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Skiing: How to Prepare and Avoid Injury

The knee joint is the most vulnerable and most common snow sport related injury. The good news is there are steps you can take to condition and prepare your body for winter sports such as skiing.

Things to do in preparation for your ski trip:
  • Core and lower extremity exercises (listed below)
  • Training your cardiovascular fitness- many injuries occur as a result of fatigue
  • Proper equipment that is appropriate for your height and skill level
  • Take a skiing technique class before hitting the slopes
Preventing Injury on the slopes:
  • First off warm up your body before hitting the slopes each day
  • Proper technique: Hands and weight forward, legs parallel and hips, knees and ankles flexed equally
  • Stay on trails that are marked for skiing safely

The following are exercises should be preformed several weeks before you plan to ski. All of the exercises should be attempted for 1 minute and increase the time as you improve.

Balance

Standing on one leg reach the other leg toward an imaginary clock face. Repeat on other side.

Lateral Jumps

With both feet close together bend your knees and jump side to side while maintaining a straight spine and a flat back as well as even weight in both feet.

Rotational Jumps

Start from a squat position with feet close together jump from diagonal to diagonal landing on the balls of the feet.

Side to side skaters

Stand on one leg and take a large step to the with the other leg and then take another large step back to where you were. Make sure your pelvis stays level and your knee does not buckle inward.

Check out the full video for these fun and helpful exercises!

Rotator Cuff: Repairs and Road to Recovery

Rotator cuff is a term that many people fear when mentioned by a healthcare provider. This fear is usually warranted but, if a partial tear, can usually be treated conservatively if caught early. This fear may come from not knowing about conservative measures that can help. On the other hand, when conservative management fails or the tear is more significant, surgery is generally indicated. The goal of this blog is to help answer many of the questions you may have when a healthcare provider mentions that your rotator cuff may be the cause of your shoulder or arm pain. A brief description of the function of the cuff and the pathology will be followed by a look at the road to recovery and what to expect as you go through the weeks of rehabilitation. 

The cuff’s main purpose is to improve shoulder stability by actively pulling the arm bone into the shoulder socket with arm motion. It does this through a concert of contractions of the 4 muscles that make up the structure. Each muscle works intricately with the other to provide the most stability possible: Even when one muscle is not working properly, it can lead to issues. Without the rotator cuff, the shoulder generally becomes unstable which can lead to further tearing or other injuries affecting the shoulder joint.

Tears are fairly common and can affect people of all ages. They occur most commonly in patients in their 50’s and above, likely due to tissue deconditioning and other age related changes. Tears also occur frequently in overhead throwing athletes. Cuff injuries generally occur gradually over a period of time where symptoms begin to evolve and worsen. Warning signs of tears include deep, dull shoulder pain, trouble sleeping, and an inability to move the shoulder through its full range of motion. Labral tears and biceps tendinopathy are common concurrent injuries that may also be addressed.

Surgery vs. conservative management will generally be decided on a case by case basis and based on failure to conservative treatment, imaging results, signs and symptoms, and quality of life reported by the patient.

Here is what to expect when surgical repair is indicated.

Day 1- week 2: Surgery is generally performed at an outpatient surgical center. Most repairs are done arthroscopically meaning a small camera will be inserted with tools on the end to complete the repair. A local nerve block as well as general anesthesia is used during the procedure so you will be asleep the entire time. The nerve block will also help to ease pain for the hours following surgery and likely into the next day. This usually only requires 2-3 small incisions in your skin. You will return home the same day following the surgery. Pain killers are generally prescribed to help ease pain, and they should be taken to make you more comfortable.

The next 2 weeks are used to allow the repair to heal properly and is the maximal protection phase. During this time your arm will be in a sling and you will likely sleep in a recliner to protect the repair. Moderate pain is a normal experience during this time so be sure to ice and take any medication as prescribed.

Week 2-4 Post-op: This is generally when physical therapy is initiated, but some surgeons will wait for 6 weeks before therapy is initiated. During this period in therapy, the therapist will move your arm for you to begin regaining normal motion. You will also begin working on activating the muscles around your shoulder blades. Gentle activation of your shoulder muscles will also start.

Weeks 5-10 Post-op: The goal of this phase is to obtain good range of motion and to be able to stabilize your shoulder throughout the range with your muscles. Range motion will continue to be progressed and active motion will be progressed gradually within relatively pain-free ranges to hopefully reach full range by week 7-8. Range of motion progresses differently in different patients so don’t be discouraged if it takes longer than normal. Strengthening exercises will also progress gradually to gain strength for normal activities.

Weeks 10-20 Post-op: The goal of this phase is to continue progressing strength and stability to prepare your shoulder for return to all prior activities. You will also be expected to become more independent with exercises. Challenging functional movements will be performed later in this stage. Complex movements like throwing will be broken down into parts to practice before performing the actual movement to ensure proper shoulder function. You will likely be weaned from PT and may be discharged to continue with comprehensive home program to continue toward the end of this period. Athletes that need more intense treatment will continue with therapy into the return to sport phase.

Be sure not to perform activities that are too taxing for your shoulder at this point. Your shoulder will be feeling much better, which makes this a common time for re-injury to occur. Although your shoulder is feeling better, that does not mean it is fully healed and ready for full return to all of your normal activities.

Weeks 20+: Typically the safe return to sport phase. You will progress back into your sport or other activities. Continue with your home exercises to continue building strength and stability throughout your shoulder complex.

You can expect to be checking in with your surgeon throughout this process to insure that everything is going as planned. Your therapist should be in contact with the surgeon throughout the process to ensure you are progressing as expected as well.

I hope this blog can ease any anxiety about your upcoming procedure and give you a brief guide for what to expect following a RTC repair. Surgery can be intimidating, but the more you know going into it, the better the outcomes!

We will be following one of our patients through rehab and will post exercise videos and updates throughout his recovery. Be sure to check them out!

Bryan Esherick, DPT

Treating Pain without a Pill

Treatments come in a variety of options. Opioids (oxycodone, hydrocodone, etc.) are often prescribed as treatment for an episode of pain patients are experiencing. If you haven’t been the recipient of these directly, there’s a good chance you know someone who has. They’ve been widely prescribed as they had always been considered both safe and effective. However, in the wake of an opioid epidemic, we want to remind our patients that there are safe and effective treatments that let you avoid the drugs – and without the side effects, That said, there are instances where these types of drugs are appropriate – post surgery or serious injury – and with proper management may be used safely. However, we want to use this platform to highlight our approach to more conservative treatments that can effectively alleviate pain.  

As physical therapists, chiropractors, and massage therapists, we look to provide that first-line treatment for acute and chronic injuries alike – including: manual therapy; joint mobilizations; massage and soft tissue release; targeted therapeutic exercise; and health education. Let’s take a closer look at these distinct areas. 

Joint Manipulation and Mobilization

Manipulation and mobilization are used throughout musculoskeletal health by chiropractors, physical therapists, and some osteopathic doctors. Despite popular belief, the aim of these treatments is not to put a bone back in place. Treatments like this work with the nervous system to affect pain (through release of endorphins), muscle tension (through reduction in pain and thus reduction in spasm), and proprioception (your brain’s sense of your joint position). In my opinion, 95% of cases require exercise to reinforce the effects of the manipulation. In other words, mobilization and manipulation gives your body a window to exercise with less pain so that you can correct the issue at fault and increase muscle tone. However, it does not correct the underlying cause of the pain independently. These are  powerful pain relieving tools that can be employed to aid in your recovery from pain, especially in the spine.

Massage

Generally massage is thought of as a relaxation and stress reducing technique, but it can also be used as a powerful pain relieving and recovery tool. Therapeutic and sports massage are given in order to improve recovery through reduction in muscle tone and improvement in blood flow. Relaxation in muscle tone allows the muscle to receive the adequate nutrition is desperately needs to heal. Think of a muscle as a sponge; when it is squeezed out (overactive) it is not able to receive the water (blood) it needs to function. We see this happen often in cases of back pain associated with sustained postures, and receiving occasional massages would help alleviate this chronic paid in a more effective and cost-effective treatment. Massage also releases endorphins through a healing touch and targeted techniques, which helps to ease pain and creates a relaxing therapeutic environment for the body to heal. Your chiropractor or physical therapist may also use targeted soft tissue techniques to promote healing and pain reduction. 

Therapeutic Exercise

Therapeutic exercise is used widely by physical therapists and chiropractors as well. Movement encourages the body to release endorphins, reduce tissue tension through increased blood flow, promote healing through cellular processes, and prevent chronic pain from fear of movement. Exercise can be used as a means for tissue to adapt and heal to specific stresses it will encounter through daily activities. We use therapeutic exercise not only as a pain relieving mechanism, but also as a way to introduce stress to healing tissues in a controlled manner. If the tissue is not properly loaded over time, it can be substantially weaker than it was prior to the injury causing recurrent injuries. The best example of this phenomenon is chronic ankle sprains. Without proper rehabilitation, ankle sprains are likely to keep occurring as the body is unable to fully heal the tissue prior to sustaining a second, third, or fourth injury. Another common misconception is with arthritis. Many people stop moving because the arthritis is causing too much pain. On the contrary, our joints need to be loaded in order to provide nourishment to the joint surfaces. Without movement, joints can continue to degrade and become more painful. Remember, movement is your friend and is ultimately what will keep you feeling happy and healthy for years to come.  

Education

Education about a particular condition should not be taken for granted. It is the responsibility of your healthcare provider to educate you on your conditions, the treatment options, and expected recovery prognosis. Please don’t hesitate to ask your provider questions – fully understanding your condition is a key element to complete recovery. Education about pain can also be invaluable for the patient, which is why our office strives to provide pain education to help contextualize thoughts and beliefs about pain. Sometimes education is the stepping stone to preventing a patient from progressing to a chronic state of pain. For this reason, our office doesn’t just treat your condition, we help you understand it.

As you can see, there are many alternative treatment options for pain relief – and with far fewer side effects – than prescription drugs. It is important when seeking care for pain, that you explore all options landing on an course of treatment. Second opinions can often be helpful when you are unsure if a certain treatment is right for you. Trying a more conservative option first may save you time and dangerous side-effects from other riskier alternatives. 

Our office uses all of the above techniques, and when necessary, uses other techniques including modalities and dry needling. Our goal is to provide our patients with the most comprehensive, evidence-based treatments to ensure the fastest and most complete recovery path from injury. We ensure that each patient is treated individually, as every patient has different needs from the healthcare system. Still have questions? Give us a call to learn more. We’d love to help you become the strongest version of  your best self!

Bryan Esherick PT, DPT

 

Concussions and a Safe Return to Sport

Concussions. They can have lasting effects later in adulthood, so prompt treatment is essential to mitigate long-term effects. While the end of summer draws near, and fall sports get underway at the start of a new school year, it’s important for parents, trainers, and coaches to remain vigilant in watching for signs and symptoms of concussion in young athletes.

Here some tips to help you recognize concussions:

  1. Your child isn’t acting quite like themselves: Look for changes in your child’s usual mood, cognition, ability to pay attention, and energy level. When your child isn’t acting like he/she normally does following a game, it’s a safe bet they may have suffered a concussion.
  2. They sustained a jarring hit: Any hit, whether it is to the head or body, has the possibility of causing a concussion. Hits to the head are obviously related to concussions, but hits to the body can also cause concussions through whiplash-like mechanisms.
  3. Nausea or sensitivity to light or sound: These are some very common signs seen following a concussion.
  4. Dizziness while using their phone or watching TV: This can be caused by a sensory issue within the vestibular system. Also watch out for dizziness or imbalance while driving and walking in busy areas.
  5. IF YOU SUSPECT A CONCUSSION SEEK MEDICAL ADVICE: Waiting to seek medical advice can have an impact on the overall time it takes for your child to recover. Seeking medical advise as soon as you suspect your child may have a concussion is key.

One of the best things that you can do for your athlete as a parent or coach is to be sure that they have baseline testing consisting of physical, cognitive, and equilibrium tests prior to participation in practice and games. Should an injury occur, baseline testing allows the coach and trainer to know when it is safe to allow the athlete to return to sport after an injury has occurred. Also be sure that the testing for your athlete is comprehensive, and not performed only using the IMPACT computer-based test that doesn’t take into account the other functions of the body that may be impacted through concussion.

When seeking medical advice, remember that advice can come from a variety of medical practitioners including medical doctors, physical therapists, athletic trainers, etc. Medical examination usually consists of some tests and measures to determine the severity of the injury. Examination is necessary to rule out other serious pathologies, including a brain hemorrhage. Usual care for a concussion is a brief period of rest (1-3 days), followed by a graded return to sport and school, and then rest. Rest is essential for the brain to heal itself in the early stages, although activity should be resumed as quickly as possible while maintaining little to no symptoms. Physical therapists can help by determining a safe level of activity for the athlete and developing a sport specific training plan. Before your child returns to sport, ensure all testing compares to baseline, that physical activity has been progressed, and that your child is symptom-free with sport specific training.

By following these key steps after sustaining a concussion, your athlete can return to sport as quickly and safely as possible.

Note: This blog is not considered medical advice that should be used if you suspect a concussion in your child. If you believe your child may have suffered a concussion or would like to receive baseline testing, contact our clinic at 434-293-3800.

More Than Just a Bump on the Head

Concussions have become more and more “hot topic” in sports in the United States over the last decade. They have been put in the spotlight by the media and even become the subject of major Hollywood films. According to the International Symposia of Concussion in sport, a concussion is defined traumatic brain injury induced by biomechanical forces. That’s right, a concussion is now considered a traumatic brain injury which represents the seriousness of the condition.

Concussions occur in many different ways ranging from sports related impact to car accidents. Many people do not understand that a concussion can occur by either contact with the head or contact with the body causing head movement (whiplash from a car accident). Sports concussions will be expanded on in the rest of this blog post, but remember they can occur in a variety of ways.

Sports concussions are of particular concern in the present day. Athletes in higher level athletics are becoming bigger, faster, and stronger. This increase in athletic ability has allowed the games to move at a higher pace than in the past. This has led an increased risk for injury for athletes because of the decreased amount of time to brace and react before being hit.

Although helmets are designed to aid in the risk reduction for concussion, their main function is to prevent skull fractures not concussions. Even with improvement in helmet padding through innovation, concussion rates continue to increase. This increase in occurrence is partially related to both the increase in athletic ability and an improvement of sideline diagnosis of the condition. Football continues to be the sport that puts athletes at the highest risk for concussion. To the right is a graph representing concussions by sport in both high school and collegiate players.

 

What to Watch For

Symptoms of concussion vary from person to person. To the left is a list of symptoms that are commonly associated with concussions. If you are a coach, parent, athlete, or spectator and notice a player that present any of these symptoms following a hit, the trainer should be notified and the player should be removed from the game. It is important to get the athlete out of the game to prevent a second contact from happening. If a second contact happens during the same game or if the person is returned to sport before the injury has had time to fully heal, brain damage or even sudden death can occur. This has been seen a number of times in high school and collegiate sports. It is better to be more conservative and keep the athlete out of the game, than to return them too soon and risk injury or death.

 

What to do If you think you or someone else has experienced a concussion?

Get that person to a medical professional ASAP! Getting an examination by a medical professional allows for early diagnosis and treatment. Early treatment generally consists of mental rest. This means time away from the TV, computer, cell phones, work, and school. This usually lasts for 1-3 days until symptoms resolve and then these activities can be reintroduced gradually as symptoms allow. Most concussions resolve within 10 days for the majority of people.

Sometimes symptoms may last past the first 1-2 weeks following the injury. When symptoms present past a week or two, the person should seek out additional support to treat possible symptoms stemming from the cervical spine or vestibular system. With treatment of these areas, symptoms generally resolve within the first month of treatment.

In summary, concussions are a serious condition and are now classified as a mild traumatic brain injury. When someone is suspected of having a concussion, medical assistance should be sought out immediately for prompt diagnosis and counseling on appropriate rest procedures. Do not hesitate to reach out for help if a concussion is suspected. It is more important to protect the brain for the future than to stay in the game and risk further damage!

Summer Fitness: 4 Injury Warning Signs

Summer is here again, and with it comes the feeling of needing to get into shape. We want to look our best, so naturally our activity levels increase drastically. This isn’t necessarily a bad thing – as exercise is one way to ensure a long and healthy life. Unfortunately, for a lot of us, a large increase in activity level without a sufficient ramp-up period can spell injury trouble. The good news is there are warning signs your body sends prior to actually sustaining an injury.

Warning Signs 

Our body does a great job of helping us know whether something is harming us. There are many checks and balances within the body that allow this to happen.  For one, the level of pain does not necessarily equal the level of tissue damage. A little ache in the knees could be osteoarthritis or a torn meniscus. Sharp pain may represent only a minor ligament sprain or inflammation. So, how do you know if you’re over-doing it?

Here are the warning signs to watch out for:
  1. Pain during your warm-up: Warm-ups should not be painful! They get the body primed to work. If it is painful while priming, there is likely something underlying that needs to be take care of. Think of a car “warming up” for a trip on the highway; if it is shuddering, stalling, and a lot of warning lights come on before you make it to the highway, you’re in trouble before you even start the trip.
  2. Soreness that lasts more than 2 days: Soreness following a run or session at the gym – even into the next 24-48 hours – is OK. But, when it lasts for more than three days, something’s wrong. Take a step back and see what can be done differently. Did you push too hard or forget to include a proper warm-up? Our tissue needs to be exposed to demands that it can handle before loading too much. A proper ramp-up period will allow the tissues to adapt and respond to the demands placed on them.
  3. Inability to do as much work as the previous session: We’re always on the go, but our bodies do need REST. If you notice that your performance on workouts is declining, it might be a good time to give your body a rest. When we exercise, our muscles experience small micro tears. Healing these tears allows our muscles to build up and adapt to increased weight, distance, or other demands on your body. Your body needs time to heal before exposure to the same demands that lead to the damage. This doesn’t mean exercise needs to be stopped, but it may be a good idea to target a different part of your body or different muscular subsystem. For example – if you’re a runner, take a day off from running and add strength training on off days. If you’re lifting weights, try alternating days between upper and lower body exercises. Our bodies need variety to adapt. Without it, a decline in performance is likely follow.
  4. When in doubt, listen to your body: This one is relatively straight forward. If you refuse to listen to your body, and continue experiencing pain, it’s likely you’ll suffer an injury. The ‘no-pain, no-gain’ cliche is out. There is a difference between pain stemming from muscular fatigue, buildup of lactic acid and depletion of energy supplies and pain experienced when tissue damage is occurring. Know the difference and respond appropriately to the signals your brain is sending.

Getting back into shape for the summer can be extremely rewarding to just about everyone. But, a phase-in period to safely ease into your programs will help to ensure your body has enough time to adapt. Remember – listen to your body, learn from your mistakes, and build on the progress that you have already made. Stay healthy my friends!

Bryan Esherick PT, DPT

Healthy Life, Healthy Back

Patients often ask: “What caused my problem and how do I keep it from returning?” The origin of a condition may be easily identified as an accident or injury. However, more than half the time, the exact cause is more difficult to pinpoint – because the problem was generated by a series of seemingly harmless events and circumstances (e.g. your posture; increased activity; mild repetitive strains; etc). In fact, most conditions are started by a “recipe” of irritants rather than any single “ingredient”. From a slight increase in your daily exercise routine coupled with less than ideal posture in an old office chair, to a few extra trips up and down the stairs and layering on the Spring chores, all add up to: “Ouch, my back…!”

When life’s physical demands exceed your body’s tolerance for those challenges, muscle, bone, joint and nerve problems begin. So, how do you prevent recurring injury?

Here are five tips to help keep the back strain away.

  1. Lift with your legs. The strongest among us are still at risk of back injury when we lift heavy objects incorrectly. Be sure to squat down, grab the item and use your leg muscles to lift up.
  2. Exercise your core. Your core muscles are key to supporting your lower back. Low-impact activities, like walking, will get your heart-rate up, deliver increased oxygen to your spine, and help keep your middle fit.
  3. Practice your good posture. Much like poor posture can lead to painful back problems, good posture can help prevent injury and strain. Set reminders for yourself throughout the day to check your posture – get up and walk around from time to time – and avoid slouching.
  4. Reduce your stress. We hold tension in our back muscles, and this type of constant stress can cause back pain. Try introducing stress-relieving activities into your daily routine – meditation, yoga, tai chi – the list of options is long. The trick is finding something that works for you.
  5. Be the healthiest You that you can be. Think of your spine as an indicator of your body’s overall health and well-being. So, practicing activities that have a positive affect on your health will also have a positive impact on your back. Drink lots of water; minimize alcohol; avoid nicotine; and limit inflammatory foods (sugar, flour, dairy, processed meats, fried and saturated fats).

Of course, prevention is always the best measure to keep your body pain-free. But, if you do encounter a mishap, partnering with your physical therapist and employing these measures to help increase strength and flexibility can also help increase your threshold for future injury.

 

Healthy Cycling in Charlottesville

Proper adjustment of your bicycle helps to minimize fatigue, discomfort, and overuse injury. The following guidelines should help fit your bike to your body:

• Choose the right size bike – a rough estimate for choosing the proper frame size is to subtract 10.5 inches from your inseam. Straddling a proper-sized bike will leave approximately 1” clearance between your groin and the top of the frame. • Adjust the saddle so that when the ball of your foot is on the pedal (with your leg fully extended in the six o’clock position) there is approximately a 10-degree bend in your knee. The saddle surface should be horizontal or tilted slightly up at the neck. Off-road riders may benefit by using a stem that contains a spring for additional shock absorption.

• Your stem height should be somewhere between parallel and 1” lower than the top of your saddle. A gentle rule of thumb for selecting the proper stem offset is to place your elbow on the nose of your seat and stretch your arm forward over the stem. The tips of your fingers should touch your handlebars. • Cycling accessories can dramatically affect your comfort level. Padded bicycle shorts are the single most important piece of clothing for long rides. Wearing cycling gloves

• Choose the right size bike – a rough estimate for choosing the proper frame size is to subtract 10.5 inches from your inseam. Straddling a proper-sized bike will leave approximately 1” clearance between your groin and the top of the frame. • Adjust the saddle so that when the ball of your foot is on the pedal (with your leg fully extended in the six o’clock position) there is approximately a 10-degree bend in your knee. The saddle surface should be horizontal or tilted slightly up at the neck. Off-road riders may benefit by using a stem that contains a spring for additional shock absorption.

• Your stem height should be somewhere between parallel and 1” lower than the top of your saddle. A gentle rule of thumb for selecting the proper stem offset is to place your elbow on the nose of your seat and stretch your arm forward over the stem. The tips of your fingers should touch your handlebars. • Cycling accessories can dramatically affect your comfort level. Padded bicycle shorts are the single most important piece of clothing for long rides. Wearing cycling gloves helps to relieve hand pressure associated with riding. Choose sunglasses with UV protection, and most importantly, always wear a helmet.