Achilles Tendon Tears: Are you at Risk?

The Achilles tendon is the largest and strongest tendon in the body, but unfortunately the aging tendon undergoes various changes that put it at risk for injury. Some changes that increase with age include decreased collagen density, decreased glycosaminoglycans and water content, decreased tensil strength and increased stiffness.

A study of 891 ruptured tendons in humans revealed 97% of the changes were degenerative in nature and about 50% of them were Achilles tendons.

How can you keep your Achilles tendons healthy?

Know your risk factors associated with Achilles tendon disorders and schedule an appointment for a physical therapy evaluation to determine the likelihood of your developing an Achilles tendon disorder and to learn research proven treatment strategies to help strengthen and avoid surgical repair.

Risk factors include:
-abnormal dorsiflexion (increased or decreased ability to flex foot)
-abnormal subtalar range of motion (increased or decrease foot joint mobility- pronation or supination)
-decreased plantar flexion strength
-abnormal tendon structure
-medical conditions associated with Achilles tendon disorders: diabetes, obesity, high blood pressure, high cholesterol

Treatment:
Studies have shown and proven that eccentric exercises with a focus on slow and controlled movement is an extremely effective nonsurgical method to treating Achilles tendonitis/tendonosis. Below are some helpful exercises for anyone dealing with symptoms or has been diagnosed with this very common injury.

Eccentric Heel Drop on Step: (Achilles Tendon Strengthening)
Begin this exercise with both feet in a neutral position with only the forefoot on the step
Perform a toe raise with both feet
Remove the unaffected leg from the step and slowly lower the affected back to neutral, keeping knee straight
Perform 3 x 15 repetitions twice a day. This is maintained every day for 12 weeks.
As soon as 2 x 15 repetitions twice a day can be done pain free, the load should be increased.
Progression:  Loaded Eccentric Heel Drop on Step–now add weighted dumbells to increase difficulty and to build strength

Side Planking for Scoliosis

Side Planking for Scoliosis

by Dylan Bartley, MSPT, CMP

Researchers at Columbia College of Physicians and Surgeons in New York produced some promising results in the treatment of scoliosis with just one simple exercise: a side plank. This common yoga pose was performed on the convex side of the curve. So if your scoliosis bows out to the right, you should put your right arm down and lift your right hip up off the floor. They offered variations to accommodate varying levels of fitness and different types of curves. The poses were held for as long as possible, once a day, starting at 10-20 seconds.

To measure the success of their intervention, they took x-rays before and afterwards and measured the degree of curvature in their subjects. After 6 months, they found a significant improvement of an average of 41%. They tried to see if there was a difference between younger subjects and older subjects with more degenerative changes and both groups responded well with no significant difference between the two groups.

Scoliosis is a problem of imbalance and asymmetry that tends to progress as we age and can lead to debilitating arthritis and muscle spasm if it goes unchecked. Over the years doctors have tried to stabilize it with complicated surgeries involving rods or uncomfortable braces. Physical therapists have tried to correct it with stretches and strengthening the core and spinal muscles. It would make sense that to treat this problem of asymmetry one would need to attack it with a set of asymmetrical exercises. Unfortunately, there has been little research to back up these hunches until now.

If you are interested in getting an assessment of your spine to see if you have scoliosis or if you’re ready to treat a scoliosis you’ve always known you’ve had, physical therapy is a great place to start. We can set up a custom protocol that would match your current level of fitness and show you how to progress things as you get stronger. Furthermore, structural factors such as a leg length discrepancy or pelvic/sacroiliac dysfunction can be the driving force behind your scoliosis and may be treatable with physical therapy.

To see the original article, click here

A Modern Take on Rotator Cuff Injuries

A Modern Take on Rotator Cuff Injuries

by Cindy Dehan, MS PT 

The shoulder is considered to be one of the most intricate joint systems in the entire human body, with interactions between the upper arm (the humerus), the scapula, and the thoracic spine, in addition to the complex neurovascular system. The rotator cuff plays a vital role in proper shoulder function. Specifically, the rotation cuff system consists of the interaction of four major muscles: the supraspinatus, the subscapularis, the teres minor and the infraspinatus. The primary roll of the rotator cuff is to center the shoulder joint and allow for proper joint motion.

Identifying the reasons for shoulder pain can be just as complex as the shoulder system itself. Similar to the spine, it is difficult to determine a true pathoanatomical “culprit” for shoulder pain, and it may be more beneficial to conceptualize issues found in the shoulder with regards to functional limitations. The American Physical Therapy Association recently published a clinical guideline article regarding the shoulder and outlined three separate types of classifications that shoulder issues may fall into. Shoulder pain and mobility deficits/adhesive capsulitis (frozen shoulder), shoulder stability and movement coordination impairments/dislocation of the shoulder joint, and shoulder pain and muscle power deficits/rotator cuff syndrome. Any of these conditions can impact the rotator cuff, but for the purposes of this article, we will focus on the muscle power deficits/rotator cuff syndrome (RCS) classification.

Traditionally, pathology of the rotator cuff was thought to be almost always be related to issues with impingement, where compression and high levels of friction were associated with the pain and dysfunction often reported by patients. More recent evidence suggests that mechanical loading of the tissue may cause changes to the tendon quality and contribute to the sensitivity of the tissue. Overhead movements such as throwing, can increase tensile load. Reaching overhead can increase the compressive forces in part of the shoulder complex. It is not uncommon to find pain while catching at midrange when lifting the arm. In fact, pain and weakness are common when performing movements that place any stress onto the rotatory cuff system.

Very few things in life have a specific protocol that you can follow from start to finish without having to adjust a little. Managing rotator cuff issues is no different. Given the fact that underlying cause of shoulder pain and dysfunction can be multifactorial the interventions should be selected to treat the impairments, not necessarily the diagnosis. Specific exercises which address the scapula and rotator cuff, in conjunction with manual therapy, has been shown to be beneficial for patients with RCS. It is also of benefit to look at the mechanics and relationship of the thoracic spine to the shoulder, as treatment to the thoracic spine may improve certain shoulder impairments. Core/midline stabilization can also contribute to issues seen in the shoulder based upon the specific activities someone participates in.

In an ideal world, we could develop a series of movements, exercises or hands on treatment that could fix everyone just the same. But the challenge is that we all are very unique and while we might share a common complaint of shoulder pain, the underlying cause is very different from person to person. That is why it is important to have a thorough, comprehensive exam so that the individual characteristics associated with your shoulder can be addressed and a detailed, personalized approach can be implemented.

Enhance Your Balance

by Dylan Bartley, MSPT, CMP
  • Falls are the leading cause of death from an injury in persons over 65
  • 75% of emergency visits are fall-related
  • 40% of hospital admissions in persons over 75 are the result of fall-related injuries

Technical Stuff

Definitions:

  • Balance is a complex process involving the reception and integration of sensory inputs, and the planning and execution of movement, to achieve a goal requiring upright posture. It’s the ability to control the center of gravity over the base of support in any given sensory environment.
  • Reflexes are automatic responses by the peripheral or central nervous system to help support postural orientation; they occur rapidly enough to not be under volitional control

Balance comes from 3 places

  • Visual System: helps us see things in the environment and orient us to the hazards and opportunities presented
  • Vestibular System (the inner ear): provides the brain with information about the position and motion of the head in relation to gravity; it contributes directly to postural stability
  • Proprioceptors/somatosensory receptors: located in joints, ligaments, muscles, and the skin

Balance is also dependent on:

  • Strength
  • Good flexibility
  • Reflexes and motor planning

When Things Go Wrong

  • The Brain needs input from all 3 systems (visual, vestibular, proprioception) to distinguish motion of the self from motion of the environment
  • Nausea, vomiting, dizziness often result as a mismatch in inputs
  • It takes the brain a little “extra work” to deal with mismatches
  • Example: When sitting in car at a stoplight and seeing car next to you creeping forward, you slam on your brakes
  • Example: When you are boating, proprioceptors perceive a rocking boat under your feet, but your eyes just see a steady horizon
  • there may be medical reasons why one of the three systems are not functioning like a stroke or diabetes or just poor vision. Make sure you are getting the help you may need to address these problems whether it is from a Physical Therapist, Doctor, or Optometrist

Treatment

Use it or lose it! Through practice and repetition, you can help the brain get used to these mismatches and be able to distinguish when the mismatch means trouble, or when it’s OK.

Do your routine 3 times a day, 10-20 reps to get your brain reprogrammed.

It may be a quick routine that only takes 5-10 minutes.

Extrinsic Risk Factors to Address

  • Check your environment: loose cords and rugs can pose threats
  • Does your home have adequate lighting, adequate space?
  • More injuries and falls are likely in crowded situations

Exercises

Minolta DSC

Single Leg Stand

tandem standing

Tandem Standing

BOSU02

Stand on BOSU or Wobble Board or Trampoline

Ways to increase the difficulty with the above exercises:

  • Close the eyes
  • Swing the arms, Spiraling, Reaching outside of your center of gravity
  • Tossing an object with a friend or bounce one against a wall
  • Scanning your eyes and turning your head from side to side

Vestibular Exercises

  • Walk and read
  • Walk while reading a moving book
  • Walk and turn head while reading
  • Walk and turn head with eyes closed

 

As always, we are here at Active Marin to help you through an individualized program to enhance your balance, whether to prevent another potentially debilitating fall, or improve your performance in your favorite sport. 

call us at 415 385 3755 or email us at info@activemarin.com for an appointment or more info

Anti-Inflammatory Foods

by Dylan Bartley, MSPT, CMP

In treating any injury in physical therapy, one must take inventory of how one’s body is prepared to fight it. We all need a good immune system and a quick response to an injury. Inflammation is a necessary part of that response, helping to temporarily immobilize the area and bring valuable inflammatory cells to begin the repair process. But our inflammatory system has a tendency to get out of hand with all the stress we place on our bodies and toxins in the environment.

Tuning up your diet a little to quiet the inflammatory system is often a great way to stay in balance. Often times an improper diet is actually the cause of excess inflammation. If one has an allergy to dairy or gluten, that person’s immune system will be working on overload to fight the food that the body has decided is toxic, and inflammation will run rampant through the body. So in building a diet to fight inflammation, one must first make sure that the diet is not the cause of inflammation. Once you’ve done that, now it’s time to add in some foods shown to control an overproductive inflammatory system. Here’s a list compiled from Jennifer Cole, Editor of FrozenShoulder.com. If your shoulder injury or knee pain has been lingering for more than a few weeks, check in with a physical therapist and go grocery shopping for some good food.

 

TOP 10 ANTI-INFLAMMATORY FOODS

    • Certain types of fruit are well regarded for their anti-inflammatory properties, specifically red, purple and blue fruits. Red grapes, for example, contain quercetin an antioxidant which may be effective in reducing inflammation. Blueberries, contain high levels of anthocyanin, an antioxidant that is known to be effective in minimizing swelling. Try to eat organic fruit wherever possible as pesticides are often hard to wash away, especially on small berries.
    • Pineapple is known to contain an enzyme which has been found to have anti-inflammatory properties. This enzyme is called bromelain. Wherever possible try to eat fresh pineapple as far less bromelain is usually present in canned products.
    • Many vegetables contain properties that may help act as anti-inflammatory agents. Try to eat plenty of fresh – ideally organic – cruciferous Vegetables. These include cauliflower, broccoli, brussel sprouts, cabbage, cress and bok choy. These vegetables are all loaded with antioxidants that can help rid the body of harmful compounds.
    • Salmon is one of the healthiest fish you can eat and is known to contain anti-inflammatory omega-3’s. It’s always better to eat fresh fish wherever possible and wild salmon is one of the highest regarded anti-inflammatory foods. Try to include oily fish in your diet your diet at least twice a week.
    • Ginger is known to have a host of health benefits. A 2010 study showed that daily consumption of ginger helped to reduce muscle pain associated with exercise by a staggering 25%. Ginger is simply a great addition to any diet as well as being effective in reducing inflammation.
    • Extra Virgin Olive Oil provides a large amount of those special fats that are effective at fighting inflammation – in addition to providing various other health benefits. It should be relatively easy to find a way to incorporate extra virgin olive oil into your daily diet. This pure oil is considered by many in Mediterranean culture to be the secret to longevity!
    • Garlic has been linked to positive health claims for just about everything from the common cold to heart disease. There are numerous claims and counter-claims about the effects of garlic as an anti-inflammatory food. , We decided that garlic should make this list purely based on the overwhelming amount of anecdotal evidence – but remember, the myth maybe larger than reality!
    • Turmeric is an Asian spice that is known to contain curcumin – a natural anti-inflammatory compound. Curcumin is also often found in various curry blends and is believed by many to be a powerful natural pain reliever.
    • Sweet Potatoes are well known to have a positive anti-inflammatory effect are a valuable source of complex carbohydrates, beta-carotene, fiber,manganese and vitamins B6 and C.
    • Despite numerous studies, there is little evidence to support the claims made for the anti-inflammatory properties of Green Tea. Nonetheless, the health benefits of green tea have been lauded in asia for centuries and just about every nutritionist continues to promote it’s wonders!