Posted by
Jeni P. on Fri, May 18, 2012 @ 02:40 PM
Risk for a hip fracture increases substantially with age. Bone density and muscle mass decrease as we get older. Post-menopausal women are at an even greater risk of a hip fracture, as the drop in estrogen production makes them more likely to develop osteoporosis. Eating a diet that is insufficient in dietary calcium and Vitamin D also contribute to a greater risk of hip fracture.
Other risk factors include family history and bone structure; those with slender builds, such as those of Asian heritage, have an increased likelihood of hip fracture.
As we age, reflexes and balance suffer, as well as vision – creating a dangerous situation. By the time we are 65 years old, most Americans are on some type of Medication that they will be on for the rest of their lives. Many medications for common diseases like hypertension and diabetes also cause dizziness and weakness. Those side effects, coupled with a natural decline in reflexes as we age, cause an increased number of falls among the elderly population.
Symptoms of a hip fracture may include an inability to move immediately following a fall, coupled with a severe pain in your hip or groin that occurs on the affected side when one attempts to put pressure on the leg. There may also be significant bruising or swelling.
Complications of a hip fracture are often severe and life-changing. It may disallow adults living independently pre-injury to continue to do so. In fact, many patients that are placed as temporary residents in a nursing home for recovery are still there a year later. A hip fracture largely limits mobility, causing a high probability of serious complications such as blood clots and bedsores, as well as a greater risk of a second hip fracture.
Many things can be done to prevent or decrease the chance of a hip fracture. It is important to maintain strength and flexibility. “Prehab” is an excellent way to stay in shape avoid being at high risk for injury.
Posted by
Jeni P. on Thu, May 17, 2012 @ 04:27 PM
Camille has been a long-time friend of WSPT.
She took her health by the wheel when she was diagnosed with Type 2 Diabetes, a trend she is concerned is rising. Not interested in being on medication to manage her diabetes, she decided to lose weight. She successfully lost 25 pounds! After a year, she is still slim and fit.
Camille was fortunate to find her motivation; receiving a diagnosis of Type 2 Diabetes or Heart Disease can make a person feel like she has already been defeated. Camille hopes that her experience working with a nutritionist and personal trainer can make her more accessible and innspirational to those headed down the same path.
Camille will be working with the participants of BronxFit as a nutritional counselor. Camille knows the real life challenges of changing an entire lifestyle. She understands that it is difficult to abandon what once felt so familiar. But if you'd ask her, she would say all the hard work is worth it when you get your health and confidence back!
BronxFit combines personal training and nutritional counseling, as well as full access to the WSPT gym, a scene Camille is an expert at navigating!
But her mission to slow the rise of diabetes diagnoses is not a fight only fought at WSPT! Camille is now providing nutritional information services for all-ages. She is currently writing a book about the life-saving decisions she made for herself entitled, "In Balance After All These Years: A Survival Guide Towards Achieving Balanced Blood Sugars."
Come see Camille today!
The NBA is in denial. To claim that playing more games in fewer days without proper training camp to get up to speed is preposterous.
This year’s NBA season began less than 2 weeks after the lock-out doors opened. The players were then thrown into a whirlwind schedule, often playing 2 nights in a row, occasionally 3 in a row. Many criticized the quality of play at the beginning of the season. My impression was that the players were pacing themselves for the grueling sprint ahead of them. Injury rates were not astronomical, but the season’s not over, actually the intensity is about to rise, as the playoffs began on Saturday.
Derrick Rose of the Bulls and the Knicks’ Imam Shumpert both went down with ACL tears on Saturday. It’s probably a coincidence that they both happened on the same day, late in a game, without contact. Commissioner David Stern, backed by renowned orthopedist Dr. David Altchek, claims that the schedule had nothing to do with it.
I don’t buy it. My theory is that muscles fatigue and neuromuscular synapses don’t fire as quickly when fatigued or unaccustomed to particular conditions. Both Rose and Shumpert sat out portions of the season with injuries. They each had to expedite their returns as the playoffs approached. Recovery time between games was minimal. Rose was probably never at full strength all season and it’s likely that Shumpert broke down slightly from the grind of his first NBA season. I’m not saying that either of these players had a weaker ACL due to the wear and tear of a brutal schedule, but it’s definitely possible that the muscles supporting their knees and the nerves that stimulate those muscles to fire were fatigued or burnt out.
The key to high-level athletic performance is recovery between sessions or games and these guys did not get a chance to recover sufficiently.
It’s impossible to say that their injuries had nothing to do with the schedule. I hope I’m not right, but I won’t be surprised if injuries continue to play a large part in the remainder of the NBA playoffs.
On Saturday 2 NBA starters, including last year’s league-MVP, went down with ACL tears. The ACL is one of the 4 vital ligaments supporting the knee. For a professional athlete, an ACL tear usually means surgery to reconstruct the knee followed by 9-12 months of rehab in order to get back to playing shape. There’s no guarantee of returning to pre-injury levels, but minimally-invasive surgeries and improved rehab techniques have significantly increased athletes’ likelihood of continuing prosperous careers despite this brutal injury. Many factors determine success rates after an ACL injury, such as:
- Pre-injury conditioning
- Concomitant injuries, such as meniscus, bone or other ligamentous damage
- Surgical technique and graft source – using a portion of the patient’s patella tendon or a cadaver ligament to replace the torn ACL
- Rehab approach – aggressive vs. conservative
- The patient’s response to every step through the process
- Emotion and psychology play a huge part in recovery from this injury. A year of recovery requires consistent hard work and commitment to get back on the court.
From a PT perspective, we typically follow general guidelines or protocols that have been proven successful over the years. Still, every patient is different, and they each require attention to their particular response to surgery, PT and life. We work to assist, coach, guide and encourage the patient on this long road. We use manual techniques to reduce swelling and restore range of motion. We progressively teach the patient to recruit muscles that become dormant after surgery. We gradually add strengthening exercises, balance drills and eventually movements and activities that simulate game action.
Kevin Wilk, PT, DPT, along with Dr James Andrews, MD and others, published a paper in the March 2012 Journal of Sports PT, entitled “Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries.” The paper summarizes years of experience backed by scientific rationale for their ACL protocol. In the paper they outline some things they’ve found that improve recovery speed and increase the likelihood of a successful recovery:
- Achieving homeostasis prior to surgery – usually 21-day program
- Reducing swelling
- Restoring range of motion
- Achieving normal muscle strength in the knee and hip regions
- Following a program that emphasizes:
- Reducing inflammation
- Full knee extension or hyperextension in the first few days
- Full passive range of motion 4-6 weeks post-op
- Normal patella mobility
- Re-establish voluntary quadriceps control
- Restore neuromuscular control
- Gradually increase applied loads
- Sport-specific training
Some tools that can assist through this process are systems that can control weight-bearing, such as aquatic therapy or an Alter-G treadmill. Regular icing and self-care by the patient are vital throughout the rehab process. It is also absolutely necessary for the PT to listen to their patient. When the patient is sore or swollen, that should be addressed and the program intensity should be increased or decreased according to the patient’s pattern of response. When they report feeling great, they should be congratulated and empathy and encouragement help any patient through a bump on the road to recovery.
The above outline is not the only means of rehabbing an ACL reconstruction, but it has been successful with the majority of patients treated this way. Considerations need to be made for concomitant injuries, other types of surgical techniques and females.
Posted by
Jeni P. on Thu, Apr 19, 2012 @ 02:50 PM
Shoulders are the most moveable joints in the body. The shoulder joint is comprised of three bones: Clavicle (collarbone), Scapula (shoulder blade) and the Humerus (upper arm bone). The socket is smaller than the ball of the Humerus, making the joint less stable than others throughout the body.
Shoulder injuries may not be the most common on-the-job injuries, but they do keep employees out of work the longest. The average amount of time missed for a back injury is 12 days – 3- months for a shoulder injury.
Athletes are the most likely to develop a shoulder injury due to excessive, repetitive, overhead motions required for sports like swimming, tennis, weight lifting and pitching. However, those whose job requires them to routinely perform such activities as hanging curtains, painting walls, filing and gardening often suffer from constant shoulder pain.
An athlete may become so used to a certain degree of discomfort that he no longer notices it, and he may compensate for the constant weakness and limited range of motion associated with shoulder injuries. This will eventually lead to a more complicated injury.
Pain is the way our body informs us something is wrong, and the onset of new pain should never be ignored. The most common symptoms of a shoulder injury are stiff shoulder joint(s), a shoulder that feels like it could pop or slide out of its socket, and weakness in the arm(s). If you are experiencing these symptoms, schedule an appointment with a physical therapist promptly to learn the severity of the problem.
Posted by
Jeni P. on Mon, Mar 19, 2012 @ 07:25 AM
Going in for surgery on the knee comes with the expectancy of receiving physical therapy as part of rehabilitating and getting back to normal. But studies have shown that going for PT prior to surgery is beneficial.
Why?
Physical therapy can help strengthen the hamstring and maximize the quadriceps muscle before surgery; two important muscles that support the knee joint. Physical therapy can also assist in maximizing range of motion. PT pre-op can also lead to better surgical outcomes as well as faster recovery times. A physical therapist can teach his patient how to properly utilize swelling by Kinesio taping at home; taping helps improve circulation and prevents fluid build-up. A pre-op patient will benefit from learning and anti-swelling and anti-inflammatory exercises that he can do at home.
Reducing surgical anxiety is another major benefit of pre-op PT; it lets a patient know what to expect after surgery. It also helps to return to a PT who is familiar with a patient’s medical history.
Seeing a physical therapist two times a week for two weeks prior to surgery should be sufficient to see results. However, it is important to have a discussion with a primary care physical regarding yearly visits allowed per insurance policy.
A typical post-op plan of care might include:
- Reduce swelling with ice/elevation/re-education of quads
- Non-weight bearing exercises to help regain full extension and flexion of the knee
- Static exercises which strengthen muscles with little movement to the joint
In conclusion, pre-op physical therapy can benefit a patient by:
- Strengthening knee muscles to take the pressure off knee joints and ligaments as well as protect the joint
- Regular stretching allows normal muscle length
- Less swelling means less scarring: recover full range of motion more quickly and allow for proper firing of quads sooner
Posted by
Jeni P. on Wed, Feb 22, 2012 @ 01:58 PM
Obesity is on its way to becoming the leading preventable cause of many common types of cancer. Obesity causes an imbalance of the amount of fatty acid in the body, which affects the actions of IGF’s, or insulin-like growth factors.
IGF’s may increase the proliferation of cells. A cell, like all things, has a life cycle. Cells live and die. In a process called apoptosis, a damaged cell is programmed to die prematurely. IGF’s tend to interfere, telling the cells to stay alive, increasing the risk that these cells will grow into tumors.
In fact, obesity increases chances of many types of cancers where the correlation between lipid levels and the presence of malignant tumors can be directly measured. Adult males who have a high amount of fat around their bellies are more likely to develop colon cancer; females who are overweight or obese have a much higher risk of developing endometrial cancer.
Being inactive and not eating well are certainly not habits to be taken lightly. There are plenty of superficial reasons to lose weight. We all want to lose a few pounds, look our best. We feel like being in better shape will change the way we interact with the world.
AT WSPT, we see patients that have any number of preventable diseases. We have gym members who come here to get into shape later in life and to combat obesity to avoid Diabetes, Cancer and chronic pain and cardiovascular disease. It is never too late to fight the detrimental effects of obesity.
Not all physical therapy is created equal. A physical therapist (PT) can quickly and effectively treat neck pain...if they use a specific treatment.
The January 2012 issue of the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) reported a study showing that using a particular thrust technique to mobilize the neck and upper back is “appreciably more effective than non-thrust mobilization in patients with mechanical neck pain.” In the short term patient reported nearly a 60% reduction in pain versus less than 13% reduction if the thrust techniques were not used.
The idea of most orthopaedic PT treatment plans is the accomplish the following:
1. Reduce pain
2. Restore normal movement
3. Teach muscles to function properly
4. Return to normal, pain-free functional activities
The faster and easier this can be accomplished, the greater benefit for the patient, the payer, and the reputation of the PT. A skilled manual PT will regularly employ these thrust techniques and will help their patients recover more effectively than a practitioner utilizing generic treatments. Treatments that can quickly reduce pain, increase motion, and improve the ability of the muscles to protect the neck may help decrease long-term disability associated with neck pain.
Thrust techniques are regularly employed by skilled manual therapists following a thorough assessment to qualify a patient. Once moving properly with decreased pain, the patient can be taught how to strengthen the supporting muscles and then move into activities that simulate their normal day.
Before receiving treatment for neck pain, ask your doctor to refer you to a PT who specializes in manual therapy. Once you meet the PT, it’s a good idea to discuss with them if they are familiar with this study and the techniques that are utilized. It may not be appropriate for you, but be sure that they are considering the best treatment specifically for your condition.
Posted by
Jeni P. on Wed, Feb 08, 2012 @ 11:18 AM
Jeff Hurm is a Physical Therapy Assistant student here at WSPT. He has been working with Lillibeth Gonzalez for the last month, and has already greatly benefited from her years of experience.
Jeff originally attended Ithaca College and received a degree in TV and Radio Communications. He worked in video production and post-production for 13 years. After deciding his heart was not in that type of work, Jeff enrolled at LaGuardia Community College to obtain a degree as a Physical Therapy Assistant.
Having received physical therapy after going through an ACL reconstruction, his interest in PT as a career began to grow. His friend, a chiropractor, confirmed that this was a good path, and recommended Jeff get a degree as a PTA.
WSPT is Jeff’s second of three clinical requirements. His first clinical requirement was fulfilled at an outpatient facility, Miccass Physical Therapy, in Manhattan. At WSPT, Jeff will be completing his clinical specialty, and the track he intends to pursue, Sports Medicine.
Jeff appreciates that Lillibeth allows him to have a generous degree of free license while working with patients. Jeff points out that what you learn in the classroom as a student can only be the framework; real learning takes place when the student is allowed to be hands on, and to participate in the actual treatment of patients.
One of the most valuable insights into practicing physical therapy that Jeff has been privy to is the realization that no two patients are alike. Every patient will have his or her own personality, medical history, anatomy and will. Understanding and appreciating that a patient’s perception of their own pain is a heavy factor in the plan of care will help make Jeff a more intuitive and effective PTA.
You may find this hard to believe, but until recently, the ADA and the ACSM guidelines had recommended that people with Diabetes Mellitus (DM) and Peripheral Neuropathy (PN) refrain from weight-bearing activity. Just to be clear, this means they were recommending that people with DM+PN should do exactly what was contributing to their condition.
The rationale was that the risk of skin breakdown was greater than the rewards associated with getting off their butts and moving around a little. Skin breakdown and ulceration can lead to gangrene, amputation and potentially death. These are extreme risks, but they are easily monitored and controlled, enabling a person with DM+PN to live a normal life.
A case study published in Physical Therapy (Jan 2012) details the benefits of weight-bearing activity. The study utilized a moderate intensity 12-week, progressive walking and resistance program reflecting the recently changed guidelines for people with DM+PN. Three times a week for 12-weeks, the 76-year old man (with a 30-year history of DM+PN) performed the following exercises:
- Stretching - toes, hamstrings, quadriceps, calves
- Balance - progressively challenging exercises with decreased support
- Strengthening - body-weight ankle strengthening exercises, stair climbing, sit-to-stand
- Aerobics - progressive treadmill walking
Precautions were taken to avoid skin injury and all exercise sessions were monitored by a physical therapist. Overall the program was successful in increasing some measures of muscle strength, physical function, and activity without causing injury in an individual with DM+PN.
This is very encouraging for patients with DM+PN. PTs should be encouraging this population to be more active and we can even design programs based on the protocol outlined in this study. I know we will be doing exactly that here at
WSPT.
If you have Diabetes Mellitus and are interested in a program to safely increase your activity level, strength, balance and overall conditioning reach out to WSPT @
info@wspt.org.