Clinical Question

Ankle Sprain Treatment and Prevention

An ankle sprain occurs when the ligaments in the ankle are stretched or torn, and most commonly occurs on the outside of the ankle. This occurs when the foot rolls inward, placing excessive stress on the ligaments and can occur during a fall, landing awkwardly after jumping, or running or walking on an uneven surface.

Signs & Symptoms

  • Swelling
  • Bruising
  • Painful to touch ankle
  • Painful to move ankle

Treatment

  • Within the first 48-72 hours, it is important to utilize the RICE principle (Rest, Ice, Compression, Elevation) to minimize inflammation, pain, and swelling.
  • Range of motion exercises in all directions and stretching of the calf muscle will help to minimize loss of mobility and stiffness in the ankle joint.
  • Ankle strengthening exercises will increase the stability of the ankle to allow full return to all activities with decreased risk of re-injury.
  • Proprioception allows you to sense where your body parts are in space and in relation to the rest of your body. This is accomplished through sensory receptors called proprioceptors located in the muscles, tendons, and joints. Using proprioceptive and balance exercises helps to train this sense, thereby increasing ankle stability. These exercises are an important component to any ankle sprain treatment program.

A physical therapist will devise the most appropriate treatment and exercise plan for your specific injury, progressing you to a point where you are able to return to all functional and sport-related activities. If you suspect an ankle sprain, the physical therapists at Harbor Physical Therapy can evaluate you to determine the degree of injury.  Based on the severity, we may refer you to a medical doctor if a more serious injury such as a fracture or complete ligament or muscle tear is suspected.

Poor Posture Can Cause Headaches

There are 3 major types of headaches:

  1. Cluster
  2. Migraine
  3. Tension

Cluster and migraine headaches generally are due to a problem with the blood vessels while tension headaches are typically due to poor posture. Tension headaches usually cause a dull pain in the head, neck, temples, scalp or shoulders.

Forward head posture is a leading cause of neck pain, headaches, and shoulder pain. For every inch your head is located more forward from sitting right on top of your shoulders, the perceived weight of your head increases by 10 pounds.

Steps to improve posture:

  1. Set-up your work station to decrease strain on your neck.
    • The top 1/3 of the screen should be even with your eyes.
    • Elbows should rest comfortably by your sides.
    • Hips should be slightly higher than your knees with your feet flat on the floor.
  2. Use a supportive neck pillow for sleeping.
  3. Perform neck stretches throughout the day.
  4. Perform postural strengthening exercises throughout the day.

If these steps do not improve your posture, schedule an appointment at Harbor Physical Therapy to address tight musculature and receive a catered exercise program based upon your presentation.

What is Shoulder Impingement?

Shoulder Impingement occurs when one of your rotator cuff muscle tendons becomes pinched, or impinged, between the bone in your arm and your shoulder blade. The friction on the muscle can cause increased pain and inflammation when lifting up the arm as the muscle becomes pinched between the two bony landmarks. If you feel pain in the front of your shoulder when lifting your arm overhead, it may be caused by shoulder impingement.  It is important to address the cause of shoulder impingement, as repetitive stress on the muscle can lead to a rotator cuff tear.
shoulder-impingement-picture

Causes:

  • Repetitive overhead movements performed during sports such as swimming, baseball, tennis, and volleyball, or during such activities such as overhead weightlifting or painting.
  • Weakness of the rotator cuff muscles, causing decreased shoulder stability and abnormal shoulder mechanics.
  • An injury or fall onto the shoulder.
  • Bony abnormalities that narrow the space underneath the shoulder blade.

How Harbor Physical Therapy can help:

  • Reducing pain and inflammation in the shoulder through modalities such as ice, heat, and electrical stimulation.
  • Patient education on which activities should be performed and which should be avoided.
  • Restoring range of motion to the shoulder through exercise and manual therapy.
  • Promoting normalized movement patterns with proper body mechanics.
  • Strengthening the shoulder complex and rotator cuff to increase shoulder stability and prevent further injury.

What is Knee Valgus?

Knee valgus is characterized by your knee collapsing inward when your hip flexes. You may also notice that the opposite side of your pelvis may collapse downward. This is seen most often in squats, lunges, jumps, landing, and descending steps. Women are more susceptible to knee valgus because women have a wider hip angle compared to men. Knee Valgus can lead to patellofemoral knee pain, ACL tears, and IT band syndrome.

jamie

Listed below are causes of Knee Valgus:
1. Weak gluteal muscles allows for over compensation of inner thigh muscles pulling the knee inwards.
2. Restricted ankle mobility does not allow for knee to progress forwards over the toe.
3. Inadequate quad strength (specifically vastus medialis function) effects knee stability and can cause the patella to track improperly.
4. Weak hamstrings may similarly allow the knee to cave in.
5. Improper motor planning of movement and poor execution of movement.

A physical therapist can help address the causes of knee valgus and provide exercises to minimize the symptoms and effects. This can be done through strengthening, stretching, and proper training of movement execution.

What is SI Dysfunction? How can Physical Therapy Help?

What is the SI Joint?

  • Sacroiliac joint
  • Lies at the bottom of the lumbar spine and above the coccyx (tailbone).  It connects the sacrum with the pelvis.  SI joints are strong and have very tight, strong ligaments connecting the bony surfaces.

What is the function of the SI Joint?

  • Acts as a shock absorber for the pelvis and low back.
  • It has minimal motion compared to other joints.
  • Transmits forces from the upper body down the pelvis and legs.

Why do I get pain at my SI joint?

  • Pain happens when the SI joint moves too much or too little.
  • Direct strain or trauma to the SI joint ligaments.
  • A fall on the buttox or mis-stepping a descending step.

Diagnosis

  • Can be difficult to diagnose because the symptoms can be diffuse and can mimic other common low back and hip injuries.
  • Assessing pelvic alignment, leg length, and palpating bony landmarks may help determine whether this joint is involved.
  • More advanced diagnostic tests like MRI, X-ray, CT scan can help with diagnosis but can also miss the correct diagnosis.

Treatment

  • Physical therapy can be very helpful with conservative management of SI joint dysfunction.
  • Assess pelvic alignment and use techniques to correct alignment.
  • Stretches to help with pain and lack of mobility.
  • Dry needling, massage, and heat can help with muscle spasms.
  • Ice can help with inflammation and irritation surrounding the SI joint.
  • Strengthening exercises to the applicable hip and core musculature will be given to help stabilize and normalize the proper pelvic alignment.

What Are The Benefits of Kinesiotape?


 kinesiotape

Kinesiotape is a 100% elastic tape with a breathable design, developed in 1970s and introduced clinically in mid-1990s. Kinesiotape has the ability to be stretched to certain levels of tension depending on the purpose of each particular taping technique. Kinesiotape is non-constrictive, providing support and stability while still allowing a muscle or joint to move through a normal range of motion.  To learn about the benefits of Kinesiotape for an injury, check out below:

Kinesiotape Usage

 

 

Defining Sciatica

Pain in the buttocks that radiates down the leg is referred to as sciatica. The most common cause of sciatica is irritation of the spinal nerves in or close to the spine. Sometimes the source of sciatic pain can be further down the leg in the buttocks. Before the sciatic nerve begins its path down the back of the leg, it runs under or through a deep pelvic muscle called the piriformis. When the piriformis squeezes or irritates the sciatic nerve, this can cause symptoms of sciatica. It has not been definitively proven why the piriformis sometimes starts to irritate the sciatic nerve. Most physicians feel it is from the muscle spasming and tightening to squeeze the sciatic nerve against the pelvic bone. It can also occur from a fall onto the buttocks that bruises the piriformis causing swelling and pressure against the sciatic nerve. As the muscle heals, scar tissue forms which is not as elastic as normal, healthy tissue. This can continue to put constant pressure on the sciatic nerve.

What is a Trigger Point?

We have close to 400 muscles in the human body.  Muscles can develop trigger points which can refer pain and cause dysfunction. Symptoms can range from intolerable agonizing pain caused by “active” trigger points, to painless restriction of movement and distortion of posture from “latent” trigger points.

There is not conclusive research on the definition of a trigger point.  However, many characteristics have been observed for decades by researchers all over the world. There are many mechanisms by which we develop trigger points. Some of those mechanisms include poor posture, injury to a muscle, muscle overuse, and repetitive stress overload. Trigger points limit range-of-motion and cause muscle fatigue.

When pressed on, trigger points feel like “knots” or tight bands in the muscle, and are usually tender. Healthy muscles usually do not contain knots or tight bands and are not tender to pressure.

Good news!!! Physical Therapy diminishes trigger points. Physical Therapy addresses trigger points by identifying and treating the primary driver of the trigger point.  This is done through trigger point release, massage, and posture re-education.

Herniated Disc- Definition and Symptoms

A herniated disc is a condition in which the tough outer wall of an intervertebral disc (a soft cushion that sits between each vertabrae of the spine) has been weakened. The herniation causes the cushion that sits between the vertebra to be pushed outside its normal position.

A herniated disc commonly occurs in the low back and sometimes in the neck. Very seldom do they occur in the mid-back due to the extra stability provided by the rib cage. In some cases, a herniated disc will press against the spinal nerves, causing pain, numbness, tingling, or muscle weakness.

Pain
Pressure on the nerve can cause abnormal sensations, commonly experienced as electric shock pains. Compression in the neck region causes pain down your arms and compression in the low back region causes pain down your legs.

Tingling & Numbness
You might experience sensations such as tingling, numbness, or pins and needles. These symptoms may be experienced in the same region as painful sensations.

Muscle Weakness
Because of the nerve irritation, signals from the brain may be interrupted causing muscle weakness. Nerve irritation can also be tested by examining reflexes or having your doctor perform an EMG test. An EMG test is a technique for evaluating and recording the electrical activity produced by skeletal muscles.

Bowel or Bladder Problems
These symptoms are important because it may be a sign of Cauda Equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency! See your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals.

If you experience any of these symptoms listed above, contact your physician or physical therapist to determine the appropriate course of treatment.