Injuries

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.

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.

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.

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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.

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.

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.

Call us at 781-326-8332

Injuries

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.

Call us at 781-326-8332

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.

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.

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.

Physical therapy will help to restore the proper alignment and movement resulting in decreased pain and improved mobility and posture.

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.

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.

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.

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.

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.

● 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.

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.

● 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.

Exercises & Stretches:

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.

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.

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:

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:

Causes: A total shoulder replacement is very successful for treating severe pain and stiffness due to arthritis.

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.

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.

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.

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.

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.

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.

Exercises & Stretches:

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.

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.