Physical Therapy for Shoulder Pain

By Mai Vu, Physical Therapist
Shoulder pain is one of the most common complaints that we see in our office. Some common causes of shoulder pain are:
Tendonitis – This occurs when inflammation is present in tendons. Tendons are the structures that connect muscles to bones.
Bursitis – This occurs when inflammation is present in a bursa. A bursa is a fluid-filled sac that helps to decrease friction when the body moves.
Tears – Tears can occur as a result of trauma such as a fall, or they can occur slowly over time. Tears can range from a microscopic level to a complete tear where the muscle or ligament is no longer attached.
Radiculopathy – This occurs when there is a problem with the nerves from the spine. The nerves from the neck travel across the shoulder and down the arm. When there is a problem in the spine, pain can be felt along the path of the nerves.

When there is shoulder pain there are many structures that may be involved, including:

• Rotator Cuff which is comprised of 4 different muscles (supraspinatus, infraspinatus, teres minor, subscapularis)

• Long head of the Biceps Tendon Subacromial Bursa Acromioclavicular Joint – this is where the clavicle (collar bone) meets the scapula (shoulder blade) 

• Glenohumeral Joint – this is where the scapula (shoulder blade) meets the humerus (upper arm bone)

• Labrum – this is part of the glenohumeral joint

• The muscles, bones, and nerves from the neck (cervical spine)

• The muscles, bones, and nerves from the trunk (thoracic spine)

We will cover some of these topics in more detail in later posts.

Stretching Tips for Office Workers

Our bodies were designed to be up and moving around.  Unfortunately in today’s world, many of us are stuck at a desk sitting down for the majority of the day.  When you sit too much, certain muscles tend to get too tight.  One muscle that commonly gets tight is the iliopsoas, also known as the hip flexors.  This muscle often needs to be stretched when we sit too much.

The iliopsoas muscle is located in the front of the hip, which is where you should feel the stretch.  There are many ways to stretch this muscle:

Standing:

Stand in a lunge position with your right leg in front.  Tuck the buttocks under.  A stretch should be felt in the front of the left hip.  If you still do not feel the stretch, lift your left arm all the way over your head.  Switch legs to stretch the right side.

Kneeling:

Start by kneeling on your left knee.  Slowly bend the right knee until a stretch is felt in the front of the left hip.  Do not arch your back.  If you still do not feel the stretch, lift your left arm all the way over your head.  Switch legs to stretch the right side.

Laying Down:

Start standing.  Lean your buttocks onto the edge of a bed or bench.  Without readjusting your buttocks position, lay onto your back and hug your knees.  Then let the left leg hang down.  You should feel a stretch in the front of the left hip.  To stretch the right side, hug your left knee and let your right leg hand towards the floor.

Generally, we recommend holding the stretch for 30-60 seconds and repeating 2-3 times per leg.

The Benefits of Pool Exercise

By  Saralyn M. Switzer, PT, DPT, Doctor of Physical Therapy
Since the summer has ended and fall is here we remember how much we enjoyed the warm weather and being in the pool.  Many people are more active in the summer since everyone enjoys going outside walking on the boardwalk or in the park, running, biking, swimming, hiking, and other outdoor activities.  This active pace is hard to carry over into the colder, winter months once we are forced indoors more.  The time is rapidly approaching when we will not want to exercise outside and we must start thinking of fun indoor alternatives.  Swimming and pool exercise can be performed in an indoor pool to continue the benefits of this activity year-round.
Pool exercise:

• increases endurance by doing continuous cardiovascular exercise in the water
• builds strength due the constant resistance from the water
• is conducive to relaxation and promotes flexibility by using the buoyancy of the water that lessens the weight of gravity on the joints
• improves circulation by using the water pressure to help the fluid in our arms & legs return easier to our heart
• improves balance
• improves chronic pain conditions, joint pain, and back pain

With all these benefits, who wouldn’t want to get in the pool this winter?
Now that you want to exercise in the water, what type of exercise can you do? As with any exercise program, aquatic exercise should focus on increasing endurance, strength, and flexibility.
Endurance or cardiovascular exercise can include walking in the water, kicking across the pool with a kick board, and doing cycling while floating on a noodle, or good old-fashioned laps
Strengthening exercises include standing at side of pool doing leg kicks backward, sideways, and forward on each leg; squatting at the side of the pool; leaning your back against side of pool and squatting so your shoulders are under water then pushing and pulling the kick board like you are making waves without letting your body come off the wall.
Flexibility can include traditional stretches performed in the water such as a runners calf stretch standing at the side of the pool facing the wall with one leg back, or hamstring stretch with one foot up on the step or ladder in the pool. The best part of stretching in the water is using the buoyancy ability to float. This can be done by using noodles to help you float and move through more motion until a stretch is felt. To stretch your hip, put one noodle under your arms to float and then put another under one knee while the opposite leg hangs down. Other types of flexibility exercise can be tai chi or yoga poses adapted for the water.
These are just some examples of many different types of water exercises.  What you choose will depend on your fitness level and comfort with the water.  Many community pools offer water exercise classes to help get you started.  Local colleges or universities may offer pool membership to the community.  Also, physical therapists and personal trainers who specialize in aquatic exercise can help you develop an aquatic exercise program that is right for you.  So, keep that bathing suit out for the winter and start swimming!
*Before starting any exercise program including aquatic exercise, clearance by your medical doctor is important.  Remember, swimming or exercising in a pool with a life guard is the most important safety rule of water exercis

Taking Control of Neck Pain

By Dr. Jay Mazzella, DC, Clinical Director
Common causes of neck pain include watching TV, using a computer, reading a book, ortalking on the phone, especially with the receiver held on your shoulder or under your chin. Fortunately, this pain usually subsides within a short period of time, particularly if you discontinue the offending activity for a while. On the other hand, chronic neck pain, the kind that doesn’t go away or that keeps “coming back,” can be a far more serious and debilitating problem.
Current treatment of chronic neck pain runs the proverbial gamut, from anti-inflammatory and pain-relief medications to group gymnastics, neck massage and manipulation. Neck-specific strengthening exercises have also been suggested as a potential treatment option. In a recent study designed to evaluate this potential, 76 men and women with chronic neck pain received active care, home care, or simple recommendations on exercising.
Active care included postural control exercises, relaxation training to reduce muscle tension, and cervical muscle endurance/coordination training. Home care comprised a neck lecture and training on exercises to be performed at home. The third treatment protocol (the control group) received a lecture on neck care and general recommendations to exercise. Patients in the active group reported greater satisfaction, reduction in pain severity, and improvements in working ability at three and 12-months compared with the home group and the control group.
If neck pain’s putting a crimp in your day, it’s about time you did something about it. For more information on neck pain and the various treatment options available to you, schedule an appointment with us for a complete evaluation. For information on line


If you have questions as to how much of your care may be covered by your health insurance, contact our desk staff and ask about a COMPLIMENTARY INSURANCE VERIFICATION.

Steps to Preventing Falls in the Home

Falls in the elderly are the leading cause of fatal as well as non fatal injuries. Thirty percent of people over the age of 65 will fall each year. The U.S. spends approximately $20.2 billion annually for the treatment of injuries to older people after falls. The majority of the cost is for hip fracture care, which averages $35,000 per patient.
The most common types of injuries sustained after falls include: hip, spine, and wrist fractures as well as head trauma. These types of injuries can result in serious disabilities and prolonged rehabilitation stays as well as possible death.
It is important to be aware of this situation, because falls can be prevented. Sixty percent of elderly falls occur in the home. By safe proofing your or your loved ones house, you can help decrease this number. Read these easy steps to fall proof a house.

Kitchen:
Clean up spills as soon as they occur
Do not store any objects above a hands reach
Use a step stool with hand rails if needed
Avoid climbing on counters to obtain objects
Living Room:
Pick up any throw rugs…. Do not have them anywhere in the house
Have ample space to walk in between furniture
Keep all electrical cords out of the way

Bathroom:
Keep a night light on at all times
Install rails in the bathtub or shower
Place a non skid mat in the shower or bathtub

Stairs:
Keep all stairways free of clutter
Install hand rails on both sides of the steps

Get the Most Out of Physical Therapy

 

While not all physical therapy experiences are the same, some general rules apply to ensure that your experience will be a positive one. Whether you have your therapy treatment in a clinic, a hospital, or at home, following some general guidelines can help you get the most out of physical therapy.

1. Arrive on Time for All Appointments

Physical therapists usually run on a pretty tight schedule. We want to spend as much time as we can with our patients to ensure that they receive the best possible care. Arrive on time to your appointment to get the best care and attention possible. If you are going to be late, call ahead and ask if the therapist can still see you or if it would be better to reschedule.

2. Wear Comfortable Clothing

Rolling up the legs of your jeans is tough to do, and it makes the examination of a painful knee difficult. Long sleeved shirts get in the way of a shoulder examination. Skirts make exercising almost impossible. Before going to therapy, plan ahead and choose the best clothing to wear. If you are unsure, call ahead and ask what clothing would be best suited for your specific condition. Many clinics have changing rooms so you can get out of your work clothes and into your exercise clothes. Also, wear or bring comfortable shoes. Exercises for hips, knees and shoulders often require that you hold weights. Wearing sandals (or no shoes at all) could put your toes at risk for fracture if a weight were to fall on them.
If you are receiving physical therapy in a hospital and are wearing a hospital gown with the opening in the back, be sure to tie it up. You may also want to put on a second gown with the opening in the front to make sure you stay modestly covered up.

3. Ask Questions About Your Condition and Treatment

As a patient, you should not simply follow the orders of your therapist. Rather, have an open dialogue with your therapist about what is to be done and what to expect. Think of your relationship with your physical therapist as a therapeutic alliance. Both you and your therapist should be working together to help you move and feel better.

4. Perform Your Home Exercise Program as Directed

Usually in physical therapy you may be required to perform an exercise program at home (or on your own in your room if you are receiving physical therapy in the hospital). It is essential that you do your best to perform the exercises prescribed by your physical therapist. If, for some reason, you cannot do the exercises, tell your therapist. Taking responsibility for your condition and engaging in a self-care exercise program can help you return to optimal function quickly.

5. Work Hard

Occasionally after injury, illness, or surgery you need to work hard to regain normal mobility. Your physical therapist won’t expect every patient to get better and dance out of the clinic or hospital. Your physical therapist will expect that you work hard and try your best.
By following some simple rules in physical therapy, you can be sure that you have a positive experience. Plus, you can feel good about working hard to decrease and eliminate your pain and improve your functional mobility. If you are unsure of what is expected, be sure to ask your physical therapist.

Types of Physical Therapy

There are many specialty areas in the field of physical therapy. Although this is well known throughout the profession, it is often overlooked by the general public. Below is a brief description of the five most common specialty areas in physical therapy. Read on to find out what specialty area is most appropriate for you or your family member.
Orthopedic Physical Therapy
Orthopedic physical therapists diagnose, manage and treat disorders and injuries of the musculoskeletal system. They also help people recover from orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative joints, sports injuries, arthritis and amputations, among other injuries and conditions. Joint mobilizations, strength training, hot packs and cold packs, and electrical stimulation are often used to speed recovery in the orthopedic setting. Those who have suffered injury or disease affecting the muscles, bones, ligaments or tendons of the body may benefit from assessment by a physical therapist specialized in orthopedics.
Geriatric Physical Therapy
Geriatric physical therapy covers numerous issues concerning people as they go through normal adult aging. These include (but are not limited to) arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders and incontinence. Geriatric physical therapists develop individualized programs to help restore mobility, reduce pain and increase fitness.
Neurological Physical Therapy
Neurological physical therapists work with individuals who have a neurological disorder or disease. These include Alzheimer's disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury and stroke. Common problems of patients with neurological disorders include paralysis, vision impairment, poor balance, difficulty walking and loss of independence. Therapists work with patients to improve these areas of dysfunction.
Cardiovascular and Pulmonary Rehabilitation
Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of people with cardiopulmonary disorders as well as those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing patient endurance and functional independence.
Pediatric Physical Therapy
Pediatric physical therapy assists in early detection of health problems as well as the diagnosis, treatment, and management of infants, children, and adolescents with a variety of injuries, disorders and diseases that affect the muscles, bones, and joints. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing and integration. Children with developmental delays, cerebral palsy, spina bifida and torticollis are a few of the patients treated by pediatric physical therapists.