Author Archives: Greg Macionsky

Do You Have a Physical Therapist?

Do You Have A Physical Therapist?

Written by: Matt Schildknecht PT, DPT

Raise your hand if you have your own, personal physical therapist, who knows you and your musculoskeletal history. If both your arms are still at your sides, don’t worry, you’re not alone. Most of us have our own pediatrician, family physician, dentist, orthodontist, dermatologist, etc. These clinical professionals know us by name and know our pertinent medial history. And yet, none of these professionals are skilled at assessing the one thing we all do every day…..MOVE! These professionals are essential to healthy physical growth and development, but they are not movement specialists like a physical therapist. So, why should YOU have YOUR own physical therapist?

 

Let’s first define who a physical therapist is and what he/she does? The American Physical Therapy Association (APTA) defines a physical therapist as a “highly educated, licensed healthcare professional who can help patients reduce pain and improve or restore mobility, in many cases without expensive surgery and often reducing the need for long-term prescription medications and their side effects.” More simply put, a physical therapist is a movement specialist. A physical therapist is a doctorate level clinician who specializes in examining, understanding, and correcting movement. Physical therapists consider the entire body, from head to toe, when assessing movement. They consider things like strength, muscular balance, flexibility, joint mobility, and coordination, and how each of these factors effect movement. Then, they develop a plan to ensure maximum efficiency and quality of any movement pattern, from the most basic getting up and down from a chair, to the more complex motions of throwing, swinging a golf club, and even gymnastics.

 

But why is movement so important? I mean, it seems pretty basic, right? We do it from the day we are born, and we typically do it without much thought. But, it’s not that simple. Our health and quality of life rely on movement. Most of the chronic pain we experience is due to repetitive faulty movement patterns. Many of the acute injuries we suffer are caused by a sudden break down and error in a movement. And, our musculoskeletal system (our muscles and bones), which makes movement possible, is considered the most reliable indicator of overall health. So, if you’re interested in avoiding chronic pain or acute injuries, and you value your overall health, then we can agree that healthy, functional movement is VERY important and should never be taken for granted.

 

So, what steps can you take to choose and build a relationship with a physical therapist (PT)? First, do some research and find a local PT who specializes in an area of your interest (e.g. running). Many PTs have specialty areas of clinical practice, including sports, chronic pain, vestibular dysfunction, and even specific regions of the body (e.g. low back or shoulder). Once you find a PT, talk to your parents about contacting the office where YOUR PT practices and setting up an initial evaluation. In many cases, YOUR PT will do a free screen and discuss with you (and your parents) any areas that may increase your risk of injury or impair your quality of movement. Ask YOUR PT for a home exercise program, which is a list of exercises you can do at home to address any movement related impairments found during your screen. Find out what social media YOUR PT uses and follow them, or check their website for regular updates. These can be great resources for daily and weekly tips and recommendations for a healthier, active, and injury free lifestyle. Ask your coach or teachers to invite YOUR PT to perform an injury prevention screen for your entire team or classroom (PTs love doing this!). Consult YOUR PT before you start a new sport, or change to a new exercise routine. They can make sure you have the necessary movement tools to avoid injury and perform your best. Make YOUR PT your first contact if you develop any new pain or suffer an injury (ask YOUR PT about Direct Access, which allows you to participate in physical therapy without a physician prescription for up to 30 days). And finally, schedule an annual movement screen with YOUR PT. As your body changes, your movement changes, so you’ll definitely want to follow up regularly with YOUR PT to get the most out of every move you make.

 

If you have any questions, please contact me, Dr. Matt Schildknecht, or Kinetic’s Adolescent Sports Medicine Program Director, Dr. Michelle Feairheller. Our contact information is right on this website. We’re more than happy to tell you the many ways a PT can make you an All Star in the game of life. And the next time someone says, “raise your hand if you have your own PT”, I hope you enthusiastically throw your hand in the air!

Prescribing Ice after an Injury- Is it time to COOL it?

Prescribing Ice after an Injury

Is it time to COOL it?

Written by: Greg Macionsky ATC

Most people who have played organized sports or competed in something that requires some sort of movement at one time or another suffered an injury.  Getting hurt is as much a part of the game as scoring a goal, making a basket, or catching a touchdown.  Frontline healthcare providers, such as athletic trainers and physical therapists, have relied on ice as a means of controlling pain and swelling after injury.  This goes back decades and is the most utilized modality to treat acute injuries; however, recent evidence suggests that not only have the positive effects of icing been overstated, but it may delay the healing process.

This isn’t to say that ice does not have any positive effects.  Ice is a proven pain control modality, but this relief typically only lasts for 20-30 minutes post icing.  Unfortunately, this short-term pain control can negatively impact the healing process.  It does so by reducing inflammation.  Wait what?  Isn’t inflammation a bad thing?  Hasn’t that been the message of every healthcare provider ever?  This has been the prevailing thought not only within the medical community but among the public as well.  However, recently this theory has come under fire from a number healthcare providers and researchers.  The general idea behind that critique is that inflammation is not a bad thing.  In fact, inflammation is vital to the healing process.  The fluid that enters the injured site is responsible for carrying cells that begin the healing process.  These cells are responsible for releasing hormones into the injured tissue.  There is no disputing that ice slows the inflammatory process, so it is not a stretch to conclude that by keeping those important cells from reaching the injured tissue the healing process would be delayed.

If ice is not the answer, what should healthcare providers be prescribing?  Exercise!  The best thing one can do after suffering an acute injury is promote healing via appropriate rehabilitative exercise.  This includes focusing on restoring range of motion, strength, proprioception, and balance.  Early introduction of range of motion exercises is vital to decreasing stiffness to the injured area and restoring normal motion.  Ice would do the exact opposite.  When ice is applied the injured area becomes stiffer which can delay the process of regaining normal motion.  Exercises that build strength are important for increasing stabilization of the injured area, and for preventing re-injury once the individual returns to sport participation.  After suffering an injury proprioception, or the body’s ability to sense where it is in space, is compromised.  The physical manifestation of decreased proprioception is the joint feeling unstable or a sensation of “giving out.”  Combating injury is most effective when these areas are addressed.

While ice can help limit pain after an injury overutilization of this modality can have a slowing effect on the healing process.  Most athletes want to get back onto the field as quick as possible.  To achieve this, a rehabilitation program that focuses on range of motion, strength, balance and proprioception should be implemented as early as possible.

 

The Spondy’s

The Spondy’s

Krista Caldwell, SPT and Nick Legacy, SPT

spondy

 

 

 

 

 

 

 

Spondylolysis is a crack or stress fracture of a section of the lower back, also known as the lumbar spine. Your lumbar spine contains 5 bones called vertebrae, and with this injury the 5th vertebrae is most commonly affected. This stress fracture can occur on one side or both sides of your body. According to the American Physical Therapy Association, this happens to 11.5% of the population in the US, and it occurs more commonly in sports requiring the athlete to bend backwards repeatedly, twist, and lift heavy loads. Does your sport require any of those movements? This injury is commonly seen in gymnasts, football players, hockey players, and dancers. It is often more common in young males. The two main causes are overuse in sports and genetics.

Spondylolisthesis describes the forward slippage of one vertebrae over the vertebrae below it. This often occurs along with spondylolysis because the bone is cracked so badly that it has difficulty staying in place. This slippage often occurs during a growth spurt.

These conditions do not always have obvious symptoms and may not be discovered until an x-ray is performed. Low back pain is the most common symptom. If you participate in one of the sports mentioned above and are experiencing low back pain here are some other symptoms to look out for:

  • Pain similar to a muscle strain in the back
  • Radiating pain into buttocks and/or thighs
  • Worse with exercise/activity
  • Better with rest
  • Back stiffness
  • Tight hamstrings
  • Trouble with standing/walking
  • Trouble with prolonged sitting
  • Relief with bending forward
  • If severe, possible numbness and tingling in legs

With proper treatment and adequate rest an athlete can recover from this in about 3-6 months.  Most athletes suffering from a “spondy” are free from pain after treatment and return to their sport with no or few issues. This injury can be prevented through proper education to athletes at high risk (gymnasts, football players, dancers, etc.). A young athlete at risk should monitor volume, intensity, and frequency of exercise. Parents should limit athlete to one high risk sport a season, only one team at a time during season, one or two days of rest a week, and slow increase in training volume/intensity/frequency. Proper core and glute training, back strengthening, and appropriate footwear can play a role as well. Lastly, proper rest, nutrition, and hydration are important for all athletes.

Work Cited

Merkel, Donna, PT. Spondylolysis. Move Forward PT, Published May 14, 2014. http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=493929d9-d02a-4c87-81dd-f1550a701f9e

 

Spondylolysis and Spondylolisthesis. American Academy of Orthopedic Surgeons. September 2016. https://orthoinfo.aaos.org/en/diseases–conditions/spondylolysis-and-spondylolisthesis

 

 

 

 

 

Specialization in Youth Sports

Specialization in Youth Sports

Dr. Ken Charleston PT, DPT

It has been a growing trend for youth athletes to specialize in a single sport. I believe this trend has become popularized by the notion that by funneling all energy into one set of sport specific skills will develop an elite level athlete. The hard truth is that a very small percentage of high school athletes will achieve collegiate level athletics and an even smaller number of athletes will ever play at the professional level. There is also growing evidence that suggests single sport specialization leads to more negative outcomes than it does positive. Athletes that participate in one sport only are at an increased risk for overuse injuries, psychological stress and burnout.

Of course there are several other factors that contribute to injury risk in athletes, however the most important risk factor was exposure.  Single sport athletes are at an increased risk for overuse injuries such as patellofemoral pain syndrome, Osgood Schlatter and Sinding Larsen-Johansson compared multi-sport counterparts.

Psychological stress and burnout should also be of concern.  Single sport athletes may experience dropout due to stress, decreased motivation and lack of enjoyment. Youth athletes that specialized too early also show increased rates of physical inactivity as an adult.

My recommendation to youth athletes is to participate in multiple sports throughout the year.  Injuries can happen in any sport, however, by shifting from single sport focus to adopting other athletic endeavors, the athlete is at a reduced risk for developing overuse type injuries.  By participating in a single sport year round, you may be missing out on other athletic experiences in which you enjoy. There is a time and a place for specialization, however this should be reserved for athletes after puberty and when at higher levels of competition. Participate in your favorite sport, but explore others as well. Become a better overall mover and athlete in the process.

How to Deal with Calf Muscle Injuries

How to Deal with Calf Muscle Injuries

Written by Jordan Stone

As an athlete you deal with aches and pains throughout a season. Some of those are part of the game while others can easily be prevented. The purpose of this article is to help you prevent calf injuries.  If your calf is already, hurt do not hesitate to come and see a physical therapist who can further assist you.  These are just basic identification and prevention tips!

What most people typically refer to as the calf is actually made up of three separate muscles (the gastrocnemius, soleus, and plantaris) that all come together to form the achilles tendon. The most common of these to be strained is the gastrocnemius. The mechanism of injury is often a rapid extension of the knee accompanied with the foot being in dorsiflexion (think trying to touch your toe to your shin). If the strain is in the gastrocnemius, it is likely that the individual will be tender in the belly of the calf. The gastrocnemius muscle originates above the knee and this means in order to be stretched or strengthened the knee must be extended. To stretch it try lunging into a wall and with your back leg keep it straight while pressing your heel into the ground. To strengthen the muscle try getting just the balls of your feet on a stair with your heels hanging off and raise your body as high as you can and lower yourself all the way down. The Plantaris is rarely injured and even if it is hurt, it is typically treated similarly to the gastrocnemius, so there is not much need to differentiate it from the gastrocnemius.

Lastly, injuries of the soleus are often misdiagnosed as gastrocnemius and therefore under reported. Most often the symptoms of a soleus strain are calf stiffness, tightness, and pain that worsens over time. If the strain is in the soleus it is likely that the individual will be tender towards the outside of the calf. The soleus muscle originates below the knee and this means in order to be stretched or strengthened the knee must be flexed. To stretch it try getting into the same lunge position as the stretch for the gastrocnemius. Now,  move your back foot closer to the wall and bend your knee while still pressing your heel into the ground. To strengthen the muscle move to a seated position with one flexed (knee towards chest). With the bent leg place a band around the ball of your foot and use both hand to hold/ stretch the band toward your body. Push your foot down toward the ground and slowly let it rise back up and repeat.

If you are already hurt the above will not be enough nor is it intended to replace proper rehabilitation. Please seek out help from a medical professional if you are concerned about already being injured, the above is meant to help spot and prevent an injury before it occurs.

Backpack Safety Tips

Backpack Safety Tips
Dr. Katie Poole, PT, DPT

Did you know that how you wear and pack your backpack can have an impact on your health? According to the American Physical Therapy Association, backpacks should weigh no more than 10-15% of your body weight. So for example, if you weigh 100 pounds, your backpack should not weigh more than 10-15 pounds. Unfortunately, many of you carry backpacks much heavier than this, causing your body to have to adapt to the heavy load. You do this by arching your back, leaning forward, or leaning to the side if only one strap is used. These changes in posture can cause strain and fatigue in the muscles of the neck, shoulders, back, and abdominals, leading to possible neck, back, and shoulder pain, headaches, and tingling in the arms.

Now that you are a few months into the school year and I’m sure your backpack is getting heavier as you get more projects and homework, here are some tips for wearing your backpack correctly:

  • Proper fit. Your shoulder straps should fit comfortably and allow your arms to move freely. The bottom of the backpack should be at your waist, not sagging towards your buttocks, as this puts more pressure on your back and shoulders.
  • Use both straps. Wearing both straps helps to distribute the weight of the backpack evenly and promote symmetrical posture. Find a backpack with padded shoulder straps if possible.
  • Wear the waist strap. If your backpack has a waist strap, wear it to help distribute the load of the backpack to your pelvis.
  • Both the shoulder straps and the part of the backpack against your back should be padded.
  • Lighten the load. Take frequent trips to your locker, only carry necessary items home, and carry books in your arms if necessary.
  • Balance the load. Especially if your backpack has multiple compartments, put the heaviest items (textbooks, laptop, etc.) closest to your body.

In addition to making sure that your backpack fits and is not too heavy, it is also important to watch your posture while carrying and lifting your backpack. When picking up your backpack, your back should be straight and neutral, not rounded, and you should lift with your legs, using good squatting mechanics. If your backpack is hard to lift, it is probably too heavy.

If you have any questions about your specific backpack, how heavy it is, and your posture, call your Physical Therapist and they can help you adjust your backpack, improve your posture, and increase your strength so you stay pain free.

Truth or Myth? Sports Related Concussions

Truth or Myth?  If You Sustain a Sports Related Concussion You Should Sit in a Dark and Quiet Room Until All Symptoms Subside…..MYTH!

Dr. Daniel Luczka PT, DPT, CSCS

More and more evidence is strongly supporting that an early return to physical activity, within 1 week, may reduce persistent symptoms of a concussion.   The Journal of the American Medical Association published a study that involved over 2,400 children and adolescents between the ages of 5 and 18 years old who sustained a concussion.  The findings showed that out of those who participated in early physical activity, only 28% still had persistent post-concussion symptoms compared to those who did not participate in early physical activity, over 40% of them continued to have persistent post-concussion symptoms at 28 days post injury.

The benefits of aerobic exercise on the brain have been documented for years.  Protocols such as the Balke or Buffalo Concussion Treadmill Test have been proven to be safe and effective in finding the proper dosage and intensity of physical activity post-concussion to help speed up the recovery of the athlete.

Do not fall into the out dated protocol of being told to “sit in a dark room and do nothing.” Make sure you are seeing a medical professional who is up to date on the most current research for Post-Concussion Syndrome.  Call your Physical Therapist as soon as you suspect a concussion to help ensure the best medical care is being provided!

Rehabbing the ACL, Both Physically AND Mentally

Rehabbing the ACL, both physically AND mentally
Dr. Lisa C. Clark, PT, DPT

The last time I wore the number 17, I was carried off the field. I had experienced the dreaded “pop”, the horrifying buckle, my worst fear. I had torn my ACL in double overtime, halfway through my senior lacrosse season. My college career was over and I was devastated. In the last 4 weeks of that season, I watched my teammates play the game I loved while I worked my hardest to prepare for a surgery I never wanted. The emptiness that I felt was overwhelming and lonely. I felt like my identity had been stripped from me. Being an athlete was all that I knew and, suddenly, it was just over.

Now, as a physical therapist, I treat athletes like me all the time. Luckily, many of them are young enough to return to their sports and find plenty of success, like receiving athletic awards and commit to colleges. The amount of joy that we both feel is tremendous. Many of these kids didn’t think they’d ever get back to sports, but they did and it took a lot of work to get there.

Tearing the anterior cruciate ligament (ACL) is, perhaps, the most feared diagnosis in all of sports. Physical symptoms include significant joint pain and swelling, loss of range of motion, quad weakness, difficulty walking, feelings of instability. In most cases, a reconstruction is the best option for anyone who would like to return to sports involving a change of direction. The rehabilitation process can take anywhere from 6-12 months. Many people staring this prognosis in the face are understandably overwhelmed. For athletes, though, this is an entire year of sports. Maybe 3 or 4 competitive seasons or a recruiting year that they’re missing out on. While they see their friends trying to make college decisions, they are just trying to walk, run, and squat properly.

Along with these physical symptoms comes the mental and emotional response, which is not often discussed, but is very prevalent. Perhaps even more important than rehabilitating the knee is rehabilitating the mind. Research shows that psychological responses, such as depression, anxiety, fear, and anger, are significant in cases where an athlete has suffered a severe injury. These emotions are shown to have a large effect on the rehab process. Athletes with depression, for example, are less likely to adhere to their treatment and home exercise programs. They struggle with returning to their sport, may experience a social withdrawal, and are at an increased risk for suicide. Literature suggests that athletes with depression are more likely to demonstrate poor functional and orthopedic outcomes and report a lower quality of life.

Even more significantly vulnerable for negative responses to injury are those who already have a history of depression. Athletes between the ages of 15-25 are the most at-risk group for ACL tears. This age group is also most vulnerable to suicide. Thus, depression following an injury is even more problematic in our adolescent and collegiate athletes. In general, injured athletes who gain self-worth and self-esteem from performance have been shown to be at risk for negative responses in comparison to their peers who are uninjured.

While this information is intimidating, it is worth mentioning that research indicates that most athletes return to their sports with minimal complications following proper rehabilitation. Therefore, as a clinician, I do all that I can to help ensure my patients that I thoroughly believe they will return to their pre-injury status. The hardest part is convincing them of the same thing, which can be an uphill battle. I always discuss the mental portion of ACL tears, like fear, discomfort, frustration, and grief. I let them know that these feelings are normal and encourage them to talk with teammates, coaches, family, friends, or even me. Sometimes just acknowledging these emotions and talking about them can take away their power. We also set goals and try to accomplish them one-by-one. I also try to schedule my ACL patients together so that they form a comradery with each other. That is sometimes more helpful than anything – strength in numbers and emotional support. If that isn’t enough, though, I encourage my patients to utilize the many resources we have to ensure our athletes are making a complete physical and mental recovery: primary care or mental health practitioner, sports psychologist, cognitive behavioral therapy, counselors or wellness professionals (to name a few).

If you are a PT/ATC/MD or any clinician reading this: please take the time to educate your ACL patients about how much mental health affects their outcomes and their return to athletics. Understand that depression can make it difficult for patients to be consistent with visits and remain compliant with home exercises, especially with time spans of 6-9 months. Instead of being frustrated, be encouraging. Show that you care and use what you know to help to motivate them. Increase their number of visits as they get closer to their return-to-sport to make sure they are sticking to their programs. Rehab compliance can help to improve their physical and mental ability. Prove to them why that is the case.

If you are an athlete who has suffered an ACL tear and are in any stage of recovery: your mental health is a HUGE factor in your return to what you love. Your PTs and the people working around you want what is best for you. These are some symptoms of depression: sadness, isolation, irritation, lack of motivation, anger, frustration, changes in appetite or sleep, and poor concentration.

If you experience any of them, please talk to someone about it. These feelings are perfectly normal and can be dealt with in whichever way is most appropriate. If any of these symptoms are interfering with your rehab process, it must be taken care of. As I mentioned above, remember that depression will make it difficult for you to stick with your exercises, but the more effort you put in, the better you will be both on and off the field. Stay involved in team activities. Go to practices and games and team functions. Do whatever fundamental drills you can participate in (stickwork, ball handling, hand-eye reaction drills, etc). You are still part of a team, even if you’re not putting on the uniform every day.

Treating patients with ACL injuries is my passion, not just because I’ve been down that road, but because I love getting to know and understanding the whole person. Not just their knee, but their emotions, their goals, their passions, and their motivations. It would be a mistake for me and all of my colleagues to not address the most important part of ACL rehabilitation: the mental recovery.

Jumper’s Knee for the Basketball or Volleyball Athlete

Jumper’s Knee for the Basketball or Volleyball Athlete
Written by : Dr. Paul Mackarey

As an athlete in many sports you are asked to run, cut, and jump. You ask your body to go through many different movements and forces day in and day out. We all have aches and pains, but some pains are better to be aware of than others.

Are you a jumping athlete?

Do you play basketball or volleyball?

Have you ever had pain just below your kneecap?

If you answered yes to any of these questions than this post is just for you!

Pain, ache, tenderness and/or soreness in the tendon just below the kneecap is a very common injury called patellar tendonitis or jumpers knee. Usually the pain seems to appear one day out of nowhere, this is known as insidious onset.

There are 4 stages of patellar tendonitis.  The first stage is associated with pain only after activity. It does not limit anything else that you do. The second involves pain during and after activity, however, you can still perform without limitation. The third stage is accompanied with lasting pain during and after activity and your performance starts to suffer. The fourth and final stage results in a complete tear of the tendon, which would require surgery. But don’t worry! If you are reading this, you will know what to do to help this long before you need surgery!

This type of injury is called jumpers knee because it is commonly associated with athletes who play sports that often involve jumping, like basketball or volleyball. If you play these sports, it is not uncommon to have some pain in the knees and if you start having pain at that spot below the knee, don’t worry! It is a very common injury and it can be treated with some easy exercises that you will learn today.

Patellar tendonitis has been shown to be associated with stiff ankle joints or ankle sprains (a very common injury that all basketball and volleyball players know too well). It is important not only to keep the knee strong but also the ankle strong as well. Another joint to consider is the hip and it’s strength. Your hip abductors (or the muscles along the outside of the hips) can help control and stabilize your knee when you are jumping and cause less pain.

Here are some exercises to consider:Decline Pistol Squats

Decline Pistols:

  • Stand on 20 degree slant board (or dumbbell)
  • Squat down (very slowly) with one leg, keeping knee over toe.
  • Go back up with 2 legs
  • It is OK to have 1-2/10 pain with this exerciseHeel Taps
  • Perform 2 sets of 15-20 reps.

Lateral Heel Taps:

  • Stand on step. Lower leg slowly until you tap your heel.
  • Remember to sit back and keep the knee over the toe.
  • Perform 2 sets for 10-15 reps.

Skater Squats:Skater Squats

  • Decline on one leg, bringing the backward until it taps the block.
  • Keep the knee over the toe.
  • Lunge back up with same leg.
  • Perform 2 sets for 10-15 reps.

Get Up!

By now you’re probably aware of the negative consequences of a sedentary lifestyle. For many, it’s the most detrimental health exposure faced on a daily basis. It’s an epidemic that should concern anyone invested in improving general health, fitness or movement.

Most kids probably sit more than their parents (which is saying something). A child who is stuck in a chair all day at school… And then stuck in a seat on the bus… And then slouched in a couch at home.

Today’s youth, just like today’s adults, tend to spend a lot of time at computers. Most people don’t sit at a computer in a good postural position. As we hunch over keyboards, the muscles of the front of the shoulders and chest shorten and their tension increases. Back muscles and those behind the shoulders elongate and have less tension. As we lean forward and peer into that computer screen, the same elongation occurs in the neck muscles. Together, those changes account for that hunched-over, head-thrust-forward look.

Grab a tennis ball, or lax ball and roll the front of your chest (pec muscles). Try to set a timer, every 30 minutes to remind yourself to sit up straight and pinch your shoulder blades together.

It gets worse. Having your legs bent under a desk all day shortens your hip flexors and psoas muscles, which attach to your pelvis and lower spine. That helps pull your lower back out of alignment, also affecting your posture.

Kneel in front of your desk chair. Prop one foot on the seat and pull your other leg into a half-kneel position. Slowly bring your chest up tall. You should feel a good stretch in the front of your hip-thigh.

Our children face additional challenges. Some youngsters carry school backpacks that weigh as much as 30 percent of their body weight, far too much for young muscles.

Keeping an extra set of books at home or school to help cut down on the amount of weight in your bag.