Our Licensed Physical Therapists successfully resolve most chronic and acute pain caused by soft tissue and orthopedic injuries. Our patients are encouraged to continue their recovery with complimentary use of the Dedham Health Complex on the day of their therapy.
Our Licensed Physical Therapists successfully resolve most chronic and acute pain caused by soft tissue and orthopedic injuries. Our patients are encouraged to continue their recovery with complimentary use of the Dedham Health Complex on the day of their therapy.
A bulging or herniation of one or more discs in the neck can cause pain when the disc presses on a nerve.
This can cause pain that radiates to the shoulders, back or arms. In most cases, the pain is resolved with physical therapy and pain management treatments.
If you have surgery to remove the damaged disc, physical therapy will guide you through your doctor’s orders to ensure safe return to your previous level of functioning.
STENOSIS
This occurs when the vertebral canal in the neck becomes narrow. As a result, the nerves and spinal cord become compressed and pain develops.
Spinal stenosis is often the result of aging and is common in people over the age of 50. A number of treatments by a physical therapist can help improve the condition of your neck.
Osteoarthritis
Cervical osteoarthritis is a degenerative condition that can cause neck pain and stiffness. Sometimes confusion is created when general terms are used interchangeably to refer to cervical osteoarthritis, including cervical spondylosis, degenerative joint disease, or simply neck arthritis.
The disease is present when the articular cartilage within the facet joints has deteriorated, both due to age-related water loss and the breakdown of protein fibers. As cartilage wears away and raw bone rubs against bone, painful inflammation develops, causing bone spurs to form.
Bone spurs may compress surrounding cervical spinal nerves, resulting in pain and other symptoms. Symptoms of weakness, throbbing and tingling can spread through the shoulders, arms and hands. In some cases, inflammation of the lubricating agent of the spinal joints can cause additional inflammation and/or headaches.
Physical therapy will help to restore the proper alignment and movement resulting in decreased pain and improved mobility and posture.
Whiplash/Sprain
Whiplash, also called neck sprain or neck strain, is injury to the neck. Whiplash is characterized by a collection of symptoms that occur following damage to the neck.
In whiplash, the joints, discs, ligaments, cervical muscles, and nerve roots may become damaged. Whiplash is caused by an abrupt backward and/or forward jerking motion of the head, often as a result of a car accident or impact to the head.
Sports injury and falls are also common reasons for neck strain. Symptoms of whiplash may be delayed for 24 hours or more after the initial trauma.
People who experience whiplash may develop pain and stiffness usually within the first few days after the injury. In the past, whiplash injuries were often treated with immobilization in a cervical collar.
However, the current trend is to encourage early movement instead of immobilization. Ice is often recommended for the first 24 hours, followed by gentle, active movement and physical therapy.
Pinched Nerve
A pinched nerve occurs when there is “compression” (pressure) on a nerve. Nerve compression often occurs when the nerve is pressed between tissues such as ligament, tendon or bone. Inflammation or pressure on a nerve root exiting the spine may cause neck pain.
It may also cause pain to radiate from the neck into the shoulder and arm. This condition is called cervical radiculopathy. How long it takes for symptoms to end can vary from person to person.
Treatment varies, depending on the severity and cause of the nerve compression. Physical Therapy can help to stretch and strengthen the muscles to relieve the pressure on the nerve.
Tension Headaches
A tension headache is the most common type of headache. It is pain or discomfort in the head, scalp, or neck, and is often associated with muscle tightness in these areas.
Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to poor posture, stress, depression, head injury, or anxiety.
They may occur at any age, but are most common in adults and older teens. Any activity that causes the head to be held in one position for a long time without moving can cause a headache.
Activities may include typing or other computer work, fine work with the hands, and looking down at your smart phone. To prevent tension headaches, learn and practice stress management.
Some people find relaxation exercises or meditation helpful. Practice good posture when reading, working, or doing other activities.
Exercise the neck and shoulders frequently when working on computers. A physical therapist will prescribe the proper exercises to relieve the tension and give training for improved posture.
Rotator Cuff Tear
Traditional Treatment: An MRI is often necessary to confirm the diagnosis of a torn rotator cuff. Conservative treatment includes ice, rest and physical therapy. If conservative treatment has not relieved the pain, your doctor might suggest a steroid injection.
How PT can help: Physical Therapy will be useful along the spectrum of this injury. From Pre-surgery strengthening to help maintain range of motion and good surgical outcomes to post surgery protocols where physical therapy will help you gain range of motion, strength, and ultimately return you to your prior activity levels. Whether they range from daily household activities or back to the sports you love, physical therapy will set programs to help achieve your goals.
Exercises & Stretches: Most surgical interventions will follow their own set of protocol exercises. Some helpful exercise may be pendulums, table slides and scapular squeezes during the early phase of recovery. As you progress through stages of recovery the exercises will progress with you.
● Pendulum: With your body bent over at a 90 degree angle, allow the injured arm to hang straight down to the floor. Slowly move your body back and forth while the arm dangles down, beginning to swing it passively in a forward and backward motion. Gently, begin to move your body in a circumduction fashion that permits the arm to swing in circles as you dictate the extent of motion from your body. Complete about 20 swings or 30s, to your comfort level.
● Table Slides: Place the injured arm on the table, thumb up. Slowly move your body back to increase the ankle into flexion (overhead) as the arm remains flat on the table. Hold position to your comfort level for 30s and repeat twice.
● Scap Squeezes: With your shoulders relaxed, slide your shoulder blades back towards your spine. Pause for 2 seconds, then return to normal stance. If your arm is in a sling you may perform with sling on. A mirror may help to prevent your shoulders from scrunching up to your ears as this motion will try to isolate retraction of shoulder blades only.
Labrum Tear
Description: The shoulder labrum is a piece of soft cartilage in the socket-shaped joint in your shoulder bone. It reinforces the ball-shaped joint at the top of your upper arm bone, connecting the two joints. The labrum is also the attachment site for the ligaments that keep the shoulder stable.
● SLAP Tear or Lesion: When the tear is above the middle of the glenoid, it’s called a SLAP tear or SLAP lesion. SLAP stands for “superior labrum, anterior to posterior,” which means front to back. This kind of labrum tear is common among tennis players, baseball players, and anyone who uses a lot of overhead arm motions. They also often occur with damage to the biceps tendon.
● Bankart Tear or Lesion: When the damage is to the lower half of the glenoid socket, it’s called a Bankart lesion or tear. Bankart tears are more common in younger people with a dislocated shoulder.
● Posterior Labrum Tear: Injuries to the back of the shoulder joint can cause a posterior labrum tear. These are rare and make up only 5 to 10 percent of all shoulder injuries.
Symptoms: A labrum tear usually results in aching shoulder pain, and difficulty with movements.
Traditional Treatment: Labrum tears are often treated conservatively with physical therapy, anti-inflammatory medication and in some cases, cortisone injection. If physical therapy fails to restore overhead activity, surgery may be needed. Younger athletes tend to recover well from the surgery.
How PT can help: After a labral tear your doctor will determine whether a surgical intervention is needed. Physical therapy will help you maintain and gain mobility, strength, and proper movement patterns to allow healthy movement of the joint or prepare them for the best surgical outcome. Reviewing posture and the importance of stabilizer muscles at this time will be imperative for best outcomes and our team will work with you to assess areas in need of strength gain and improvement of overall function.
Exercises & Stretches:
● Doorway Stretch: This can be performed single armed or bilaterally at the same time. In a door frame, place your hand and elbow along one side (or both) as you stand in the doorframe. Slowly take 1 small step thru the door frame and begin to lightly move your torso forward. You should begin to feel a light stretch in your chest. Stop when at a comfortable stretch and hold for 2x 30s. The height of arm placement will vary per individual however the goal will be to feel the stretch in the chest.
● Internal and External rotations: With a theraband (or not!) of your therapists choosing, you will hold it with the elbow placed by your side. For external rotation, begin with your hand on your stomach then slowly turn the arm outward like you’re opening a door, making sure to move through the full range of motion. Once completed, return to start. For internal rotation, you will begin facing the opposite direction with the arm in the opened position (elbow by side) and pull the band towards your stomach. Once completed, return to the starting position. Typical recommendation may be 2 sets of 10 repetitions.
Biceps Tendonitis
Description: Biceps tendonitis is inflammation of the tendon of the upper arm. The biceps have 2 tendons that attach the muscle to the bones in the shoulder. The long head of the biceps tendon attaches to the top of the shoulder at the glenoid.
Causes: Biceps tendonitis can be caused by wear and tear on the tendon over time. Repetitive activity like sports, work or chores can stress the tendon. Injury to the tendon can occur from a fall or compensation for another injury.
Symptoms: Common symptoms include pain in the front of the shoulder that travels down the arm, weakness and a clicking or catching feeling.
Traditional Treatment: The most common treatment is rest, ice, NSAIDS, injection and physical therapy.
How PT can help: Physical therapy can help loosen the tight muscles in the area through manual work, modalities and stretching and improve the strength of surrounding muscles to decrease the workload of the biceps. Physical therapy will help improve functional movement by allowing decreased strain on the muscle and area.
Exercises & Stretches: Stretching and tissue management is key during the beginning stages of treatment. Stretches like biceps wall stretch, doorway stretch, or wrist flexor stretch may be utilized to loosen up the surrounding areas and improve tissue quality and length.
● Doorway Stretch: This can be performed single armed or bilaterally at the same time. In a door frame, place your hand and elbow along one side (or both) as you stand in the doorframe. Slowly take 1 small step thru the door frame and begin to lightly move your torso forward. You should begin to feel a light stretch in your chest. Stop when at a comfortable stretch and hold for 2x 30s. The height of arm placement will vary per individual however the goal will be to feel the stretch in the chest.
● Biceps Wall Stretch: Facing a wall, place the palm of the affected arm on the wall about hip/waist height. Slowly begin to turn away from the wall, away from the arm. As you begin to feel a light stretch down the biceps, stop turning when you feel a comfortable stretch that can be held for 30 seconds. Repeat twice.
● Wrist Flexor Stretch: Hold affected arm in front of you straight, palm up. With the opposite hand, place it on the fingers of affected side and slowly move them down toward the floor. You should begin to feel a stretch in the forearm. When it’s comfortable, hold there for 30 seconds and repeat twice.
Shoulder Arthritis
Description: Shoulder arthritis occurs when the normally smooth cartilage on the ball and/or socket begins to wear down.
Causes: Shoulder arthritis is often caused by age, over time the cartilage will wear down. Trauma, such as a fall, fracture, dislocation or infection can also cause arthritis.
Symptoms: Shoulder arthritis causes pain, stiffness, weakness and a grinding feeling in the shoulder. It is often described as a deep, aching pain.
Traditional Treatment: An x-ray will reveal the extent of the degeneration. Typical treatment includes rest, ice or heat, physical therapy and non-steroidal anti-inflammatory medication. If conservative treatment fails to decrease pain, a total shoulder replacement may be necessary.
How PT can help: Maintaining and working to improve range of motion is important when living with arthritis. Physical Therapy can show you stretches and exercises that will allow you to maintain and improve the ease of which you can complete daily activities and tasks.
Exercises & Stretches:
● Pulley: The overhead pulley should be positioned over a doorway. Sit in a chair with back against door, directly underneath pulley. With involved elbow straight and thumb facing backward, use the uninvolved arm to raise involved arm overhead as high as possible. Assist as much as needed. Repeat 10 times.
● Pendulum Circles: Begin by leaning over, supporting your upper body with a table or chair standing with one foot in front of the other. Let the arm to be exercised hang straight down completely relaxed. Gently move your body in circular motions, allowing the relaxed arm to begin swinging in small circles. First rotate the arm clockwise, then repeat going counterclockwise. Repeat 10 times.
Description: The acromioclavicular joint (AC joint) is at the top of the shoulder. An AC joint sprain is injury to the ligaments at the top of the shoulder that connect the collarbone to the shoulder blade. It may also be called an AC joint separation.
Causes: It is usually caused by a fall or direct trauma to the joint as in contact sports like football.
Symptoms: An AC joint sprain usually causes pain at the top of the shoulder when reaching overhead or trying to sleep on your side. There may be a deformity or bump on the top of the shoulder where the collar bone ends.
Traditional Treatment: X-rays will determine the extent of the sprain and most injuries to the AC joint heal with conservative treatment. Rest, ice, NSAIDS and physical therapy are common treatments.
How PT can help: Physical Therapy will restore the normal movement and strength to the shoulder after an AC joint injury. Kinesiotape is often helpful to stabilize the AC joint while healing. Your physical therapist will apply the Kinesiotape during your treatment session.
Exercises & Stretches:
● Table slide: Begin by sitting in a chair facing a surface approximately chest high. A towel may be placed on the table to assist the sliding motion. Place the hand of the arm you wish to stretch placed palm down on the table with the opposite hand placed on top of it. Using the top hand to control movement, lean forward until a light stretch is felt in the affected shoulder and held for the desired amount of time. Return to the starting position by sliding the bottom hand back, controlled by the top hand. Repeat 10 times.
● Internal Rotation with resistance band: Begin by placing an exercise band at chest height securely around a doorknob. Standing perpendicular to the doorway with the arm you wish to exercise closest to the doorway. Place a towel roll between your elbow and your side and bend the elbow to be exercised to 90 degrees. Slowly bring your hand towards your stomach, keeping your elbow bent and arm at your side. Repeat 2 sets of 10 repetitions.
Shoulder Replacement
Description: Total shoulder replacement is the removal of the portions of the shoulder joint that may be injured from arthritis or trauma. The parts of the joint are then replaced with artificial implants. In a typical shoulder replacement, a plastic lining is attached to the socket to allow smooth movement. The surgeon removes the top of the arm bone and inserts a metal stem with a ball on the end. A reverse total shoulder replacement may be needed if your rotator cuff is severely injured. If the rotator cuff is not healthy, the shoulder may be unstable or not move properly. In a reverse shoulder replacement, the normal ball-and-socket structure is reversed. An artificial ball is attached to the shoulder blade. An artificial socket is attached to the top of the arm bone. The large deltoid muscle that covers the shoulder is then able to move the arm.
Causes: A total shoulder replacement is very successful for treating severe pain and stiffness due to arthritis.
How PT can help: Physical therapy will be an important part of the recovery to allow for full function of the shoulder. Your physical therapist will guide you through the phases of rehabilitation starting with passive range of motions. Mobility, strength, stability and function will be the main focus to return you to your prior level of activity.
Exercises & Stretches:
● Shoulder adduction isometric: Stand with rolled towel placed between your arm and the side of your body. Elbow should be bent to 90 degrees and shoulders back. Lightly press your arm into the towel for 10 seconds and then relax. Repeat 10 times.
Herniated Discs
Description: Our discs are natural shock absorbers that allow for movement. Discs are like jelly donuts. A disc bulge is when the inner disc material bulges out beyond the normal edge. A herniated disc is when the center nucleus or jelly breaks through the outer wall.
Causes: Most disc injury is the cause of general wear and tear over time. Most people can’t pinpoint the cause of the disc injury. Others experience the severe pain with a certain movement or activity such as shoveling snow. Being overweight also puts increased pressure on the disc.
Symptoms: Pain can come from the disc itself, but oftentimes can cause the pain, numbness, tingling and weakness down the leg if the disc presses on a nerve. In most cases the disc will shrink or recede with time.
Traditional Treatment: Physical Therapy should be the first treatment option. Studies have found PT to be the most beneficial in eliminating pain and increasing function. (The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities.2018 Sep; 27(Suppl 6):851-860.) Injections to spine can also help with the healing process.
How PT can help: Proper stretching and strength training with the help of a physical therapist can restore normal function. Aquatic therapy is helpful in many cases to help alleviate the pressure of the disc.
Exercises & Stretches:
● Knee to chest stretch: Begin by lying with knees bent and feet on the surface. Place your hands behind your thigh on the side you wish to stretch. Pull your knee towards your chest. Hold 30 seconds.
● Lower Trunk Rotation stretch: Lie with both feet placed flat on the supporting surface and knees bent. Keeping your shoulders flat on the surface, allow your knees to slowly fall together to the side, rotating at your lower back as you do so. Hold 30 seconds. Return to the starting position and then allow them to slowly fall to the opposite side. Hold 30 seconds
Chronic Back Pain
Description: Pain lasting even a few days can be unbearable. Pain lasting for weeks and months can affect people mentally, emotionally, spiritually and physically. Often times the source of the pain can be related to what is called soft tissue dysfunction. Soft tissue dysfunction is injury to the muscles, tendon, and ligaments that lead to abnormal movement patterns. These abnormal movements and postures can cause pain.
Causes: Muscles are either too tight, too weak or de-conditioned. Muscle imbalance can cause extra stress on the body. Nerves can be hypersensitive to pain.
Symptoms: Many people experience localized back pain, worse with movement. Sometimes leg pain will occur also.
Traditional Treatment: Application of heat packs and ice packs will help with the localized. Physical activity is usually helpful.
How PT can help: Physical Therapy can have a significant impact on correcting many conditions related to chronic back pain. Stretching the tight muscles and strengthening the weak ones will help restore the muscle balance and decrease the stress on the spine. Your physical therapist will prescribe specific exercises that are safe and effective.
Exercises & Stretches:
● Bridging: Begin by lying with knees bent and both feet placed on the floor with arms at your sides. Raise your hips off the surface by squeezing your gluteal muscles. Attempt to bring the hips up to where they are in line between the knees and shoulders.
● Prone press up: Lie face down with your arms beside your body and your head turned to one side. Bring your arms up and place your hands under your shoulders. Straighten your elbows and push your top half up as far as pain permits. Remember to keep the pelvis, hips, and legs limp and allow your lower back to sag. Hold for 1-2 seconds and lower to starting position. Try to raise yourself up a bit further with each repetition.
Pregnancy/Postpartum
Description: Due to pregnancy related hormones, the ligaments in your body naturally become more relaxed to allow for easier labor. This can put a strain on the joints in your back and cause lower back pain.
Causes: Weight gain, posture changes and hormone changes can all be a cause of the back pain. Lifting heavy objects can easily strain the back.
Symptoms: Many women experience localized lower back pain or pain in both hips. Sciatica can also occur if the Sciatic Nerve is irritated. Please see information under Sciatic.
Traditional Treatment: Pregnancy support brace or belly bands can help support the spine and hips. Prenatal or postnatal yoga is often helpful to relieve back pain. Drugs and other topical treatments are not advised due to the risk to the unborn baby or passing medication to the baby while nursing.
How PT can help: Aquatic Therapy can be very useful to alleviate the pressure on the spine due to the growing fetus. Please check with your doctor and ask if Aquatic Physical Therapy will be helpful for you. Traditional Physical Therapy will increase core strength safely. It will also help to keep the hips and spine in proper alignment.
Exercises & Stretches:
● Cat-Camel: Begin on your hands and knees with your hands below your shoulders and your knees below your hips. Arch the upper portion of your back as much as you can while bringing your head toward your chest. Return to the starting position, and immediately arch the lower portion of your spine so that your stomach comes toward the floor while simultaneously raising your head.
Back Spasm
Description: A back spasm is a sudden, involuntary contraction of the back muscles usually caused by heavy lifting, strain, overuse, or weakness. Spasms can be extremely painful sending even the toughest folks to the ER.
Causes: Back spasms can be caused by injury to the muscles, tendons, and ligaments. Heavy lifting is a common cause.
Symptoms: The pain usually stays in one area, but other muscle groups such as in the buttock and legs may get tight and sore as they respond to the stress of a spasm.
Traditional Treatment: Treatment can include rest, medications (muscle relaxants, anti-inflammatories, and pain meds) heat and ice. Imaging such as x-rays and MRI are rarely ordered when spasms are suspected.
How PT can help: Physical Therapy will guide you through a comprehensive strength training and stretching routine to increase strength and flexibility. Having a stronger back and core can significantly reduce your risk for having future episodes.
Exercises & Stretches:
● Child’s pose: Begin kneeling with your legs tucked underneath you and your bottom resting on your legs. Place the palms of both hands in front of you shoulder width apart and slowly move them away from you until your forehead is resting on the mat. Hold for 30 seconds.
Sciatica
Description: Sciatica is the medical term used to describe pain going down the leg from the lower back. Anything that aggravates the Sciatic Nerve can cause Sciatica.
Causes: Common culprits include disc herniations, disc narrowing, degenerative changes and Piriformis Syndrome (please see information under Piriformis Syndrome
Symptoms: Pain that usually radiates down one leg. Tingling, numbness, and weakness can occur.
Traditional Treatment: An MRI can be ordered in severe cases. Treatment will focus on decreasing the swelling and inflammation. Medication for pain and physical therapy are common treatment options.
How PT can help: Physical Therapy can help by strengthening and stretching the muscles, ligaments and tendons that have shortened or weakened in response to the pain allowing you to resume normal function.
Exercises & Stretches:
● Low Trunk rotations: Lie with both feet placed flat on the supporting surface and knees bent. Keeping your shoulders flat on the surface, allow your knees to slowly fall together to the side, rotating at your lower back as you do so. Return to the starting position and then allow them to slowly fall to the opposite side.
Description: As the body ages degenerative changes in the spine, such as spurs and degenerating intervertebral discs between the vertebrae, can occur. Spondylotic changes in the spine are frequently referred to as arthritis. Degenerative disc disease is not actually a disease but an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column deteriorates or breaks down, leading to pain.
Causes: When the joints in the spine experience trauma, the protective cartilage wears down and bone spurs form. These changes lead to malalignment, stiffness, pain, and poor mobility.
Symptoms: Common symptoms include back pain, weakness, numbness, and pain that radiates down the leg.
The aging process cannot be cured, but physical therapy can address the pain, strength, flexibility, and functional deficits. Spinal injections can help with pain and inflammation.
How PT can help: Increased core strength can help minimize the stress to your spine, improve posture, reduce inflammation, and decrease your pain. Many people benefit from the low impact activity during Aquatic Therapy. The buoyancy of the water can help relieve the pressure on the spine due to the arthritis.
Exercises & Stretches:
● Posterior pelvic tilt: Begin by lying on your back with your knees bent and feet flat on the floor. Using your abdominals, gently roll your hips backwards, feeling your low back press downwards towards the floor. Hold as directed. Repeat as directed.
Scoliosis
Description: Our spine normally has curves: a a curve to the front in our neck or cervical spine, a curve to the back in our thoracic area, another curve to the front in the lumbar area and another curve top the back in the sacrum. However, when there are curves to the sides, in a C or S shape, this is known as Scoliosis.
Causes: Children are often screened in school for scoliosis, because it begins to occur during growth spurts and adolescents. Muscle tightness and shortening can also lead to the lateral curvature.
Symptoms: Common symptoms are uneven shoulders, uneven hips and back pain.
Traditional Treatment: Minor curves are just watched, larger curves may require bracing or surgery.
How PT can help: Mild and moderate scoliosis can benefit from exercises designed to slow the curvature of the spine and decrease pain. Exercises will keep the back flexible and strong.
Exercises & Stretches:
● Standing side bend stretch: Starting Position: Stand with feet hip width apart, lower abdominals engaged and gluteal muscle contraction. Place the hand of the unaffected side on your hip. Take the arm of your affected side and reach overhead. Movement: Slowly lean away as you reach up and over to the opposite side. You should feel a comfortable stretch on the affected side while continuing to breathe normally.
● Open book stretch: Starting Position: Begin by lying on your side with knees bent and your hands together, directly in front of you. Movement: Slowly lift your top arm toward the ceiling, rotating through your chest in order to reach as far behind you as possible. Make sure you follow your arm movement with your head and keep your eyes focused on your hand throughout the entire exercise. Tip: Keep the arm you are reaching with straight throughout the entire exercise.
Stenosis
Description: Stenosis means narrowing. As we age, the canals that our nerve roots go through can become smaller typically due to overgrowth of bone or bone spurs.
Causes: Common causes are arthritis and shrinking discs.
Symptoms: Back pain, leg pain, numbness, tingling, and weakness are common symptoms. These symptoms become worse with standing and walking and are usually relieved with sitting. You may notice that you can walk better and for longer when you lean on the grocery cart. You may notice difficulty with balance too.
Traditional Treatment: An x-ray can show how much space there is between bones. An MRI may be ordered when a closer look at the soft tissue is needed. Oral medication, injections and surgery may be part of the treatment plan. However, Physical therapy can often help.
How PT can help: Physical therapy can help you maintain an active lifestyle and reduce pain by increasing strength, flexibility, balance, and endurance. Aquatic Therapy can help alleviate the pressure in the back and relieve the pain also.
Exercises & Stretches:
● Seated lumbar flexion: Begin by sitting at the edge of a chair with your legs spread. Place both hands between your legs and gently lean forward, allowing your lower back to bend. Hold 30 seconds.
● Lower trunk rotation: Lie with both feet placed flat on the supporting surface and knees bent. Keeping your shoulders flat on the surface, allow your knees to slowly fall together to the side, rotating at your lower back as you do so. Return to the starting position and then allow them to slowly fall to the opposite side.
Golfer’s Elbow
Description: Golfer’s elbow is an inflammation on and around the tendons that attach to the small bony part on the inner elbow also known as the medial epicondyle.
Causes: It is caused from overuse of the tendons and muscles in your forearm. Golfers are not the only ones susceptible to this, often chronic and painful condition. Jobs, sports, and recreational activities that require repetitive use of your hands, wrists and fingers increase the stress on the tissues.
Symptoms: Sharp pain on the inner side of your elbow, swelling and tenderness especially worse following activity that involves repetitive activity, weakness in your elbow, and pain with flexing your wrist and fingers.
Traditional Treatment: Rest, ice, brace and in some cases a Cortisone injection or surgery in cases of rupture.
How PT can help: Physical therapy will incorporate massage, stretches, application of modalities for pain and inflammation reduction, eccentric exercises to strengthen the surrounding uninvolved muscles.
Exercises & Stretches:
● Golfer’s stretch: Extend your affected arm in front of you with the elbow straight, the front of your forearm facing up, and palm facing down. Movement: In this palm up elbow extended position, pull back on your fingers until you feel a stretch through your fingers, palm, and front of your forearm. Hold 30 seconds.
Tennis Elbow
Description: Tennis elbow is an inflammation on and around the tendons that attach to the small bony part of the outer elbow also known as lateral epicondyle.
Causes: It is caused by racquet sports and recreational or work-related activities that involve repetitive movement of your elbow, wrist or hand.
Symptoms: Pain in the outer aspect of the elbow on the lateral epicondyle and often in the forearm as the tendons that attach to the bone are connected to the muscles in your forearm.
Traditional Treatment: Rest, Ice, brace, avoidance of repetitive activities, in some cases cortisone shot and in case of ruptures, surgical repair.
How PT can help: Your physical therapist will perform a thorough evaluation to assess the extent of the injury. Treatment may include massage, modalities to improve circulation and pain reduction, taping/bracing, ice massage, education of improving sport technique, exercise to improve forearm strength and stretches for the wrist and forearm muscles.
Exercises & Stretches:
● Tennis elbow stretch: Extend your affected arm in front of you with the elbow straight, the back of your forearm facing up, and palm facing down. Movement: In this palm down elbow extended position, pull back on your fingers until you feel a stretch through your fingers, palm, and back of your forearm. Hold 30 seconds.
Triceps Tendinitis/Bursitis
Description: Triceps tendinitis is an injury or inflammation in the tendon that connects muscle on the back of the arm (triceps) to the elbow bone.
Causes: Triceps tendinitis is usually caused by overuse or injuring during activities that involve repeated extending of the elbow, like work activity or throwing a baseball.
Symptoms: Symptoms that indicate that you may have triceps tendinitis include:
● Achiness in the area of your triceps, shoulder, or elbow
● Pain that occurs when you use your elbow
● A limited range of motion in your arm
● A bulge or area of swelling on the back of your upper arm, near to your elbow
● Weakness in or around your triceps, elbow, or shoulder
● A popping noise or feeling at the time of injury
Traditional Treatment: Initial treatment should involve rest, ice, compression, and elevation (RICE). If the injury does not respond to treatment, surgery may be necessary.
How PT can help: Physical therapy will promote the healing by restoring range of motion and reducing swelling. Exercises can then begin to increase strength and function.
Exercises & Stretches:
● Triceps Stretch: Begin either sitting or standing, and bring the arm to be stretch up over your head as if you were going to rest your hand on your opposite shoulder. With your opposite arm, grasp your upper arm just above the elbow, and gently pull toward your opposite shoulder until you feel a moderate stretch in the back of your arm. Hold 30 seconds.
● Triceps Kickback: While standing, lean over a table or chair with your other arm as a support. Hold a weight in the other hand with your upper arm parallel to your trunk, elbow bent. Straighten your elbow to raise your hand backward without moving the upper arm. Return to the starting position and repeat 10 times.
Quadriceps Pain/Strain
Description: The quad muscles make up the front of the thigh and assist the hamstrings to bend and extend the hip & knee joints.
Causes: The quad muscle can be sore or in pain due to activities that contain running, kicking, or jumping. Overuse or high forces can cause the muscles to tear, which is a strain.
Symptoms:
● Inflammation, bruising or swelling on the front of the thigh
● Difficulty bending and straightening the knee
● Overly tired, stiff, or weak quad muscle
● Pain when walking or using the quad muscle
● Sharp pain when running, jumping, or kicking
Traditional Treatment: Rest can be enough for mild to moderate strains but more severe strains should be treated with physical therapy.
How PT can help: Physical Therapy can help to speed the recovery of the muscle by decreasing swelling, increasing mobility and strength. PT will also help to avoid scar tissue that may form in the muscle, causing weakness.
Exercises & Stretches:
● Quadriceps stretch: Starting position is lying on your side with leg to be stretched on top. Begin the stretch by bending your top knee so you can grasp your ankle and gently pull back towards your buttocks. Pull until you feel a gentle stretch on the front of your leg. Hold 30 seconds. Be sure not to arch your back as you perform the stretch. NOTE: You can use a towel or belt around your ankle to pull it towards buttocks if necessary.
● Step ups: Standing in front of a step, place the foot of the leg you wish to exercise onto the step and step up, fully straightening your knee and standing up straight. Lower yourself back to the starting position and repeat 10 times.
Hamstring Pain/Strain/Rupture
Description: The hamstring muscles make up the back of the thigh and assist the quads with moving the hip and knee. Sometimes people will refer to this type of injury as a pulled hamstring. A ruptured hamstring may require surgery.
Causes: A strain can occur during an activity that includes running, jumping or sudden stop and start motions. Other causes include:
● Improper warm-up or lack of stretching
● Muscle weakness specifically in the glutes
● Improper footwear
Symptoms:
● Sudden and severe pain during exercise
● A snapping or popping feeling
● Pain in the back of the thigh and lower buttock
● Pain when walking, straightening the leg, or bending over
● Tenderness or bruising
● Inability to walk or even stand with severe strains
Traditional Treatment: Rest can be enough for mild to moderate strains, but more severe strains should be treated with physical therapy.
How PT can help: Initial evaluation will assess the extent of the injury. Beginning treatment will include ways to reduce the pain and inflammation to allow the muscle to heal. Advanced treatment will focus on stretching and strengthening the injured muscle tissue. PT will help to speed the recovery time.
Exercises & Stretches:
● Hamstring Stretch: Begin by lying on your back with your knees bent and feet flat on the floor. Keeping your knee bent, place your hands behind the knee on the side you wish to stretch and pull your leg towards your chest. While holding your leg in this position, actively straighten your leg, feeling a stretch in the back of your thigh. Hold 30 seconds.
● Standing Hamstring Curls: Begin by standing with a stabilizing surface in front of you. Place both of your hands on or just above the stabilizing surface. Slowly lift the lower portion of the leg to be exercised up and back toward the buttocks by bending at the knee. Slowly lower back down to starting position. Repeat 10 times.
Groin/High Adductor Strain
Description: The groin or adductor muscles usually refer to the inner thigh. The muscles originate at the hip and act as stabilizers for hip movements, especially moving the leg inward. A strain to the groin is usually over stretching or tearing of the muscle.
Causes: Actions such as kicking, pivoting, changing direction, or twisting. A groin strain is most common in sports where individuals are suddenly jumping or changing directions quickly. Other risks for a groin strain include:
● Previous groin or hip injury
● Weak thigh or hip adductor muscles
● Muscle fatigue from overuse
● High intensity training or exercise
● Increasing age
Symptoms:
● Pain and tenderness in the groin area and inside of the thigh
● Bruising or swelling in the groin area and inside of the thigh
● Pain when bringing legs together
● Pain with raising the knee
● Warmth and redness
Traditional Treatment: Icing the area can relieve some pain and swelling. Proper rest is recommended. Physical therapy can help with more severe strains.
How PT can help: Physical Therapy will help with the healing process by decreasing the scar tissue, promote healing, reduce inflammation and decrease pain. Your PT will also prescribe appropriate exercises to gently increase the flexibility and strength of the injured muscle.
Exercises & Stretches:
● Butterfly stretch: Begin seated on a mat with both legs straight. Bend both legs up and bring the knees outward, placing the bottom of both of your feet together. Place your hands on your feet and bend forward until you feel a stretch in your groin, making sure to keep your back straight. Hold 30 seconds.
● Standing Adductor stretch: Stand with your feet wider than your hips. Keep your leg that you intend to stretch straight. Bend other knee and lunge towards that side. With feet firmly planted, continue to lunge onto bent knee until you feel a stretch along your inner thigh. Keep your trunk upright throughout the stretch. Hold 30 seconds.
Hip Flexor Pain/Strain
Description: The hip flexors are the muscles that bends the hip and bring the knee towards the body. The iliacus and psoas major muscles, also known as your iliopsoas and the rectus femoris, which is part of your quadriceps are collectively known as the hip flexors.
Causes: The most common cause is overuse in active individuals or athletes. However, individuals who have a sedentary job, like working at a desk for long periods of time, may have weak and tight hip flexors. This can cause the muscles to shorten and result in injury.
Symptoms:
● Cramping or pain in upper leg
● Muscle spasms in the hip or thigh
● Reduced mobility and discomfort when moving
● Inability to kick, jump or spring
● Swelling or bruising around the area
● Tightness or stiffness after waking up or sitting for long periods
Traditional Treatment: The best way to relieve pain from a hip flexor strain is to stretch and strengthen the muscles. Hip movement is vital to an individual’s movement throughout the day, so improving hip mobility quickly is important.
How PT can help: Physical Therapy will evaluate the injury and prescribe exercises and stretches to help heal the hip flexor injury. gentle stretching is often recommended to restore the proper mobility to the hip and prevent tightness. It is important that scar tissue is addressed with manual treatment or other tissue mobilization techniques during the healing phase. During the strengthening phase, appropriate exercises are given to return to your activity and sport.
Exercises & Stretches:
● Runner’s Stretch: Starting Position: Stand near a stable surface like a kitchen countertop so that you can use it to maintain balance. Stagger your feet in a lunge position with your affected leg (leg you are stretching) behind you and unaffected leg in front. Movement: With upright posture, shift your body weight forward to the front leg without letting your front knee go over your toes. Keep your back knee straight and lunge until the point of a gentle stretch at the front of your hip of the back leg.
Hip Replacement
Description: A total hip replacement (THR) is needed when there is severe arthritis in the hip joint. A THR is when the damaged cartilage is removed and replaced with an artificial joint made of metal and plastic.
Causes: There are many different reasons an individual may need to have a total hip replacement. The main cause for a total hip replacement is that previous treatments were not successful. Increasing age is also a factor.
Symptoms: Chronic pain in the hip and arthritis are symptoms that may lead to a person have a total knee replacement. Additionally, walking or getting up from a chair may be more difficult and the hip may be stiff.
Traditional Treatment: The best way to regain motion and strength in the hip is physical therapy. Your physical therapist will guide you through the recovery protocol. Your PT will evaluate the range of motion and strength to help restore proper function to the hip while healing. They will also help you improve your walking, getting up from a chair and climbing stairs.
How PT can help: Your physical therapist will guide you through the recovery protocol. Your PT will evaluate the range of motion and strength to help restore proper function to the hip while healing. They will also help you improve your walking, getting up from a chair and climbing stairs.
Exercises & Stretches:
● Exercises & Stretches: Exercises may vary depending on the type and approach to surgery. Your physical therapist will instruct you based on the specific protocols.
Patellar Tendonitis
Description: The patellar tendon connects the kneecap (patella) to the shinbone allowing the knee to extend forward. This motion helps you kick a ball, run up a hill or jump up in the air. When the tendon is overused, small tears occur in the tendon. As more tears occur, they cause weakness in the tendon and pain from inflammation.
Causes: Overuse of the tendon often resulting from excessive jumping. Athletes that participate in jumping sports like basketball and volleyball are the common population that have this injury, but runners and athletes of other sports can overuse the tendon as well.
Symptoms: The first symptom you experience is pain in the knee. First, pain is experienced at the beginning of or just after physical activity or participating in sports. As it worsens, you may have pain throughout the activity. Eventually, the pain can begin to interfere with activities of daily living such as standing up out of a chair or walking upstairs (activities that involve bending the knee).
Traditional Treatment: Physical therapy is best to reduce the symptoms of patellar tendonitis. If left untreated, patellar tendonitis can lead to degeneration of the tendon.
How PT can help: Your physical therapist will evaluate the muscle tightness and weakness that may be the cause of the imbalance leading to overuse. Exercises to stretch the leg muscles and strengthen the hip and thigh, massage, modalities to decrease inflammation are common treatments.
Exercises & Stretches:
● Hamstring stretch using a rope or stretch strap: wrap strap around foot and lie back, keeping your knee straight raise your leg up
● Quad stretch: Lift one foot up behind you and grab the ankle with your arm, pull the ankle toward your backside to feel a stretch in the front of your thigh
Patellofemoral Syndrome
Description: Patellofemoral pain syndrome is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. It is often referred to as Jumper’s Knee, because it is common in athletes that run and jump.
Causes: Many things may contribute to the development of patellofemoral pain syndrome. Problems with the alignment of the kneecap and overuse from vigorous athletics or training are often significant factors.
Symptoms: The pain and stiffness can make it difficult to climb stairs, kneel down or perform everyday activity. You may feel the kneecap moving out of place and feel like your knee is buckling, catching, or locking. There may be swelling and pain in the knee. You may feel pain when bending or straightening the knee.
Traditional Treatment: Strengthen and stretch the muscles surrounding the knee. It is also important to stretch and strengthen the hip muscles that control the leg alignment and stability.
How PT can help: Your physical therapist will perform a comprehensive evaluation to determine the cause of the muscle tightness, weakness and imbalance leading to the pain. Exercises, taping, manual treatment, and aquatic therapy are common treatments.
Exercises & Stretches:
● Quad Stretch: Lift one foot up behind you and grab the ankle with your arm, pull the ankle toward your backside to feel a stretch in the front of your thigh.
● Step up: Stand in front of step. Step up onto step with right leg and bring left leg up to meet it. Return to floor with both feet. Repeat with left side.
Knee Bursitis
Description: The bursa of the knee is a sack of fluid located between the kneecap and the skin, which acts as a cushion for the knee. Knee bursitis occurs when the bursa becomes irritated and produces excess fluid. This then causes the bursa to swell and put pressure on the knee.
Causes: Knee bursitis is caused by pressure to the kneecap. This can occur from excessive kneeling, like plumbers, roofers, carpet layers, and gardeners do. Also, if you experience a hit to the knee or land on your knee, you can experience a knee bursitis. If you have rheumatoid arthritis or gout, you can be susceptible to this injury.
Symptoms:
● Swelling, warmth, redness, & tenderness
● Mild pain that increases with activities, especially kneeling
● Stiffness when walking
Traditional Treatment: Stretching and strengthening of the knee muscles, rest, and ice application.
How PT can help: Physical therapy treatment will help to control the inflammation in the knee causing the bursitis. Proper stretching and strengthening around the knee will help to alleviate the pressure on the bursa.
Exercises & Stretches:
● Heel slides: Begin by lying on your back with both legs straight. While keeping your heel in contact with the table, bend one knee and bring your foot as close to your buttocks as possible. Slowly straighten the leg again with the heel contacting the table throughout the entire movement.
● Quad stretch: Lift one foot up behind you and grab the ankle with your arm, pull the ankle toward your backside to feel a stretch in the front of your thigh.
● Quad set: Begin by lying on your back with a towel roll underneath the knee to be exercised. Slowly push down into the towel by tightening your thigh muscles until your knee is straight. Hold as directed. Repeat 10 times.
Knee Osteoarthritis
Description: Knee osteoarthritis is the degeneration of the cartilage within the knee that causes the bones to rub against each other. This can cause bone spurs and decrease the space within the knee joint. Often, it will be described as “bone on bone.”
Causes: Osteoarthritis is not generally caused by overuse but rather from gradual “wear-and-tear” and degeneration over time.
Symptoms: The most common symptoms are pain, swelling and stiffness of the knee joint. This can result in difficulty walking or climbing stairs. Other symptoms include:
● Pain and swelling in the morning or after sitting for long periods of time
● Flare ups after vigorous activity
● Weakness or buckling of the knee
● “Locking” or “sticking” during movement
● Some individuals report increased pain when it rain
● Difficulty getting the knee to straighten
● Night pain
Traditional Treatment: Decreasing activities that irritate the joint can help. Going to physical therapy is a common treatment.
How PT can help: Physical therapy will help restore range of motion and strength to the joint and surrounding muscles. In addition, your physical therapist will help educate you on activity, exercise and movements that will preserve your knee joints, decreasing further “wear and tear.”
Exercises & Stretches:
● Stationary bike: Exercising on a stationary bike is one of the most effective and safe exercises for knee arthritis. Biking eliminates the impact on the joints while allowing for improved mobility and range of the knee joints. In addition, biking is a wonderful way to improve your cardiovascular endurance. You can exercise your heart and your legs at the same time!
IT Band Syndrome
Description: The IT Band begins at the hip joint and attaches to the outside of the knee joint, running along the outside of the thigh. The IT band acts as a stabilizer for the hip and knee joints during movements like running or cycling.
Causes: The most common cause for IT band syndrome is overuse, especially with activities where the leg turns inwards. This can come from running downhill or on uneven surfaces or wearing improper footwear. This syndrome can also be the result of tight glute or thigh muscles.
Symptoms: The most common symptoms are pain and swelling to the outside of the knee, above the joint. Pain can be felt at the hip joint as well. Other symptoms include:
● Pain down the leg
● Aching, burning or tenderness on outside of knee
● Warmth and redness on the outside of the knee
● Feeling a click or pop on the outside of the knee
● Pain when walking downstairs or standing up from a chair
Traditional Treatment: Taking a break from running or strenuous exercise is encouraged. Active rehabilitation can be beneficial, so physical therapy is recommended.
How PT can help: Physical therapy will help to stretch the tight muscles and strengthen the stabilizers to eliminate the over use and imbalance. Your physical therapist will perform a gait analysis to help with proper technique.
Exercises & Stretches:
● IT band Rope stretch: Begin lying on your back on an exercise mat. Loop a belt around the foot and hold the other ends in your hands. Use the belt to bring your straight as close to 90 degrees as you can while maintaining a comfortable position. Without moving your trunk and keeping the knee straight, use the belt to bring your leg across your body toward the opposite leg. You should feel a stretch in the outside of your hip. Hold 30 seconds.
● ITB foam roll mobilization: Begin by lying on the floor on the side you wish to exercise. Place a foam roll under your hip and support your upper body by placing both hands on the floor. Keep the lower leg straight and cross the upper leg in front of the lower leg, bending the knee and placing the foot flat on the floor. Use your upper leg and arms to push and pull your body forward and backwards, rolling the hip and leg over the foam roll. perform for 2-3 minutes.
Knee Sprain/Strain
Description: A knee sprain or strain is the result of torn or damaged ligaments of the knee. There are 3 levels to a sprain graded mild, moderate, or severe. Depending on which ligament you damage and how severe your sprain is, the treatment may vary.
Causes: There are a variety of movements that can lead to a ligament sprain. See below for specifics of each ligament.
MCL LCL Sprain/Strain: The MCL and LCL are ligaments on the medial (inner) and lateral (outside) sides of the knee, respectively. They hold the upper bone of the leg to the lower bones of the leg, crossing over the outside of knee joint. The MCL prevents the knee from bending inward.
Causes: MCL and LCL sprains can occur when you bend, twist or change direction quickly. In sports like soccer or football, the knee can be hit and cause injury. In sports like skiing where you stop and go, jump or weave can cause injury. MCL injuries are commonly related to ACL injuries.
MCL symptoms:
● Pain and swelling
● Buckling of the knee outward
● Tenderness near the tear area
LCL symptoms:
● Pain and swelling
● Buckling of the knee inward
● Tenderness near the tear area
ACL PCL Sprain/Strain: The ACL and PCL are ligaments within the knee joint that connect the bones of the leg together to form the knee joint.
Causes: An ACL injury is caused by irregular placement of the leg during a decelerating, cutting, or jumping motion that results in instability of the knee. 70% of ACL injuries are non-impact, meaning you were not directly hit. 50% of the injuries occur along with a MCL and meniscus injury. The ACL is more likely to be injured than the PCL. A PCL injury is caused by a direct hit to the shin just below the knee joint or falling on a bent knee.
ACL symptoms:
● A popping sound at the time of injury
● Swelling
● Severe knee pain
● Bruising
● Weakness or buckling of the knee
PCL symptoms:
● Mild knee swelling, with or without weakness
● Difficulty moving the knee
● Pain in the back of the knee that worsens when you kneel
Traditional Treatment: You can ice the area to decrease pain and swelling. Wearing a knee brace can reduce pain, instability and swelling as well.
How PT can help: Physical Therapy will restore proper range of motion, increase strength, improve gait and increase stability. Your physical therapist will guide you in returning to your prior level of activity.
Exercises & Stretches:
● Heel slides: Begin by lying on your back with both legs straight. While keeping your heel in contact with the table, bend one knee and bring your foot as close to your buttocks as possible. Slowly straighten the leg again with the heel contacting the table throughout the entire movement. Repeat 10 times.
● Quad sets: Begin by lying on your back with a towel roll underneath the knee to be exercised. Slowly push down into the towel by tightening your thigh muscles until your knee is straight. Hold as directed. Repeat 10 times.
Meniscus Injury
Description: The meniscus is a tough piece of cartilage the acts as a shock absorber between the legs bone within the knee joint. A tear in the meniscus can be a painful and debilitating injury
Causes: A tear in the meniscus can be caused by forceful twisting or hyper-flexing of the knee.
Symptoms:
● Pain
● Swelling
● Popping
● Clicking and locking when walking
● Feeling like the knee is going to give out
Traditional Treatment: In some cases, surgery is needed to repair the meniscus.
How PT can help: Many individuals are successful with non-operative treatment of a meniscus injury through physical therapy. Physical therapy will focus on maintaining your mobility and improving your strength to decrease stress on the knee and symptoms of clicking/locking.
Exercises & Stretches:
● Hamstring stretch: Start by placing a strap around the foot of the leg you intend to stretch. Lay back, bending opposite knee so foot is flat on table. Begin lifting your affected leg up, keeping your knee straight and use the strap to provide a comfortable stretch behind the back of your leg and knee. Hold 30 second
● Straight leg raises: Lying on your back with knees bent and feet flat on the floor, straighten the leg you wish to exercise. Start by contracting the muscles on the front of your thigh. While keeping these muscles tight and knee straight, lift your leg off the ground until your knee is at the height of the other knee. Slowly lower it back to the floor. Repeat 10 times.
Total Knee Replacement
Description: A total knee replacement is when the damaged cartilage is removed and replaced with an artificial joint made of metal and plastic.
Causes: There are many different reasons an individual may need to have a total knee replacement. The main cause for a total knee replacement is that previous treatments were not successful. Increasing age is also a factor.
Symptoms: Chronic knee pain and arthritis are symptoms that may lead to a person have a total knee replacement.
Traditional Treatment: The best way to regain motion and strength for the knee is physical therapy.
How PT can help: Physical Therapy will help you recover from the total knee replacement faster. Your physical therapist will create an individualized exercise plan to address any issues and speed your recovery, safely and effectively.
Exercises & Stretches:
● Heel slides: Begin by lying on your back with both legs straight. While keeping your heel in contact with the table, bend one knee and bring your foot as close to your buttocks as possible. Slowly straighten the leg again with the heel contacting the table throughout the entire movement. Repeat 10 times.
● Wall Squats: Begin with your back against a wall and your feet in front of you shoulder width apart. Perform a squat by keeping your back straight and bending at your knees, lowering your body down. Return to starting position. Repeat 10 times.
Calf Strain
Description: The calf muscles attach at the ankle joint and are responsible for pointing the foot down, like the act of stand on tiptoes. A calf strain is a tear in the calf muscle.
Causes: Strains in the calf muscle often result from sudden explosive change in direction. They can also be caused by a pushing off motion, or over stretching of the muscle. If you do not warm up properly, leaving muscles tight, they are more likely to tear. Poor footwear can also cause calf strains.
Symptoms: Depending on the degree of the strain, symptoms may vary. Some symptoms include:
● Tenderness and pain in the muscle
● Loss of strength
● Bruising
● Limping and difficulty walking
● In severe cases, weight bearing on the leg is very painful
Traditional Treatment: Rest is encouraged to allow the muscle enough time to heal and prevent re-injury. Ice is used to treat inflammation and pain. If the strain is more severe, crutches or a walking boot may be prescribed. Physical therapy is also recommended.
How PT can help: Physical Therapy will help to reduce the chance of increased tightness if the muscle is immobilized in a boot to recover.
Exercises & Stretches:
● Calf stretch: place hands on the wall with one knee straight and heel flat on the ground. place the other leg in front and then slowly lean into the front leg, keeping heel on the ground. Hold for 30 seconds.
● Foam rolling: divide the muscle that you’re rolling into three segments—bottom, middle, and top. roll each section for 30-60 seconds, 2 times each.
Shin Splints
Description: Mild to severe pain in the shin.
Causes: Repeated stress to the shin bone and connective tissue surrounding the bone. Other causes include:
● Improper stance that leads to stress on the calf muscle and shin
● Tendonitis
● Muscle dysfunction of the calf muscle or muscle surround the shin bone
Symptoms: If you exercise or stand for prolonged time on hard, uneven surfaces, have flat feet or have weak ankles, you are likely to have shin splints. Symptoms include:
● Lower leg pain, shin cramps, tenderness at the inner side of the shin
● Mild swelling in the lower leg
Traditional Treatment: Rest is encouraged to allow time for the muscles and bones of the shin to heal. If left untreated, shin splints can develop into a stress fracture.
How PT can help: Our expert Physical Therapists will identify the areas that are causing the strain and leading to the shin splints. Common treatment will include stretching the tight muscles, strengthening the weak muscles, improving balance and manual treatment to allow for proper alignment and foot mechanics.
Exercises & Stretches:
● Heel raises: hold onto the counter or back of a chair. slowly raise up onto the balls of your feet and slowly lower down, perform 20 repetitions.
● Single leg stance: Stand directly behind a table or chair and place your feet slightly apart, Lift one leg six inches out to the side, hold this position for 10 seconds. Repeat with the opposite leg.
● Calf stretch standing: place hands on the wall with one knee straight and heel flat on the ground. Place the other leg in front and then slowly lean into the front leg, keeping heel on the ground. Hold for 30 seconds.
Plantar Fasciitis
Description: Plantar Fasciitis is pain on the bottom of the foot caused by injury to the tissue that supports the arch of the foot. The pain is most common with the first steps getting out of bed or when sitting for a period of time.
Causes: Plantar Fasciitis is often caused by overuse such as standing for long periods of time, increased walking and running or obesity
Symptoms: The most common symptoms are sharp pain in the heel or bottom of the foot. Sometimes people will experience burning into the heel.
Traditional Treatment: Conservative treatment is most common. The use of a night splint is helpful to maintain the ankle in a neutral position and will passively stretch the plantar fascia overnight preventing the tightness.
How PT can help: Our Physical Therapists will identify the biomechanical imbalances in your foot that are causing the increased tension on the plantar fascia. Gait training, taping techniques, footwear prescription, stretching and strengthening are common treatments.
Exercises & Stretches:
● Rolling foot on a frozen water bottle: freeze a 16-ounce water bottle, place it sideways on the floor and roll the bottom of your foot on the bottle. This will massage the tissue and decrease inflammation. perform for 2-3 minutes until the foot is cold.
● Towel scrunches: These exercises will help build the intrinsic muscles of the foot. Sit in a chair and place a towel under your foot. Use your toes to scruche the tolwe closer to you. Repeat 10 times.
Ankle Sprain
Description: The ankle joint is held together by several ligaments that allow your foot to move around freely while also maintaining stability. A common ankle sprain occurs when the lateral or outside ligaments of your foot are pushed past their typical range of movement causing pain and discomfort. In some cases, the ligaments can tear.
Causes: Ankle sprains can occur when you twist, turn, or roll the foot. It can also occur when you step the wrong way on uneven ground or land the wrong way when stepping down. Ankle sprains can happen when you take part in physical activity and sports. Most people have experienced a rolled ankle at some point in their life.
Symptoms: Common symptoms include pain and swelling around the ankle joint. Some bruising can occur or the area may be red and warm. If the sprain is more severe, you may have difficulty bearing weight on the foot, which can result in trouble walking.
Grade I: The ligaments have been stretched but did not tear. Mild pain and swelling, pain jumping and running
Grade II: Ligaments have partly torn, pain, swelling, bruising, loss of motion, pain walking
Grade III: ligaments completely torn, pain, swelling, bruising and loss of motion. In addition, there will be loss of stability.
Traditional Treatment: Rest & physical therapy are the best ways to treat ankle sprains. Based on the ligament that is sprained and the grade of the sprain, recovery time and treatment may vary. You may be given a walking boot to avoid weight bearing on the ankle. Ice is highly recommended for all types of sprains.
How PT can help: Physical therapy treatment will help you increase the range of motion of the joint, gradually get you back to using your ankle comfortably. It will also focus on stretching and strengthening the muscles surrounding the joint to help you prevent future injury.
It is encouraged that you give the ankle enough time to recover while also maintaining some movement. During your initial evaluation, a printout of exercises will be provided for you to do at home. With proper rest and rehabilitation, you will be back doing your favorite activities in no time.
Range of motion- ROM exercises may include simple flexion and extension movements
Balance- both static and dynamic balance exercises will help build strength in the muscles and ligaments surrounding the joint. These exercises help support ankle stability
Plyometrics and agility- these exercises include jumping and/or footwork activity. They are important exercises for athletes returning to sport, but also important for all individuals when walking on uneven surfaces like sidewalks and sandy beaches or hiking on trails.
Exercises & Stretches:
● Ankle alphabet: place your foot off the edge of the bed and slowly draw the letters of the alphabet using your foot and ankle
● Heel raises: hold onto the counter or back of a chair. Slowly raise up onto the balls of your feet and slowly lower down, perform 20 repetitions.
● Calf stretch with towel: roll a towel and loop it around the ball of your foot. Keeping your knee straight gently pull the foot back toward you until you feel a stretch in the back of your leg. Hold 30 seconds.
High Ankle Sprain
Description: A high ankle sprain is similar to a regular ankle sprain in that it results from the strain of a ligament. The ligaments involved are above the ankle joint. Recovery time for high ankle sprains is usually longer than regular ankle strains due to the location of the ligament.
Causes: Athletes that participate in high impact sports like football, basketball, soccer and lacrosse are most likely to have an ankle sprain. The injury occurs when your foot twists or turns while you are running or jumping.
Symptoms: High ankle sprains do not appear to be as severe as regular ankle sprains because they don’t always swell or bruise. You may have pain around the joint and up the leg, with pain while walking.
How PT can help: Physical therapy treatment will help you increase the range of motion of the joint, gradually get you back to using your ankle comfortably. It will also focus on stretching and strengthening the muscles surrounding the joint to help you prevent future injury.
It is encouraged that you give the ankle enough time to recover while also maintaining some movement. During your initial evaluation, a printout of exercises will be provided for you to do at home. With proper rest and rehabilitation, you will be back doing your favorite activities in no time.
Range of motion- ROM exercises may include simple flexion and extension movements.
Balance- both static and dynamic balance exercises will help build strength in the muscles and ligaments surrounding the joint. These exercises help support ankle stability.
Plyometrics- these exercises include jumping and/or agility activity. They are important exercises for athletes returning to sport, but also important for all individuals when walking on uneven surfaces like sidewalks and sandy beaches or hiking on trails.
Exercises:
● Balance on single foot: standing close to the counter or wall, stand on one leg for 30 seconds.
● Resisted ankle plantar flexion with a band: wrap the band around the ball of your foot, pull back on the band slightly and then press the ball of your foot into the band as if you are pressing on the gas pedal. Repeat 20 times.
Achilles Tendon Tear
Description: The Achilles tendon attaches your calf muscles to your heel. This tendon is needed when you walk, run or jump. It is also needed to rise up on your toes or point your foot. When the tendon becomes inflamed, it becomes painful and swollen leading to tendonitis.
Causes: Achilles Tendonitis can be caused by sudden increase in activity, calf tightness or a bone spur.
Symptoms: Common symptoms include pain and stiffness along the Achilles tendon in the morning, pain along the tendon or back of the heel that worsens with activity, severe pain the day after exercising, and thickening and /or swelling of the tendon.
Traditional Treatment: Avoid activity that places increased stress on the tendon such as running up hill or jumping.
How PT can help: Physical Therapy will decrease the inflammation and will stretch and strengthen the calf and leg.
Exercises & Stretches:
● Heel drop: Stand on the edge of a stair or raised platform. Put the ball of your feet on the step and hold on to the railing. Slowly lift your heel up and slowly lower down. Perform 20 reps
● Standing calf stretch: Place hands on the wall with one knee straight and heel flat on the ground. Place the other leg in front and then slowly lean into the front leg, keeping heel on the ground. Hold for 30 seconds.
Stress Fractures
Description: A stress fracture is a small break in a bone that most often occurs in the bones of the foot, as the foot carries the weight of your entire body.
Causes: Stress fractures can be the result of overuse or repetitive force on the feet like with jumping or running. Other causes include:
● Improper footwear
● Improper training/exercise technique
● Other foot problems such as tendonitis or bunions
● Osteoporosis
Symptoms: Pain is the most common symptom that can arise from stress fractures in and around the break. Pain can be deep within the foot and may arise after normal activities. Swelling can also occur.
Traditional Treatment: Typically, stress fractures can heal on their own if necessary, actions are taken such as decreasing activity level, stopping the high impact activity that is suspected to have caused the stress fracture, and use of protective footwear. Sometimes a walking boot is necessary to allow the foot to rest.
How PT can help: Physical therapy will help with a gradual return to activity. Gait training, stretching and strengthening are common activity to restore normal movements.
Exercises & Stretches:
● Ankle alphabet: Place your foot off the edge of the bed and slowly draw the letters of the alphabet using your foot and ankle.
● Calf stretch with towel: Roll a towel and loop it around the ball of your foot. Keeping your knee straight gently pull the foot back toward you until you feel a stretch in the back of your leg. Hold 30 seconds.
Sever’s Disease
Description: Sever’s disease is heel pain in young athletes resulting from repetitive stress and overuse to the growth plates of the heel. This condition is typically seen during the 2-year rapid growth period at the beginning of puberty.
Causes: Sever’s disease can result from participation in sports and physical activity where running and jumping occur. Doing these activities on hard surfaces can cause irritation. Putting constant pressure on the heel, like standing for long periods of time, can be a cause. Improper footwear can bother the heel as well.
Symptoms: Pain and tenderness in the heels are the most common symptoms. Other symptoms include:
● Heel swelling and redness
● Difficulty walking
● Waking up in the morning with stiffness in the foot
● Tight calf muscle
Traditional Treatment: Sever’s disease goes away on its own when the bone of the heel is done growing or if physical activity is reduced.
How PT can help: Proper stretching exercises will help the muscle stretch while the bones are still growing. Manual treatment will help with the tightness also.
Exercises & Stretches:
● Calf stretch: place hands on the wall with one knee straight and heel flat on the ground. Place the other leg in front and then slowly lean into the front leg, keeping heel on the ground. Hold for 30 seconds.
Heel Spur
Description: A heel spur is a calcium deposit that develops at the bottom of the heel. While this may not directly cause pain in your ankle, heel spurs are often associated with plantar fasciitis (mentioned above).
Causes: Heel spurs develop over time and are often a result of muscle or ligament strains in the foot, irritation of the plantar fascia, or repeated tearing of the membrane surrounding the heel bone. Heel spurs can also be caused by jumping and jumping.
Symptoms: Like previously mentioned, heel spurs are often associated with other foot pain. Symptoms are similar to those of plantar fasciitis.
Traditional Treatment: Physical therapy is a common treatment of heel spurs. Often times shoe orthotics can help reduce pain and ice is recommended to reduce swelling.
How PT can help: Our expert Physical Therapists will identify the areas that are causing the strain and leading to the bone spurs. Common treatment will include stretching the tight muscles, strengthening the weak muscles and manual treatment to allow for proper alignment and foot mechanics.
Exercises & Stretches:
● Calf stretch: place hands on the wall with one knee straight and heel flat on the ground. place the other leg in front and then slowly lean into the front leg, keeping heel on the ground. Hold for 30 seconds.
● Rolling foot on a lacrosse ball or golf ball: place the ball below one foot and roll it from the ball of the foot to the heel.
Description: As the body ages degenerative changes in the spine, such as spurs and degenerating intervertebral discs between the vertebrae, can occur. Spondylotic changes in the spine are frequently referred to as arthritis. Degenerative disc disease is not actually a disease but an age related condition that happens when one or more of the discs between the vertebrae of the spinal column deteriorates or breaks down, leading to pain.
Causes: When the joints in the spine experience trauma, the protective cartilage wears down and bone spurs form. These changes lead to malalignment, stiffness, pain and poor mobility.
Symptoms: Common symptoms include back pain, weakness, numbness and pain that radiates down the leg.
The aging process can not be cured, but physical therapy can address the pain, strength, flexibility and functional deficits. Spinal injections can help with pain and inflammation.
How PT can help: Increased core strength can help minimize the stress to your spine, improve posture, reduce inflammation and decrease your pain. Many people benefit from the low impact activity during Aquatic Therapy. The buoyancy of the water can help relieve the pressure on the spine due to the arthritis.
Exercises & Stretches:
● Posterior pelvic tilt: Begin by lying on your back with your knees bent and feet flat on the floor. Using your abdominals, gently roll your hips backwards, feeling your low back press downwards towards the floor. Hold as directed. Repeat as directed.
