns are properly addressed.  Don’t skip this step as poor nutrition can and will derail your recovery process.

Have your food choices positively or negatively affected your recovery from an injury or illness?  Which supplement might you consider taking?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Why You Won’t Heal – Part 3

Psychological, Emotional, and Social Conditions are affecting your Healing

The human experience is a web of how we relate to our surroundings as a physical, social, mental, and spiritual being.  So it comes as no surprise when we recognize that a person’s ability to overcome injury and illness isn’t purely physical.  There are very strong psychological, social, and spiritual elements to it.  It’s nearly impossible to separate the different aspects of our being or experience as a human.  The human body is a complicated.  To fully recover and heal from an injury or illness, all aspects of our being must be addressed at some level.  In Part 3 of the series, Why You Won’t Heal, I address how and why physiological and social conditions can affect your healing.

Your belief in your ability to heal and recover is a critical component to how you actually will heal and recover.  If you fully believe that you will make a recovery and return back to a pre-injury state, then you truly are more likely to do so.

So often I work with individuals who have fear associated with a full recovery.  A common example is someone who has severely injured his/her low back.  It’s common to be overly fearful and afraid that the pain may return if you do the wrong thing.  Consequently, that person will not push his/her rehabilitation and recovery.  And therefore, he/she doesn’t return to his/her prior baseline and will likely never fully recover physically as well as mentally and psychologically.

Because of this large barrier to recovery, most progressive back rehabilitation programs will address fear avoidance beliefs and the fear of disability from pain versus true musculoskeletal disability from injury.  The fear of re-injury is very powerful not only to the general population, but also for elite athletes.  Many elite athletes have failed to return to pre-injury glory because of fear and psychological dysfunction associated with his/her injury.

Other psychosocial issues that I have encountered include identity issues.  Many conditions become chronic because the condition and injury lingers for a long period of time.  As a person maneuvers through the health care system, this sick phenotype becomes ingrained in who the person is at a deeper psychological level.  The person forgets what life was like without the condition and now they become a person with that particular injury or illness.

Once a person takes on this type of deep routed feeling about who he/she is, it can be nearly impossible to actually heal from the condition as the condition is no longer only physical, but now psychological.  The condition and illness becomes part of his/her emotional psychological state and part of a new altered identity.  Subconsciously, this becomes an emotional and psychological paradox to recovery which affects the person physically as well.

Motivations also play a key role in a person’s ultimate recovery.  Are there secondary gain issues?  If a person dislikes his/her job, maybe he/she isn’t really motivated to return to work after a workers’ compensation injury.  Is a person depressed about other issues in his/her life, so he/she isn’t really that motivated to recover or improve?  All of these factors need to be addressed to insure optimal recovery.

However, it’s important to keep in mind that a person’s rehabilitation process can be highly variable even within those who are recovering from the same type of injury.  While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who took significantly longer to heal.

This is completely normal within a course of recovery.  Each person’s physical ability to heal and recover is different.  Unfortunately, there are some who were never able to recover to any significant degree.  The lack of recovery is always routed in physical as well as psychosocial reasons.  The severity of an injury is not necessarily a predictor of who will or will not recover or how the injury may affect a person physiologically.

Although I am not a psychologist, it’s my job as a physical therapist to help clients heal, recover, and/or adapt to injury or illness.  This includes addressing all aspects of the person’s recovery not only from the physical perspective, but also from an emotional, social, psychological, and spiritual perspective.  My treatment primarily focuses on the physiological issue, but I’m always aware of the other aspects and needs within the recovery process.  I help and advise where I can and when needed, I recommended other trained medical professionals.

If you are struggling to heal and recover from an injury or illness (regardless of the severity), consider the possibility that part of your recovery must include the other aspects of who you are as a person.  It’s common to include physiological, emotional, and spiritual support in your recovery.  (And I highly recommend it!)  We need to fully embrace ourselves and who we are (including our feelings and physical and psychological status) to insure that our bodies are operating at the highest level possible.  This type of self-awareness can be painful and difficult at times.  Don’t feel you have to do it alone.  Seek professional help because options are available.  Don’t give up on yourself!

Have you ever struggled to recover from an injury or illness?  How were you able to recover psychologically and emotionally?  Sharing your story can help others in their recovery process.  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Why You Won’t Heal – Part 2

The Injury or Condition isn’t Capable of Healing

People choose healthcare as a profession because we have a deep desire to assist others in times of need.  It’s our unique way to make a difference in someone’s life and to make this world a better place.  Our health and our life is the most precious asset we have.  When a person has been ill or injured, the hope is that recovery is possible.  Regardless of the condition, we hear stories of miraculous recovery as well as devastating loss.  Why do some people recover while others do not?

In Part 2 of the series, Why You Won’t Heal, I discuss a topic that no one really wants to hear.  Regardless of intent and hope, sometimes an injury or condition just isn’t capable of healing.  Our current knowledge of the human body through the use of Western or Eastern medicine may not be able to assist the person in healing.

While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who are unable to heal and recover.  Therapy (like speech, occupational, and physical) and assistance from physical medicine physicians and other rehabilitation specialists can help the client to live the best life possible with adaptive equipment and technology when recovery to prior function isn’t possible.

Sadly, some medical conditions are not curable, and a person will not have the ability to heal.  It’s important to keep in mind that there is wide variation of how these types of conditions will present and how a person can adapt and overcome to still lead a productive life.  It’s also important to realize that each individual responds differently to an injury.  One should always try everything he or she can to reasonably try to heal and recover.  However, if those efforts fail, then the focus needs to be on adapting (and not recovering) in order to live a productive and fulfilled life.

Below is a partial list of injuries that may not be able to heal, so other means of adaptation must be taken:

  • Spinal cord injuries
  • Severe spinal nerve root injuries causing paralysis
  • Some peripheral nerve injuries
  • Severe brain injuries
  • Some cerebral vascular accidents (CVA’s), known as brain attacks or strokes
  • Some types of infections
  • Loss of limbs
  • Some chronic progressive neurologic diseases

This list is by no means exhaustive.  No two injuries are alike, so you may have one or more of these conditions and have recovered or nearly recovered.  However, sometimes recovery just isn’t possible.  Openly discuss the injury or condition along with the associated impairments in order to acquire methods of adaptation.  Continuously looking for a cure or waiting for a complete recovery can derail your ability to adapt and move on with a productive life.

Common Traits that may Impair Your Ability to Heal: 

  • There is catastrophic neurologic involvement.  This may be from severe injury to the brain, spinal cord or larger peripheral nerves.
  • There is a chronic progressive neurologic disease which currently doesn’t have treatment methods available.
  • There is an incurable viral or other type of incurable illness.
  • There has been catastrophic injury to the musculoskeletal system to the point that repair isn’t possible (such as in the case of amputation).
  • There has been catastrophic injury to other organs of the body either through trauma or other chronic disease.  In the case of severe kidney disease, the only remaining treatment is dialysis.

If you or your loved one suffers from an illness or injury that is likely unable to heal or improve, then a heartfelt honest discussion with your medical provider is in order.  This is critical if you or your loved one wants to take the next step of learning how to adapt around the condition and continue to live a productive life.

One of the reasons I chose to be a physical therapist was to help others.  Throughout my career, I have met many clients who have been ill or injured without hope of recovery.  Yet these clients (through the use of current adaptive equipment and the will to overcome) are living very inspiring and fruitful lives.  If you can’t fix it, then adapt around it!

What has your experience been like when learning how to adapt to an injury or condition of yours or that of a loved one?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Why You Won’t Heal – Part 1

You’re Getting the Wrong Treatment for Your Condition

As a physical therapist, I have the opportunity to work with individuals who suffer with chronic disease, cardiovascular conditions, neurological disorders, and of course, my specialty:  musculoskeletal and orthopaedic conditions.  A person’s rehabilitation process can be highly variable even within those who are recovering from the same type of injury.  While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who took significantly longer to heal.  Unfortunately, there are some who were never able to recover to any significant degree.

The reasons why a person may not recover are vast and complicated.  However, I have identified six categories of common reasons why a person will not fully heal and recover or take an extended time.

6 Categories of Common Reasons Why You Won’t Heal:

  1. You’re getting the wrong treatment for your condition.
  2. The injury or condition isn’t capable of healing.
  3. Physiological and social conditions are affecting your healing.
  4. Poor nutrition.
  5. Poor sleep quality.
  6. The risk factors and causative factors that led to the disease and injury are still present and affecting the current condition.

In Part 1, treatment for the condition is addressed.  In subsequent posts, I will cover the other categories in addition to providing you with methods and strategies for recovery to insure that you will heal and recover and/or effectively be able to manage your injury or medical condition.

You’re Getting the Wrong Treatment for Your Condition:

Sadly in today’s health care environment, it’s not uncommon for individuals to get the wrong treatment for his/her condition and/or inappropriate care which can affect the recovery process.  As a physical therapist, I continue to see countless examples of individuals getting wrong and/or ineffective treatments to manage a particular injury or medical condition.

Sometimes this is deliberate as part of some newest and greatest product scam that is touted as curing this or that condition, but most of the time, it’s done inadvertently.  This problem isn’t just in one medical profession.  It’s throughout the entire healthcare system.

The following three examples illustrate what happened to some of my prior physical therapy clients.  Unfortunately, this list could be very long if I included every example I have witnessed.

Example 1: Total Hip Replacement

The client presents with apparent hip and leg pain.  The client has undergone a total hip replacement in an effort to eliminate the pain only to have it still be present.  Upon further examination, the cause of the hip and leg pain was an undiagnosed lumbar spine injury.  Once the lumbar injury was managed appropriately, the pain in the hip and leg resolved.  Although the client had arthritis and deterioration in the hip to justify the hip replacement, it wasn’t the real cause of the pain.  In this case, the client never needed the hip replacement in the first place.

Example 2: Low Back Pain

The client complains of ongoing low back pain (LBP).  Although there are many reasons why one may experience LBP, the pain is of mechanical origin in the majority of cases.  This means that something in the musculoskeletal system is the pain generator.  The client should be able to establish movement patterns that can help to determine if the pain is improving or worsening.  This directional preference helps me as a physical therapist to guide treatment decisions.

Extending the spine makes the pain improve, but the client’s previous physical therapist has him performing primarily flexion (bending forward) exercises as part of the rehabilitation protocol.  This treatment is not only ineffective, but it significantly slows the healing response as the client continued to aggravate the injury by moving repeatedly in the wrong direction.  Upon stopping the flexion based exercises, the client’s LBP improved and fairly quickly went away.

Example 3: Chronic Headaches

The client sees a neurologist for assistance managing what appears to be a case of chronic migraine headaches.  The client is given prescription medications which are taken on a regular basis in order to help manage the migraines.  Although the medication helps to reduce the length of time of suffering, the client continues to experience migraines on a regular basis.  The treatment may not be wrong, but it certainly isn’t overly effective.  Worse yet, there is the potential for multiple side effects from taking the medication.

In this particular case, the client had a cervical alignment issue which caused mechanical neck pain that would trigger a migraine.  Together, we were able to correct the alignment issue, and more importantly, fix the chronic poor sitting posture that lead to the alignment issue.  This eliminated the headaches completely and the need for the migraine medication.

I tell these stories from past clients to illustrate the point that wrong and/or ineffective treatments can lead to a significantly longer than necessary recovery time.  These clients were fortunate because the true cause for the pain was identified and recovery occurred.

There are a countless number of people who continue to suffer with an incorrect or ineffective treatment therapies.  The key to successfully rehabilitating and recovering from a condition is to direct the right treatment plan for the condition.  This includes how the actual injury or condition is being handled as well as addressing other risk factors or precipitating factors that directly affect the condition.

How to Identify an Incorrect or Ineffective Treatment Therapy:

  • You aren’t experiencing any relief in pain or symptoms from the treatment.
  • Your symptoms continue to worsen.
  • You have been using the same treatment for weeks or months without resolution.  In the case of chronic disease, management of the condition hasn’t been effective.
  • The treatment and why it’s effective cannot be logically explained.
  • You haven’t been given any tools or education on how you to help improve or manage the condition, the rehabilitation or disease process, and its symptoms.
  • You are told that there are no other options.

If you are unsure whether or not the treatment you are receiving for your condition is helping, then it’s up to you to be proactive and seek a second opinion.  Although you should be cautious in researching for medical information online, there are reputable websites that can help to educate you about symptoms and possible causes for your condition.

If you suspect that your treatment course is incorrect, discuss your concerns with your medical provider.  Don’t be afraid to seek a second (or even third opinion) if necessary.  There are many options, and help is available.  Don’t give up!

Have you experienced an incorrect treatment or ineffective medical treatment before?  What did you do in order to resolve it?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Preventing Knee Pain

There isn’t a shortage of promising lotions, braces, taping techniques, exercises, and electric modalities when treating knee pain.  Many of these fancy options may or may not work to prevent and/or reduce pain.  There are many potential reasons for experiencing knee pain.  However, an often overlooked cause is the lack of a normal range of motion and tightness in the quadriceps and/or hamstrings.  Getting back to the basics can be an integral component to successfully treating knee pain or preventing further injury.

Potential Risk Factors for Knee Pain:

  • Poor quadriceps strength (particularly, the inner/medial quadriceps).
  • Poor hip abductor and/or hip external rotator strength.
  • Prior knee injury.
  • Over use.
  • Obesity.
  • Poor foot biomechanics including overpronation (when the feet excessively roll inward, which causes the knee to roll inward during each step).
  • A larger “Q-angle” which is the associated angle between the hip and knee.
  • Even anomalies in the shape of one of the bones that make up the knee joint could predispose you to knee pain.

The most obvious (yet rarely talked about) reason for experiencing knee pain directly relates to your range of motion (ROM).  In its simplest form, the knee is a hinge joint.  It bends and straightens (flexes and extends).  If your knee isn’t able to fully bend or straighten because of either excessive quadriceps tightness and/or hamstring tightness, then you’re at an elevated risk for many common knee pain diagnoses including Patellar Femoral Pain Syndrome (PFPS) and Patellar Tendinitis.

Quadriceps Tightness

Poor range of motion in the quadriceps can be associated with a higher risk for developing knee pain.  One potential reason for this is that the quadriceps muscle blends into the quadriceps tendon.  Eventually it attaches to the patella (kneecap) before becoming the patellar tendon where it attaches to the tibial tubercle on the tibial bone (the main lower leg bone).

Excessive tightness will cause alterations in force and tracking of the patella.  This can lead to inflammation and ultimately, pain in or around the structures of the knee (including the patella, quadriceps tendon, patellar tendon, the patellar femoral joint or the infrapatellar fat pad).  The following four muscles make up the quadriceps:  vastus lateralis; vastus medialis; rectus femoris; and the vastus medialis.  The rectus femoris is most likely to be tight as it crosses two joints–both the hip joint and the knee joint.  The other muscles only cross one joint–the knee joint.

Normal range of motion in the quadriceps will vary from person to person (especially, the older you get or if you have a history of injury).  For most healthy and younger to middle aged people, normal range of motion could be defined as the ability to touch your heel to your buttocks with your hip and low back in a neutral (not flexed or extended) position (as demonstrated below).

Regular static stretching and mobilization will help you to improve your range of motion in the quadriceps and ultimately, avoid knee pain. 

Static Stretch

Static stretching is best performed post workouts.  (Static stretching prior to a work out or activity has been shown to decrease performance.)  Hold the following stretch for at least 60 seconds, and perform two to three repetitions.

Quadriceps “Tack and Floss” Mobilization

You can use a foam roller to help mobilize the quadriceps while working on your range of motion.  Position your upper thigh onto the foam roller.  Roll around until you locate a particularly tight and/or restricted area, and then very slowly bend your knee back and forth.  If this is painful, do not exceed more than a mild to moderate amount of pain.  Perform 1-2 minutes on each leg once per day.

Hamstring Tightness

Hamstring tightness can often restrict full knee extension (particularly, during functional activities).  The most common reason for poor hamstring mobility is chronic poor posture while sitting and standing.  Most of us sit for a good portion of the day.  This results in tight hamstrings and increases your risk for experiencing knee pain as well as low back pain.

Poor range of motion can also be a contributing factor to muscle imbalances.  A hamstring that is either too long (over stretched) or a hamstring that is too short and contracted will not generate as much force and strength as a hamstring within its optimal length.  The ability for a muscle to contract optimally is dependent on it being at an optimal length.  This is known as the length tension relationship.

Many people (women in particular) struggle with adequate hamstring strength in relationship to quadriceps strength.  This muscle imbalance can lead to pain and is a major risk factor in suffering an ACL tear.  Therefore, one way to insure proper hamstring strength is to insure proper hamstring length. 

Hamstring Stretch in Doorway 

Static stretching is best performed post workouts.  (Static stretching prior to a work out or activity has been shown to decrease performance.)  Find a doorway and place one leg on the frame and stretch the opposite leg through the doorway.  Try to keep your back with a neutral arch.  As your hamstring relaxes, slowly move closer to the wall or doorframe.  Hold for at least 1 minute per side, and preferably two repetitions per side. 

Hamstring Mobilization Using the Foam Roller 

Place your leg on the foam roller.  Roll your hamstring back and forth on the foam roll.  Move slowly and spend extra time on the more painful areas.  Be sure to mobilize the entire hamstring and feel free to work on other areas of the leg that feel tight or restricted.  If this is painful, do not exceed more than a mild to moderate amount of pain.  Perform for 1-2 minutes per leg.

Don’t forget the basics when it comes to self-treating knee pain.  Lack of range of motion could be the most simple and obvious reason for why you’re experiencing knee pain.  Implement my recommended exercises in order to address any tightness in the quadriceps and/or hamstrings.  Getting back to the basics can be an integral component to successfully treating your knee pain and preventing further injury.

If you’re experiencing knee pain, do you think either poor range of motion and/or tightness in your quadriceps and/or hamstrings are causing it?  Which strategy can you implement to alleviate your pain and prevent injury?  Please share below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Why Does My Shoulder Hurt?

Shoulder pain is one of the most common ailments treated by physical therapists.  There are many potential causes of shoulder pain, but the two primary issues to consider include poor mobility and muscle imbalance.  The key to treating most common shoulder related pain is to improve your posture while focusing on thoracic mobility, shoulder position, and proper shoulder strengthening.

Poor Mobility

The most common reason for mobility issues is poor posture.  Poor thoracic mobility and tightness in the posterior capsule of the shoulder are the most common contributors to the lack of mobility which can ultimately lead to shoulder pain.

Mobility issues can occur if you adopt a chronic forward head with rounded shoulders posture.  As this position becomes more chronic, the thoracic vertebrae lose backward mobility (extension).  This happens in conjunction with shortening of the pec minor (which is located underneath the pec major) and causes the shoulders to roll forward.  The forward shoulder posture causes the humeral head (arm bone) to be positioned more forward.

This causes tightness in the posterior (back) portion of the shoulder joint which affects the natural roll and spin motion of the joint.  The alterations of the roll and spin motion combined with alterations in shoulder blade motion negatively affects the mechanics of the shoulder joint.  The alteration in mechanics is what ultimately leads to pain as the rotator cuff or biceps tendons become impinged, irritated, and painful.

This is commonly referred to as Shoulder Impingement Syndrome.  Shoulder impingement pain is often associated with pain reaching overhead, behind your back and/or out to the side.  Those who experience it may feel weaker in the affected shoulder and experience pain when sleeping on the affected side.

Perform the following stretch to address shoulder posterior capsule tightness.  Lie on the side of the affected shoulder.  Be sure to support your head with a pillow.  Your arm should be straight out from your body with your shoulder tucked under your body.  The goal is to pin your shoulder blade down with the floor.  Gently push your arm down (as shown).  You should feel a gentle stretch.  Hold for 30-60 seconds for two to three times.  Perform once or twice per day.

In case you haven’t already subscribed to my e-mail list, please take a moment to do so in order to access my FREE resources, including My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  It’s a downloadable .pdf file with my recommended stretches and exercises to address poor thoracic mobility and pec minor tightness.  These simple exercises (with complete instructions and photos) will help you to improve thoracic mobility and can be performed at home.

GET MY FREE RESOURCE

Muscle Imbalance

Muscle imbalance is often an associated causative factor for shoulder pain.  In addition to mobility issues, altered strength and muscle activation patterns are also related to shoulder pain and shoulder impingement syndrome.  The reasons for muscle imbalance can vary, but are often associated with poor posture and/or cervical/neck related issues.

Two common muscles that must be strengthened in order to insure proper shoulder mechanics are the lower trapezius muscle and the supraspinatus muscle (which is one of four rotator cuff muscles).

The rotator cuff muscles are responsible for the stability of the shoulder and proper roll, glide, and spin of the ball and socket shoulder joint.

The lower trapezius muscle is responsible for proper shoulder blade timing and rotation during arm movements.  It helps in maintaining a proper upright posture.

For three easy and effective exercises to perform to improve your lower trapezius and rotator cuff muscle strength, please refer to Exercises for Lower Trapezius and Rotator Cuff Muscle Strength.

Most shoulder symptoms typically resolve when thoracic mobility and strength in the shoulder is improved.  Shoulder impingement is painful, but worse yet if left untreated.  It can lead to fraying of the rotator cuff tendons (and ultimately, a rotator cuff tear).  It’s always best to be proactive and address the causative factors early.

If you’re not improving or your symptoms worsen, consult with your medical provider to determine if other causes are contributing to the problem.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

If you’re experiencing shoulder pain, do you think either poor mobility or a muscle imbalance is causing it?  How can you improve your thoracic mobility and strength in your shoulder?  Please share below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!