Birth-Proofing Your Body with Prenatal PT

Prenatal PT: Pushing back against pain and preparing for childbirth

Taking Care of Aches and Pains with Prenatal PT 

Carrying a growing fetus, adapting to changing body proportions during pregnancy, and giving birth vaginally or by cesarean section is nothing short of a miracle, but there is no denying it is also one heck of a workout! Just as you probably wouldn’t choose to enter a marathon race without training or pick up the heaviest dumbbells on the rack during your first day at the gym, it’s wise to take steps to prepare the body physically for the demands of pregnancy and childbirth.

Physical therapists with training in prenatal care are an excellent resource to guide you through this preparation and to help address any aches and pains that may develop along the way. This article will address both how physical therapy can improve symptoms of pain or discomfort that might develop during pregnancy and how physical therapists can create an exercise plan to keep you comfortable and prepare your body for childbirth. 

IS EXERCISE SAFE DURING PREGNANCY?

Because every woman and every pregnancy is different, it is important to talk with your obstetrician to get the green light before beginning an exercise program. Generally, however, exercise that includes aerobic activity and specific strength and flexibility training is thought to improve the ease of pregnancy and birth and help with postpartum recovery. 

One study published in 2016 by Di Mascio et al. in the Journal of Obstetrics and Gynecology gathered data from several randomized controlled trials during which women with uncomplicated, singleton pregnancies performed aerobic exercise for 35-90 minutes, 3-4 times per week. Compared to those that did no aerobic training, the aerobic exercise group experienced a significantly higher incidence of vaginal delivery and lower incidence of delivery via cesarean section. They also had significantly lower rates of gestational diabetes and hypertensive episodes while the incidence of pre-term labor did not differ significantly between exercisers and non-exercisers. 

ADDRESSING PRENATAL PAIN

Pain and discomfort in muscles and joints is not uncommon during pregnancy, especially as it progresses. Before, during, and after childbirth a woman’s hormones are fluctuating significantly. Hormones such as progesterone and relaxin cause increased ligament laxity during pregnancy. This has the effect of allowing the pelvis to expand during the birth but also causes laxity in other joints such as the lower spine and hips. Because the ligamentous laxity tends to reach its height during the second trimester as a woman’s uterus is expanding, her belly is getting larger, and her posture is changing, low back, hip, and pelvic pain may develop. 

It is also possible to develop pain or discomfort outside of the lower back and pelvis. Prior lower extremity injuries may be exacerbated by changes in body proportions and aches and pains can even develop in the neck or upper body in response to repetitive activities or moving in new ways. If you are experiencing pain or discomfort, a physical therapist trained in antepartum (before childbirth) physical therapy can assess your symptoms and develop an individualized treatment plan. Also, they can advise you on which exercises are safest and most beneficial to perform during the first, second, and third trimesters. 

WHAT CAN I EXPECT DURING PRENATAL PT?

Prenatal physical therapy should always be individualized to each woman to address her specific needs. Here are some of the treatment techniques a physical therapist may prescribe:

Stretching, mobility and flexibility exercises:  Muscle shortness or tightness can cause discomfort and lead to pain during pregnancy. Flexibility and mobility limitations that may not have bothered you much before pregnancy should be addressed early to limit issues with pain and discomfort. Whether you are seeing your PT because you are already having pain or looking for ways to prevent its onset, your PT can help identify these issues and teach you targeted stretches and mobility exercises. 

Strengthening exercises: Strengthening exercises are key to managing joint or muscle pain during pregnancy and to help prepare the body for childbirth while shortening recovery times. If you are having pain in a certain area, your PT will progress you through a strengthening program targeted to the area of injury. If you are simply looking to develop a program of exercises to prepare your body for giving birth, then you can expect that your program will include exercises to strengthen the abdominals, the back, the pelvic floor and even the legs. 

Pelvic Floor Training: The pelvic floor muscles and tissues are undergoing changes throughout pregnancy and experience trauma during the birthing process. A pelvic health physical therapist can advise you on exercises to strengthen and prepare your pelvic floor for giving birth. There is much more to pelvic floor PT than kegals. These PTs can help address issues of pain, discomfort, or incontinence that might develop during pregnancy and teach you strategies for minimizing these issues after childbirth.  

Soft Tissue Mobilization: Increased muscle tension and decreased soft tissue mobility can exacerbate pain and discomfort during pregnancy. Your PT may choose to apply gentle soft tissue mobilization techniques to address pain and impaired tissue mobility.   

Diastasis rectus abdominus prevention: A diastasis rectus abdominus is a separation of the left and right outermost abdominal muscles known as the rectus abdominus. It most commonly occurs as a result of pregnancy. As the fetus grows, increased pressure is placed on the connective tissue between the two sides of abdominal muscles causing separation. It commonly develops during the second or third trimester and often will resolve on its own in the first few postpartum months. Sometimes, however, it will persist and can cause discomfort, feelings of weakness in the abdominals, low back, hip, or pelvic pain, and feelings of “flabbiness” in the abdominals. 

Physical therapy during the prenatal months can help decrease the likelihood of developing a diastasis rectus abdominus that does not heal quickly on its own. A program of specific abdominal and pelvic floor strength and stabilization exercises performed throughout pregnancy has been shown to be highly effective. 

Just as eating the right foods, getting enough sleep, and managing your stress can help with a healthy pregnancy and delivery, keeping a strong and flexible body should also be a priority. Physical therapy is a great resource for supporting your physical health and reducing pain and discomfort. Whether this is your first pregnancy or fourth, Evolve PT would love to be a part of your journey through a healthy pregnancy and delivery. 

Click here for more information about physical therapy for pregnancy

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

What is the best exercise for tight hamstrings?

Tackling Tight Hamstrings-

Are you suffering from tight hamstrings? Are you feeling pulling or tension in the back of your thigh during exercise or activities? Have you been wanting to address this feeling of tightness and improve the flexibility in your hamstrings but are unsure where to start? If so, this article is a great place to begin as we will be discussing hamstring tightness and how to treat it.

LET’S TAKE A CLOSER LOOK AT THE HAMSTRING MUSCLES

The hamstrings, as we refer to them, are actually a group of three separate muscles: biceps femoris, semimembranosus, and semitendinosus. Their tendons attach at either the inferior aspect of the pelvis or posterior aspect of the femur (the long bone of the thigh) and travel along the posterior thigh inserting below the knee on either side of the lower leg. Collectively these muscles bend the knee and extend the hip and are used in activities such as walking, running, bending over to pick things up off the floor, and much more.

WHAT DO YOU MEAN BY “TIGHT”?

When a client arrives for a physical therapy assessment complaining of tight hamstrings, it is important to distinguish between a sensation that the hamstring muscle has increased tension and an observation that the muscle feels shortened. Both can exist simultaneously but may be addressed differently. A muscle can have a physiologically normal length but have increased neuromuscular tension causing a sensation of tightness. Similarly, a muscle can be relaxed but may be too short to allow full mobility for the tasks you are trying to do.

What might be adequate hamstring length for a runner may be inadequate for a dancer or gymnast who may perceive their shortened hamstring muscle as feeling tight when they try to kick their leg high over their head or bend down to touch the floor. Conversely, a runner or soccer player may have adequate hamstring length but still feel a sensation of tightness and stiffness at the end of a run or game. 

HOW CAN WE TREAT TIGHT HAMSTRINGS?

When a muscle is short, different methods for improving tissue mobility and lengthening the muscle may be prescribed. Some of these strategies will promote a relaxing of the tension created in the muscle by the nervous system causing an immediate but often temporary lengthening, while others will focus on long term changes in the muscle structure itself.

Here are some ways to improve muscle length:

Static Stretching: Most people are familiar with this type of stretching in which a muscle is lengthened until a stretch is felt and then held in that position for a period of time. This can be performed in several positions. Note, it is a good idea to warm up before stretching your muscles and the stretch sensation should be only a 2-4/10 discomfort. 

Seated hamstring stretch: Sit on the floor with your leg extended out in front of you or in a chair with your foot on the floor or elevated on a small stool. Start by sitting up straight then slowly bend forward at the waist, reaching toward your toe until a moderate stretch is felt along the back of the leg. Maintain a small arch in your lower back throughout this stretch.

Lying Down hamstring stretch: Lie down on your back and hook a strap or belt around the foot of the leg you wish to stretch. Extend the leg until it is as straight as possible and slowly pull on the strap to help pull your leg toward your head. Stop when you feel a moderate stretch. If you straighten the opposite leg along the floor it will intensify the stretch, if you bend it, it will lessen the stretch.

Hold either of these stretches for increments of 15-60 seconds and repeat until you have completed a total of 60 seconds of stretch. Repeat 2-3x per day for best results.

PNF stretching: Proprioceptive Neuromuscular Facilitation (PNF) is a stretching technique used to improve muscle elasticity and has been shown to improve both passive and active mobility of muscles, even more so than static stretching. Unlike the static stretches described above, PNF stretching techniques involve actively contracting either the target muscle or its opposing muscle. It has been proposed that these active muscle contractions cause a reflexive relaxing or inhibition of the target muscle, allowing it to lengthen further.  Two of the most common techniques for hamstring mobility are as follows. Note, it is a good idea to warm up before stretching your muscles and the stretch sensation should be only a 2-4/10 discomfort. 

Contract Relax:  This technique requires either a partner or a sturdy surface that you can prop your leg against. Lying on your back with your legs extended, lift your leg up off the ground (or have a partner lift it) as far as you can until you feel a moderate stretch or resistance to further stretch. If you have a partner, they will hold you in this position for the next step. If you are by yourself, you will prop your leg against a wall or other sturdy surface to hold you at your end range. Next, you will contract your hamstring muscles and push your leg down against your partner’s resistance or the sturdy surface as though you are trying to push your leg back to the ground.  Keep pressing down for 6 seconds then relax. You do not need to push down as hard as you can, you should utilize 50-60% of your maximum strength only. You (or your partner) will then move your leg further into the stretch as the muscles have relaxed, holding for about 30s. Repeat this cycle several times or until no further increase in flexibility is noted.

Antagonist Contraction: In this technique the “antagonist” or opposing muscle (quadriceps) is contracted actively and held for several seconds. To perform this stretching technique it's best to lie on your back. If you have a partner or a strap around your foot you will pull your leg up until you feel a moderate hamstring stretch and hold for 30s. Next, you will actively contract your quadriceps muscle, trying to straighten the knee, and hold this contraction for 6 seconds. Remember, you only need to contract the quads at 50-60% of their maximum effort. After relaxing, try to stretch the hamstring a bit further and hold for 30s before repeating the cycle again for a few rounds or until no more improvements in flexibility occur. 

Instrument Assisted Soft Tissue Mobilization (IASTM): these techniques involve using tools such as cups or handheld instruments to target the fascial layer that envelops our muscles, the skin, muscles and tendons. IASTM can improve tissue mobility and alter nervous system input that may be increasing tension in the muscle. These techniques have been shown to be more effective than static stretching but should only be performed by your physical therapist as they can be injurious if done incorrectly. 

If the actual length of the hamstring is not limited, then the sensation of tight hamstrings is more likely related to weakness, lack of stability and motor control of the tight muscle and surrounding muscles. When a muscle is unable to adequately stabilize and control the movement at the joints around it, the body may create more tension in the muscle to compensate. This can be perceived as a feeling of tightness. Physical therapy treatments for this cause of hamstring tightness can include the following:

• Hamstring strengthening exercises

• Strengthening exercises for the muscles that work in conjunction with or oppose the hamstring muscles

• Exercises to improve the motor control around the pelvis, hip, and knee, to improve the stability in that area. 

PHYSICAL THERAPY CAN BE YOUR GUIDE

If you want to learn which specific techniques to address hamstring tightness are best for you, call Evolve PT. The physical therapists here will assess the length and strength of the hamstrings and surrounding muscles and give you a program to improve your hamstring flexibility and mobility for good!

Click here for more information about physical therapy for hamstrings and legs

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Brooklyn Locations!

1-718-258-3300

https://EvolveNY.com

Get Movin’: The Undeniable Benefits of Exercise

Got Exercise? How Exercise Keeps You Healthy, Feeling Young, and Disease Free…

Live Longer, Happier, and Healthier with Regular Exercise!

Did you know that exercise is one of the best things we can do to stay healthy, live longer, and manage disease? The Centers for Disease Control and Prevention report that one in two adults are living with one or more chronic diseases and that only 50% of adults get the physical activity they need to reduce and prevent chronic diseases. In total this results in around $117 billion in annual healthcare costs associated with inadequate physical activity. Depending on your access to health insurance you may be footing a hefty portion of that bill.

Whether you love to exercise, hate to exercise, or don’t mind exercising, the truth is humans are physiologically designed for physical activity. Before comfy couches, work from home, and access to modern amenities, our ancestors were hunter gatherers roaming large swaths of land to survive, moving with the seasons, and needing a body that was capable of sustaining them through heavy loads of physical activity. Despite the conveniences of modern life, our DNA still carries the blueprint of that active lifestyle and failing to move our bodies in a way that stresses it appropriately has serious consequences. 

BUT I DON’T ENJOY EXERCISE

If you aren’t naturally inclined to participate in regular exercise for enjoyment, let’s take a look at some of the health benefits of exercise that might provide a different source of motivation.

Most children are naturally active but certain circumstances such as living in an unsafe neighborhood, too much screen time, lack of access to sports or physical education classes in their homes and communities can encourage too much sedentary time. It is important, however, to find ways to encourage physical activity in children as it has been shown to reduce their risk for depression, improve bone health and favorable body composition, and even improve attention and some measures of academic performance (with school physical activity programs).

As we move through adulthood, the importance of physical activity continues and the benefits expand. Adults who participate in regular physical activity have lowered risk for high blood pressure and stroke, have improved mental health and cognitive function, lower risk for weight gain, and reduced arthritis symptoms. In older adults regular physical activity can even improve their sleep, extend years of quality, active life, improve their balance and joint mobility, and reduce their risk for falling. 

Additionally, research shows that regular exercise could prevent:

• 1 in 8 cases of breast cancer

• 1 in 8 cases of colorectal cancer

• 1 in 12 cases of diabetes

• 1 in 15 cases of heart disease 

HOW MUCH PHYSICAL ACTIVITY IS ENOUGH?

The 2nd Edition of the Physical Activity Guidelines for Americans outlines science-based recommendations for physical activity for all ages. Here are some of their findings:

• Children ages 6-17 should do 1 hour (60 minutes) or more of moderate to vigorous physical activity daily. If they aren’t getting this in school, it is important to find ways to encourage physical activity at home and in the community. The sixty minutes of activity should include aerobic activities like running or bike riding, muscle strengthening activities, and bone strengthening activities.

• Adults should aim to move more and sit less throughout the day. Substantial health benefits are gleaned from doing at least 150 minutes (2 hrs, 30 min) to 300 minutes (5 hours) a week of moderate-intensity or 75 minutes ( 1 hour, 15 min) to 150 min (2 hrs, 30 min) of vigorous intensity (or a combination) aerobic activity spread out throughout the week. They should also perform muscle-strengthening activities for major muscle groups of moderate or greater intensity on 2 or more days per week. 

• Older adults also gain substantial benefits from participating in physical activity and should participate in aerobic, muscle strengthening, and balance training weekly. If they have chronic conditions they should understand how their condition affects their ability to do regular physical activity and aim to get as close to the 150 minute recommendation for aerobic activity as they can, safely.

• For adults, there are some health benefits to doing any amount of moderate to vigorous physical activity even if they aren’t able to consistently meet the recommended amount.

• For adults with chronic health conditions or disabilities, it is recommended to meet the same physical activity recommendations outlined above for adults. When it is not possible to meet the above guidelines, they should avoid inactivity and engage in as much regular physical activity as possible.

• Adults with chronic conditions or symptoms should be under the care of a healthcare provider and consult a physical activity specialist or healthcare provider about the types and amounts of physical activity appropriate for their abilities and chronic conditions.

HOW CAN I INCREASE MY PHYSICAL ACTIVITY?

Now that you have learned all the amazing benefits of physical exercise and have an understanding of how much is recommended each week, it's time to make a game plan for your increasing activity throughout the week. Here are some suggestions for ways to meet these activity guidelines:

• Join a gym or local community center that has fitness classes

• Use sites like YouTube to find free exercise videos that require little to no equipment

• Clear out a space in your home to create a home gym 

• Take your children out on bike rides or walks after school or on weekends

• Join a community rec league for a sport that interests you

• Schedule your exercise time into your weekly calendar like you would an appointment

• Invite friends or family to exercise with you to make it more enjoyable

• Try different ways of exercising to find ones that are enjoyable for you

IS EXERCISE SAFE FOR ME?

Before you begin an exercise program you should consult your doctor to understand how any acute or chronic conditions may affect your ability to exercise. With this understanding, some people may still feel apprehensive about physical exercise if they are experiencing regular pain or living with chronic conditions that affect their movement and mobility. The physical therapists at Evolve are a great resource for addressing pain, movement, and mobility difficulties and helping you establish a safe and individualized exercise program. 

Don’t let these concerns stop you from engaging in physical activity. In most cases, the benefits of exercise far outweigh the risks when guided by knowledgeable exercise professionals. Physical therapy can help you start and progress your exercise journey so you can live longer in better health. No matter your age, physical activity can improve your life in many ways, it’s never too late to start! You may even find you enjoy it!

Click here to find out more information about our specific services for personalized workout routines, running and gait, and sports physical therapy

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Say Hi to Your SI (Joint)

What is the SI Joint?

The Lowdown on Your SI Joint…

The sacroiliac joint, ever heard of it? Maybe you’ve heard the term “SI joint.” Whether you’ve heard of it or not, if you are a human with a spine and a pelvis then you have a sacroiliac joint. In fact, you have two. 

The sacroiliac joints are the connections between the sacrum at the base of the spine and the ilium bones of the pelvis. If you take both of your hands and place them on the narrowest part of your waist then slide them downward until they are resting on top of the large crest of bones that wrap from back to front, you have found your ilium bones. The pelvis which connects the spine and the legs is formed by two halves, each made up of three bones–the flat and broad ilium that form the crest at the top, the pubis which is the lowest bone and connects with the opposite side and the ischium which is near the lower and posterior aspect of the pelvis and forms what we often call the “sit bones”. The three bones come together to form the socket of the hip joint. 

The sacrum itself is a flat, spade shaped structure near the base of the spine. It is positioned below the lumbar spine and above the coccyx. Just as the other areas of the spine above it–the cervical spine (neck), the thoracic spine (mid back), and the lumbar spine (low back) are made up of individual vertebrae stacked on top of one another, the sacrum is composed of five individual vertebrae. Unlike the segments of the spine above it, however, the sacral vertebrae eventually fuse into a solid mass of bone beginning in the 2nd- 3rd decades of life. On occasion some people are born with six sacral vertebrae or only four. Many muscles cross from the bony sacrum to the pelvis and the femur bone of the thigh.

As noted above, where the flat sacral bone meets the ilium on either side is called the sacroiliac joint. The articulation is enclosed by a fibrous joint capsule and filled with a lubricating fluid called synovial fluid. Several ligaments span between the sacrum and the ilium further stabilizing the bony connections. 

WHY IS THIS JOINT SO IMPORTANT?

Aside from acting as the only bony connection between the spine and pelvis, the SI joint’s main job is to stabilize this bony connection and to attenuate (reduce the effect of) forces traveling up the legs. While the joint is quite stable, it is capable of moving very small amounts as it absorbs the forces that travel up the legs toward the spine. 

WHY DO PHYSICAL THERAPISTS WORK WITH THE SI JOINT?

Sacroiliac joint pain and dysfunction can occur for a number of reasons. Pain that is felt at the base of the spine, near the buttocks, especially on one side (though both sides can be affected) may be SI joint pain. Walking, climbing stairs, or crossing your legs may provoke this pain. Pain radiating down into the buttocks is not uncommon. Often an inciting incident can be pinpointed though not always. 

Trauma such as a slip and fall, a car accident, or even repetitive trauma from sports or heavy weight lifting can cause irritation or injury to the ligaments of the joint causing inflammation and pain. Hypermobility conditions such as Ehlers Danlos Syndrome and the hormonal changes that occur in pregnancy can cause reduced tautness of the joint capsule and ligaments leading to instability and irritation. Arthritis and an inflammatory condition such as sacroiliitis can also cause SI joint pain and dysfunction. 

Because low back pain and SI joint pain can be confused for one another, physical therapists often perform a series of tests and assessments to differentiate between the two. Once SI joint dysfunction has been identified, a physical therapist can prescribe a rehabilitation program to restore normal mobility to the joint, stabilize it, reduce irritation, help the client return to their regular activities, and reduce the likelihood of the pain recurring. 

WHEN SHOULD I CALL A PT?

If you are experiencing pain or discomfort that sounds like it may be coming from your SI joint, the physical therapists at Evolve are ready to help. Not only can they identify the location of your pain, help you understand the condition, and begin to address your symptoms, but they will empower you with the knowledge and understanding to stay symptom free moving forward. If you are having pain, call for an evaluation today and get on the road to recovery. 

Click here for more information about physical therapy for back pain

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com 

Rotoscoliosis: A Twisted Tale of the Spine

Are You Living With Rotoscoliosis?

The human skeleton is designed to be balanced and aligned so that our muscles, tendons, ligaments, and organs can work optimally. But variation still exists within the bones and joints of individual skeletons. In some cases these variations go unnoticed unless picked up incidentally on imaging. In other cases they are visible to the naked eye and can affect the functioning of the body in small and large ways. In this article we will be discussing a condition of the spine that can have large implications on movement and daily functioning called rotoscoliosis.

LET’S TAKE A LOOK AT THE SPINE ITSELF

Balance between stability and mobility allows the spine to keep you standing tall but allows you the flexibility to bend, twist, and arch your back. Whether you are reaching down to pick your child up from the floor or hitting a hole-in-one on the golf course, appropriate spinal alignment and flexibility are essential. Let’s take a closer look at the anatomy of the spine. 

The spine is made up of five distinct segments. The seven vertebrae that make up the neck, known as the cervical spine, the 12 vertebrae that make up the mid back, or thoracic spine, and the 5 vertebrae that make up the lower back, or lumbar spine, create a long canal that houses the spinal cord. The broad and flat sacral bones sit beneath the last lumbar vertebrae and act as connectors between the pelvic bones and the spine. Beneath that, lies the coccyx or tailbone.

If you look at a model of a typical, healthy spine from the back or front it appears to be a straight column of vertebrae stacked on top of one another.  When you view the spine from the side, however, you will see that the spine is actually curved in several places. In the neck the spine curves toward the front creating a small arch or “lordosis” in the neck. It then switches directions and a gentle backwards curve or “kyphosis” can be seen in the thoracic spine followed by another reversal and lordosis in the lumbar spine. Even the sacrum and coccyx are slightly curved. This normal alignment of the spine allows for all of the movement we expect from the spine, proper shock absorption capabilities, and good alignment from the head to the feet. 

WHAT IS ROTOSCOLIOSIS?

Scoliosis is an abnormal curvature of the spine. It affects about 2% of women and 0.5% of men and can begin in infancy, childhood, adolescence, or adulthood. While a certain amount of curvature in the spine from front to back is normal, curvature that goes from left to right is characteristic of scoliosis. Several subsets of scoliosis exist based on the location of the abnormal curvature and its characteristics. Rotoscoliosis is used to define one of the most severe forms of scoliosis. The name comes from the word “rotation”. In this type of scoliosis the vertebral column is both curved toward the side and rotated. All scoliosis has a degree of rotation or twisting of the spine but in rotoscoliosis it is severe. 

Scoliosis can be congenital, meaning it is present before birth (usually caused by abnormal formation of spinal bones)--or idiopathic, in which case it develops after birth. The cause of a scoliosis can typically be identified as one or more of three causes. A functional scoliosis develops in response to a skeletal or movement abnormality elsewhere in the body. For example, a discrepancy in length between the legs could cause a functional scoliosis to develop because the hips are not even. A scoliosis can also be neuromuscular in origin meaning it is associated with a condition that affects the nerves or the muscles. Finally degeneration of the vertebral bodies and weakening of their supporting ligaments can cause scoliosis to develop in adults.

HOW IS THIS CONDITION IDENTIFIED?

If scoliosis is mild it may be hard to identify without an X-ray, CT, or MRI of the spine. If moderate or severe, the following are visible signs that may indicate scoliosis:

    -One shoulder is higher than the other

    -One hip is higher than the other

    -A “rib hump” can be seen on one side of the back as the person bends forward

    -One shoulder blade is more prominent than the other

    -The spine appears twisted

    -Clothing appears to hang unevenly

Radiologists use certain measurement techniques to quantify the degree of curvature of a rotoscoliosis. This allows them to monitor progression over time and to guide treatment decisions.

HOW DOES IT FEEL?

A mild rotoscoliosis may not cause any symptoms. As the rotation and sidebending of the spine increase, discomfort or pain in the back or rib cage may develop. A person may notice changes in their walking gait or in their ability to perform daily tasks like reaching, bending, or even sleeping. If the degrees of curvature and rotation are severe enough, the heart and lungs can even be affected. With the changes in rib cage position, taking a full breath may become restricted.

WHAT CAN BE DONE?

Observation: In young children with a mild scoliosis observation may be the first course of treatment. If a child has a mobility impairment it can be helpful to use proper positioning equipment to make sure their spine is aligned optimally, for example while they are sitting to help limit curvature and rotational progression. 

Physical Therapy and Exercise: Advances in conservative treatment for scoliosis have come a long way. Exercise and physical therapy are important tools to help manage a condition like rotoscoliosis. At Evolve, we utilize the Schroth Method, a physical therapy technique that can help stop the progression of scoliosis and has been proven to reduce pain.

Bracing: Bracing is often helpful in stopping the progression of skeletal maturity in those with moderate scoliosis who have not yet reached skeletal maturity. Bracing is customized to fit the individual’s body and needs to be regularly reassessed to ensure proper fit. They may need to be worn for 16-23 hours a day until skeletal maturity is reached.

Surgery: Surgical intervention to straighten and stabilize the spine may be recommended in children with severe curvature and adults with severe curvature who are also experiencing signs of nerve damage or compression such as leg weakness and bowel or bladder issues. 

The appropriate treatment measures for your rotoscoliosis should be decided upon by you and your physicians. Whether observation, bracing, or surgery is the route you are taking, physical therapy can be an important treatment strategy to improve your pain, slow the progression of rotoscoliosis, and help maximize your ability to participate in all the activities of daily life. 

Click here to find out more information about scoliosis treatments in Brooklyn

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Pediatric Sports PT; Just What the Coach Ordered

Sprinting Away from Pediatric Sports Injuries

Sports and athletics can be one of the most fun and rewarding aspects of a young child or teenager’s life. Through sports, children and adolescents learn how to set goals, how to manage their time, how to work as a team, and strategies for improving their performance. They also develop their fitness, coordination, balance and agility. One aspect of sports and athletics for kids and teenagers that cannot be ignored, however, is the risk of injury. According to sports injury statistics through Stanford University, more than 3.5 million children ages 14 and younger get hurt annually while participating in sports or recreational activities.

While avoiding all injuries might not be possible, having the right rehab professionals in your corner makes all the difference. Is your athlete injured? Schedule an appointment with a local physical therapist right away to jumpstart the recovery process. Looking to dodge those injuries before they happen? You should also schedule an appointment with a physical therapist because PTs don’t just treat injuries after they happen but they treat athletes before they are injured! 

IS MY CHILD AT RISK FOR INJURY?

While anyone participating in sports and athletics is susceptible to an injury, certain things about young athletes' bodies may make them more prone to injury than their adult counterparts. First, their bodies are growing and maturing. Bones, tendons, and ligaments are still developing and when combined with still-evolving coordination, stamina, and strength, are more susceptible to injury.  Additionally, while severe injury is less common in young children, individual teenage athletes may be at differing phases of growth and development and are capable of moving at much faster speeds and generating high levels of contact force which may increase their risk for injuries.  

In recent years, guidelines and limitations on length, duration, intensity and frequency of practices and competitions have changed as professionals recognize that the bodies of young athletes cannot withstand the stresses of intense, frequent practices in the same way that an adult can. There is a lot that can be done, however, to make their bodies as resilient and prepared as possible for the demands of their favorite sports and activities.

WHAT PEDIATRIC SPORTS INJURIES DO PHYSICAL THERAPISTS TREAT?

Sports injuries in young athletes fall into two main categories. Acute injuries occur suddenly in response to a force, stretch, or strain that is too great for the body’s tissues to handle. A fall while diving for home base results in a fractured wrist. A poorly aimed kick to the thigh instead of the soccer ball causes a hematoma. A rolled ankle after a jump shot leads to a sprained ankle. In each of these cases pain, inflammation, bruising, and difficulty moving or using the injured body part sets in immediately or shortly after the injury. Protecting the joint, helping the injured tissues begin to heal, preventing loss of flexibility and strength to the greatest degree possible, and eventually restoring normal strength, coordination, flexibility, power, and neuromuscular control are the primary goals of physical therapy in this case. 

Outside of acute injuries, young athletes may be dealing with chronic conditions or overuse injuries. In this case an area of the body experiences minor injury or irritation but does not fully recover between bouts of use or exercise which causes symptoms to recur and persist. Chronic and overuse injuries often happen when athletes are performing repetitive activities like pitching in baseball or running in track but their tissues are not strong or resilient enough to handle the load that the high volume demands. They can also occur when poor movement patterns or biomechanical errors repeatedly overload parts of the body incorrectly. Tendinopathies such as achilles tendinopathy, patellar tendinopathy, or tendinopathies in the elbow are examples of overuse injuries. Stress fractures and plantar fasciitis are other examples. 

INJURY REHAB STARTS ON DAY ONE

Whether the young athlete is trying to recover from an acute injury or has been dealing with these symptoms for some time, pain, inflammation, weakness, and difficulty or inability to participate in their sport can occur. While reduction or modification to training is often important to allow injuries to heal, stopping activity altogether and resting completely is often not the best course of action. It is important, however, to seek the guidance of a trained professional like a pediatric sports physical therapist who understands the process of tissue healing and how to maximize the rate of healing and return to sport while minimizing the time you are sitting on the sidelines.

If you are being treated for an acute injury such as a sprain or strain,  fracture or muscle contusion,your physical therapist will educate you on how to protect these newly healing tissues. Treatment may include compression or bracing, offloading the injured area through crutches, modalities such as ice, ultrasound, or electrical stimulation to reduce pain and swelling, and activity modification. 

In well-healed tissues or in chronic or overuse injuries, your physical therapy program will focus not only on continuing to reduce pain, irritation, or instability but also on addressing areas of weakness, tightness, and impaired neuromotor control both at the site of injury and in surrounding areas. Because physical therapists are movement experts, they will individualize the rehabilitation plan to match the demands that the young athlete’s sport or activity places on the body to prepare for return to full sport and decrease the likelihood of injury recurrence. 

AN OUNCE OF PREVENTION

Because of the dynamic nature of sports, we can expect that bones, ligaments, muscles, and tendons that aren’t prepared for the dynamic forces of athletics are more likely to be injured. There is no reason to wait for an injury to occur, however, before implementing a plan to fix muscular imbalances, improve coordination, and enhance technique. Areas of weakness, areas that lack flexibility, and errors in movement control can be identified by a physical therapist through careful assessment. By evaluating a young athlete before they are injured, there is an opportunity to address individual risk factors through exercise and training and educate the athlete, their parents, and their coaches on how to properly warm up and to avoid playing when very tired or already in pain. 

Staying injury-free is one way to promote lifelong participation in sports and recreational activities. Work with a pediatric physical therapist at the first sign of injury to help get the young athlete back on the field. But also take advantage of their expertise to individualize a training program for aerobic, resistance, and mobility training that will keep young athletes healthy and happy in their favorite sports for years to come. A physical therapist at Evolve is ready to get your young athlete optimized for injury prevention and sports performance.

Click here for more information about pediatric sports physical therapy

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com 

Getting to the Heart of Cardiopulmonary Physical Therapy

Heart and Lung Trouble Ruining Your Day?

Rehabbing Your Heart and Lungs With Physical Therapy…

When you hear the words “physical therapist” most people picture professionals that help people recover from injuries to their back, neck, arms, and legs. Fewer people know that physical therapists (PTs) are also trained to help persons recover from heart and lung conditions. With specialized education and training in the cardiopulmonary system and in depth understanding of the principles of exercise, PTs are a vital part of a care team for someone looking to strengthen their heart and their lungs so they can get back to their everyday activities.

According to the Centers for Disease Control and Prevention, 4.6% of American adults have been diagnosed with respiratory conditions including COPD, chronic bronchitis, and emphysema. Hundreds of thousands of visits to the emergency department will occur each year for complications related to conditions like COPD. Conditions affecting the function of the lungs can be acute–such as a recent COVID-19 infection–or chronic such as with asthma, lung cancer or restrictive lung disease. They may be caused by bacterial, viral, or fungal infections or from environmental causes. In any case, these conditions can have a significant impact on the lungs ability to absorb the vital oxygen we need to sustain life, get rid of the carbon dioxide byproduct, and support our body’s functions from sitting up to running a marathon.

Cardiovascular disease is the leading cause of death among Americans. According to the CDC, someone in the United States has a heart attack every 40 seconds and over 18.2 million Americans over the age of 18 are living with coronary artery disease. Just as the lungs are vital for supplying the body with the oxygen it needs, the heart is the organ that ensures this oxygen gets transported to all the cells in the body. The cardiovascular system is a network of vessels that transports oxygenated blood to and deoxygenated blood from all the muscles and organs and which is pumped by the strong smooth muscles of the four chambers of the heart. This system can become less efficient and effective due to any condition that impacts the heart and the vessels such as congestive heart failure, coronary artery bypass graft surgeries, a heart attack, and many others.

EXERCISING THE HEART AND LUNGS 

When we are healthy we take for granted that our heart and lungs can support all of the physical activities we do each day. If you take up running as a new sport, you can expect your heart and lungs will become more efficient at their jobs over time allowing you to run faster and longer with less effort. When the heart and lungs are injured or impacted by disease, their ability to perform at a level that supports even your basic functions can be compromised. This is where cardiopulmonary physical therapy can assist in restoring the function of these organs to the greatest degree possible. 

WHAT CAN I EXPECT FROM CARDIOPULMONARY PT?

If you’ve been referred to cardiac or pulmonary rehabilitation or if you are reading this article wondering if you might be a good candidate, you should know that your therapist will be working closely with your cardiac and pulmonary specialist physicians to understand the restrictions and contraindications to exercise you may have. Each person and each body is different, but the goals of this type of rehabilitation are to help individuals improve their breathing and their aerobic capacity in a carefully monitored environment. 

Establishing a Baseline: If appropriate, your physical therapist may administer an exercise test to help establish your baseline lung and aerobic capacity. Typically in this setting it is a submaximal test due to concerns for safety. Most often these tests include pedaling on a stationary bike or walking on a treadmill at gradually increasing speeds, resistances, or inclines while carefully monitoring things like symptoms, rate of perceived exertion, heart rate, oxygen saturation and heart rhythm. 

Safety First: Monitoring vitals and heart rhythm is how your therapists know that you are exercising in an optimal and safe range. Before beginning your exercise program for the day, you can expect to have your baseline heart rate, oxygen saturation, blood pressure and symptoms recorded. These will then be monitored either continuously or intermittently while you exercise. If you have been referred to a specialized cardiac or pulmonary rehab program versus a regular physical therapy clinic, you may be asked to wear a portable EKG so your therapists, nurses, or exercise physiologists can also monitor your heart rhythm.

Graded Aerobic Exercise: To improve aerobic capacity and breathing, you will be performing aerobic conditioning that will always challenge you but never exceed your capabilities. As your body adapts to the exercise it may increase in speed, duration or intensity so that gradually, over time, you can tolerate more activity outside of therapy. 

Graded Resistance Training: Resistance training such as free weights or weight machines is also an important aspect of cardiopulmonary physical therapy. If you haven’t done resistance training before, don’t worry! Your therapist will work with you to develop a resistance training program that is appropriate for you and that you can progress as you get stronger.

Breathing Exercises and Airway Clearance Techniques: Learning how to breathe more efficiently to take in oxygen and clear out carbon dioxide, specific exercises to strengthen the muscles that expand and compress the lungs, and techniques for clearing out secretions in the airways are all a part of pulmonary physical therapy. 

Exercises and Manual Therapy to Improve Ribcage Mobility: Having a mobile and flexible ribcage and spine will allow the lungs to expand and compress to their maximal capabilities. Rigidity in the trunk muscles, stooped posture, or conditions like scoliosis can reduce the flexibility of the ribcage and impair lung function. You may be prescribed mobility exercises that you perform yourself and your therapist may also apply some hands on techniques such as joint or soft tissue mobilization to improve tissue and joint flexibility around the spine and ribcage.

Lots of Learning: One of the most important aspects of cardiopulmonary physical therapy is the education it provides. While restoring function is always the ultimate goal, understanding the anatomy and physiology of your condition and how it affects long term prognosis is an important part of these programs. Learning strategies to conserve energy, how to balance rest and activity, understanding what assistive devices are available to you to support you in being more independent and active, and getting referrals to other medical professionals and community resources are all a part of cardiopulmonary physical therapy. 

If you have been feeling like you can’t participate in life like you did before because of a heart or lung condition, cardiopulmonary physical therapy can help. It can be scary and intimidating to begin a new exercise program when your heart or lungs aren’t in top shape, but you do not have to do it alone. A better quality of life is out there and your physical therapists are standing by to guide you there. 

Click here for more information about cardiopulmonary physical therapy in Brooklyn

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Feeling Dizzy? PT Can Help

Stopping the Spins–Physical Therapy for Vertigo

Remember when you were a kid and loved spinning around until you were so dizzy you fell to the ground laughing, waiting for the world to stop spinning? While you may have gotten a thrill out of this feeling when you were a kid, if you are having that room-spinning feeling just from rolling over in bed or bending down to tie your shoes, or perhaps you just woke up this way–you are experiencing an uncomfortable sensation known as vertigo.

Vertigo refers to the sensation that a person or their environment is spinning, when in fact neither is occurring. Vertigo often develops suddenly and typically signifies a problem in the inner ear, though it is important to rule out other potential sources. This article will help you to better understand the possible causes of vertigo and how physical therapy plays an important role in treating this condition. 

WHERE IT ALL BEGAN

We are going to start by taking a look at some of the structures of the inner ear. Deep inside the inner ear lie what are called the vestibular organs. These organs are part of the vestibular system that gathers sensory information about the position and movement of the head and plays an important role in balance and stability. Inside each inner ear lie 5 small organs–3 semicircular canals that provide information about angular acceleration (head rotation) and 2 otolith organs that are sensitive to linear (straight line) acceleration.

When the head and body move, viscous fluid inside the organs in each ear is displaced which triggers sensory receptors and sends information via the vestibular nerve into the brain to update the nervous system about how the body is moving so it can fire the proper muscles to keep you balanced and stable. Typically, the signals in each ear balance one another. Certain medical conditions can cause a sudden imbalance in vestibular input between the ears. When this happens, the brain interprets this information as a sign that the body is moving, when in fact it is not, and the result is the intense and uncomfortable spinning sensation we call vertigo. 

WHAT MIGHT BE THE CAUSE OF MY VERTIGO?

Vertigo can have several underlying causes ranging from benign to very serious. It is important to determine the cause of your symptoms as it helps determine what treatment will be most appropriate. While many people may describe vertigo as a feeling of “dizziness”, it is important to distinguish between the sensation of room-spinning vertigo and other feelings of dizziness such as lightheadedness, as the underlying causes differ.

A common cause of vertigo is a condition called Benign Paroxysmal Positional Vertigo or BPPV. BPPV is characterized by brief episodes of vertigo that are triggered by changes in position. For instance, rolling over in bed or bending down to clean out the dishwasher may trigger a bout of vertigo in someone with BPPV. BPPV occurs when small crystal-like otoconia which normally exist inside the otolith organ called the utricle are displaced into the semicircular canal. When the head changes position, these otoconia drift through the canals causing an increase in signaling from the affected ear and results in the sensation of vertigo. As the fluid slows and the otoconia settles, the sensation will stop until the head is repositioned again. This condition may feel very distressing and even cause moderate to severe nausea, but as the name implies, is relatively benign and can be treated by a physical therapist. It is diagnosed by a physical therapist through a series of head and body positions (for example the Dix Hallpike or Roll Test).

Other causes of vertigo that originate in the inner ear are Meniere's disease, vestibular neuritis and labyrinthitis. Vestibular neuritis and labyrinthitis are caused by inflammation of the vestibular nerve and inner ear. These conditions are often preceded by a viral or bacterial infection and develop suddenly. Often vertigo is severe in these conditions and can last several days to weeks. Nausea and vomiting are not uncommon due to the severity of spinning sensations. If the labyrinth of the inner ear is inflamed, hearing loss and a ringing in your ear (tinnitus) may develop but often resolve within a few weeks. A person may feel unsteady and have difficulty balancing and walking due to the vertigo. 

Meniere's disease is thought to be caused by an abnormal amount of fluid in the inner ear. It is unclear exactly what the underlying cause is, but certain factors may predispose one to Meniere's. Similar to the other conditions outlined above, vertigo is characteristic of Meniere's disease. Episodes are often unpredictable and are not preceded by a change in position. They can last from 20 min to 24 hours. Hearing loss, tinnitus and feeling of fullness in the ears is present in this condition and some of these symptoms may be permanent. 

When being evaluated for vertigo, it is important for healthcare providers to rule out more serious causes of vertigo such as a stroke or TIA (transient ischemic attack), multiple sclerosis, vestibular migraine or tumor. The presence of weakness (especially on one side of the body), loss of coordination, changes in vision, severe headache, confusion, changes in speech and certain abnormal eye movements can indicate one of these conditions and it is essential to seek urgent medical care. 

HOW CAN PHYSICAL THERAPY HELP MY VERTIGO?

Once the underlying cause of vertigo is determined, it is time to begin treating it. The physical therapist approach to treating vertigo will vary based on its cause and any other symptoms you are experiencing. If someone has been experiencing vertigo for some time, they may develop problems with their balance that should also be addressed during treatment. 

If you are suffering from BPPV, the therapist will first use a series of head and body positioning to determine which canal the otoconia are located and then will typically prescribe a series of precise changes in position that will help the otoconia leave the semicircular canal. You will likely experience vertigo during the treatment and possibly some nausea but it should improve significantly once the treatment is complete or shortly after. You may be prescribed some of these movements as homework and might experience relief in as little as one treatment. 

If you have been diagnosed with Meniere's Disease, you may have been prescribed medications by your physician to help control nausea and motion sickness. Your physical therapist will likely educate you on lifestyle modifications that can help reduce the likelihood of another Meniere's attack. Limiting salt intake, taking in a steady amount of fluids throughout the day versus all at one time, and limiting caffeine, tobacco and alcohol use can help maintain a more appropriate fluid level in the inner ear. The vertigo experienced with vestibular neuritis and labyrinthitis will decrease as the inflammation subsides. In any of these three conditions, you may experience some residual dizziness with head movements or feelings of imbalance. Your PT may prescribe a series of head and eye exercises to strengthen the vestibular nerve and a series of balance exercises to help you feel more steady and reduce your risk of falling. 

If your vertigo was caused by something like a stroke or multiple sclerosis, it is important that you receive the right medical care to treat the underlying conditions. If you continue to experience feelings of vertigo, dizziness or unsteadiness, a physical therapist may be able to lessen these symptoms with exercises to habituate the body to motions that cause dizziness, to improve your balance, strengthen the vestibular nerves when possible, or help the body adapt to a vestibular system that is not functioning optimally. 

DON’T WAIT TO SEE A PT

Whatever the cause of your vertigo is, don’t wait to seek treatment. While it is essential to identify serious underlying causes that require emergency medical care, even the “benign” causes of vertigo can disrupt your daily life. Schedule an appointment with a physical therapist today to help identify the cause of your vertigo and get you on the road to feeling better!

Click here for more information about vertigo physical therapy in Brooklyn

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Sorting Out Your Sprain– PT is the Way to Go

Physical Therapy, The Smart Way to Treat a Ligament Sprain

Are you Suffering From a Ligament Sprain?

Whether you are running across the soccer field to score a goal or walking across your icy driveway on the way to work, accidents happen, and muscle strains and ligament sprains can happen to anyone. While a strain refers to an injury to a muscle, a sprain refers to an injury to one of the ligaments that stretches between joint surfaces to help stabilize it. If you’ve ever sprained your wrist or your ankle, then you know how uncomfortable these injuries can be. The good news is that in most cases the care of a physical therapist can help reduce your symptoms and get you back to your full activities. Read more below to learn about sprains and how PT can help you recover.

WHAT HAPPENED TO MY JOINT?

Many times ligament sprains happen in response to stepping or landing awkwardly, twisting the knee or ankle, or even falling and landing on an outstretched arm. Muscle fatigue, such as at the end of a long workout may increase the risk of uncontrolled joint movements that can injure ligaments. Uneven footing and improper or poorly-fitted equipment may also put one at a higher risk for experiencing ligament sprains.

Ligaments are bands of tissue that support bones, joints and organs. Many ligaments stretch from one side of a joint to the other to connect the bones together and stabilize the joint. When a joint is moved beyond its normal range of motion it stresses and stretches the inelastic fibers of the ligament and can cause tearing. For example, if you’ve ever stepped wrong during a hike and rolled your ankle, the ligaments on the outside of the ankle joint may have been sprained. If you’ve ever slipped on ice and stuck your arm out behind you to brace your fall, your wrist may have extended a bit too far causing a wrist sprain. Because the primary function of ligaments is to provide passive stabilization to the area, loss of stability can range from mild to severe with a ligament sprain.

We can categorize a sprain based on its severity:

- Grade I (mild): microscopic damage has occurred to the ligament but only mild local tenderness and minimal bruising/swelling is noted without compromising joint stability. Typically takes 2-3 weeks to heal.

- Grade II (moderate): partial tear/rupture of the ligament. Obvious swelling and tenderness noted over the injured ligament but joint instability is either minimal or absent. May require up to 6 weeks to heal.

- Grade III (severe): complete rupture of the ligament with severe swelling and tenderness. This injury may be difficult to distinguish from a fracture initially. Instability of the joint is noticeable due to the severity of the rupture. Prolonged time to heal is frequent and may require surgery to repair.

START THE HEALING PROCESS ON THE RIGHT FOOT

If you’ve injured yourself, it is important to assess the severity of the injury and identify what structures are involved. If you cannot move the injured joint, can’t bear weight on it, or notice severe swelling and tenderness, it is important to see a doctor right away to rule out a fracture. As noted above, severe ligament sprains and fractures can initially mimic one another in their presentation, but their treatment is quite different.

A physical therapist can advise you on this matter and can also identify the ligaments that may be injured. In the first week or so after injury your physical therapist will guide you on how to protect the recently injured and newly healing ligament. You want to minimize any movement that causes pain or places any stretch or strain across the injured site. They may recommend bracing or taping to protect the injured area and reduce pain or advise you to use crutches if you cannot walk without limping.

Aside from protecting the area of injury, in this very early phase your physical therapy treatment will focus on reducing inflammation and pain, and maintaining strength in unaffected areas above and below the injury. To achieve these goals your physical therapy treatment may consist of the application of ice or light soft tissue work to mobilize any edema. Modalities such as electrical stimulation or ultrasound may be applied to increase circulation, decrease inflammation and control pain.

As the healing tissues become stronger, inflammation subsides and pain is reduced, it is time to move on to the next phase of physical rehab. If your ligament sprain is in one of the joints of the leg, ankle or foot, it is important that you are able to walk with a normal gait pattern without any assistive devices before you start adding too much stress to the healing ligament. Your PT will help you know when you have reached these milestones and you may begin to perform gentle pain-free stretching and range of motion exercises to restore mobility to the joint. It is also important in this phase to start performing light resistance training to the muscles around the affected ligament as muscles partner with ligaments to stabilize a joint.

Finally, in the later stages of healing your physical therapy treatment will focus on exercises and activities that prepare the injured ligament to withstand the stress and strain of everyday life and the sports and recreational activities we love to do. In this stage you may begin more sport-specific exercises and activities to restore power, agility and speed. Optimizing biomechanics and muscle strength and motor control is essential to support the previously-injured joint and reduce the likelihood of experiencing an injury in the future.

GET HEALTHY AND STAY HEALTHY

Because a moderate or severe sprain can compromise the integrity of the ligament and cause long-term instability, having the guidance of a rehab professional like a physical therapist is important to reduce the likelihood of re-injury. Though suffering an injury can feel discouraging, you can speed up the time it takes you to get back to the activities you love and reduce the risk of becoming re-injured through an individualized physical therapy program. The physical therapists at Evolve are ready to get you feeling better and back on track!

Click here for more information about physical therapy for sprains

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Strained Muscle Stopped You in Your Tracks?

Physical Therapy for Muscle Strains

Do You Know What to Do When You Strain a Muscle?

We’ve all been there before, joining in on your kids’ game of football only to “pull a hammie”, jumping back into the gym after a hiatus and grabbing the same weight you used the last time you were there only to feel a sudden sharp pain in your shoulder muscle, or maybe helping your friend move a couch up the stairs and realizing you should have lifted with your legs. In all of these cases you find yourself dealing with a sore muscle that feels a little (or a lot) worse than just typical post-workout soreness. In fact, you’ve strained a muscle. 

While it may be true that there are no inherently “bad” movements for your body, there certainly are movements for which the body is unprepared. When a muscle is overstretched or asked to contract hard against a sudden load, or even just overused, injury can occur. When this happens it is important to take the appropriate steps to allow the muscle to heal and to understand how to reduce the likelihood of it happening in the future. The good news is that low and moderate muscle strains typically heal with conservative care like physical therapy. 

HOW DO I KNOW IF IT’S A STRAINED MUSCLE?

If you’ve ever been injured before, you know it can sometimes be hard to pinpoint exactly what structure is causing your pain. When a muscle is strained, you will typically experience pain in that specific muscle when it is contracted strongly or stretched. If the strain is moderate in severity you may also notice some localized stiffness, tenderness, and swelling in the area. You may also observe that the muscle feels weaker than usual. Finally, if it is severe and the muscle belly has separated from the tendon or all the fibers have torn, the range of motion of the joints at either end of the muscle may be either significantly reduced because of guarding or excessive because the torn muscle is no longer limiting it. 

It is important to note that in most cases a muscle that has been severely torn will need surgery to repair the injury so the muscle can function normally again. For less severe injuries, physical therapy is just what the doctor ordered. Not only will they help you identify an injury to the muscle versus the joint, for example, but they can guide you through the recovery process in a smart and efficient manner. 

HOW LONG IS THIS GOING TO TAKE?

When someone has an injury, the most common first question is: How long will it take to heal? The answer provided by your local physical therapist will depend on several factors. First, the severity of the muscle strain and how many fibers were injured will affect recovery time. Second, comorbid conditions that impair healing like diabetes could impact the time to recover. Third, how well you follow the instructions of your PT for facilitating healing and how diligent you are with your home program can also play a role in the healing time.

Finally, the time it takes to rehabilitate a muscle strain can depend on the demands of the activities in which you are involved. For example, if someone has strained their hamstring but their daily routine involves some walking for exercise and working at a desk, they will likely find themselves “recovered” to their baseline faster than someone who plays professional basketball and will be jumping, running and cutting during practice and games. In this second scenario, the muscle has to heal to a level in which it can withstand the demands of this sport to prevent reinjury. 

PHYSICAL THERAPISTS CAN HELP YOU RECOVER

In the first 5-7 days after a muscle strain the primary goal is to protect the muscle so that it can begin healing. The initial repairs that the body makes are quite delicate. If you jump back into activity that stresses the repair too early, you may send yourself right back to square one. During this stage your PT will guide you on how to rest and protect the muscle. They may or may not recommend ice or cryotherapy but may apply different types of compression or taping to improve swelling and inflammation. They may also employ modalities like electrical stimulation or ultrasound. While the injured muscle may be benched for the week, muscles above and below the injury and on the opposite limb can still get a good workout!

Once you’ve passed the acute stage of healing it is time to gradually begin loading and using the injured muscle. Once again, it can be easy to overdo it at this stage which is why it is important to work with someone knowledgeable, like your PT. They will advise you on how much stress and strain the muscle can take at this stage to prevent re-injury. At this stage your PT may perform some gentle soft tissue mobilization to the area and surrounding areas. You may begin some very gentle stretching to help prevent loss of flexibility and start performing submaximal exercises to gradually load the muscle fibers to help them heal and get stronger. 

After 2-3 weeks of solid healing, a muscle strain is typically entering what is considered the “chronic phase” which means it is ready to start working back to full strength. It might seem like a good idea to jump back into your former activity level at this point, but the muscle will still be vulnerable to re-injury for some time which is why your PT will program a workout routine for you to build up the muscle’s resilience. This may include a stretching and mobility routine and different strengthening exercises that include isometric, concentric, and eccentric contractions. 

One of the great things about working with a PT after a muscle strain is that they will understand the demands that your daily and recreational or professional sporting activities require and can ensure that your program mimics the demands of these activities on the injured muscle. After completing your program, your muscle strain should be healed and you will have the knowledge and understanding of how to maintain these improvements and reduce your likelihood of straining the muscle again. 

DON’T GO IT ALONE

Whether you are experiencing a muscle strain for the first time or are stuck in a cycle of healing and re-injury, physical therapy is a fantastic resource to help you recover. There is no need to guess what the best steps are early or late in your recovery. The physical therapists at Evolve are here to educate you on the process of healing, get you back to your favorite activities and teach you how to prevent re-injury in the future. 

CLick here to find out more information about physical therapy for muscle strains

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics-

There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Treat Pregnancy and Postpartum Pain with Physical Therapy

Prepare Your Body for Pregnancy and New Mom Life with Physical Therapy

Pregnancy Doesn’t Have to Hurt! Physical Therapy Can Help

Pregnancy is often a time of great joy and anticipation but there is no denying that a woman’s body undergoes many changes before, during, and after childbirth. Emotional, physical, and hormonal changes are all a part of the process of pregnancy, childbirth, and postpartum life for new moms. If you are pregnant or thinking of becoming pregnant, you may have heard other women discuss the changes their body has undergone before and after pregnancy. While some of these changes are out of your control and simply a necessary part of the process, others may be prevented, controlled or relieved with the help of a knowledgeable physical therapist!

It's true, physical therapists can undergo specialty training in the care of antepartum (before childbirth) and postpartum (after childbirth) women. While you may have heard that low back pain during pregnancy, incontinence after childbirth and new muscle and joint pain from caring for a newborn are all to be expected, the truth is, there is a lot that a physical therapist can do to help treat, alleviate and prevent many of these problems! As is the case with all medical conditions, it is important to check with your doctor before starting any new physical activity while pregnant, but this article will give you an introduction to how physical therapists help their clients before and after pregnancy.

WHAT IS THE CAUSE OF PREGNANCY-RELATED PAIN?

Before, during, and after childbirth your hormones are fluctuating significantly. Hormones such as progesterone and relaxin cause increased ligament laxity during pregnancy. This has the effect of allowing the pelvis to expand during the birth but also causes laxity in other joints such as the lower spine. Because the ligamentous laxity tends to reach its height during the second trimester as a woman’s uterus is expanding, her belly is getting larger, and her posture is changing, low back and pelvic pain may develop. 

Other causes of musculoskeletal pain or discomfort are the new physical demands of caring for a newborn. Bending down repeatedly to pick up an infant out of a crib or off the floor, holding a baby in one arm for prolonged periods, or even holding a bottle for an extended time can cause stress and strain on the muscles, joints, and nerves. Neck, shoulder, wrist, hip, or leg pain may develop but can often be addressed with a good physical therapy program. 

Finally, pregnancy and childbirth place a high physical demand on the pelvic organs and pelvic floor. Constipation, urinary and/or bowel incontinence, painful sex, and pelvic pain can result. Many women may find these issues embarrassing or assume they are just a “normal part of having a baby” and don’t know that a pelvic floor physical therapist can educate them on these symptoms and create a treatment plan for them. 

HOW CAN PHYSICAL THERAPY HELP?

Prevention, prevention, prevention! Because we know that pregnancy will put a certain amount of strain on your musculoskeletal system, preparing the body to handle that stress is one of the best ways you can decrease your risk of developing pain or discomfort before or after childbirth. In most cases, exercise is safe during pregnancy and if your doctor has given you the green light to exercise, you might be wondering what is and isn’t safe for you to do while pregnant. A physical therapist with training in the assessment and treatment of pre- and postpartum clients is an excellent resource for developing an exercise plan to prepare your body for the process of nurturing a growing fetus, giving birth and starting new routines of caring for your child.

During an evaluation, physical therapists will perform an individualized assessment of your muscle strength, flexibility, movement patterns, prior history of injury, and level of activity. After assessing these areas, they can prescribe a series of stretches, movements, and exercises to help keep you strong, flexible, healthy, and as pain-free as possible throughout your pregnancy. Because of their area of expertise, you can feel confident that your physical therapist understands the special considerations for pregnancy and exercise so that your program will be both safe and effective.

What if you are already having pain? Not to worry, if you are feeling pain or discomfort associated with pregnancy or after giving birth, there is a lot that can be done to help. One of the most important roles your physical therapist will play is as an educator. Understanding how to move your body and care for your baby in the most biomechanically sound way possible can help to relieve some of the excess stress on your nerves, joints, and muscles. 

If you have an old injury that is flaring up or new pain or discomfort that has developed, a physical therapist will be able to assess the area of discomfort to determine how best to address the issue. They can advise you on safe application of heat or ice to reduce pain and teach you appropriate stretches, strength and stabilization exercises to help reduce or eliminate your symptoms.

Finally, if you have already given birth, whether vaginally or by cesarean section, your body has been through quite a lot of physical trauma. Many women don’t know that a postpartum evaluation by a physical therapist can help address pelvic floor and musculoskeletal issues like a diastasis recti (separation of the abdominal muscles) or pelvic floor muscle dysfunction, early. A good PT program will help you recover from childbirth and pregnancy so you can enjoy taking care of your baby and getting back to the activities you love to do.

Let’s not forget about the pelvic floor. The pelvic floor and pelvic organs are star players in pregnancy and childbirth. They are asked to work harder than normal during this time and often need extra care. Issues of bladder or bowel leakage, incontinence, pelvic organ prolapse, or pain during sexual intercourse can occur during pregnancy and after childbirth and it is important that women know there is help out there for these conditions. A specially-trained pelvic floor physical therapist can teach you strategies, good habits, and exercises to decrease the likelihood of developing these conditions and when necessary, can help to treat them after they’ve developed. 

So no matter where you are on your pregnancy journey, it is a great idea to involve a physical therapist. Addressing problems early on and preventing new ones from developing can help you to have an enjoyable pregnancy and recovery after childbirth. Specially-trained PTs at Evolve are waiting to join you on this journey!

Click here for more information about physical therapy for pregnancy

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

New Pilates Class in Brooklyn Starting May 1st at Evolve Physical Therapy

Pilates!

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Pilates! 〰️

Take Your Fitness to the (Pilates) Mat at Evolve NY in Brooklyn!

Evolve NY physical therapy clinic in Brooklyn is excited to announce the addition of Pilates classes to our list of health and wellness services. If you are looking to take your practice to the next level, are interested in starting Pilates for the first time, or are hoping someone can help you modify your practice to accommodate for injury or health conditions, keep reading to learn how Evolve NY is the perfect place to practice.

While you may be new to Pilates, Pilates is not new to the fitness scene. In fact, Pilates was developed in 1920 by fitness instructors Joseph and Clara Pilates when they opened their Body Conditioning Gym in New York City. Joseph developed many of his techniques while working to rehabilitate patients who could not walk. Since then it has continued to hold an influential space in the fitness industry attracting those looking for a way to strengthen body and mind and rehabilitate from injuries. 

At Evolve NY we are offering traditional mat Pilates which may involve the use of other equipment to promote strength, stability, and flexibility. Pilates exercises develop the body through muscular effort that stems from the core, which helps to improve general  fitness and overall well-being. In keeping with the tradition of Pilates, classes will incorporate the 6 Principles of Pilates:

• Breath

• Flow

• Concentration

• Centering

• Control

• Precision

WHAT ARE THE BENEFITS OF PILATES?

One of the great things about Pilates is that no no matter your fitness or experience level, Pilates will challenge your body. Aside from the general health benefits that participating in any regular exercise program will give you, Pilates provides many specific benefits including:

• Improving your posture

• Strengthening your core

• Improving your flexibility

• Helping to reduce aches and pains

• Improving your body awareness and breath control 

MEET YOUR INSTRUCTOR

Donna Cicchesi is a Doctor of Physical Therapy with experience treating  patients of all ages from pediatric to geriatric. She received her BA in dance from Hofstra University and her DPT from SUNY Downstate. Donna's  pilates classes draw on both the science of Physical Therapy and the art of dance and movement. Her goal is to make sure that clients understand  that pilates is accessible to virtually anyone, no matter their  physical capabilities.

A HAPPY MARRIAGE BETWEEN PHYSICAL THERAPY AND PILATES

No matter your experience with Pilates, working with an instructor like Dr. Cicchesi provides benefits that you won’t find at a traditional Pilates studio. As a Doctor of Physical Therapy, Dr. Cicchesi is a movement expert with years of formal instruction, continuing education and practice in the evaluation and treatment of injury and injury prevention, anatomy and physiology.

While you will not be undergoing physical therapy while participating in Pilates classes at Evolve NY, Dr. Cicchesi’s experience creates an environment in which anyone, no matter your age or physical ability, can benefit from the practice of Pilates. If you have an injury or condition that may make exercising difficult, Dr. Cicchesi is able to modify your practice to ensure you can safely participate in the class and reap the benefits of regular practice. 

Don’t Miss Out on Evolve Physical therapy’s New Pilates Classes in Brooklyn! 

To learn more about Pilates classes at Evolve, check out our website where you can learn about Evolve and sign up for your first pilates class in Brooklyn! 

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Torn muscle? Call Our Physical Therapists In Brooklyn

Physical Therapy for Muscle Tears

Rehabbing Your Torn Muscle.

Are you suffering from a torn muscle or think you may be? If you are experiencing muscle pain with a strong contraction, swelling or stiffness in the muscle, or weakness in that area, you might be right. A torn muscle, also called a “muscle strain”, occurs when muscle fibers are overstretched, overused, or contracted against a sudden load. At the moment of injury the stretch or stress on the muscle fibers is too great for the muscle to handle causing the fibers to tear and be injured. This article will help explain the anatomy and physiology of a muscle tear and how physical therapy can help it heal. 

LET’S TAKE A CLOSER LOOK AT YOUR MUSCLES

Muscles are the movers and stabilizers of the body. There are more than 600 muscles in the human body from the large muscles that straighten the knee to kick a soccer ball to the small muscles in your throat that help you produce sound when you talk. Muscles are made up of bundles of muscle fibers aligned in specific patterns. When these fibers contract they shorten the muscle and pull on the bones they attach to creating movement and strength.

At either end of these fibers is a strong band of tissue called the tendon which connects the muscle fibers to the bone. The tendon itself does not contract but is an essential component to muscle function as it creates stable attachment points on the bone to allow the muscles to do their work on the skeleton. 

If you’ve ever participated in sports or a regular workout routine, you know that one can increase the size and strength of muscles by regularly overloading them. This stress stimulus, when large enough, signals to the body that it needs to increase the size and efficiency of the muscles in order to meet the new demands you are placing on them.  For example, when you first start lifting weights you may find squatting with a 25lb kettlebell to be challenging.  After weeks to months of consistent training, however, you are now able to squat holding a 40lb kettlebell while the 25lb one feels “light”. 

HOW DO MUSCLE TEARS OCCUR?

The key to building strong and resilient muscles is through overload. This means asking the muscle to move a load or resist a force that feels difficult to you. When applied correctly, overload results in stronger muscles. Injury can occur, however, when muscles are asked to resist a stretch, force or load for which it is unprepared. This could happen when you select a weight that is too heavy while working out at the gym or when you pivot quickly and start to sprint off toward a ball during a soccer game causing your hamstring or calf muscle to suddenly contract very forcefully.

Muscle tears are categorized based on their severity:

Grade I strain (mild): very few muscle fibers are injured. Pain typically occurs the next day but no swelling or bruising is observed. Pain may be felt when the affected muscle is strongly contracted or stretched at its end range.

Grade II strain (moderate): many (but not all) fibers are injured resulting in stiffness, loss of flexibility and loss of strength. Pain is felt both during contraction of the muscle and during stretching. Swelling and bruising over the injured area is common. 

Grade III strain (severe): all fibers of the muscle are completely torn or the muscle belly has detached from its tendon. Severe pain is often felt upon injury and heavy swelling and bruising will develop. Range of motion may be either significantly reduced due to pain or excessive because the muscle is no longer limiting it. This muscle will generally be unable to produce any force due to the severe disruption in the fibers. 

SO YOU’VE TORN YOUR MUSCLE, WHAT NOW?

How you care for a torn muscle and how long it will take to heal depends on the severity and location of the muscle tear. In any case, a physical therapist can guide you on the initial steps for recovery and how to prepare the injured muscle for return to normal activity. When you first visit a physical therapist they will ask you a series of questions about your symptoms and examine the area of injury. The examination may involve palpating (gently pressing or feeling) the injured muscle for tenderness, swelling, or abnormalities, gently stretching the affected muscle to look for stiffness, pain, excessive or restricted range of motion, testing the muscle strength and observing your movement. 

Physical therapy treatment for a muscle tear depends in part on how long after the injury you seek care. If you visit your PT right after injury, and before seeing your doctor, and your physical therapist determines that your muscle tear is moderate or severe (grade II or III) they may refer you to a physician to further examine the injury and determine if any medications are necessary to facilitate healing and manage symptoms. Your doctor may recommend imaging such as an X-ray to examine the surrounding bones, or an MRI or ultrasound to examine the injured fibers. If the muscle tear is severe a surgical repair may be recommended.

During the acute phase of healing which typically refers to the 5-7 days immediately post-injury, the goal of physical therapy will be to protect the site of injury. In the acute phase of healing the body will begin to repair the injured tissue but at this point those repairs are very delicate. Any stretching or strong contraction of the injured muscle could re-tear the healing tissue causing the healing process to regress or begin again. 

If you tore a muscle in your leg and are limping, your PT may recommend crutches to allow the muscle time to heal until you can walk without limping. Splinting or bracing may be recommended to limit excessive movement or stretching of the muscle and help reduce pain. Application of ice, compression or taping techniques may also be prescribed to help reduce excessive inflammation and reduce pain. 

As the muscle tear begins to heal your PT may begin to apply very gentle stretching to help maintain tissue flexibility and later on more intensely to restore muscle length. You will begin to perform exercises to restore the motor control and coordination of the muscle initially and the strength and power of the muscle later on. Your physical therapist will help educate you on signs that your muscle is ready to progress to the next stage of rehab and signs that you have overstressed the tissues, such as increased swelling or prolonged pain, and advise you on how to care for it.  

If you had surgery to repair a severely torn muscle, your physical therapist will help to progress you through your post-surgical protocol with the same goals of managing pain, decreasing swelling, improving flexibility and restoring strength and coordination. Whether you are an athlete wanting to get back out onto the field or an injured worker trying to get back to your job, physical therapy is a great tool to heal your muscle tear. The physical therapists at Evolve are here to educate you on the process of healing, get you back to your favorite activities and teach you how to prevent re-injury in the future. 

Click here to find out more information about physical therapy for muscle tears

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Gout Got You Down?

Physical Therapy for Gout 

Are you suffering from gout? Physical Therapy Can Help

Gout–many people have heard of it but for the more than 8 million people in the U.S. suffering from gout, it is a painful reality they’d love to prevent. While medical care from a physician is an important part of managing gout, many people do not know that a physical therapist can help address the symptoms and risk factors associated with gout. 

WHAT IS GOUT?

So what is gout? Gout is a complex form of arthritis characterized by sudden, severe bouts of joint swelling, pain, warmth, redness, and tenderness. Accumulation of needle-like urate crystals in the joint causes the inflammation and pain characteristic of gout. 

Urate crystals form when either too much uric acid is produced by the body or too little is excreted by the kidneys. Uric acid is produced normally by the body when it breaks down what are called purines. Purines are substrates found commonly in food we eat such as red meat, organ meat and some seafood like tuna, anchovies, and mussels. Eating these foods in high amounts can cause elevated uric acid as can drinking certain alcohols such as beer or sugary cocktails.

Men tend to be at higher risk for developing gout than women, though post-menopausal women are at a higher risk than their pre-menopausal counterparts. Certain medications such as low dose aspirin, ACE inhibitors and anti-rejection medications for post-organ transplant patients may increase levels of uric acid in the body. Finally, a family history of gout and a personal history of certain medical conditions such as obesity, uncontrolled high blood pressure, diabetes, metabolic syndrome, or heart and kidney disease increase one’s risk of developing gout.

Gout attacks are most common in the joint at the base of the big toe but can actually occur in any joint. Ankles, knees, fingers, wrists and elbows may be affected by gout as well. An attack of gout typically occurs suddenly. You may awake in the middle of the night with pain, heat, and redness in a joint so severe that even the bedsheet touching the area is unbearable. 

It is important to call your doctor if you develop these symptoms. Firstly it is important to rule out other causes of joint pain, redness and swelling such as an infection or acute injury. Secondly, untreated gout can lead to joint erosion and prolonged pain. 

HOW IS GOUT TREATED?

During an acute gout attack your physician may prescribe medications to reduce inflammation and manage pain. They may also recommend medications to prevent the build-up of uric acid and improve its removal from the body to decrease your risk of future gout attacks. 

While your physician is an important and necessary first point of contact for treating gout, a physical therapist should be another important member of your care team. 

WHAT IS A PHYSICAL THERAPIST’S ROLE IN TREATING GOUT?

Once the gout attack is under control, physical therapy is a great option to help restore normal joint movement and function and also to address lifestyle modifications that will lower your risk for future gout attacks. 

Lifestyle modifications: If you go back and review the list of risk factors for gout outlined above, you will notice that many of them can be addressed with modifications to one’s lifestyle. It should feel empowering to know that medication is not the only way you can decrease the likelihood of another gout attack and of developing long term joint damage. 

Participation in a regular exercise program consisting of moderate to high intensity cardiovascular and strength training can improve risk factors for diabetes, heart disease, high blood pressure, and metabolic syndrome, all conditions associated with an elevated risk for gout. 

For many people, lack of familiarity with exercise and concerns about injury or worsening pre-existing conditions such as joint pain or heart disease is a barrier to entry for exercise. Luckily, physical therapists are experts in prescribing exercises that are individualized to not only prevent worsening of your pre-existing medical concerns but to actually help improve them! When you work with a physical therapist they can advise you on how to safely begin an exercise program. Your physical therapist will take the time to get to know your medical history, your current abilities, your concerns, and your motivating factors and help tailor a program to meet your needs. 

Physical therapy treatment: Physical therapy for gout will focus on managing pain symptoms and improving function. Modalities such as cryotherapy (cold/ice) have been shown to improve inflammation and pain during a gout attack. Your physical therapist may advise you on splinting, or bracing the involved joint or on assistive devices such as a cane or crutches when pain is severe enough to impair walking. 

As the acute attack wanes or in the case of chronic joint damage from gout, restoring normal joint motion is an important part of restoring your function. Your PT may apply gentle hands-on techniques such as passive range of motion, soft tissue therapy or joint mobilization, myofascial release techniques, or taping to improve the mobility and health of the joint and soft tissues that are affected. 

In the case of chronic gout, while the surfaces of the joint may no longer be pristine, how the joint moves and how much stress is applied across a joint can play a large role in how much pain you experience and how much you have to limit your activities. Proper strength and flexibility in the muscles surrounding the joint can optimize the movement of the joint and may reduce some of the rubbing that occurs between uneven joint surfaces. Your physical therapist will test your muscles to identify areas that need work and can guide you through a progressive program of exercises to address these issues.

 As muscles get stronger and tissues regain their proper length and flexibility, learning to activate muscles at the right time and in the right order during a specific activity is essential. Even if your muscles are strong, the motor control of these muscles may not be adequate to properly perform a movement without putting excessive stress across a certain joint. As you learn to control and fire your muscles while performing motions such as going up stairs or running, you will experience less pain.

The ultimate goal of a physical therapy program is to help you get back to the activities you love and need to do throughout your life. While you may not be able to prevent every gout attack, you can help prevent long-term disability associated with joint injury and inactivity. Don’t let gout get in your way of a happier, healthier, and more active life. Schedule an appointment with a physical therapist at Evolve where they will empower you to make lifestyle changes to reduce your risk for another gout attack and help you get back to activities in the safest, most effective and quickest way possible. 

Click here for more information about physical therapy for Gout

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Physical Therapy: Fighting Against Fibromyalgia

Physical Therapy for Fibromyalgia

If You are Living With Fibromyalgia, Physical Therapy Can Help…

Are You Living With Fibromyalgia Pain?

Affecting nearly 5 million people in the United States alone, fibromyalgia can have widespread consequences for those diagnosed with this chronic condition. 

WHAT IS FIBROMYALGIA?

Fibromyalgia is a chronic condition thought to result from alterations in how the nervous system processes pain signals. The definitive cause is unknown at this time but research shows fibromyalgia can be triggered by a traumatic event, a surgery, an infection, arthritis, major emotional stress, or can develop gradually over time. Certain systemic medical conditions may predispose someone to develop fibromyalgia. These conditions include lupus, rheumatoid arthritis, and ankylosing spondylitis.  

Most individuals are diagnosed with Fibromyalgia during middle age, however, it can develop much earlier or later in life. In some cases a family history can predispose an individual to developing this condition and women are twice as likely to have fibromyalgia as men. 

Diagnosing Fibromyalgia can be complex, as this disorder is considered a syndrome consisting of several signs and symptoms. Common presentations include:

• Muscle stiffness especially early in the morning

• Widespread pain and tenderness

• Chronic fatigue

• Headache, including migraine

• Difficulty sleeping

• Memory, thinking and concentration issues

• Gastrointestinal symptoms

• Depression and anxiety

• Tingling or numbness in the hands or feet 

There are no specific blood tests or imaging that can be done to diagnose Fibromyalgia which means your provider will need to take a thorough history to better understand the symptoms you are experiencing. A formal diagnosis is usually made based on symptoms of extreme fatigue, pain in multiple tender points (that move around), trouble sleeping, memory difficulties and anxiety. If your physical therapist suspects you may have Fibromyalgia they are not able to make the formal diagnosis but may refer you to a rheumatologist for further examination. 

HOW CAN  PHYSICAL THERAPY HELP?

As movement experts, a physical therapist should be an important member of your care team. Reducing pain, improving ability to participate in desired daily activities, and increasing health-related quality of life are three primary aims of physical therapy in the treatment of fibromyalgia. Research performed on various physical therapy interventions for fibromyalgia found that aerobic exercise, muscle strengthening, stretching, and education are effective in decreasing the pain and severity of fibromyalgia and enhancing quality of life. 

If you have found that increasing activity has caused a flare in your symptoms, a physical therapist can help guide you in how to pace your activities, and how to start slow and progress when ready. They will discuss ways to set realistic goals for exercise  and when you should modify your exercise plans if you are experiencing added stress or increased symptoms. 

WHAT CAN I EXPECT DURING A PHYSICAL THERAPY TREATMENT?

If Fibromyalgia pain and fatigue have caused you to restrict or limit the amount of exercise and physical activity you do, your physical therapist will work with you to begin a well-paced but progressive exercise program. Although you may initially experience an increase in your symptoms, physical activity is generally considered safe for persons with Fibromyalgia and under the supervision of a physical therapist you can become more confident in progressing and modifying physical activity on your own.

Here are some examples of physical therapy treatments to address symptoms of fibromyalgia:

Meditation/Mindfulness/Guided Imagery: anxiety is a hallmark symptom of this condition. Whether feeling stress and anxiety are primary symptoms of the disorder or results of feeling unwell and in pain for a prolonged duration, techniques like meditation, diaphragmatic breathing, mindfulness and guided imagery may be prescribed to promote increased parasympathetic nervous system activity to reduce pain and anxiety.

Aerobic Exercise: Daily aerobic exercise has been shown to improve global quality of life and reduce pain symptoms in persons with fibromyalgia. If you are new or returning to aerobic exercise, your PT will help you select a form of aerobic exercise that is most interesting to and comfortable for you and guide you in progressing the time and intensity to give you maximal benefit. 

Strengthening: A muscle strengthening routine has been shown to reduce fibromyalgia-related pain. While it may not be a good idea to jump right into the gym and start a high intensity strength program like you used to do before your fibromyalgia symptoms developed, a supervised, individualized, and graded strengthening routine is a great idea. A PT will measure the strength of your muscles and prescribe exercises that will help to reduce your pain symptoms and help you feel stronger to perform your daily activities. 

Stretching: Stretching areas of the body that feel stiff or tender can reduce feelings of pain. If you are unsure where to begin with stretching, your PT may perform gentle manual stretches to elongate and relax your tissues and teach you stretches you can perform on your own at home.

Manual Therapy Techniques: Soft tissue mobilization or massage may be helpful to some people with fibromyalgia to manage feelings of pain and stiffness. Your physical therapist will work on specific areas of your body to help improve blood flow to the area and reduce symptoms of pain and discomfort. 

As with all conditions, the physical therapy approach to treating fibromyalgia is as individual as the clients who walk in the door. If you are living with fibromyalgia, though, you do not have to look for answers on your own. Physical therapy can help empower you to find ways to manage your symptoms and to participate in more activities throughout your life. Evolve physical therapy is here to help you take those first steps!

Click here for more information about physical therapy for Fibromyalgia

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com 

Are Your Fingers Tingling? It May Be Carpal Tunnel Syndrome

Physical Therapy for Carpal Tunnel Syndrome

Getting Control of Your Carpal Tunnel Syndrome with Physical Therapy…

WHAT IS CARPAL TUNNEL SYNDROME?

Have you been experiencing numbness, tingling, or burning in your palm, thumb, index or middle fingers? In the beginning maybe you would wake up with these symptoms and be able to relieve them quickly but now they are occurring more often during the day, especially after you’ve been using your hands for a while. The numbness might linger and eventually you start noticing some weakness in your hands. If this sounds familiar, you might be experiencing carpal tunnel syndrome (CTS). 

Carpal tunnel syndrome refers to a group of symptoms that are caused by pressure on the median nerve as it passes through the carpal tunnel of the wrist. The carpal tunnel is a narrow passageway on the palm side of the wrist created by a ligament called the transverse carpal ligament that crosses from left to right between several wrist bones. The median nerve and several tendons travel through and are protected by the carpal tunnel. 

The median nerve arises from the neck region of the spinal cord and travels through the muscles and tissues of the upper arm and forearm, through the carpal tunnel and it’s branches travel into the hand. The median nerve supplies motor impulses to several forearm and hand muscles and transmits sensory information between the thumb, index, middle, and half the ring fingers, their corresponding palm areas, and the brain. 

You can see why pressure on the median nerve as it travels through the carpal tunnel would cause numbness, tingling or burning in the first 3 (and sometimes part of the 4th) fingers. In fact many people find themselves shaking their hands out frequently to relieve these sensations. If the compression is prolonged or severe, it can interfere with the nerve’s ability to transmit motor signals to corresponding muscles and a person can notice weakness in their hands and grasp and more difficulty performing fine motor tasks such as typing, writing, or handling small objects. 

WHO IS AT RISK FOR DEVELOPING CTS?

While nerves are pretty resilient against occasional pressure and compression, prolonged pressure can cause the types of symptoms we see with CTS. Because of the nature of this condition, repetitive forceful finger use, prolonged vibration through the hands, and extreme wrist positions can raise your risk of developing CTS. Data shows that women are more than three times more likely to develop CTS and that certain professionals such as assembly line workers, manufacturing, sewing, cleaning, and meatpacking workers develop CTS at higher rates. Even repetitive typing and keyboarding, if the wrists are angled less than optimally, can cause CTS. 

CTS is also associated with certain health conditions in some people:

• Trauma or injury to the wrist that causes inflammation such as a fracture or sprain

• Diabetes

• Overactive pituitary gland

• Underactive thyroid gland

• Rheumatoid arthritis or gout

• Fluid retention during pregnancy or menopause

• Hand or wrist deformities

HOW IS THIS CONDITION DIAGNOSED?

A thorough subjective exam is often adequate to diagnose CTS. Your physical therapist will ask you about the duration and nature of your symptoms and what kinds of activities you do in your job, for recreation and in your daily tasks. This information gives the physical therapist insight into potential underlying causes and helps rule out other conditions that may cause symptoms in the hand and fingers. 

Once they have interviewed you, you can expect to undergo a physical exam to evaluate your strength, sensation and coordination of your affected hand and forearm. Your PT will likely also examine your neck and shoulder as the median nerve originates in the neck and at times conditions of the neck can mimic symptoms of CTS. They may also perform certain special tests to detect compression and irritation of the median nerve:

• Phalen’s test: gently pressing the backs of your hands together to flex both wrists for one minute. Tingling or numbness in the fingers that occurs within 60s is suggestive of CTS

• Tinel sign: your physical therapist may tap over the median nerve where it passes through the wrist. Tingling that results in the thumb, middle or index finger may indicate CTS

If you see a specialist physician such as a Neurologist, they may recommend specialized electrical and nerve function testing such as an electromyogram (EMG) to determine how well motor impulses are traveling through the nerve. A nerve conduction velocity test may also be utilized to assess how well the median nerve transmits sensory information. These tests can identify and assess severity of CTS. In some cases an x-ray or MRI may be ordered to assess for possible trauma or deformity in that area. 

HOW CAN PHYSICAL THERAPY IMPROVE MY SYMPTOMS?

Physical therapy can be helpful in improving symptoms as a form of conservative care or as part of a post-surgical rehabilitation plan. Non-surgical treatments are typically recommended first and may include physical therapy, corticosteroid injections or non-steroidal anti-inflammatory medications prescribed by a physician, and splinting. If the condition is severe or does not respond to conservative treatment then surgical intervention may be recommended to create more space within the carpal tunnel to relieve the pressure on the median nerve. 

A physical therapist will always create an individualized plan to meet your specific needs but generally aims to reduce your pain and help prevent surgery, increase your ability to be functional and active, and help you resume your normal work, home and leisure activities. If PT is recommended after CTS surgery then additional goals will include minimizing scar formation and restoring normal strength and range of motion. 

Due to the nature of CTS, you can expect that education and activity modifications will be an important part of your custom physical therapy program. Understanding what specific activities and hand/wrist positions may have caused your symptoms to develop in the first place is an important step in improving symptoms and reducing the likelihood of recurrence. Modifying the tools you use, taking breaks, adjusting your workspace to allow for a more neutral wrist position and reducing the force that you put repetitively through your wrist and hands are just a few of the suggestions your PT may make to help prevent return or worsening of CTS.

If you start to notice any of these symptoms developing it is important to seek treatment early, however, much can still be done even if you’ve had these symptoms for a while. A physical therapist at Evolve is trained to help identity signs and symptoms of CTS and can recommend modifications you can make immediately to start improving your symptoms but perhaps more importantly, can prescribe a plan of treatments to help you recover the strength and sensation you have lost, reduce your pain and get you back to your regular activities with the confidence in knowing how to prevent carpal tunnel syndrome from returning. 

Click here for more information about physical therapy for carpal tunnel syndrome

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com 

Give Osteophytes the One Two Punch!

Physical Therapy for Bone Spurs

Feeling Bad About Bone Spurs? PT Can Help!

Have you been experiencing pain in your joints or tendons, loss of joint flexibility, numbness or weakness in the legs or arms? Your symptoms may be caused by bone spurs, known as osteophytes, that develop over long periods of time usually in or near joints. Though the name suggests a ragged or sharp outgrowth of bone, bone spurs are usually smooth and depending on their location may or may not cause symptoms. If you suspect you may have a bone spur or have been told by your doctor that you do, this article will help you better understand where they come from and how physical therapy can help treat your symptoms. 

WHAT CAUSES BONE SPURS?

Bone spurs are most common in adults over the age of sixty and usually grow in areas where osteoarthritis–breakdown of the cartilage from wear and tear–has formed in a joint. Other conditions such as Ankylosing Spondylitis which affects the spine can also put someone at risk for bone spur formation. Bone spurs can grow from any bone but are most common in the foot (especially the heel, big toe and ankle), the hands and fingers, hips, neck and spine, knees and shoulders. 

The body most commonly develops bone spurs in an attempt to repair or address an injury. It does so by producing excess bone where there has been trauma to the joint, repeated tendonitis, breakdown of the cartilage or repeated overuse of a joint. Does anyone else in your family have bone spurs? Research suggests it may also have a genetic cause.

WHAT ARE SYMPTOMS OF A BONE SPUR?

Most bone spurs are asymptomatic if they are not in a place to rub or irritate any other tissues. In this case you may not even know you have them unless they are identified on imaging such as an X-ray. In some cases, however, bone spurs can cause pain and loss of joint flexibility if their location restricts joint movement or causes rubbing on soft tissue structures such as tendons or ligaments. 

Bone spurs in the heel can be especially painful secondary to the pressure you put on your foot each time you walk. Bony nodules, stiffness and pain may be noticeable when bone spurs develop in the hands or fingers whereas pain and loss of flexibility is more common in joints like the hip and knee. Bone spur formation in the spine can be especially bothersome if its location causes a narrowing of the spinal canal where your spinal cord travels or of the space where the nerve roots exit. In this case the pressure on the delicate nerves of the spinal cord or nerve roots can cause radiating pain, weakness, numbness or tingling in the arms or legs. 

CAN PHYSICAL THERAPY TREAT MY BONE SPURS?

It is important to understand that not all bone spurs require treatment. If you are experiencing pain or discomfort in a particular area and imaging reveals there is a bone spur nearby, a physical therapist can help determine the impact that the bone spur has on your symptoms. Pain, weakness, loss of flexibility, swelling and discomfort can all have multifactorial causes and the presence of a bone spur may play a large role, a small role or no role at all in those symptoms. 

Reduce Pain and Swelling: Your physical therapist can provide treatment to manage pain and inflammation. Modalities such as heat and ice, ultrasound, and electrical stimulation may be applied to improve these symptoms. Hands-on treatments such as gentle soft tissue mobilization may also be used to improve the mobility of the tissues surrounding the bone spur. In some cases, special orthotics or shoe inserts may be recommended to reduce pain and irritation from bone spurs in the foot or toe. 

Improve Joint Motion: Improving motion of the involved joint and the tissues that surround it can improve both pain and function. A program of stretching and mobility exercises can help to improve the flexibility of a joint so you can more easily and comfortably perform your daily activities. Your PT may also gently mobilize the involved joints to help restore motion.

Improve Quality of Movement: Improving the quality of movement around an area with a bone spur can help reduce excessive stress across the joint and may reduce the irritation and rubbing of a bone spur on surrounding tissues. Also, as mentioned above, the presence of a bone spur may be only one factor causing your pain or discomfort so treating muscle strength and neuromuscular control issues around the involved area is also very important to ensure all contributing factors are addressed.

While in some cases surgery may be necessary to remove bone spurs, a physical therapist at Evolve can help you to reduce pain and swelling, improve your joint mobility and optimize your movement patterns. You may be wondering how you can continue with your favorite activities when you are dealing with a bone spur, but remember, bone spurs are often only one factor that can be targeted to improve your symptoms. Your physical therapist can advise you on how to modify your activities when needed and develop a program to help you to get back to your normal routines whenever possible while preventing recurrence of these symptoms in the future. 

Click here for more information about physical therapy for bone spurs in Brooklyn.

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics-

There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Is Arthritis Stopping you From Enjoying Your Life?

Physical Therapy Treatment for Arthritis

Did you know that there are over 100 types of arthritis and related conditions? In fact, the Arthritis Foundation lists arthritis as the leading cause of disability among Americans. People of all ages may be affected by this condition to varying degrees, even children, and while its effects may be merely an annoyance to some, to others it can interfere greatly with everyday tasks. As arthritis progresses simple things like getting out of bed, opening a tight jar, or going up stairs can become more difficult.

So what is arthritis? The term arthritis is an umbrella term for conditions involving inflammation and pain in the joints. Osteoarthritis is the most common type of arthritis. It causes degeneration of cartilage lining the joint and most often affects weight bearing joints such as the hips and knees. This type of arthritis is often associated with “wear and tear” as a person ages. Other types of arthritis with different underlying causes exist as well. Arthritic conditions can typically be classified as degenerative, inflammatory, infectious or metabolic. Rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, lupus and gout are examples of other types of arthritis

WHAT ARE THE SYMPTOMS OF ARTHRITIS?

Joint pain, swelling, stiffness and decreased range of motion are common symptoms of arthritis. In mild osteoarthritis joint pain and swelling typically occur in response to activity and improve with rest. As joint surfaces degenerate further pain, stiffness, and inflammation may persist even at rest and be worse, for instance, when first getting up in the morning or after sitting for a long time. 

Inflammatory arthritis such as rheumatoid arthritis is caused by an autoimmune response leading to inflammation in the joints. Similar to osteoarthritis, swelling, joint pain, and stiffness are common. Inflammatory conditions, however, can also affect other connective tissues such as lungs, heart, eyes and other organs. Heat and tenderness to touch around the joint line is also very common. The small joints of the hands and feet are often involved and in many cases multiple joints throughout the body are affected. Because this type of arthritis is caused by an overactive immune response, a specialist such as a Rheumatologist will often be involved in treating and managing the underlying condition. 

HOW IS ARTHRITIS DIAGNOSED?

If your physical therapist suspects arthritis, they will interview you on what symptoms you are experiencing, what aggravates and eases your symptoms and where they are located. They will gently move your joints to assess their mobility, palpate (feel) the joints and surrounding tissue for any inflammation, heat or tenderness, and assess your movement during functional activities such as standing, walking or squatting. They may also perform specific tests to the joints themselves to rule out other conditions involving the muscles, tendons and ligaments.

In some cases your physical therapist or physician may recommend imaging such as an X-ray, CT scan or MRI to evaluate the joint surfaces for any cartilage breakdown, signs of inflammation or deformities. As arthritis progresses the congruency of the joint surfaces decreases which can further exacerbate pain and result in a need to change the way you stand, walk or move. If you, yourself have arthritis, you are probably familiar with the creative ways people often adapt to arthritis pain. 

HOW CAN A PHYSICAL THERAPIST TREAT MY ARTHRITIS?

While physical therapy cannot reverse the effects of arthritis on joint tissues, research shows that physical therapy is an effective tool to reduce pain and improve function. When physical activity worsens pain, it is common for persons with arthritis to begin self-limiting activity. First you may cut back on how many miles you run then you move into a single story house to avoid the stairs. Soon you find yourself walking with a cane or walker and saying no to invitations to attend baseball games and trips to the mall. 

Though it may seem counterintuitive, less motion is often not the answer to arthritis pain. This is where a physical therapist can help. After interviewing and examining you, your PT at Evolve will work with you to understand your goals and develop a plan to help you get there. 

Pain Reduction: Joint pain may be mild, moderate or severe but physical therapy can help to address your pain symptoms. Modalities such as heat, ice or electrical stimulation may be prescribed by your PT to reduce inflammation and provide pain relief. They may also apply gentle hands-on techniques such as passive range of motion, soft tissue or joint mobilization, myofascial release techniques, or taping to improve the mobility and health of the joint and soft tissues that are affected. 

Restore Joint Motion: Joint stiffness and loss of range of motion are common with arthritis. Restoring normal joint motion is an important step in getting you back to your favorite activities. If mobility is restricted in the connective tissue structures around the joint itself, joint mobilization techniques may be utilized to improve that motion. Active range of motion might be prescribed initially to reintroduce motion to the joint and later on stretching may be prescribed to help lengthen chronically shortened tissues. 

Address Biomechanical Impairments: While the surfaces of the joint may no longer be pristine, how the joint moves and how much stress is applied across an arthritic joint can play a large role in how much pain you experience and how much you have to limit your activities. Proper strength and flexibility in the muscles surrounding the joint can optimize the movement of the joint and may reduce some of the rubbing that occurs between uneven joint surfaces. Your physical therapist will test your muscles to identify areas that need work and can guide you through a progressive program of exercises to address these issues.

 As muscles get stronger and tissues regain their proper length and flexibility, learning to activate muscles at the right time and in the right order during a specific activity is essential. For example, proper firing of foot, ankle, and hip musculature is essential for good biomechanics with running and stair climbing. Even if your muscles are strong, the motor control of these muscles may not be adequate to properly perform a movement without putting excessive stress across a certain joint. As you learn to control and fire your muscles while performing a motion such as hitting a tennis ball, you will likely experience less pain in your shoulder joint. 

Getting Back to Activities

The ultimate goal of a physical therapy program is to help you get back to the activities you love and need to do throughout your life. At Evolve, your PT will help you get back to activities in the safest, most effective and quickest way possible. They will always strive to help get you back to these activities but in cases where that is not possible without some modification, your PT is there to help advise you on adaptations you can make to help control your symptoms.

While arthritis pain may have been in the driver’s seat for some time, there is something you can do about it. Schedule an evaluation with a physical therapist at Evolve to learn more about your condition and begin taking steps to regain control over your arthritis pain.

Click here for more information about physical therapy for arthritis

About EvolveNY-

Brooklyn’s Premier Holistic Physical Therapy Clinics-

There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better! First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Physical Therapy for ACL Injury: Getting Started on the Right Foot

Did you Injure Your ACL? PT Can Help!

If you are an avid sports fan or an athlete yourself, it is likely you’ve heard of athletes injuring their ACL. The anterior cruciate ligament (ACL) is part of a team of ligaments that stabilize the knee joint. This ligament runs through the center of the knee joint between the two bones that make up the knee–the femur (thigh bone) and the tibia (lower leg bone). The ACL’s primary role is to restrain anterior translation of the tibia on the femur but aids in stabilizing against excess movement in other planes as well.

HOW DO ACL INJURIES OCCUR?

Most ACL injuries occur during athletics, however, a poorly executed everyday task can also result in an injury to this area. Younger athletes seem to be at higher risk than older athletes of tearing their ACL and women are at higher risk than men. Soccer, football, and skiing are three of the most common sports responsible for ACL injuries. 

Believe it or not, most ACL tears are what is called a non-contact injury meaning the injury occurs in the absence of another player, for example, crashing into the knee of the athlete (though this certainly can be the cause of an injury to the ACL). Because of the mechanics of the ACL, it is susceptible to tearing when excessive strain is placed across the knee. One common mechanism of injury is sudden hyperextension of the knee joint with internal rotation of the tibia bone such as when a basketball player lands after a jump. Deceleration injuries are common also such as when a soccer player plants their foot in the grass while pivoting their upper body to change direction. It is possible, however, to injure this ligament simply by taking a misstep off of a curb if the joint is stressed in just the right way.

When the ligament tears it often produces a sudden pop along with significant pain. Swelling often develops within the first 24 hours and may last for quite a while. A deep pain or ache felt in the knee that worsens with walking or stair climbing is typical and a feeling of instability or giving way at the knee may occur. Tenderness, bruising and difficulty straightening the knee fully are also common. In about 50% of cases other structures in the knee such as the cartilage lining the joint, the meniscus or another ligament are also injured when the ACL tears. 

HOW IS AN ACL TEAR DIAGNOSED?

Because of the ACL’s role in stabilizing the knee, there are several tests that can be performed by a physical therapist, athletic trainer or physician to help rule in or out a suspected ACL tear. The Lachman’s Test, Anterior Drawer Test and Pivot Shift Test are three examples that may be performed to assess the laxity of the ACL by gently attempting to translate the tibia forward. An intact ACL will resist this movement. A low grade ACL tear (Grade I) may present with pain but laxity will be minimal whereas a larger grade ACL tear (Grade II or III) will allow the examiner to pull the tibia forward more than expected. An MRI is often utilized to confirm the diagnosis and examine the surrounding ligaments, cartilage, and soft tissue for injury. An X-ray will help to identify any injuries to the bone.  

WHAT DOES TREATMENT LOOK LIKE FOR AN ACL INJURY?

The majority of people with an ACL injury will undergo surgery to help re-establish good stability and control at the joint. Some people will opt for nonsurgical management by modifying their activities to minimize excessive stress on the joint while a small number of people termed “copers” will return to athletics and be able to perform relatively well. 

Nonsurgical management of an ACL injury focuses on using secondary structures such as the surrounding muscles to compensate for ligamentous instability in the long run while managing pain, swelling, weakness and range of motion impairments immediately after injury. Your physical therapist will educate you on ways to modify your activities to reduce unwanted stress across the joint. If the ligament has not completely ruptured, healing of the tissues will occur over many weeks but may never heal completely. As pain and swelling improve your PT will teach you exercises to improve strength and motor control around the knee joint and help you slowly increase your activity level. If return to sport is in your future then running and agility tasks will begin later in your rehabilitation. 

Surgery for an ACL tear is the most common approach. Some surgeons will recommend a short course of physical therapy before surgery to help decrease swelling, improve knee range of motion, and strengthen the quadriceps muscles. Because repairing a ligament is nearly impossible, the torn ACL is typically removed and replaced with a graft from the patient’s patellar tendon or hamstring tendon. Sometimes a cadaver tendon graft will be used. 

Physical therapy is an essential component of recovery from ACL surgery and progresses through several stages:

Recovery from surgery: Many surgeons will prescribe a knee brace and weight bearing restrictions for a period of time after surgery. During the initial recovery stage after surgery your PT program will aim to control swelling through modalities such as ice, taping or electrical stimulation; improve quadriceps muscle firing, regain full passive extension of the knee and begin to improve knee flexion mobility. Your PT will make sure you know how to use any assistive devices such as crutches and educate you on how much weight you can put through your leg based on your surgeon’s instructions.

Strength and neuromuscular control: Regaining leg muscle strength and motor control is an essential component of the next phase of rehabilitation. Exercises to improve leg muscle strength will be prescribed. Activities to challenge single leg balance and control of joint angles during tasks like a single leg step down or single leg squat are important to help recover full function of that leg. 

Agility, running and landing: Once good neuromotor control, muscle strength and flexibility have been established on the surgical side it is time to begin applying more load and stress to the knee to prepare it for return to sport and recreation. Regaining full strength and balance is essential to this phase of physical rehab. Under the supervision and guidance of a physical therapist the athlete will progress through a graded jumping, running, and agility program to improve the ability of the muscles, tendons and ligaments to withstand and control acceleration, deceleration and rotation.

Return to sport: Your physical therapist will use a series of functional and sport-specific tests combined with subjective and symptom reports to guide you in returning to your sport. Re-injury of the ACL is the biggest concern when returning to sport and it is important that your knee is ready to accept the stresses that returning to sport will place on it. Sport specific drills and graded return to sport are important components of this phase of rehabilitation

Preventing future injury: Now that you’ve done the hard work of recovering from an ACL injury, it is important to continue a program that will minimize the risk of re-injury of the same knee or injury of the opposite knee. Your PT will individualize a series of balance, strengthening, and plyometric exercises to be performed more than once a week to reduce the likelihood of future injury. 

If you’ve sustained an injury to your ACL, recovery may seem overwhelming at first. With physical therapy you can start taking steps toward healing even before you’ve had surgery. Schedule an evaluation with a physical therapist at Evolve to help you get on the road to recovery and minimize the recurrence of re-injury.

Click here to find out more information about physical therapy for ACL injuries in Brooklyn

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics-

There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Shoulder Injury: When to Call In the Physical Therapist

Physical Therapy for Your Shoulder

Does Your Shoulder Need Physical Therapy?

Shoulder pain and injury can be experienced at any age. Acute injuries to the joint and surrounding tissues can occur from a fall, a hard impact during a game or in response to a sudden and unexpected force. Other shoulder injuries develop over time with repetitive use, wear and tear. Whether you can pinpoint the exact moment when your symptoms began or you noticed them developing over time, a physical therapy assessment can help you determine the cause and a plan of action to treat it. 

A QUICK TUTORIAL ON THE SHOULDER

The shoulder joint is a ball and socket joint. This configuration allows a great deal of mobility so you can reach overhead, behind your back, across your body and in several other directions to perform all your daily tasks. While a certain amount of flexibility is needed to perform everyday tasks, some sporting activities require increased ranges of motion at the shoulders. Gymnasts, acrobats, and baseball pitchers are examples of athletes who often have hypermobility in some or many planes of shoulder movement. 

With all this movement available the body has to control it. Joint capsules, ligaments, and fascia stretch across and around the joint providing boundaries to its mobility. Lack of appropriate stability at the shoulder can contribute not only to pain or injury at the shoulder itself but can lead to dysfunction in areas of the body above and below. Wrist, elbow or neck pain may originate from movement, mobility or strength impairments at the shoulder.

There are also several muscle groups that act on the shoulder. The rotator cuff consists of four muscles--the supraspinatus, infraspinatus, subscapularis and teres minor-- that help elevate, and rotate the upper arm. The large deltoid muscle at the top of the shoulder helps to elevate and extend the shoulder. Several other muscles that originate near the spine such as the rhomboids and trapezius muscles help to move and stabilize the scapula (shoulder blade) while the large muscle in the back called the latissimus dorsi stretches to the upper arm to help extend and rotate the shoulder. 

HOW DO I KNOW IF I NEED PHYSICAL THERAPY?

While occasional soreness or pain that resolves quickly may not be of great concern, it is a good idea to talk with your physical therapist about any symptoms that are moderate to severe, persisting, recurring or unusual to you. Numbness, tingling or changes in sensation can signal nerve compression. Loss of flexibility or mobility in the shoulder may be caused by injuries to the muscles or conditions affecting the joint itself. Sharp or throbbing pain, swelling, warmth or heat often indicates an acute injury that needs attention. Clicking, catching or feelings of instability may point to an intra-articular injury. Any shoulder pain or discomfort that occurs consistently with a certain motion or activity should be evaluated by your physical therapist. 

WHAT SHOULDER CONDITIONS CAN MY PHYSICAL THERAPIST TREAT?

Adhesive Capsulitis (Frozen Shoulder): 

Loss of movement and worsening pain caused by scar tissue formation around the joint are characteristic of this condition. The actual cause of adhesive capsulitis is a matter of debate but may be a result of inflammation in the synovial lining of the joint or of an autoimmune process that causes the body to attack the tissues of the shoulder joint. In some cases it may be preceded by a recent shoulder injury such as a rotator cuff tear, tendinitis or bursitis or after immobilization following a surgery or fracture. 

There are 4 stages of Adhesive Capsulitis:

1. Pre-Freezing (1-3 months of symptoms): increasing sharp shoulder pain with movement and aching at rest.

2. Freezing (3-9 months of symptoms): progressive loss of shoulder movement and increased night pain. Range of motion is limited by both pain and stiffness..

3. Frozen (9-14 months of symptoms): Significant loss of shoulder range of motion. Pain with any movement is common early in this stage while pain at the limits of your mobility is more common late in the stage.

4. Thawing (12-15 months of symptoms): Pain, especially at night, is significantly decreasing. Range of motion is still limited but your ability to use the shoulder to complete daily tasks is improving rapidly.

Early rehab for this condition will focus on managing pain and maintaining as much range of motion as possible. Range of motion exercises and manual therapy techniques along with modalities to reduce pain and inflammation such as heat/ice, electrical stimulation or ultrasound are common. In later stages stretching and strengthening are added to your routine to help progress the return of shoulder mobility. 

Biceps Tendinopathy: Pain at the front of the shoulder with repeated overhead movements or when reaching across your body or behind your back may be a tendinopathy of one of the bicep muscle tendons--most commonly the long head that stretches over the head of the humerus and attaches to the labrum that lines the socket portion of the shoulder joint. 

Repetitive compression, tension or rubbing of this tendon can lead to irritation, swelling and pain. It may feel achy after activity and muscles around the shoulder may feel weak. Treatment of this condition involves identifying and treating contributing factors such as muscle weakness, poor biomechanics of the shoulder during repetitive motions and flexibility impairments. This condition typically responds very well to physical therapy.   

Dislocations/Subluxations: A shoulder dislocation refers to separation of the head of the humerus from the socket of the scapula. A partial dislocation is called a subluxation. Dislocations are typically a result of a sudden traumatic force such as a fall. In persons with joint hypermobility or laxity or those with a history of dislocation, shoulder dislocations and subluxations can happen more easily, sometimes while performing everyday tasks. A shoulder dislocation requires immediate medical intervention to restore normal joint alignment and assess for any resulting fractures or soft tissue injuries that may require surgical intervention. With an acute dislocation your physical therapist will help you to manage pain and maintain available range of motion. As you progress in your healing or for those with chronic joint laxity or instability, a physical therapy program optimizing muscle length and strength, biomechanics and joint and muscle retraining is common. 

Labral Tear: A ring of cartilage called the glenoid labrum lines the socket portion of the joint to help keep it in place. Fraying, tearing or disruption of the labrum can cause pain, catching, clunking, instability or in severe cases, dislocation. The cause may be traumatic or nontraumatic. Small tears may be asymptomatic but larger tears typically require surgery. If symptoms are minor and the joint is still stable a physical therapist can apply manual therapy techniques to normalize joint motion and reduce pain and teach you stretching, strengthening and postural re-education techniques to help you return to normal activities.  

Rotator Cuff Tear: As mentioned above, these 4 muscles help move the shoulder joint but also play an important role in stabilizing it. An injury to the muscle or tendon of the rotator cuff can disrupt normal movement and stability of the joint and may be the result of an acute injury or of chronic wear and tear. Pain or weakness in the shoulder, especially when trying to reach overhead or behind the back is a common symptom. Your physical therapist can perform special tests to help pinpoint which muscle is injured. In some cases surgery is necessary to repair the tear but physical therapy is an important part of your recovery in either case. 

Impingement: Pain when sleeping on your shoulder or with moving the arm overhead or out to the side may be shoulder impingement syndrome. In this condition the bursa, tendons or ligaments of the shoulder are repeatedly compressed or “impinged” under the acromion of the scapula. Restricted shoulder motion and weakness may develop over time. Rehab for this condition will include techniques to reduce painful symptoms, however the main focus is on improving the biomechanics of shoulder movement to lessen the impingement and prevent its recurrence in the future. 

Acromioclavicular Joint Injuries: The acromioclavicular or AC joint is located where the end of your clavicle meets the acromion, the bony extension of the scapula at the top of the shoulder.  A small ligament stretches across this joint to connect them together. Most often a trauma, such as a fall onto the outside of the shoulder causes an injury to this joint but at times it can be an overuse injury. Mild to severe joint separation occurs during this injury and dictates the necessary treatment protocol. Pain with reaching across the body or overhead, visible swelling and tenderness or a lump over the top of the shoulder, loss of range of motion and shoulder strength are all indicators of a possible AC joint injury. Initially reducing pain and minimizing stress to the joint will be the focus of your physical therapy treatments. As the ligaments heal your physical therapist will apply hands on manual therapy to help restore normal range of motion and joint mobility and prescribe strengthening, stretching and motor control exercises to progress you back to your normal everyday activities. 

Whether your shoulder symptoms are new or chronic, there is no reason to put up with them in the long run. A physical therapist at Evolve is ready to help you get to the root of your problem, construct a plan to improve your symptoms, empower you to get back to your normal routine and educate you on preventing these same problems in the future. 

Click here for more information about shoulder physical therapy in Brooklyn

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com