Going In for Surgery? How Physical Therapy Can Help Pre and Post Op

Should I Start PT BEFORE Surgery?

Pre-and Post Surgery PT is the Key to Success…

Don’t Skip Physical Therapy Before or After Surgery

Did you know that physical therapy is not only a great tool to help you recover from surgery but also one that can help prepare you for surgery? It’s true. Physical therapy prior to surgery, sometimes called prehab, has many benefits that can help improve your surgical outcome. So if surgery has been recommended as the best treatment for your condition, read on to learn how physical therapy can set you up for success on both sides of the operating table.

WHY SHOULD I CONSIDER PREHAB?

Prehab was a term coined to describe the use of health interventions to avoid injury, decrease pain, or prepare for surgery. Many times after we’ve sustained an injury or if we’ve been dealing with symptoms for a long time we naturally decrease our level of movement and exercise to avoid provoking uncomfortable or painful symptoms. While this choice will most likely accomplish the goal of reducing your symptoms, it doesn’t necessarily put you in the best position for an easy recovery from surgery. If the surgery isn’t an emergency there are many ways that a physical therapist can help prepare you and your body for the upcoming procedure.

Know what to expect: The idea of surgery can frankly be quite scary. Having an idea of what to expect after the procedure can ease some of your anxiety and make sure you have what you need to support your recovery. Getting to know your physical therapist before surgery will help build trust with them when it comes time for post-operative care. They can also advise you on any equipment or modifications to your home that might be necessary, help you understand what kind of help or support you will need from others, and prepare you for how your body may feel after surgery.

Manage pain and inflammation: Pain and inflammation are natural results of injuries. They alert us that we need to protect the injured area and that the body is taking steps to start the healing process. In some cases, however, your surgeon may require that your injury is “quiet”, meaning it can tolerate some stress and activity without causing significant swelling, before they want to operate. If this is the case, or if surgery is delayed for any reason, learning strategies to manage pain and inflammation in the meantime will help you stay comfortable and as active as possible.

Learn how to use assistive devices: If you will be leaving the hospital with a shiny new walker, cane, or set of crutches, learning how to use them beforehand can be very helpful. Immediately post surgery, when you are still feeling the effects of anesthesia and pain and stiffness are setting in, is not the best time to learn how to use an unfamiliar device that is meant to protect your recently operated-on body part.

Build or maintain strength and flexibility: While the brain knows that surgery is intended to “heal” the injury, the body views the surgical procedure as another injury to the tissues. Think about it, surgery requires incisions and instrumentation that often disrupt many layers of tissue. While the surgeon may have sewn a torn ligament or fused a couple of vertebrae which will ultimately improve your symptoms and get you moving again, the body will need to heal from the effects of the surgery before that can happen. Maximizing strength and flexibility prior to the surgery can help decrease muscle atrophy and stiffness following the procedure which can ultimately quicken your recovery. 

WHAT CAN I EXPECT AFTER MY SURGERY?

Post-surgical physical therapy has many goals:

• Control pain and inflammation

• Protect the surgical site while it heals

• Promote the healing process 

• Educate you on how your healing is progressing and what you can do at home and in therapy to support this process

• Restore strength, flexibility, and neuromuscular control

• Help you to return to your prior level of activities

Most likely your surgeon will provide you or your physical therapist with a post-surgical protocol that outlines parameters for exercise and activity at different stages of your recovery. It often provides goals for each stage of rehabilitation and gives allowances for how much weight you can bear through your arms or legs, how much stretching or range of motion is allowed, how much weight you can lift, and what kinds of activities are permitted. 

The type of surgery you had will dictate how long you can expect to be under the care of a physical therapist and how quickly you can progress back to your prior level of activity. Even when the surgeon feels that the surgical site can withstand normal activity, your body may not be ready to jump back into heavy weight lifting, long runs, or aggressive training. Ramping up activity too quickly without adequately preparing the body is a recipe for re-injury. Your physical therapist will continually assess you and help you prepare your body to safely accept the stresses of your favorite activities so you can keep this surgery a distant memory.

DON’T WAIT TO GET STARTED

If you know that a surgery date is on the calendar, call Evolve PT to schedule appointments today. The physical therapists at Evolve can help you prepare your body and mind for surgery and will be standing by to help you recover after it’s finished.

Click here to find out more information about prehab physical therapy and post-op 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 Brooklyn Physical Therapy Locations!

1-718-258-3300

https://EvolveNY.com

MSK Physical Therapy Services

Musculoskeletal PT: Get to the Root of the Problem?

The Many Faces of Musculoskeletal Physical Therapy 

Physical therapy for the musculoskeletal system is the subspecialty of physical therapy with which most people are familiar. The term physical therapist often conjures up images of clients doing back strengthening exercises, athletes working on their shoulders and older adults rehabbing a total knee replacement. These are all examples of physical therapy for the musculoskeletal system and many PT professionals will dedicate their careers to mastering the assessment and treatment of the bones, joints, tendons, fascia, ligaments and soft tissue, the structures that make up the musculoskeletal system. Let’s take a further look into how physical therapists work with the musculoskeletal system.

WHAT KINDS OF MUSCULOSKELETAL CONDITIONS DO PHYSICAL THERAPISTS TREAT?

A wide range of conditions and injuries affect the musculoskeletal system. In general, we can think about musculoskeletal physical therapy as addressing four primary categories of musculoskeletal concerns. 

Acute injuries: Acute injuries are those that have recently occurred, typically within the last few weeks (subacute injuries are included here).  Symptoms of an acute injury to the musculoskeletal system include:

• Pain

• Swelling and inflammation

• Muscle or joint stiffness

• Muscle weakness

• Redness and warmth 

• Local deformity

• Difficulty moving or bearing weight through the area

Chronic injuries and issues: Chronic injuries are those that are more than a few weeks old, have (optimally) entered a more chronic phase of healing wherein things like pain and inflammation have significantly decreased. An example of this type of chronic injury is a person seeking PT four weeks after an acute ankle sprain. This can also include chronic irritation or pain that is ongoing or intermittent and may or may not be easily attributed to a particular incident. For example, someone who experiences knee pain whenever they run.

Pre- and post-surgical rehab: Surgeries are performed to address a wide range of medical conditions and injuries. Any surgery, no matter how small, disrupts tissues in the body and can lead to impairments in tissue mobility, scarring, pain, stiffness, muscle weakness and alterations in movement. Musculoskeletal physical therapy aims to address all of these concerns to help restore optimal functioning of the affected area. The goal of pre-surgical rehab is to prepare the body for surgery and to help optimize the post-surgical recovery and outcome. 

Injury Prevention: Sometimes the goal of musculoskeletal physical therapy is to identify risk factors for injury and intervene to address them before the injury occurs. This is often done in the context of athletes who are preparing for an upcoming season or a new training block. In this case therapists combine their knowledge of the musculoskeletal system and their familiarity with the demands of a particular sport or activity to identify areas of movement and performance that may predispose the individual to injury in the future. After a thorough assessment, treatment and exercises are prescribed as necessary to optimize performance and lower the risk of injury. Another area of musculoskeletal physical therapy centered on injury prevention is PT for pre-partum women.

As you can see, musculoskeletal physical therapy can address a wide range of conditions affecting the body. Here is a list, though far from comprehensive, of conditions that musculoskeletal physical therapists treat

• TMJ disorders

• Back pain and neck pain

• Other joint pain (knee, ankle, foot, hip, shoulder, elbow, wrist, hand)

• Arthritis

• Post-surgery (examples: ACL repair, bunion repair, hip or knee replacement, carpal tunnel surgery, spinal fusion, and many, many more)

• Fracture recovery

• Rotator cuff injury

• Muscle strain

• Ligament sprains

• Muscle contusions

• Joint replacement recovery (knee, shoulder, hips, etc.)

• Headaches

• Muscle stiffness and tightness

• Pain with activity

• Pre- and post-partum 

WHAT DOES MUSCULOSKELETAL PHYSICAL THERAPY LOOK LIKE?

As with all physical therapy, musculoskeletal physical therapy should be individualized to meet your specific needs. After interviewing you about your symptoms and performing a physical exam, your physical therapist can discuss with you the plan of care. Typically you will work with your physical therapist between 1 and 3 times a week for a number of weeks, tapering off as you make improvements and near your discharge date. The main goals of this type of physical therapy is to help you return to the functional activities you need and love to do with as few symptoms as possible and to give you strategies to maintain the improvements you made during therapy to prevent recurrence of the problem in the future. 

Some of the primary goals of musculoskeletal physical therapy are as follows:

Reduce pain, inflammation and irritation: While completely eliminating your symptoms may take time, making you more comfortable in the meantime is an important first step in your rehabilitation. Applying ice or heat, ultrasound or electrical stimulation to the affected area can often give you some relief. Soft tissue mobilization or gentle joint mobilization may also be employed by your physical therapist to reduce tissue irritation.

Improve flexibility: Your PT program may include stretching, myofascial release techniques, joint mobilization and mobility exercises to improve flexibility and range of motion. 

Build up your strength: You will learn exercises to help strengthen the muscles around the injured area and other connected areas of the body. Having good strength throughout the body allows stress to be distributed across multiple joints and helps to prevent injury and irritation in the future. 

Optimize your movement: Learning proper biomechanics and enhancing the neuromuscular control of joints and muscles is an essential component of healing and preventing injuries. Physical therapists are movement experts and through analyzing your movements, can guide you in improving how you move and train your muscles to perform those movements in the safest and most effective way possible. 

REST IS NOT ALWAYS BEST

Many of us are in the habit of resting and cutting back our activities whenever we feel pain or experience injury but active recovery is often the best strategy. The important thing, however, is to do it in a way that enhances the resiliency of the injured or irritated tissues and doesn’t injure it further. This is where the knowledge and expertise of a licensed physical therapist comes in handy. Even if the injured area must be immobilized and rested for a period of time, finding appropriate ways to exercise adjacent areas and promote movement will help with healing and recovery. 

So if you are struggling with a new injury, planning on having surgery, looking to prevent a future injury or are tired of dealing with some chronic irritation, don’t play the wait-and-see game. Call Evolve PT today and let our skilled team of providers guide you to long lasting recovery and improvements. 

Need Physical therapy for MSK Issues?

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

Wait… Do I have TMJ or TMD?

What is TMJ?

Here’s What We Have to Say About the TMJ

You may hear people say that they have TMJ when referring to popping, clicking, tightness, or pain in their jaw joint. The term TMJ, however, actually stands for temporomandibular joint, the hinged joint located in front of each ear where the jaw bone attaches to the skull.

What people usually mean to say is that they have TMD (temporomandibular dysfunction) or TMJD (temporomandibular joint dysfunction), the name of the condition affecting the inside or the outside of the TMJ that causes these symptoms.

Despite its relatively small size, the TMJ has some really important jobs to do and those suffering from TMD know that these joints can cause a whole lot of suffering when they aren’t working optimally.

WHAT AND WHERE IS THE TMJ?

The temporomandibular joint is located in front of the ear on each side of the face. It is the connection between the mandible or jaw bone and the temporal bone of the skull. The joint is a bit unique in that it acts a little like a hinge joint and a little like a ball-and-socket joint. This allows for movements of the jaw in many directions. The jaw can open and close, protrude (slide forward) or retrude (pull back), and move side to side. The two joint surfaces are separated by an articular disc and surrounded by fibrocartilage. Several ligaments stretch between the skull and the jaw bone to stabilize the TMJ. Muscles of the face allow movement of the jaw in its many directions.

Without the TMJ you would find a long list of things you could no longer do. The multiplanar movements of the jaw, facilitated by the TMJ, are necessary for chewing, sucking, talking, swallowing, breathing, facial expressions, and opening and closing the mouth to eat and drink. When loss of optimal function occurs in this joint we call it TMD or TMJD and now that you know how important the TMJ is, you can see why addressing this condition is so important. 

LET’S TALK ABOUT TMD

Problems both within the joint itself and outside of the joint may fall under the umbrella of TMD. Aside from the functional problems with eating, talking, facial expressions, etc., dysfunction at the TMJ can also cause facial pain, jaw pain or soreness, jaw fatigue, earache or ringing in the ears. Additionally headache, popping of the joint, locking of the jaw, teeth sensitivity without dental issues, limited mouth motions, and changes in the way the teeth fit together can occur. Often these symptoms are more pronounced upon waking up and in the late afternoon. It is important to know that jaw sounds like popping or clicking that are not accompanied by pain or limited jaw movement are not considered a serious problem. The truth is, joints are noisy, even healthy ones can make noise when there are no problems to worry about.

The cause of TMD may originate from problems with the joint such as arthritis or it can originate in the muscles or ligaments that surround it. Often the cause of TMD is thought to be multifactorial. Biological, environmental, emotional, social, and cognitive triggers for TMD exist. The incidence is higher in persons diagnosed with other conditions such as autoimmune conditions, sleep apnea, mental illness, or fibromyalgia. TMD can be the result of arthritis in the TMJ or from displacement of the articular disc. Jaw or facial fractures and surgery of the face or jaw may lead to TMD in some persons. Also problems with teeth alignment (malocclusion) and frequent jaw clenching (bruxism) can trigger TMD. Even poor posture habits can lead to TMD if repeated frequently. We don’t know the exact statistics on TMD but some estimates suggest over 10 million Americans may be living with this condition.

WHAT CAN I DO IF MY JAW IS BOTHERING ME?

If you’ve noticed that you are experiencing any of the symptoms of TMD you may be wondering what you can do about it. If the problem is new and not severe or accompanied by warmth, redness, or swelling of the joint, chest pain or pressure, or fever, you can probably start with some at-home treatments to see if this helps. Here are some things you can try:

• Set a timer when you are working to check in every 15-30 min and see if you are clenching your jaw. Practice separating your teeth and relaxing your muscles

• Apply a cold or warm (not hot) compress to the area for 10-15 min. The cold can help reduce inflammation while the warmth will increase blood flow and help relax muscles. Be sure to set yourself a timer to remind you to take it off and don’t fall asleep with either of these on

• Practice meditation or breathing techniques to help relax you and relieve stress. Jaw clenching and teeth grinding often increase when we are stressed

• Work on your posture. Poor postural habits can exacerbate TMD. Try changing positions throughout the day if you tend to sit in one place to work, for example, for hours at a time

• Get a good night’s sleep and use a pillow that is supportive and allows your neck and jaw to relax

WHEN TO CALL THE DOCTOR…OR DENTIST

If you’ve tried these home remedies for a couple of weeks and aren’t seeing improvements in your symptoms it is a good time to reach out to a professional. Because several other health conditions can cause symptoms that mimic TMD it is important to have a qualified healthcare professional examine you if you aren’t improving quickly or if you have any symptoms that suggest a more acute problem. A visit to your physician or dentist is a good first step. Sinus infections, certain types of headaches, dental issues like a tooth abscess, and a nerve condition called trigeminal neuralgia can also present as jaw symptoms but need to be treated differently than TMD. 

The most concerning cause of jaw pain or discomfort is cardiac ischemia or lack of blood flow to the heart. This can occur during a heart attack but also can occur as a warning side of an impending cardiac event. Nausea, vomiting, chest pain or pressure, pain in the left hand, arm or shoulder, or even teeth pain that accompanies the jaw symptoms could indicate a cardiac origin and needs immediate medical attention. 

WHAT ABOUT PHYSICAL THERAPY?

Physical therapy is an excellent form of conservative treatment for TMD. Because of the multifactorial nature of these conditions, a physical therapist that takes a holistic approach to your care can help you make changes or improvements in several of the areas that could be contributing to your symptoms and teach you how to prevent recurrence. 

Here is a sneak peek at some of the treatments your physical therapist may use to address jaw joint dysfunction:

Postural re-education: PT will assess for any postural abnormalities and teach you how to be aware of them and begin to correct them.

Manual Therapy to improve jaw mobility: Restoring the normal motions and mobility of the TMJ and jaw can be done through gentle hands on techniques either outside of the mouth or sometimes from inside the mouth. 

Strengthening Exercises: Exercises to strengthen the muscles around the jaw and neck can be very helpful in reducing symptoms of TMD, improving jaw range of motion, and reducing the likelihood of recurrence.

Dry needling, ultrasound, electrical stimulation: Your therapist may choose to apply these modalities to manage your pain and inflammation 

Whenever possible a conservative approach is a good first step to addressing symptoms of TMD. If conservative treatments like physical therapy have not been successful, it may be time to talk with your doctor or dentist about treatment options like oral splints or night guards, botox injections, medication management and as a last resort, surgical intervention. If you have been dealing with pain or discomfort in the TMJ this article should help you understand more about your condition and give you an idea of first steps you can take on the road to improving your symptoms. 

Click here for more information about our TMJ physical therapy services.

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

Do You Have Issues in Your Soft Tissues?

What is Soft Tissue Therapy?

What is Soft Tissue Mobilization?

Soft tissue therapy or soft tissue mobilization techniques have long been a part of physical therapy practice. While massage is a broad term that encapsulates the practice of kneading or rubbing of muscles and joints with the purpose of relieving tension and can be performed by many different types of practitioners, soft tissue mobilization (STM) is a more specialized technique that requires a deep understanding of the anatomy and physiology of deep tissue layers. STM requires the assessment of these tissues and an understanding of how manipulating them impacts function. In this article we will take a look at the layers of soft tissue in the body, examine the stages of healing that these tissues undergo after injury, and explore how soft tissue mobilization techniques can help treat pain, impaired posture, inflammation, and range of motion and mobility restrictions. 

What is STM?

Soft tissue mobilization is a low load manual technique that employs long duration forces applied in various directions to improve mobility between underlying and adjacent layers of connective tissue. (Deshmukh, et al., 2014). STM is a general term and over the years different styles and approaches to STM have been discovered. Some examples of STM in physical therapy include:

• Myofascial Release

• Instrument Assisted Soft Tissue Mobilization (IASTM)

• Active Release Technique

• Cross Friction or Transverse Friction Massage

• Graston Technique

• Strain Counterstrain

• Myofascial Decompression (Cupping)

• Trigger Point Therapy

• Manual Lymphatic Drainage

• Foam rolling

Some of these techniques are performed using only the therapist’s hands while others require special tools to help facilitate the treatment.

LAYERS OF TISSUE

Between the visible top layer of skin and the underlying bones lie several layers of tissue that are important in soft tissue therapy. Most superficially we have the epidermis or the outer layer of skin. Beneath that lies the dermis which houses nerves, hair follicles, sweat glands, blood vessels, connective tissue and other structures. Underneath the dermis is the superficial fascial layer then the layer of subcutaneous fat, more blood vessels, and nerves, followed by the deep fascia and then the muscle. 

When layers of soft tissue are not sliding and gliding like they should be it can result in pain, reduced joint mobility, scar tissue formation, and flexibility issues. Tissue dysfunction, pain, inflammation, and injury can happen at any of these levels and soft tissue therapy may play a role in treating the symptoms. 

WHO CAN BENEFIT FROM SOFT TISSUE MOBILIZATION?

STM is indicated to help treat a variety of conditions. These conditions include tendinopathies, muscle strains and tears, subluxations or dislocations, overuse injuries, contusions, edema, inflammation, post-surgery, and scarring. It may also be used to address a range of motion restriction, pain, impaired posture, muscle guarding, and poor tissue mobility.

WHY DOES SOFT TISSUE MOBILIZATION WORK?

While research shows us that STM is effective in promoting tissue healing, reducing pain, and improving range of motion in many cases, the exact physiological mechanisms underlying these changes are still being examined (Hawkins, Williams and Galloway, Kaytlin, 2020). When you sustain a tissue injury it follows a predictable pattern of healing consisting of inflammation, proliferation, then remodeling. During the inflammation phase, blood flow to the injured tissue increases so that damaged tissue can be broken down and carried away, allowing for transition into the second phase. During the second phase, the proliferation phase, cells called fibroblasts increase in number around the injured area in order to synthesize collagen fibers that form the scaffolding that will eventually become fully-healed tissue in the remodeling phase.

It is thought that the compression of tissues during soft tissue mobilization can facilitate tissue healing by stimulating fibroblast activity during this proliferation phase and by helping to realign and reorganize the new collagen. It is also used to break up scar tissue and increase blood flow to the area to promote the formation of new and better-organized collagen fibers. Additionally, STM is thought to have an effect, at least temporarily, on pain receptors and mechanoreceptors which may account for reductions in sensitivity to pain and improvements in range of motion that occur after STM. 

IS SOFT TISSUE MOBILIZATION SAFE?

When performed by a licensed physical therapist, soft tissue mobilization is generally considered safe but there are contraindications to using these techniques including, but not limited to, over areas of unhealed wounds, over a fracture, in an area of cancer, certain types of kidney and heart failure, and others. Talk with your physical therapist about your medical history so they can decide if these techniques are safe for you.

If you have been going to physical therapy or have been thinking about scheduling an appointment, talk with your therapist about whether soft tissue mobilization may be right for you. While soft tissue mobilization is only one part of a complete rehab program, it can be a great tool to help reduce and manage your symptoms now and in the future. 

Click here to find out more information about our soft tissue therapy services

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 Physical Therapy Clinic Locations!

1-718-258-3300

https://EvolveNY.com

What’s New in Nonsurgical Scoliosis Treatment?

Has Conservative Management of Scoliosis Changed?

If you or a loved one have been diagnosed with scoliosis you may be wondering what new treatments are out there to address it. Scoliosis refers to an abnormal curvature of the spine and depending on its severity can range from a minor cosmetic annoyance to a severe deformity that causes pain and can affect breathing and movement. In this article we will examine some of the advances in nonsurgical scoliosis treatment so you can feel informed about the decisions you are making about your care. 

WHY IS SCOLIOSIS A PROBLEM?

When you observe a model of a healthy spine from the front or the back you will notice the vertebrae are stacked on top of one another in a straight line. When you move to the side, however, you will notice that it curves gently from back to front changing direction as the neck or cervical spine transitions into the thoracic spine, or mid back, and again as the mid back transitions into the lumbar spine, or low back. With scoliosis, the most noticeable change is often the presence of one or more curves from left to right forming a “C” or an “S” when you look at the spine from behind. It might not be as obvious, but scoliosis often involves some degree of abnormal spinal rotation and increase in the front to back curvature also making it a three dimensional problem. 

It can be present at birth but is most often diagnosed in early adolescence. 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.

Stopping progression of the curve is a primary goal of scoliosis treatment. Without treatment scoliosis curvature can progress leading to changes in appearance, difficulty walking or moving, pain, and can even restrict heart and lung function if the scoliosis compresses the ribcage. When treated during skeletal immaturity there is the greatest likelihood of stopping the progression and sometimes even improving the scoliosis as the skeletal system is more adaptable at this time. To better understand the current recommendations for the treatment of Scoliosis we reviewed the second edition of The Harms Study Group Treatment Guide published in 2021. The Harms Group is a worldwide cohort of surgeons, with over twenty years of productivity, who perform comprehensive, multi-center, prospective research studies focused on pediatric spinal deformity. 

CONSERVATIVE TREATMENT:

Scoliosis treatment that is nonsurgical in nature is considered to be conservative. The most recent guidelines published by the International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) list the goals of nonoperative intervention for Adolescent Idiopathic Scoliosis as stopping curve progression at puberty, preventing or treating respiratory dysfunction, preventing spinal pain, and improving aesthetics via postural correction. In adults, the primary goal is to treat pain and improve function. The use of spinal bracing and physiotherapeutic scoliosis-specific exercises will be discussed here.

Bracing: Despite advances in medicine, bracing of curves greater than 25 degrees is still the first line treatment in skeletally immature patients because of the likelihood of continued progression of the scoliotic curve even after reaching skeletal maturity (usually achieved by 25 years of age). Smaller curves should be carefully monitored on a regular basis, typically every six months. Curves greater than 45 deg will often be treated surgically. 

Customized bracing made from a mold of the person’s torso, evidence shows, can not only prevent progression, but in some cases improvements, in larger scoliotic curves. Generally bracing is worn between 12 and 23 hours a day until skeletal maturity is reached. Additionally, nighttime bracing of smaller curves may prevent progression in up to 25% of people. While adjusting to brace-wearing can be difficult for young persons, getting to choose the color and pattern of the brace and picking out clothing that is fun and comfortable to use while wearing it, can help.

Physiotherapeutic scoliosis-specific exercises (PSSE): Physical therapy has long been considered an important form of conservative treatment for scoliosis. In recent years the physical therapy community has been studying the effectiveness of PSSE versus conventional physical therapy. The Harms Study Group further defines PSSE:

PSSE consists of very specific exercises developed based on a detailed assessment of the patient’s curve pattern characteristics in all three planes. Patients are trained to“autocorrect” or “self-correct” their alignment in all three planes: coronal, sagittal, and axial. This corrected alignment is then incorporated into stabilizing exercises as well as balance, coordination, and proprioceptive training to automatize the more centered alignment. Patients are taught to incorporate the corrected alignment into activities of daily living. Although PSSE and general or conventional physical exercise both work on core and posture strengthening, conventional therapy does not take into consideration the individual’s specific scoliotic curve pattern, and conventional therapists have not undergone specific education and certification in scoliosis assessment and management.

While research will continue to be done to assess who will benefit most from this type of physical therapy, you can learn more about these types of exercises by working with a therapist trained in the Schroth Method of PSSE. This treatment method focuses on achieving elongation of the spine and derotation of the vertebrae to improve breathing function and posture by individualizing treatment to each person’s unique curvature. It can also help relax stiff muscles, promote better pelvic alignment, and address pain. 

EARLY TREATMENT IS OPTIMAL

If you or your child have been identified as having scoliosis, early management is optimal to prevent progression of the curve when possible and address symptoms of pain, breathing difficulties, and losses of function. If you are interested in learning more about the Schroth approach to scoliosis and how physical therapy can help, call and schedule a physical therapy evaluation at Evolve.

Click here to find out more information about physical therapy for Scoliosis.

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 Chronic Pain

Can Physical Therapy Treat Chronic Pain?

Seeking Relief from Chronic Pain?

If you have been experiencing chronic pain and are looking for solutions, you are not alone. Chronic pain may affect as much as 40% of the population worldwide (Cohen et al., 2021) and those living with chronic pain experience effects ranging from negative social-emotional and physical impacts to heavy financial and psychological burdens. In this article we will discuss how chronic pain differs from acute pain, how it impacts an individual’s life and how physical therapy may be beneficial to alleviate some symptoms of chronic pain.

HOW DOES CHRONIC PAIN DIFFER FROM ACUTE PAIN?

Pain is the body’s method for recognizing a stimulus is injurious or potentially injurious to our tissues. Without pain, you would not know to lift your hand quickly off of a hot stove top or recognize that you should seek care and protection for a broken bone. Without the ability to perceive pain, serious injury or illness would occur possibly without seeking treatment. 

Acute pain occurs in response to an injury or irritation to the body’s tissues. It can range from mild to severe. As the tissue heals we expect this pain to lessen, a sign that the tissue is becoming more healthy and recovered. One hallmark of acute pain is that it is generally short-lived, typically not lasting more than 3 months. Physical therapy typically treats the area of injury and the pain level will improve.

Chronic pain, on the other hand, is pain that lasts more than about 3 months. It can be localized but may also be more widespread. Sometimes chronic pain can develop from an acute condition in the case of an injury or surgery that does not heal well. In other instances, the pain may result from an underlying medical condition. 

One hallmark of chronic pain syndrome is that unlike acute pain, chronic pain often occurs independently of actual tissue injury or irritation. This does not mean it is not real but indicates that the brain is incorrectly interpreting non-harmful or non-injurious body signals as evidence that there is a threat to the body. This misinterpretation can keep someone in pain well past normal tissue healing times as the brain remains on “high alert.” Many people with chronic pain fear movement and exercise because they assume that their experience of pain is truthfully alerting them that their tissues are being injured where in many cases (though not all), the pain centers of the brain have become oversensitized to normal everyday sensations. 

WHAT ARE THE CONSEQUENCES OF CHRONIC PAIN?

While pain or discomfort may be the hallmark of chronic pain syndrome, many chronic pain sufferers find they develop more systemic symptoms over time.  High levels of fatigue and deconditioning are common with chronic pain disorders and may be tied in with disturbances in sleep. Muscle aches, stiffness, burning or aching pain are also common. Mood problems such as depression, anxiety and irritability are often seen with chronic pain as well and all of these symptoms can contribute to difficulties completing daily tasks.

Chronic pain is one of the leading causes of disability and can have ramifications far beyond living with a high level of daily discomfort. It can have negative impacts on personal relationships and self esteem, and the ability to work and afford adequate housing (Cohen et al., 2021). Addressing chronic pain can lead to improvements in all of these areas leading to a global improvement in quality of life. 

WHAT ARE SOME CONDITIONS THAT CAN CAUSE CHRONIC PAIN?

Chronic pain may originate from an injury or as a result of another medical condition but it is important to recognize that chronic pain is considered a disease in and of itself and not merely a symptom of another condition. Physical therapy can help address symptoms of chronic pain originating from many sources. Some conditions that may be associated with chronic pain are listed here:

-Acute injuries: In some instances chronic pain can originate from an acute injury. In this case the pain persists despite healing of the original injury. 

-Cancer: localized tissue or more widespread nerve damage from cancer treatments can cause chronic pain symptoms.

-Low back pain: chronic low back pain can be caused by many triggers, both traumatic and nontraumatic.

-Headaches: chronic headaches can interfere significantly with one’s ability to work, go to school and take care of necessary daily tasks.

-Complex Regional Pain Syndrome: a form of chronic pain that typically affects the arm or leg, CRPS can develop after an injury or surgery and lead to severe and ongoing pain.

-Arthritis: Loss of the smooth and cushioned joint cartilage can lead to chronic pain, stiffness, inflammation and difficulty moving the joint.

-Fibromyalgia: Pain in multiple tender points as well as fatigue, trouble sleeping, and memory difficulties are classic signs of fibromyalgia.

-Neuropathies: damage to nerves which can cause burning, aching or weakness.

-Diabetes: diabetes can cause long term damage to nerves that can result in chronic pain.

-Limb amputation: after amputation chronic pain can develop as “phantom pain” experienced as though the amputated limb were still present and hurting.

HOW CAN PHYSICAL THERAPY TREAT CHRONIC PAIN?

A personalized and multimodal approach to chronic pain is most effective. Physical therapy may be only one aspect of an integrative treatment approach to your pain but conservative approaches like physical therapy can help improve symptoms of pain, deconditioning, muscle stiffness and more. Reprogramming the nervous system to move out of a “high alert” state so that you can move without pain is an important goal of physical therapy.  While a physical therapy program is always individualized, the program may include:

Manual therapy: Manual therapy is a hands-on manipulative type of physical therapy that your physical therapist can use to reduce areas of pain and discomfort. This may include passive mobilization or manipulation of joints or mobilization of soft tissues, for example.

Postural re-education and body mechanics training: learning to move well can be an important step to managing chronic pain. By learning to adjust your posture and move in an efficient and safe way you can perform more activities with less pain.

Graded exercise: It may be scary at first to think of exercise as an appropriate treatment when you are experiencing chronic pain but regular participation in an exercise program has been shown to be more effective in improving function than the reduction of pain itself and can improve sleep and reverse deconditioning (Cohen et al., 2021). Rather than just prescribing general exercise, physical therapists will prescribe a personalized exercise program to target any specific impairments in the musculoskeletal or neuromuscular systems that may be contributing to your symptoms of pain. Relearning non painful movement is an important part of a physical therapy exercise program for chronic pain.

Education: Understanding the mechanics and physiology of chronic pain is an important first step in treating it. Education may also include ways to modify your activities to support your goals for physical therapy and how to use assistive devices or adaptive equipment. 

IT’S NEVER TOO LATE TO GET STARTED 

Whether you have been experiencing chronic pain for some time or you are sensing that your painful symptoms may soon become chronic, our team at Evolve PT is here to help. We will take the time necessary to get to know you and your story and work with you to develop a plan to address your chronic pain and help you to get back to the activities you enjoy. 

Click here to find out more information about physical therapy for chronic pain 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 Brooklyn Locations!

1-718-258-3300

https://EvolveNY.com

What are You Doing with Your Year-End PT Benefits?

Don’t Lose Those Year-End PT Benefits 

Many people don’t consider what type of insurance coverage they have for physical therapy until something happens that necessitates treatment. Different types of insurance plans place various limits and allowances on the amount of physical therapy they will cover over a year’s time. Typically when you schedule your first physical therapy visit the clinic will verify your benefits and tell you this information before the appointment but it is always a good idea to talk with your insurance company ahead of time. 

Commercial, federal, and state-funded insurance plans can vary widely on their coverage but here are some different scenarios that you may encounter:

• A doctor’s referral is required for the initial visit (this can vary based on insurance and also whether the state has direct access that allows physical therapists to treat a patient without a physician referral)

• A patient can make an appointment for an initial evaluation without a referral from a physician 

• A patient can be seen for the initial evaluation but the clinic must request authorization for a prescribed number of follow up visits before they can be scheduled

• A patient can be seen for the initial evaluation and then schedule follow ups without additional authorization from insurance

• The number of allowed visits per year is decided by the insurance plan (example 15, 30, 40 visits) and more cannot be requested, even if they are needed, until the insurance plan renews

• The number of visits is “based on medical necessity” and it is up to the physical therapist to provide documentation that supports the need for ongoing therapy. Some plans will require intermittent authorizations be performed to ensure it is medically necessary before agreeing to more visits. 

WHAT HAPPENS AT THE END OF THE YEAR?

Most insurance plans renew on January 1 but certain plans may renew at other times of the year. Be sure to look at your policy so you know when your benefits and deductible will start over. As you approach the end of your insurance year, it’s time to think about what to do with remaining physical therapy benefits. Unused health insurance benefits do not roll into the next year so if you don’t use them, you lose them. 

WHY SHOULD I CONSIDER PT AT THE END OF THE YEAR?

Physical therapy is an excellent way to address injuries, aches, and pains, weakness, balance problems, pelvic floor dysfunction, and more. You do not need to wait until your symptoms are severe to seek help. In fact when possible, it’s better to begin addressing these symptoms early on. 

If you have a limited number of physical therapy visits available to you each year you can maximize the number of visits you have by using some before your insurance year ends. For example, if you have a chronic condition or severe injury and anticipate needing a long course of rehab but have a hard limit of 30 visits per year, starting your course of care before the year ends allows you to get more than 30 visits for one course of care. For example you may have ten appointments in December and then use ten visits in January which equals twenty visits but you still have twenty more visits to use throughout the rest of the year. If you started that care in January you would have only ten visits left to use for the rest of the year. 

If you have met your deductible then your out of pocket expense may be lower depending on whether you have a co-insurance to pay or have met your out-of-pocket expenses for the year. This can save you a lot of money that you may not have wanted to spend early in the year. Once the insurance renews for the next year you are once again responsible for the entire deductible. Physical therapy visits can occur one to three times a week so taking advantage of the time when your deductible has already been met can save you money. 

If you have a medical or health flexible spending account (FSA) and are approaching the end of the year you may want to act now. An FSA is a medical spending account that works like a savings account and is provided by certain employers. Pre-tax money is deposited throughout the year up to a maximal amount ($2850 in 2022) and can be used to pay medical expenses like copays, vision expenses, over-the-counter medications, etc.. Since the money is “pre-tax” you will be saving the money that would typically be taken out as taxes. 

In the past, only 20% of the annual contribution limit could be carried over into the next year. All other unused funds would be lost. Recently, as part of COVID-19 relief, the Consolidated Appropriations Act, 2021, signed into law at the end of 2020, and IRS Notice 2021-15, issued February 2021 all remaining unused funds from accounts in 2020 could be carried over into the plan year ending in 2021, and account balances from year 2021 could be carried over into the plan year ending in 2022. This means that in the past two years no funds were lost. It is important to note that many of the rule changes for FSAs in 2020-2022 are not mandatory for employers to adopt. Also, it is unclear if this same rule will be renewed going into 2023, so stay tuned as the year progresses. If this benefit is not renewed into 2023 and you are nearing the end of the year and still have unused funds in your FSA, this is a good time to schedule appointments with a physical therapist as the money can help cover any copays or coinsurance you owe. 

If you have a health savings account (HSA) this is another tool you can use to cover the cost of therapy near the end of the year. Like an FSA a health savings account consists of pre-tax dollars deposited into the account throughout the year and used for medical expenses. Annual inflation-adjusted limit on HSA contributions will be $3,650 for self-only and $7,300 for family coverage in 2022. Unlike an FSA which can be sponsored by any employer, an HSA is associated with a high deductible health plan. Also, money deposited into an HSA rolls over from year to year and has the potential to earn interest. If you have money in your HSA at the end of the year you can use it to cover therapy expenses. 

In the end, we don’t always get to choose the time of year that we need physical therapy as we often don’t have control over when and how injuries or illnesses occur. If you do find yourself near the end of the year, having some aches and pains, don’t leave those benefits on the table. Call and schedule a physical therapy assessment and get started on your care right away. You may find you enjoy physical therapy so much that you are happy to save some visits in the next year, just in case. 

Give Evolve Physical Therapy in Brooklyn a call today to see how you can use your end of year benefits! Call: 1-718-258-3300

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 Physical Therapy Clinic Locations!

1-718-258-3300

https://EvolveNY.com

Feeling Dizzy? You May Need Vestibular Therapy

Vestibular Physical Therapy Services

Off Balance? Dizzy? Vestibular PT Can Help

Feeling off balance or dizzy after getting off of a ride at the local fair may be normal but if you are experiencing these symptoms in everyday life it may signal a problem with your inner ear, or vestibular system, and you may benefit from vestibular physical therapy.

Symptoms of dysfunction in the vestibular system can include vertigo, or room spinning dizziness, disequilibrium or feelings of being off balance, motion sensitivity, loss of balance or falls, bouncing or blurred vision, nausea, feelings of floating or lightheadedness.

If you have been experiencing these symptoms, read on to determine if a referral to a vestibular-specialist physical therapist may help. 

WHAT EXACTLY IS THE VESTIBULAR SYSTEM?

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 or a reduction in function in both ears. When this system is not functioning optimally symptoms like vertigo, dizziness, and unsteadiness result.

WHAT IS CAUSING MY SYMPTOMS?

Symptoms such as dizziness, motion sensitivity, or disequilibrium, for example, can often be treated with vestibular physical therapy, but it is important to first identify the underlying cause of your symptoms. While in some cases the underlying cause may be relatively benign, in other cases it can signal a more serious condition or even a medical emergency. Strokes or TIAs, Multiple Sclerosis, cardiac conditions, brain tumors, or infections are examples of serious conditions that can cause these symptoms. 

If you are experiencing symptoms of a vestibular problem along with any of these other symptoms it is essential to seek urgent medical care:

• Weakness, especially on one side of the body or face

• Loss of coordination

• Changes in vision

• Severe headache

• Changes in sensation

• Abnormal eye movements

• Confusion

• Changes in speech

• Vomiting

• Chest pain or pressure 

• Unrelenting vertigo or dizziness

At the onset of new symptoms your doctor may recommend imaging studies such as MRIs or CT scans to rule out some of these more serious causes of dizziness and imbalance. In some cases you may be referred to an ENT or audiologist for specialized testing of the vestibular system. Some medications can also be damaging to the vestibular nerve or vestibular organs so it is important to discuss your medications with your doctors as well.

As long as more serious conditions like a stroke or tumor have been ruled out, or have been addressed medically, physical therapists can also perform clinical testing during their evaluations to help determine the cause of your symptoms and guide treatment. Below you will find a list of some of the conditions that can benefit from treatment by a vestibular physical therapist:

Vestibular hypofunction: This is a term that refers to a reduction in the function of the inner ear in one or both ears. It can have many causes including ototoxic medications, brain tumors such as acoustic neuromas, a brain injury affecting one side of the brain, autoimmune diseases that affect the inner ear over time, weakening of the structures of the inner ear due to aging, and as a result of conditions such as Meneire’s Disease or Labyrinthitis. 

BPPV: Benign Paroxysmal Positional Vertigo is characterized by brief episodes of room-spinning vertigo that are triggered by changes in position. 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.  

Concussion: While a concussion injury does not show up on an MRI or CT scan, it can damage or affect the inner ear and vestibular system to cause lasting symptoms of dizziness, motion sensitivity, or imbalance. 

Vestibular migraine: In persons with migraine headaches, spells of vertigo, nausea and imbalance may occur even without the accompanying headache pain. These spells can last seconds, minutes, hours, or days. Many people do not know about this type of “atypical” migraine.  

Cervicogenic Dizziness: In persons with a history or whiplash, neck pain, or degeneration of the cervical spine, sometimes the symptoms of dizziness, nausea, headache, imbalance or feelings of unsteadiness may arise from problems in the neck. Neck pain, stiffness, or limited range of motion may accompany these other symptoms.  

Persistent Postural Perceptual Dizziness (3PD): Symptoms of vague dizziness or lightheadedness that increases with movement or in busy or crowded places and improves with sitting or lying down and which persists for more than three months may be 3PD. It may be triggered initially by a sudden inner-ear event during which the body becomes more reliant on visual input. 

HOW CAN VESTIBULAR PHYSICAL THERAPY HELP?

Vestibular physical therapy techniques will be prescribed based on the underlying cause(s) of your symptoms. This is why it is important to undergo screening or testing for these conditions at either a doctor’s office or at the physical therapy clinic. Depending on causes, here are some physical therapy treatments you may experience during vestibular therapy:

Canalith Repositioning Maneuvers: If your vertigo is caused by BPPV (see above), your therapist will take you through a series of head and body positions called canalith repositioning maneuvers to move the crystals out of the semicircular canals which should improve the vertigo symptoms.

Habituation exercises: In many cases the vestibular system has become oversensitized to movement and symptoms of dizziness, imbalance, or unsteadiness can occur with daily tasks. Habituation exercises involve performing symptom-inducing movements in a controlled fashion to help habituate and desensitize the vestibular system to these triggers

Gaze stabilization: The inner ear is intimately connected to the eyes and poor gaze stabilization can contribute to many of the symptoms outlined above. Gaze stabilization exercises can be performed in the clinic and at home to improve or compensate for the loss of stability. 

Neck physical therapy: If there is a cervicogenic component to your symptoms your physical therapist may perform manual hands on techniques like joint mobilization or soft tissue mobilizations to improve neck pain and stiffness. You may perform strengthening and stretching exercises for the neck and work on the joint position sense of the neck called proprioception.

Cardiovascular training: If your symptoms are triggered by an increase in heart rate then a graded cardiovascular training program on a treadmill or bike will be prescribed to train the body to work at increasing intensities without symptoms.

Balance exercises: balance training may be needed if you are experiencing unsteadiness, falls, or losses of balance. 

VESTIBULAR PHYSICAL THERAPY CAN HELP

As you can see, though there are many causes of symptoms like dizziness and disequilibrium, there are also many ways that vestibular physical therapy can help. If you have been experiencing these symptoms recently or for some time, call and schedule an evaluation at Evolve PT so we can get to the bottom of your symptoms and create a program to help you recover.

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

So You Need Meniscus Surgery?

Meniscal Repair Surgery and Post op PT Rehab

WHERE IS THE MENISCUS?

The meniscus is a C-shaped cartilage disc that cushions and helps stabilize the knee. There are two of these discs in each knee between the end of the thigh bone (femur) and lower leg bone (tibia). The one on the inside of the knee is called the medial meniscus while the one on the outer side is called the lateral meniscus. 

HOW DO MENISCUS TEARS TYPICALLY OCCUR?

Tears in the menisci are categorized as either acute or degenerative. Acute meniscus tears occur suddenly, usually when the leg is twisted while the foot is planted and the knee is bent. Due to the mechanism of injury, other structures in the knee such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL) may be injured at the same time. Degenerative tears occur as a result of general wear and tear in the knee joint.

In general the menisci have poor blood supply. Blood is what carries the nutrients and growth factors and carries away damaged cells to help heal an injury. Because the blood supply is poor, when torn, the meniscus is less likely to be able to heal on its own. While not all meniscus tears require surgery, symptoms of catching or locking usually require a surgical evaluation. Similarly, while conservative treatment like physical therapy is often recommended as a first line treatment approach, failure to respond to physical therapy may indicate surgery is necessary. 

HOW IS MENISCUS SURGERY PERFORMED?

Currently there are three main methods of surgical management of meniscus tears (Doral et al., 2018). Which surgical approach is used often depends on the severity of tear, the location of the tear, and the type of tear. 

Arthroscopic Partial Meniscectomy: During this procedure the damaged part of the meniscus is trimmed away and removed.  As an arthroscopic procedure, it is minimally invasive. This is the most common surgical approach to treating meniscus tears as it is quick, has a low rate of morbidity, and good short term results. It is commonly used to treat degenerative tears and radial tears but may not have as good of long term outcomes as a meniscus repair and thus is often not recommended as a first line treatment of choice. 

In the past, total meniscectomy, or the removal of the entire meniscus, was sometimes performed. This type of surgical approach is rare these days due to its association with early osteoarthritis and poor long term clinical outcomes. 

Meniscus Repair: This approach is intended to preserve the entire meniscus by repairing the tear. This technique can be performed through an arthroscopic approach or an open approach. Not every tear or every patient is a good candidate for this type of surgery but it is preferable when possible to retain as much of the meniscus as possible. At times what is called an augmentation technique (ex. needling) or the addition of a biological product (ex. Platelet-rich plasma or mesenchymal stem cells) will be used to try and improve the rate of healing after the surgical repair. 

Meniscus Reconstruction: This is a more complex procedure used to replace a partially or totally resected meniscus in symptomatic patients who have been unresponsive to conservative management. The main goal is to fill the defect and safely place a functional meniscus that is similar anatomically and structurally to the native meniscus. The intent of this procedure is to improve both pain and function of the knee and delay the onset of osteoarthritis. 

POST-OP PHYSICAL THERAPY

Physical therapy is recommended following meniscus surgery. Your physical therapist will work with your surgeon to follow their post-surgical physical therapy protocol. The goal of of physical therapy after meniscus surgery is to return to your prior level of function but while you are undergoing treatment you can expect your physical therapy treatments to address several different areas:

• Manage pain and swelling: not only are pain and swelling uncomfortable but they limit knee range of motion and can inhibit muscle activation. Your physical therapist can help you manage your knee pain and swelling through things like icing, compression and elevation.

• Returning to weight bearing: crutches, or a walker if needed, are typically used for a few weeks to a few months depending on the type of surgery. In physical therapy you will learn how to use your crutches or walker for things like going up and down a curb and guide you through progressively putting more weight on your leg until it is time to wean off them completely. 

• Restore knee range of motion: restoring full flexion and extension of the knee is an important step to returning to your prior activities. Soft tissue mobilization and myofascial techniques, active and passive range of motion exercises, and stretching can be used to accomplish this goal. 

• Improve strength and neuromuscular control: strengthening exercises in the muscles around the hip, knee, and ankle are important to help support the knee joint as you return to activity. Similarly, neuromuscular control exercises help the body coordinate the firing of muscles to provide good stability around the knee joint during things like walking, running, and jumping. 

• Return to sports and athletics: once healing has progressed, your physical therapist will gradually include dynamic exercises specific to the sports and activities you love and want to resume.

While having meniscus surgery may seem daunting, having a good physical therapist in your corner can make the process much easier. The physical therapists at Evolve are experienced in the rehabilitation of meniscus tears and post-op meniscus surgery and would love to guide you through this process and get you back to doing the things you love and need to do.

Click here to find out more information about physical therapy for meniscus 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

In-season Training and Offseason Training Tips for Athletes

Tips for In-Season vs Off-Season Training

Do You Know The Difference Between In- and Off-Season Training?

If you are hoping to improve your athletic skills or gain a competitive edge then the training you do out of season is just as important as the training you do during your competitive season. The approach to training, however, is not the same throughout the entire year.

During off-season training you are working to maximize gains in strength, power, endurance, and speed and addressing any injuries or weaknesses that may predispose you to injury.

Once you begin your competitive season, however, your goals should be to maintain as many of the gains you earned in the off-season while ensuring proper recovery between competitions and practices. Keep reading to learn more tips about how to structure your off-season versus in-season training regimens. 

OFF SEASON IS THE TIME TO HUSTLE

While it may seem like the off-season is the time to relax and recover after finishing your competitive season, your time will be much better spent in the training room. It's true, in order to prevent burnout, you need to ensure that you make time for things you enjoy such as spending time with friends and family and participating in other hobbies that interest you. It is also important, however, that you spend your time wisely if you want to be in shape to perform at your best when practices and competitions resume. 

So what is so special about the off-season? One of the reasons the off-season is the ideal time to develop things like strength, power, speed, and endurance is because you do not have to worry about how these workouts may negatively affect your performance during a competition. Strength, power, and speed development, for example, require performing exercises at high intensity which leads to muscle micro-injury and fatigue and can result in delayed onset muscle soreness. None of these things is ideal for a player that is about to line up on the blocks for their next track race or step onto the field for their soccer match. 

During the off-season you will often deprioritize some of the sport-specific drills and exercises, at least until pre-season training begins, and you will spend more time on the following:

Muscle hypertrophy and strength development: improving muscle recruitment and increasing muscle size should be a priority of the off-season. Lifting heavy (but within your capabilities) is what leads to muscle hypertrophy. If you haven’t done this type of training before it’s important that a trainer or physical therapist observes your form. Lifting heavy, when done correctly and in the right volume, will lead to gains in strength, but done incorrectly can definitely lead to injury

Power development: Power workouts involve developing the ability to apply or create maximum force as quickly as possible. A sprinter requires power to explode off the blocks. A defensive tackle requires power to quickly oppose the equally powerful forces generated by the offensive line. A javelin thrower needs to generate power to propel the javelin as far as possible. Plyometrics are an example of a power workout. Lifting for power involves moving loads near your 1 rep max performed at low volumes. Workouts to develop power should build upon a foundation of good strength and good biomechanics and should be tailored to meet the demands of your specific sport. 

Anaerobic conditioning and aerobic endurance: Building aerobic endurance and anaerobic conditioning requires a lot of time to develop and plenty of time for recovery. If your sport requires you to run a lot at a moderate speed with bouts of sprinting, for example, soccer or lacrosse, you can use your off season time to work on your endurance with plenty of long slow runs and your speed with some carefully crafted speed workouts. If you want to move up to a longer distance swimming event, for example, then spending more time in the pool swimming longer distances will build your capacity to compete at these distances more efficiently.  

Injury rehabilitation and prevention: If you came out of the competitive season with any nagging injuries this is the time to address them. Working with a physical therapist that is familiar with your sport will ensure that your rehabilitation program is tailored to the demands of the sport you play. Did that nagging ache or pain go away after the season ended and you got to take some time off? Great! You should still consult a physical therapist or work with an athletic trainer though, because the reduction in volume may account for the improvement in your symptoms but failing to address the underlying problems that led to your injury ensures it will likely return as practices ramp up and the season starts again

Sport-specific skill development: You’re right, we did say in the beginning that sport specific skill development takes a back seat during the off-season but as you approach the pre-season time frame you should begin to incorporate more sport specific drills to improve neuromuscular control. Practicing these skills as you approach the competitive season will help build motor patterns that improve proficiency and precision on game day. 

IN-SEASON IS NOT THE TIME TO REST EITHER

Many athletes put in a lot of great work during the off-season only to lose it when the season starts because they aren’t sure how to adapt their workouts to the demands of in-season training and competition. If you experienced muscle fatigue and soreness after workouts during the off-season you may be hesitant to keep lifting because, as we pointed out above, this is not how you want to feel when you wake up on the day of a competition or game. With some modification to the programming, however, you will be able to keep up a training routine that will help you maintain the strength and power gains, improvements in neural connections, and changes in body composition that you worked so hard for in the off-season. 

Keep lifting heavy but lower the volume: You became strong in the off season by lifting heavy weights. If you stop lifting those heavy weights you will definitely lose strength but lowering the volume to fewer sets will help maintain muscle mass without impacting performance

Focus on recovery: Recovery is king during this time. Tissue work like foam rolling, stretching, and using the massage gun can help reduce soreness and tightness. Getting enough sleep, staying hydrated, and fueling properly are also incredibly important to help heal any small injuries and allow the body to recover fully. 

Keep up an injury prevention routine: Proper dynamic warm up and accessory muscle activation, for example, prior to practices and competitions can prevent injury. The best routine to warm up and get muscles fired up and ready to meet the demands of your sport will depend on the sport you play. A physical therapist can help you develop a personalized warm up routine to get your muscles and tendons ready for play and reduce the likelihood of injury. 

Address aches and pains right away: Employing the “wait-and-see” approach is a bad idea. What may initially feel like merely an annoyance can quickly turn into a full blown injury if not addressed quickly. While you might worry that if you talk with your coach or trainer you could lose valuable playing time, handling these issues when they first develop can save you from sitting out more than just a game or two. 

A WELL-THOUGHT OUT TRAINING PROGRAM IS A WINNER

After reading this article you should feel more confident in the type of work needed to maximize performance both in-season and off-season. By understanding how to make the most of your off-season and how to maintain those gains as you enter the season of competitive games, meets, and matches, you will be well on your way to being the best athlete you can be.

Click here for more information about in-season and out of season training and sports physical therapy services

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 Technology Are Physical Therapists Using Today?

New PT Technologies- IAPT

AdvanceMENTS in PT Technology…

While individually prescribed exercise programs are often the bread and butter of a physical therapy plan of care, there is no denying that technological advances in physical therapy tools have a place in the clinic also. If it’s been a while since you’ve been to physical therapy you might be wondering what new technology exists to target tissue mobility, reduce pain, and improve the effectiveness of strengthening programs. This article will introduce you to some new pieces of equipment you might find at your next PT visit. 

Myofascial Decompression (MFD): Myofascial decompression is a negative pressure soft tissue mobilization technique based on the traditional cupping method. During this treatment cups are placed on a particular area of the body and a special tool is used to create suction within the cup. Unlike other forms of soft tissue work in which the skin, fascial layers, and muscles are compressed, for example during foam rolling, these instruments actually pull the skin, muscle, and fascial layers up into the cup creating space and temporarily altering blood flow to the area. When placed strategically and paired with active movement, MFD can alter the mechanical and fluid properties of fascial layers, increase blood flow to the area and allow the fascial layers to glide and slide on one another more easily. Given that pain and movement receptors are often found in the deeper layers of the fascia this treatment can help improve tissue mobility, reduce pain, and improve neuromuscular control and biomechanics. 

Percussive Massage Guns: Massage guns are becoming common in many physical therapy clinics. These tools provide a percussive vibration from a single, interchangeable, head at the end of the handheld “gun.” They typically have different settings and the intensity can be adjusted as needed. When used before or after intense exercise it can help reduce delayed onset muscle soreness (Imtiyaz et al., 2014) and when used before it can provide short-term increases in muscle length. It also may increase blood flow to an area and reduce inflammation which can have pain relieving benefits. One benefit to this tool is that it is portable and many people feel a benefit after its use. 

Blood Flow Restriction Training Method: This technique consists of applying a pneumatic tourniquet cuff to the proximal portion of a limb to partially restrict venous outflow from the areas below it. This technique causes blood to pool in the capillary beds and has been shown in many studies to increase muscle strength and size while exercising at loads less than would be typically required to induce strength gains. It has also been shown to have positive effects on bone mineral density and tendon stiffness. It is often used in patients who are recovering from surgeries such as an ACL or tendon repair in which weight bearing and load tolerance is low but they need to regain strength. As you can imagine, if done incorrectly, injury can occur, so this is not something to try at home but should be applied by a PT trained in this particular modality. 

Neuromuscular Electrical Stimulation (NMES): In the body, muscles are activated through nerve signals originating in the brain and spinal cord. If there has been an injury to the brain or spinal cord the descending motor signals to the muscles are impaired and sometimes nearly absent resulting in weakness and poor motor control of the muscles affected. This can result from an injury to the central nervous system such as a stroke, spinal cord injury, or Multiple Sclerosis, for example. NMES consists of a machine that sends an electrical signal to a muscle through a pair of electrodes placed over the muscle. NMES can help restore some of the brain- and spinal cord-muscle connectivity as a patient actively tries to move their muscle while the external signal causes a muscle contraction. In the past, these machines were mainly for use in the clinic but advances in technology have allowed for the production of at-home units that can be prescribed by your physical therapist and are relatively low-cost. This technology has also been incorporated into several different types of wearable technology to help with things like foot drop or grasp and release. 

THE NEW PHYSICAL THERAPY FRONTIER

While the role of physical therapists as movement and injury rehabilitation experts will remain, new advances in technology will undoubtedly help us to be more effective practitioners. Every year new research is being done on technology to help you move better and feel better and while time and repeated use will determine which of these technologies deserves to remain in the physical therapist’s toolbox for the long run, for now we are excited about what is to come!

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

Get Back on the Ice with Physical Therapy for Hockey Players

Physical Therapy for Hockey Players

In the last thirty years the sport of ice hockey has seen a sizable increase in participation at all levels of the sport. From youth hockey to the professional level, more players on the ice means more potential for injury. Whether it’s a nagging discomfort you’ve been noticing for a while or a sudden injury that’s just occurred, finding a physical therapist familiar with the demands of ice hockey is important. This article will discuss common injuries in hockey and how physical therapy can address these injuries to help you get back out onto the ice.

COMMON INJURIES IN ICE HOCKEY

If you’ve ever played ice hockey or enjoy spectating, you will notice that ice hockey differs from other sports in a few ways. Hockey is a collision sport and requires quick changes in direction and movement in all planes but unlike other contact sports, it is played on a frictionless surface while players balance on a very narrow contact surface (the blade). 

Depending on the position you play you may spend more of your time skating backwards than forwards while some positions perform more crossover skating. Goaltenders may spend a period of time relatively still then be required to make quick movements that require large ranges of motion and flexibility. Furthermore, stickhandling the puck requires good hand eye coordination, strength, and proprioception (Wolfinger, Christopher and Davenport, Todd, 2016). 

A review of hockey injuries in highschool and collegiate men’s and women’s hockey found that injuries were most common to the head/face, shoulder/clavicle, and hip/thigh/upper leg. Injury type ranged from concussion (most common), ligament sprains, muscle/tendon injuries and contusions (Lynall et al., 2018). Body checking accounts for a high percentage of injuries. 

Depending on the type and severity of injury, loss of practice and play time can be a real concern. Having a proper rehabilitation plan and perhaps just as important, a comprehensive prehabilitation program, can help limit time spent recovering off the ice and reduce the likelihood of injuries overall. 

WHAT DOES PHYSICAL THERAPY FOR HOCKEY LOOK LIKE?

Prehabilitation: Prehabilitation refers to participation in therapy based movements and exercises in order to avoid injury, decrease pain or to prepare for surgery. In the context of hockey, prehabilitation is intended to prepare the body for the physical demands of the sport to improve injury resilience and maximize the ability to recover from injury. Below are some of the components of prehabilitation for hockey players:

Flexibility: Hockey requires quick changes in direction and the ability to push off the skates quickly. Having adequate flexibility throughout the lower body and trunk will allow for improved mechanics while skating and more reach while tending the goal. It also decreases the likelihood of sustaining a muscle strain which can occur when the muscle is stretched beyond its level of flexibility. 

Endurance: Muscle and cognitive fatigue can lower reaction times and decrease stability and protection around joints. Having the stamina to maintain proper form, biomechanics, speed, and agility through all four periods of a game can decrease one’s risk for injury and make playing the game more enjoyable. 

Stability: Having sufficient shoulder, pelvic, and core stability not only makes one more resistant to being thrown off balance with a body check, but it allows for more powerful transfer of energy through the body. The ability to powerfully shoot the puck and transfer energy from the skates through the rest of the body to accelerate and decelerate is related in part to muscles contracting in a coordinated fashion to stabilize the bones and joints. 

Strength: Full body strengthening is important to maximize power output and speed and to increase injury resilience during practice and competition. It is important to include shoulder strengthening exercises as shoulder and clavicle injuries are common in hockey.

Power: Skating powerfully, being able to reach across the crease as the puck comes flying at you, and driving the puck across the ice into the net requires the ability to generate large amounts of force quickly, also known as power.

Injury Rehabilitation: Despite great preparation, injuries can still occur and applying the right rehabilitation techniques is vital to ensuring full recovery of the injury, minimizing time spent off the ice, and reducing the likelihood of reinjury. Let’s take a look at how physical therapy can address some of the more common hockey injuries.

Concussion: Concussion is considered a functional brain injury. Its effects can not be seen in a CT Scan or an MRI but we know from more advanced imaging that it affects the brain’s ability to function which leads to the signs and symptoms we see after a concussion. Concussion is a serious condition and failure to allow full recovery before returning to full play can put one at risk for serious brain injury if they sustain another blow to the head. 

Although most players will recover from a concussion within a couple of weeks, consulting with a physical therapist is important to both recognize signs of postconcussion syndrome, in which recovery is delayed, and also to guide the player through active recovery. A concussion does not necessarily require total rest but understanding what activities to limit and when to begin resuming activity is essential. If issues with dizziness, headaches, poor tolerance to higher intensity exercise, imbalance, or gaze stabilization persist, vestibular physical therapy can help a hockey player improve these symptoms. 

Muscle strains:  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. 

Recovery from a muscle strain depends on the severity but physical therapy can guide you through that process. Your physical therapist can advise you on how to manage pain and inflammation and protect the newly injured muscle while still performing exercise with uninjured body parts to limit overall deconditioning. Next you will be guided through a program of gradually strengthening and restoring flexibility to the muscle and then performing hockey-specific exercises to prepare the muscle for the demands of return to play. 

Femoroacetabular Impingement (FAI): This condition in which there is bony overgrowth on the femoral head (ball) or acetabulum (socket) of the hip joint can lead to pain and pinching in the groin. It is most common in goaltenders who spend a lot of time in the “butterfly position” moving in and out of hip internal rotation and flexion which typically trigger symptoms of pain with this condition. When mild, this condition can often be treated conservatively with physical therapy but if a surgical approach is warranted then physical therapy will be needed after surgery to rehabilitate the hip and recover strength, mobility, and stability for return to play.

Ligament sprains: When a joint is moved beyond its normal range of motion it stresses and stretches the inelastic fibers of the ligaments surrounding it and can cause tearing (sprains).  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. Ligament injuries can occur in any joint but are common in the ankle, knee, shoulder and wrist. Your physical therapist can assess the joint to determine which ligaments are involved. 

They will advise you on how to protect the ligament in the earliest phase to reduce pain and inflammation and protect healing tissues. In later phases of rehab you will focus on improving strength in the muscles that add stability to the joint and on motor control and proprioception to help protect the joint from future injury. When ready, your PT can advise you on how to begin hockey-specific drills and exercises to ease back into full participation. 

CHOOSE PHYSICAL THERAPY

More time spent on the ice makes you a better hockey player and if hockey is what you love, then staying injury free is a priority. While you can’t prevent all injuries, physical therapy can help you identify the areas that make you more susceptible to injury so you can begin addressing them now. If you do find yourself injured, the physical therapists at Evolve will get you started right away on the road to recovery so you can get back on the ice. 

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

How to Prepare for ACL Surgery with Prehab Physical Therapy

How to Prepare for ACL Surgery w/ Prehab

Did You Know Pre-ACL Reconstruction Rehab Leads to Better Outcomes?

Prepare for ACL Reconstruction with Prehab Physical Therapy-

Many people ascribe to the notion that the best way to address an injury is to rest. While this is true in certain cases, like when healing a bone fracture, in many other cases complete rest can lead to muscle atrophy and delay return to full function.

A torn ACL is an injury that defies this notion as well and though activities will most definitely need to be modified due to the pain, swelling, and instability that arise from an acutely torn ACL, a carefully prescribed rehabilitation program prior to ACL reconstruction surgery may lead to better long term outcomes (Melick et al., 2016).

In this article we will talk about what components may be included in an ACL reconstruction preoperative program.

WHAT PREOPERATIVE FACTORS SHOULD I TARGET?

Much research has been done to try and determine what preoperative factors are associated with better long-term outcomes for those undergoing ACL reconstruction. Some factors like age and sex cannot be modified with a preoperative ACL program. Other factors, however, such as knee range of motion, quadriceps strength, and level of activity prior to surgery (measured by the Tegner Activity Scale) are associated with positive indicators at one to two years post-surgery and beyond.  

Decrease swelling and restore range of motion: The primary goal of early preoperative management for ACL injury is decreasing swelling (joint effusion) and restoring full passive and active knee range of motion. Regaining knee extension and flexion range of motion is an important goal before ACL reconstruction surgery. Trouble regaining full knee range of motion is one of the more common complications of ACL reconstruction surgery and failing to achieve full range of motion in the preoperative phase is a risk factor for this complication (Quelard et al., 2010).

Since swelling in and around the joint capsule impairs range of motion and can inhibit muscle activation, reducing swelling should be one of the first goals of an ACL surgery prep program. Here are a few methods for managing swelling:

• Apply ice to the area for 15 minutes, 3-4 times a day

• Elevate the leg above the level of the heart throughout the day

• Apply compression with a bandage or compression sleeve

• Modify weight bearing as needed to limit an inflammatory response

Start a progressive exercise program: Goals in this second phase of early post-injury rehab for an ACL tear include maximizing muscle strength, specifically quadriceps muscle strength, and neuromuscular control. Having at least 90% return of quadriceps strength compared to the opposite side is important leading into ACL reconstruction but undergoing additional therapy to address impairments in neuromuscular control of the knee and all the joints of the leg can improve functional outcomes two years after surgery (Failla et al., 2016). Once you’ve attained a “quiet knee” without joint effusion, with full range of motion, and the ability to hop on one leg, progressing toward heavy resistance training and even plyometric exercises has been found to be safe with a low incidence of adverse events and can have benefits that extend years beyond ACL reconstruction (Filbay, S. and Grindem, H., 2019). 

It is important to consult with a physical therapist who can prescribe and progress a program that is specific to you. Trying to do this on your own may lead to failure to achieve and sustain a “quiet knee” but also may lead to underdosing of beneficial exercises. Let's take a look at examples of exercises that might be included in a 5-6 week preoperative protocol. Please note that these exercises are not necessarily ordered as a progression.

Quad sets: performed in sitting with the injured leg extended in front of you, try and lift your heel as you press the back of your knee into a towel. When possible, try to sustain a contraction of the quadriceps muscle for six seconds. This exercise is great to establish motor control and volitional contraction of the quadriceps muscle. 

Straight leg raise: lying on your back, with the injured knee straight, raise the leg up off the table without letting the knee bend then slowly lower it back to the table.

Squats: Starting with body weight, use a mirror as feedback to maintain equal weight through both legs. Progressions of this exercise include adding weight and performing as a single leg squat or single leg sit to stand.

Knee extension: Initially you may perform this exercise seated in a chair and extending the injured knee to raise the lower leg against gravity. As you gain strength you may progress to adding ankle weights or using a resistance machine.

Single leg balance: Stand on one leg while trying to maintain a level pelvis. Aim to increase the time you can hold this position and vary the surface to a softer or more compliant surface for added challenge.

Perturbation training: these dynamic exercises help to improve the stability of the knee. Most likely starting as a double leg activity and progressing to a single leg activity, perturbation training involves withstanding challenges to balance and postural control in multiple planes of movement. They may be performed on a variety of unstable surfaces.

While an ACL injury can feel overwhelming and the recovery may seem daunting, a good preoperative rehabilitation program can set you up for better success. Let physical therapy guide you through this process and create an individualized ACL reconstruction preparation program just for you so that you can go into surgery with the comfort of knowing you have done everything you can to have the best surgical outcome possible. The physical therapists at Evolve are ready to help even day one after an injury because the road to recovery from an ACL tear begins right away. 

Don’t Wait Until After ACL Reconstruction to Begin Your Rehab! Click here to find out more information about ACL physical therapy and our specialized prehab physical therapy programs.

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 Physical Therapy Clinic Locations!

1-718-258-3300

https://EvolveNY.com

5 Best Exercises to Prepare for Basketball Season

Get Ready for Basketball Season with These 5 Workouts

5 Principles for Offseason Basketball Training

When you’ve finished the last game of the season you might be thinking it’s time to take a few months off but if you are looking to improve your performance during the next competitive season then this is the time to get to work. Focusing on basketball-specific training principles during the off-season will allow you to maximize performance and minimize injury risk when it’s game time again.

Basketball is considered a contact sport and it involves sprinting, jumping, landing, withstanding contact from other players, and pivoting quickly. If you want to improve your performance on the court you need to incorporate training elements that enhance your ability to perform each of these skills and prepare the body’s tissues to withstand the high forces associated with training and competitive basketball. 

During a 10 year period of seasons between 2008 and 2019, 66% of professional basketball players sustained an injury with a median three game loss as a result of the injury (Bullock et al, 2021). The most common injuries occurred at players’ ankles, followed by knees, hips/groin/thighs and ranged in severity from mild to severe. While injury rates may differ for players outside of a professional league, it stands to reason that any player is at risk for injury and maximizing injury resilience in the off-season is a wise idea. 

Incorporating strength training for the legs, trunk/core, and arms is an essential part of training during this time. Exercises like deadlifts, lunges, pull ups, hamstring curls, squats and overhead press target the entire body and can help support many of the skills needed on the court. Since many of you will already be doing a full body strengthening routine this article will introduce you to five other elements of training that you can incorporate to get ready for basketball season. 

FINE TUNING YOUR WORKOUT ROUTINE

Stability Matters: though strength development should always be a part of pre-season training for basketball, don’t forget to incorporate exercises that develop stability. Stability is provided by coordinated co-contraction of muscles surrounding joints. Having good stability not only reduces the risk of injury to ligaments and muscles that can happen when they are stretched beyond their normal length but it is vital for transferring power through the body to make that three pointer or land on your feet when another player contacts you during a jump. Dynamic exercises standing on one foot, for example, can improve the motor control and stability of ankle muscles to prevent ankle sprains, a common basketball injury. Core stabilization exercises like pallof presses and shoulder stability exercises like plank variations are another good place to start.

Mobility: without enough flexibility in the upper and lower body and the spine it will be difficult to translate the speed and power you developed during pre-season training into quick changes in direction, explosive jumps, and powerful shots on the court. Off-season is the perfect time to start working on your flexibility. Static and dynamic muscle stretches and joint/muscle mobility exercises that target the hips, groin, knees, ankles and shoulders can reduce injury and improve performance. 

Stiffen up those tendons: while it may sound counterintuitive, stiffness in the tendons that attach a muscle to the bone is actually a good thing. Stiff tendons are more resilient against injury. They are also capable of stretching further during a muscle contraction, storing the elastic energy and then recoiling strongly to produce more powerful movements. Stiffer achilles tendons, for example, are often seen in faster runners. 

Many of us focus on concentric exercises in our workouts wherein a muscle is shortening against a load, for example, a bicep curl. Research shows, however, that eccentric and isometric exercises are much more effective at developing tendon stiffness. Eccentric exercises, also sometimes called “negatives”, consist of a muscle lengthening against a load.  An example would be slowly or “eccentrically” lowering into a squat then standing up quickly.  An 8-12 week eccentric training program for the calf muscles, for example, can significantly improve achilles tendon stiffness which may result in higher jumps and fewer tendon injuries (Geremia et al., 2018). Similarly longer duration isometric contractions of a muscle, in which the muscle contracts against a load but doesn’t change length, can also improve muscle strength and tendon stiffness (Kubo et al., 2006; Kubo et al., 2017).  

Power training: If all you were required to do on the court was lift or push something heavy then strength training might be all you needed. Basketball players, though, need to accelerate or decelerate very quickly as they jump and land, change directions, and shoot a ball. This is where speed and power training become important. Power lifts at >80% of one rep max, plyometrics, and sprints are great ways to develop explosive speed. Incorporating the upper body into this type of training is important so you can catch, pass, and shoot the ball with power and control. This type of training is hugely beneficial to prepare for basketball season but needs to be incorporated carefully as it can be easy to injure oneself if done incorrectly. Your coach or trainer can help you build a program for speed and power that meets your current fitness levels to improve your play and decrease your risk for injury.

Basketball specific drills: being strong, fast, and powerful will certainly help during a basketball game but if this was all that was needed to be a great player then just about any Olympic athlete should be able to earn a spot on a professional basketball team. The reason strength, speed, and power don't automatically make a player great is that training for any sport requires specificity. If you want to be good at basketball you need to be practicing skills and drills that are specifically used during a basketball game. Training for soccer, for example, might help you get fit but it won’t make you a better basketball player. In the off season pick 3 or 4 of your favorite basketball drills for shooting, passing, and footwork and incorporate these into your training to hone your neuromuscular control.  

Now that we see how offseason prep in the training room is important to prepare for basketball season, we should also acknowledge that the offseason is the perfect time to rehab any injuries or irritations. If you are currently injured or have noticed a pain or irritation that develops as training and practices ramp up, now is the time to schedule an appointment with the physical therapists at Evolve so they can help you recover and build resilience ahead of basketball season.

Click here for more information about physical therapy for basketball players

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 Gamers and Workaholics

Physical Therapy for Gamers and Workaholics

Hit Pause on Pain from Gaming and Computer Work

In the modern world of technology many of us find ourselves sitting for much of the day looking at computers or screens. You might sit in a desk chair for the better part of eight hours doing work on your computer and then hop onto the couch and wind down for a few hours playing video or computer games. If you are one of the many people who spend a majority of their day sitting in front of a computer, phone, or television, you are probably familiar with how your body feels after sitting in one position for a long time. In this article we are going to examine some of the more common physical symptoms and conditions that gamers and workaholics experience and how physical therapy can help you find relief during your workday and while you game.

Neck pain/stiffness/fatigue: Neck pain, neck muscle stiffness, or neck muscle fatigue can happen when you are working on a computer or gaming all day. A few causes are likely to blame. First, after staring at a screen for a while we often begin to experience eye strain or fatigue. Many of us will tend to stretch our heads forward to bring our eyes closer to the screen and this “forward head posture” can lead to neck pain or stiffness. Depending on how your workstation or gaming system is set up you may find yourself spending prolonged periods of time with your head turned to one side to look at papers or your computer or looking up at a raised TV screen. These prolonged postures can also cause neck pain or stiffness. In worst cases symptoms may radiate down into the arms or hands as the nerves exiting the spine are compressed. 

Headaches: There are many potential causes of headaches but for those working at a desk most of the day or spending long hours in the gaming chair both eye strain and cervicogenic (originating from the neck) headaches are common. Eye strain occurs after spending a prolonged time looking at a screen. As you contract your eye muscles harder to maintain focus a headache can develop. Similarly those with neck pain or neck muscle stiffness may experience cervicogenic headaches. These headaches are typically one-sided and can feel like a dull ache in the neck, head or face.They can worsen with movements of the neck or pressing on the tender neck muscles. 

Carpal Tunnel: 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. Symptoms of carpal tunnel include numbness, tingling, or burning in your palm, thumb, index or middle fingers or weakness in the hands. You may wake up with these symptoms and they will often recur when you have been using your hands for a while. 

“Gamer’s thumb” (De Quervain’s Tenosynovitis): pain and inflammation in the tendons that run from the wrist to the thumb are characteristic of this condition. This condition is caused by repeated wrist or hand movements and is sometimes called “mother’s thumb” because it is common in parents who are holding infants for long periods of time. More recently the term “gamer’s thumb” has also been used to refer to this condition in persons experiencing these symptoms after lengthy sessions of using gaming controls. 

Back Pain: If you’ve ever had to sit for a long period of time you have likely noticed that it can be tough on your back. Unsupportive chairs, tight muscles, and the tendency to remain in one position for too long are likely contributors. Feelings of stiffness in your spine are common after spending a lengthy period of time in one position. You may experience an ache on one side of your spine or tightness on one or both sides. In some cases sharp, burning, or aching pain may radiate down into the legs. 

HOW CAN PHYSICAL THERAPY HELP?

If you find yourself in pain or discomfort frequently while working or gaming, it’s time to do something about it. Physical therapy is a great choice to address the underlying causes of your symptoms, improve them, and prevent them from returning. Here is what you can expect from physical therapy for these conditions:

• Subjective Assessment: In order to treat your symptoms your physical therapist will need to understand more about your symptoms. They may ask you some of the following questions:

• How long have you been experiencing these symptoms?

• Where on your body are you feeling pain/discomfort/tightness?

• How long can you work or game before your symptoms start?

• What can you do now to alleviate the symptoms?

• How often do you change positions or take a break while you are working or gaming?

• What does your work/gaming setup look like?

• Physical Exam: The physical exam will allow your physical therapist to assess your body systems, for example, your joints and muscles, and assess how you move. During this portion of the appointment they will be looking at your muscle strength, muscle length, joint mobility, movements that cause pain, neuromuscular control, and posture. 

• Treatment Interventions: treatment may include hands-on techniques such as joint or soft tissue mobilization to improve overall mobility and reduce pain. Your therapist may apply modalities such as heat, ice, ultrasound or electrical stimulation to manage inflammation and pain. You will also be given exercises to do both in therapy and at home such as stretching, strengthening, and neuromuscular control exercises to both reduce your immediate symptoms and give you long term relief

• Education: modifications to the equipment you use, how the equipment and tools are set up and how you utilize them can play a big role in triggering or relieving symptoms. Education on a more ergonomic work or gaming space, the importance of changing positions throughout the day and how to integrate exercises like stretching into your daily routine can be a game changer for these types of conditions and injuries. 

Since many of you will not be able to give up working or want to give up gaming as a solution to your symptoms, it’s time to look for other answers. The physical therapists at Evolve are here to provide you with long term solutions for your pain and discomfort so you can get back to doing the things that matter most! Give us a call today to schedule a consultation! Call: 1-718-258-3300

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 Physical Therapy Clinic Locations!

1-718-258-3300

https://EvolveNY.com

Work Out? How A PT Can Enhance Your Training

How Physical Therapy Can Take Your Workout to the Next Level-

There is no denying that exercise and working out produce a long list of benefits for your physical and emotional well-being. Reducing risk factors for developing chronic diseases, preventing injury, improving brain health, strengthening bones and muscles, managing your weight, improving ability to do functional activities, reducing stress, anxiety and depression are only a few of the benefits you will receive by participating in regular physical activity. 

Whether you love running or biking, olympic weight lifting or crossfit, yoga or hiking, at some point in time you may start thinking about how you can enhance your performance in these activities. Most of us think about personal trainers or coaches as the primary resource for learning how to optimize your performance and progress in your ability but today we are going to talk about how physical therapists can play an important role in enhancing your training. 

WHAT MAKES A PT QUALIFIED TO HELP YOU IN THIS AREA?

Physical therapists help people live healthy and active lives. The American Physical Therapy Association defines physical therapists as movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education. Many people think about physical therapists as professionals who help people recover from injury, which is certainly true, but physical therapists also work with people who just want to become healthier, perform their sport or activities better, and prevent injuries before they happen. 

While some seasoned physical therapists may have a bachelor’s degree in physical therapy, the majority of practicing physical therapists have a master’s or doctorate level education in movement and exercise. They go through rigorous education on anatomy, physiology, and biomechanics to understand how the body should work. They also undergo extensive education on exercise physiology, disease, injury, and dysfunction of the body as a platform on which they build their skills as rehabilitation professionals who work to restore optimal movement and prevent recurring injury. 

While other exercise professionals and coaches have a great depth of knowledge in exercise principles and training for different sports, a physical therapist has a great depth of knowledge in exercise principles and training specifically for you, as an individual whose body may have capabilities and injuries that necessitate a more individualized training plan.

IS A PHYSICAL THERAPIST THE RIGHT RESOURCE FOR ME?

If you’ve been reading this article and wondering if a physical therapist is the right resource to help you enhance your training keep reading below to see if you fit into one of these categories.

I have an injury or am experiencing pain/discomfort: No matter the type of workout you are engaged in you may find yourself experiencing pain or discomfort during or after you exercise. There are many potential causes to injury, pain, or discomfort during a workout but without understanding the cause it’s hard to fix the problem. A physical therapist can help you with this in many ways:

• They will perform physical assessments and special tests to examine the area of pain or discomfort to better understand it’s origin.

• They will perform physical assessments of related areas and movement analyses of your specific workout components to see if deficiencies in strength, flexibility, stability, or motor control may be causing extra stress and strain on the area of pain or discomfort.

• They will create a treatment plan to help rehabilitate the injury or reduce pain and discomfort while staying active and getting stronger and more injury-proof.

• They can advise you on how to modify either temporarily or permanently the workouts and exercises you love to increase your ability to perform them pain and injury-free.

• They will educate you on how to self-monitor your own positions and performance during your workouts so you will feel confident in your ability to return to full activity after discharge from physical therapy while limiting the chance for re-injury.

I want to start training more, differently or at a higher intensity or become more competitive but I don’t want to injure myself: You have been working out for some time but are ready to take it to the next level. This may mean entering races or competitions, lifting heavier weights, trying new compound moves, or going longer distances. Whenever you increase any component of training such as time, speed, or intensity, you may experience an increased risk for injury if your body is not prepared to handle the new load. Here are several ways consulting a physical therapist with special knowledge in your sport or workout can help:

• PT’s are movement experts and a PT with extensive knowledge in your sport or workout will understand what optimal movement or mechanics look like for each component of your workout.

• Since they know what is needed to enhance your performance of a particular skill they will next examine your body and your movement performance to see how your strength, flexibility, power, agility, etc. line up with the demands of the skill.

• If areas of deficiency are noted in your performance then your PT can create a plan to fix them.

• They can also advise you in proper warm up and cool down routines as well as any cross-training that would both reduce your injury risk and improve your performance on your favorite workout.

I have a history of disease, surgery, or injury and I could use some guidance on how to safely enhance my training and workouts: As long as you have been cleared to exercise by your physician, finding ways for you to workout more or differently is something PT’s love to do. Because physical therapists have a strong background in injury, disease, and differential diagnosis they are specially positioned to help those who may be unsure or intimidated by working out, get more comfortable.

• A PT will get a thorough medical and surgical history and work with your doctors to understand if there are any precautions or contraindications for exercise.

•  They will find out what kind of exercise and workouts excite you and what concerns you have about starting or progressing these workouts.

• They can teach you safe and effective modifications to activities when needed to help you perform your workouts safely and effectively.

• They can monitor things like heart rate, blood pressure, or oxygen saturation while you exercise to keep you safe and help you monitor your body’s response to the workout.

• They can provide you with a program of exercises and activities to supplement your favorite workouts to manage pain or discomfort and reduce injury risk.

So as you can see, physical therapists can help you optimize and enhance your workouts whether you are fighting off an injury or wanting to prevent one. With a unique combination of knowledge in disease, injury, and movement dysfunction with expertise in movement and exercise PTs want to help you take your workout to the next level. 

Click here for more information about sports physical therapy for athletes

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 

Different Types Of Arthritis Explained

The Many Faces of Arthritis; What Kind of Arthritis Do You Have?  

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 actually an umbrella term for conditions involving inflammation and pain in the joints. This article will introduce you to the different categories of arthritis and some of the more common types of arthritis. 

WHAT’S IN A NAME–CLASSIFYING ARTHRITIS

All arthritic conditions can be typically classified as degenerative, inflammatory/autoimmune, infectious or metabolic. While each of these affects the joints, their underlying physiologic mechanisms differ. Let’s take a closer look at each category:

Degenerative arthritis: Degenerative arthritis is more commonly known as osteoarthritis (OA) and is the most common type of arthritis. This condition refers to the wear and tear of the cartilage that cushions the ends of the bone. It can happen in any joint but is more common in joints like the hips, knees, spine, and hands. OA typically develops slowly and may worsen over time. It can be diagnosed via an x-ray to evaluate the integrity of the joint surfaces but the presence of OA does not necessarily mean you will be symptomatic. 

Symptoms of OA include joint pain during or after movement and stiffness that often worsens after a period of inactivity. You may feel tenderness when applying pressure over the joint and notice swelling in the soft tissue nearby. Flexibility or range of motion of the joint may also decrease. You may even feel a grating sensation or hear popping or cracking in the joint when you move it though even healthy joints can make noise sometimes. 

Inflammatory (autoimmune) arthritis: Much less common than OA, inflammatory arthritis is typically caused by an auto-immune response in which the body begins to attack its own joints. These conditions are usually managed in part with medications to modulate the immune response. Unlike the gradual wear and tear mechanism of OA, this type of inflammation can quickly affect the cartilage and surrounding tissues causing morning stiffness that lasts more than an hour, joint pain, swelling, tenderness and warmth. 

The pain and discomfort felt in this type of arthritis is often multifactorial. Sources of pain may include:

• Erosion of the bone beneath the cartilage

• Inflammation of the synovial lining of the joints which releases chemicals that irritate nearby nerves

• Fluid buildup inside the joint can cause pressure, stiffness, and irritation

• Muscle weakness can put more stress on the joints and the inflammation may damage the ligaments that support the joint

• The fusion of joints (most often in the spine) can happen in certain types of inflammatory arthritis

• Chronic pain and long standing pain can become what is called centralized after which the body’s perception of pain can become heightened

Some of the more common types of inflammatory arthritis include the following:

Rheumatoid arthritis: small bones of the hands and feet are most commonly affected. More common in women than men and onset is often between 30 and 50 years of age. It is the most common type of autoimmune arthritis.

Psoriatic arthritis: Occurs in people who have psoriasis of the skin. Most often occurs years after skin symptoms present but sometimes can occur beforehand. Can affect any joint and range from mild to severe. Like psoriasis it may have active periods and periods of remission.  

Systemic Lupus Erythematosus (SLE): This autoimmune condition can be life threatening. Not only does the inflammation cause joint damage but it can cause damage to many of the other organs such as the skin, kidneys, lungs and brain and affect blood vessels. 

Ankylosing spondylitis: Inflammation targets the joints and ligaments of the spine leading to stiffness and sometimes over time fusion of the vertebrae and sacrum. Back pain and stiffness may be mild and episodic or severe and chronic. This type of arthritis can affect areas outside of the spine as well such as the hips, ribs, shoulder, feet, and ankles. 

Infectious (septic) arthritis: this type of arthritis is caused by infection-causing germs entering a joint space. These germs may enter the body through a wound, a surgery, or an injection and may travel a ways before settling into one (or rarely two) joint. The onset is usually rapid and damage can be severe and permanent if not addressed quickly. Bacteria are the most common cause of septic arthritis and the bacteria Staphylococcus Aureus is the most common perpetrator. Viruses and fungi can also cause septic arthritis. 

Unlike other types of arthritis the onset is typically very quick and pain is accompanied by swelling, warmth, redness, fever and chills. The knee is most commonly affected but hips, ankles, and wrists may also be affected. Treatment of this condition typically requires antibiotics, antivirals or antifungals and often fluid needs to be drained from the affected joint. 

Metabolic Arthritis: Imbalances in the metabolism of the body can lead to arthritis. The primary example of metabolic arthritis is gout. Gout is also considered to be an inflammatory arthritis but since it is not caused by an autoimmune response it was not included in the list above. 

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. 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 but recurrent bouts can cause lasting joint damage. 

WHAT TO DO ABOUT ARTHRITIS?

As you can see, there are many types of arthritis and the treatment of arthritis will vary based on its cause. For example, the treatment for an autoimmune mediated arthritis will differ from the treatment for an arthritis caused by an acute infection or even from gradual wear and tear. One thing we do know is that physical activity and physical therapy can be effective tools in managing the symptoms of arthritis and improving mobility and function. If you’d like to know more about how physical therapy can help your arthritis symptoms, schedule an evaluation with a therapist at Evolve and we will be happy to share more about our treatment approach. 

Click here for moe 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.

Four Convenient Physical Therapy Clinics Throughout Brooklyn!

1-718-258-3300

https://EvolveNY.com

Best Sleeping Positions to Combat Back, Neck, Foot, and Elbow Pain

Is Pain Keeping You Up at Night?

Did you know that the average person who lives to be seventy-nine years old will spend the equivalent of seven years of their life trying to fall asleep and twenty-six years of their life sleeping? There is a reason we sleep so much. Sleep plays a vital role in maintaining health and functioning at an optimal level. Scientists from the Division of Sleep Medicine at Harvard Medical School have found that insufficient sleep is associated with a number of diseases and health problems and impairs perception, judgment, and safety.

Pain and discomfort are important causes of lost sleep and if you have been struggling to find a comfortable position for sleeping, then this article is for you. Read on to learn about tips and tricks to modify your sleeping situation to reduce pain and discomfort and catch some extra Zs.

WHY DO I HURT MORE AT NIGHT?

Both nervous system-related and orthopedic causes of pain may seem worse at night. There are a few possible reasons for this. First, as your body prepares to transition into sleep, hormone levels shift. Reduction in the anti-inflammatory hormone Cortisol may actually cause a heightened sense of pain at night. Additionally, if you’ve been struggling to get enough quality sleep, the impact of repeated insufficient sleep can also increase your perception of pain. Couple this with the lack of distractors present as you climb under the covers and you may find your pain at the center of your attention. 

One other cause of sleep loss or night pain that needs to be addressed, however, is how you are positioned while you sleep. Sometimes the way our bodies are positioned as we fall asleep or throughout the night can cause increased stress and strain on painful areas. So while we can’t change the natural rhythm of our hormone cycles or the fact that we have less to distract our minds when it is time to go to sleep, we can often make changes to our sleeping positions that will reduce pain and discomfort and allow us to sleep better through the night. 

Below we will address some positioning strategies to relieve pain from different areas of the body. Some of these suggestions require simply changing the way you lie while others suggest the addition of different types of pillows or bedding to relieve discomfort. 

Back Pain-

The trick to relieving back pain is often improving alignment of the spinal column. Some people find their pain increases if their spine is flexed or extended too much and so sleep positioning should aim to stay out of painful ranges of motion. 

Side Sleeping: If you are a side sleeper try drawing your knees up slightly toward your chest and placing a pillow between your legs so your thighs are parallel. 

Back Sleeping: Depending on the firmness of your mattress, sleeping on your back can sometimes be uncomfortable. Try placing a pillow or wedge (sloping down away from you) under your knees so your hips and knees are gently bent. You can also use a small pillow roll or rolled up towel under the small of your back for extra support. If you have a bed that adjusts behind the knees, use the controls to elevate the mattress behind the knees to imitate the use of a wedge.

Stomach Sleeping: Stomach sleeping tends to be hard on the back but if this is your favorite position you can take a pillow and place it under your lower stomach and hip bones to reduce the arch in your lower back. 

Neck Pain-

Having proper support and alignment of the head and neck while sleeping can improve sleeping-related neck pain. Oftentimes a trial of different pillows is needed but one key aspect is to ensure the head is fully supported and the neck is well-aligned with the rest of the spine. Back and side sleeping is best as sleeping on the stomach requires the neck to be fully rotated to the side and can be irritating to the neck.

Side Sleeping: In this position you want the head and neck to be aligned with the rest of the spine. A flatter pillow that is thick enough so your head is in line with but not lifted higher than your back is important.

Back Sleeping: Because the back of the skull extends beyond the curve of the neck, a pillow that has a thicker area at the front to fill in the space behind the neck and a smaller, flatter area for the rest of the skull is often helpful to reduce pain. These are sometimes called cervical or neck pillows and can be purchased at many stores. If you think you may benefit from one of these you can experiment at home by rolling up a towel and sliding it into the pillow case just at the front of the pillow to simulate the contour of a neck pillow.

Elbow Pain-

If you are experiencing elbow pain at night there are a few things you can do to make waking up with pain less likely

• Don’t sleep on the affected elbow: this might seem obvious, but if you are a side sleeper, try and sleep on the opposite side and use a pillow in front of you to rest your upper arm and forearm on to reduce stress on the elbow

• Try and avoid sleeping with arms overhead or under the pillow

• If you like to sleep on your back you can place a small pillow under the back of the upper arm and elbow to elevate it so that it aligns with the rest of the trunk.

• An elbow that is warm may be less likely to stiffen overnight so using a neoprene sleeve over the elbow while you sleep may help.

Foot Pain-

Sleeping positions for foot pain will vary depending on where you have pain and what is causing it:

Change your blanket: a heavy blanket or one that is tucked tightly under the end of the mattress will push down on your toes and foot. To combat this use only a light blanket or no blanket on the feet themselves and use warm socks to keep your feet warm

Elevate your feet: If foot swelling or inflammation are an issue for you, use a wedge under your legs that slopes upward away from you to elevate the feet

Pillow between the legs: If your feet or ankles pressing together is uncomfortable or if the side of your foot hurts, try and lie on your opposite side and place a pillow between your knees, lower legs, and feet to reduce the pressure

If pain is keeping you up at night then give these suggestions a try. If you find yourself needing more individualized suggestions to help you sleep comfortably at night then the physical therapists here at Evolve are ready to help. Give us a call to schedule an initial evaluation and mention your painful sleep so they can address not only your sleep issues but help get to the root of the problem so you can sleep comfortably through the night and feel great during the day.

Click here for more information about our physical therapy services

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

Have you checked out your neck curvature lately?

It’s Time to Check Your Neck Curvature

Let’s face it, we all find ourselves slumping throughout the day while working at the computer, watching TV, or standing at our jobs for a long time. Occasionally we recognize we have abandoned good posture completely and will quickly stretch our necks and backs and try to sit or stand up taller. Maintaining good posture requires a lot of attention and awareness and over time the unconscious habit of rounding our upper back and pushing our heads forward can transform from a temporary loss of spinal alignment to a more permanent change in our posture. In this article we will examine how changes in the normal curvature of the neck can lead to symptoms of pain, discomfort and difficulty gazing forward and what we can do about it.

LET’S GET A BETTER UNDERSTANDING OF THE ALIGNMENT OF THE NECK AND SPINE

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 (spinal bones) 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 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.

Because the body is one continuous system connected by muscles, ligaments, fascia, and connective tissue, a change in one part of the body often results in a compensatory change in another. The curvature of the neck may change in response to chronic postural habits or in response to changes in the curvature of the upper back or even due to changes in function or alignment of the lower body. Since the neck vertebrae protect and provide an exit for the nerves that supply the muscles and skin of the arms and hands, changes in neck curvature can sometimes have significant effects both locally and more distantly. Nerves can be compressed leading to radiating symptoms into the arms and muscles can be over lengthened or overworked causing tightness, pain, fatigue, or headaches. 

HOW DO I KNOW IF MY SPINAL CURVATURE IS ALIGNED?

If you are wondering if your neck curvature has changed over time, there is an easy way to check but it's helpful if you have someone to help. First, stand tall with your arms resting at your sides. Using your phone or a camera, have someone take a photo of you from the side. First take a look at the shape of your neck between your ear and your shoulder. Is it curved slightly toward the front or does it look flattened? Is the ear aligned over the shoulder, the hip, knee and ankle like it should be in a body with good alignment or is your ear positioned further forward than your shoulder?

MY NECK CURVATURE SEEMS FLATTENED, WHAT SHOULD I DO?

If you notice that your ear has moved in front of your shoulder or that your neck no longer seems to have that typical lordotic curve, you may be wondering what you should do. Classically, the loss of curvature in the neck was always considered problematic and worthy of correction but recent research suggests we need to assess people on a case by case basis. A recent review of studies that compiled x-rays of individuals without any neck, back or radiating pain symptoms found that there was a larger range of curvature among asymptomatic necks than recently realized. Some necks were more flattened and others were more lordotic but in this case none had pain (Virk, et al, 2020). So when deciding whether to seek care, here are a few things that would suggest you may benefit from treatment to address your neck curvature:

• You are having neck pain or upper back pain

• You are experiencing neck or upper back tightness or fatigue

• You are experiencing headaches– typically one sided, exacerbated with head or neck movements or with pressure applied to neck musculature or the base of the skull

• You are having trouble maintaining a forward gaze and find yourself looking down at the ground

• You are experiencing radiating pain, numbness, tingling, or weakness in the arms or hands.

HOW CAN NECK CURVATURE BE IMPROVED?

If changes in your neck curvature are causing pain or dysfunction or impacting your daily activities then physical therapy can help. Your physical therapist will assess your entire spine and may locate areas of the body outside of the neck such as the upper back or hips that may be contributing to your change in neck curvature. Here are examples of what you might expect during a physical therapy treatment to address this problem:

Manual Therapy: Your therapist may apply various soft tissue mobilization techniques to the muscle and fascia around the neck to reduce tension and improve the health and mobility of the tissues. They may also perform mobilization techniques to the neck joints themselves to restore normal movement between the seven vertebrae of the neck. If indicated, these same techniques may be applied to the upper back or related areas of the body.

Modalities: To manage pain and reduce radiating symptoms your therapist may recommend the use of cervical traction to gently stretch and decompress the spinal segments in the neck or other modalities like electrical stimulation to manage pain symptoms.

Stretching:  Both passive stretching performed by your therapist and self-stretching performed by you can help optimize the length of muscles that may have become shortened as a result of the changes in your neck curvature. If other areas of the body are also involved you may be instructed in other back, chest, hip or lower body stretches as well.

Strengthening: Strengthening exercises targeting the muscles that help support the neck and upper back in good alignment are important to treat this condition. Exercises such as chin tucks and scapular stabilization are examples of common exercises to improve neck alignment and curvature. 

If you’re ready to tackle symptoms caused by your neck curvature, it’s time to call the local physical therapists at Evolve PT. The skilled physical therapists at Evolve can assess your neck curvature and over all movement patterns and biomechanics and create a treatment plan to improve your symptoms and reduce the likelihood they will progress or return. 

Click here to find out more information about physical therapy for neck 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.

4 Convenient Physical Therapy Clinic Locations in Brooklyn!

1-718-258-3300

https://EvolveNY.com

The Truth Behind the Hot and Cold Compress Debate

The Low Down on the Heat vs Ice Debate

Heat or Ice? Which Should I Apply to an Injury?

When it comes to pain relief most of us are familiar with using heat or ice. Sprain and ankle? Apply an ice pack. Back sore from doing yard work all day? Lie on the heating pack. While you may have heard clear cut instructions on when to use heat and when to use ice, the real answers actually lie a bit more in the gray area. To gain some clarity on this topic, keep reading as we sort through the heat versus cold therapy debate. In this article when we reference heat we are talking about superficial heat which includes things such as hot packs or heating pads while cold therapy typically refers to ice packs. 

WHAT EFFECT DO HEAT AND ICE HAVE ON THE BODY

It seems appropriate to kick off this inquiry with a deeper look at the physiological effect that hot and cold have when applied to the body. Afterall, the reason we apply these modalities in the first place is because we hope they will have a healing impact on the body.

When an injury occurs, tissue damage and inflammation typically follows. Pain, tenderness to palpation, sometimes bruising and difficulty moving or bearing weight through the injured body part can result. On a molecular level recovery from an injury involves tissue destruction, repair and then remodeling of connective tissue, muscle tissue, and blood vessels.

When ice or cold therapy is applied to an injured tissue, the cooling effect reduces swelling and slows the arrival of inflammatory mediators. It is also thought to reduce tissue metabolism and secondary tissue damage while also having an anesthetic effect that reduces pain (Swenson et al.,1996, Malanga et al., 2014). Heat or thermotherapy warms the skin and underlying tissues and has a vasodilating effect which brings more blood to the area and may promote healing by bringing more nutrients and oxygen to the injured area. It also has a pain-mediating effect and increases the elasticity of connective tissue (Malanga et al., 2014). 

WHAT DOES THE EVIDENCE TELL US?

While we understand the physiological mechanisms of applying heat and ice, many of the recommendations we have about when to use each modality are based on anecdotal evidence. In 2015 Petrofsky et al. specifically examined the use of heat and ice to manage post-exercise muscle soreness and damage. They found that cold therapy immediately or 24 hours after exercise was more beneficial in reducing soreness than heat but wasn’t better than heat to mediate muscle damage. In 2014 Malanga et al., did a literature review of a large number of individual studies and reviews evaluating the effectiveness of heat and ice to treat acute musculoskeletal injuries and delayed onset muscle soreness. Their review found that many of the studies were of poor quality and found conflicting evidence in some cases. They concluded, however, that ice was more effective to treat acute injury with inflammation and heat for muscular pain and soreness and joint pain and stiffness.

As you can see the research is still somewhat unclear about the benefits of using heat versus ice in some scenarios. Typically individuals with joint pain and stiffness such as those with osteoarthritis prefer to use heat to manage their symptoms. If you have sustained an acute injury, especially if there is inflammation, using heat would not be recommended as it can worsen the inflammation. For muscle soreness after exercise or activity the literature is mixed and it's probably effective to use either modality based on your preference or experience in the past. 

WHAT ABOUT USING ICE ON ACUTE INJURIES?

As mentioned above, it’s probably not wise to apply heat to an acute injury as the vasodilative effect can worsen inflammation. More recently, however, researchers and rehab professionals have been questioning whether using ice to stop the inflammatory process in an acute injury is actually helpful or harmful (Zi-Ru Wang and Guo-Xin Ni, 2021). The RICE approach to acute injury (Rest, Ice, Compression, Elevation) has been standard practice for quite some time but has recently come into question for quite a few reasons. The conventional wisdom of using ice immediately after injury is one of these reasons as we consider whether inflammation after acute injury is the big bad wolf we always made it out to be.

The inflammatory response actually serves an important role in injury recovery. Inflammation is the process of flooding the injured area with fluids containing white blood and other cells whose jobs it is to destroy bacteria and eat up dead and dying cells. This step is needed before tissue repair can begin. So if we think about inflammation as the first step to injury repair then it stands to reason that we should think twice about interfering with this process as it actually delays recovery. 

For now we need more high quality studies to fully understand how and when cold therapy should be used with acute injuries. When injuries are severe and swelling is a limiting factor for recovery then ice or cold therapy is still likely a smart option to get control of inflammation so rehabilitation can progress. If the injury is mild or moderate, shortening the duration or frequency of applying ice may be something you want to consider so the body’s natural healing process can proceed. 

BOTH ICE AND HEAT SHOULD BE USED WITH CAUTION 

While the aim of both heat and cold therapy is to heal injured or painful tissues, when used incorrectly both of these modalities can cause injury. Here are some precautions and contraindications for each therapy (Seidel et al., 2021, Malanga et al., 2014). These lists are not exhaustive so you should always check with your doctor if you are unsure if these treatments are safe for you:

    Cold Therapy 

• Frostbite, skin burns and neuropathy of superficial nerves can occur if ice or cold therapy is applied for too long

• It should be used with caution in those with hypertension, mental or cognitive impairment, or decreased sensation

• It should not be used in those with cold hypersensitivity, cold intolerance, Raynaud’s disease or over areas of vascular compromise or open wounds, 

• It can cause short term changes in joint position sense, muscle strength and neuromuscular control post-cooling

    Heat Therapy

• When used incorrectly and without proper protection heat therapy can cause skin burns or ulcerations

• It is contraindicated in those with peripheral vascular disease, bleeding disorders, local malignancy, acute inflammation or trauma, edema, infection, open wounds, over large scars, those with impaired sensation (neuropathy) or impaired ability to communicate/cognitive impairments

• It should be used with caution in those with diabetes and multiple sclerosis

THERE IS MORE WORK TO BE DONE

While there is still more work for scientists and researchers to do to settle the debate between heat and ice once and for all we hope you found some clarity after reading this article. Using heat and ice to manage pain or inflammation can be helpful in the early stages of injury recovery or exacerbation but don’t forget that active recovery is one of the best tools to promote healing and the physical therapists at Evolve are here to walk you through that process.

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