Q & A

Stroke Tennis Elbow

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Fibromyalgia Syndrome:

My sister is having trouble sleeping and complains of pain and burning throughout her muscles. She says that she hurts all over. She has been diagnosed with Fibromyalgia Syndrome by her doctor. What is fibromyalgia and how is it treated?

Fibromyalgia is a complex disorder which is characterized by widespread muscular aching and burning throughout the body. Some patients say that they feel like they have the flu all of the time. This syndrome is also associated with other disorders which include chronic fatigue, sleep disorder, irritable bowel syndrome, chronic headaches, temporomandibular joint dysfunction, and sensitivity to the environment such as odors, noise, bright lights, etc, among other symptoms. Fibromyalgia typically occurs among women of middle-age, but it also occurs in men and in other age groups. There are many theories as to the cause of fibromyalgia, but no definitive answer as of yet. However, fibromyalgia is a self-limiting condition meaning that it is not a terminal illness, but a cluster of symptoms that require daily management in order to function as normal as possible. Some of the current treatments include improving deep level sleep that is so crucial for body functions, trial of different medication schemes, physical therapy, stress-management techniques, relaxation techniques, therapeutic massage, and a consistent exercise program. It is possible to manage fibromyalgia symptoms with a comprehensive treatment plan in order to return to normal daily activities.

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Ergonomics:

I have worked as a receptionist in a busy office for 15 years. I have headaches and aching in my neck and shoulders almost every day during and after work. I saw my doctor who told me to assess the “ergonomics” at my work station. What does this entail?

Ergonomics is the study of how people interact with their work environment. If you work in an office, this means how you “fit” at your work station. An improper fit can cause strain and fatigue on your spine and muscles that support your spine. Some questions you can address are:

  • Can you adjust your seat height?
  • Are your feet firmly on the floor?
  • Are hips at the same level as your knees?
  • Do you have a good lumbar support?
  • Are your arms supported by armrests?
  • Is your keyboard at a height where your wrists are not bent?
  • Are your shoulders relaxed, not “shrugged”?
  • Is the center of your monitor at eye level and arms length from you?
  • Do you have a document holder?
  • Do you have a wrist rest?
  • Are you able to take short breaks to move out of a static position?

These questions should help you take a good look at how your body is positioned while you perform your desk job. Ergonomic improvements do not have to be expensive and can be the difference of whether you can perform your job efficiently and without discomfort.

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Frozen Shoulder:

My doctor is sending me to physical therapy for a “frozen shoulder”. I have heard physical therapy is very painful. What is a frozen shoulder, and what should I expect during my treatment?

A frozen shoulder, which medically is called adhesive capsulitis, means that you have significant loss of mobility of your shoulder movement. The cause of a frozen shoulder is varied. It can result after injury to the shoulder, but many cases are from an unknown cause. Many times patients will describe their shoulder as becoming increasingly stiff and painful over a period of time. The pain is progressive over a period of weeks and often results in the patient limiting their movement due to pain which causes a cycle of more pain, less movement, more pain, with increasing loss of mobility. This loss of motion results in being unable to do simple tasks such as reaching overhead into a shelf or behind the back to tuck in a shirt.

In physical therapy, you will first undergo an evaluation performed by the physical therapist where your range of motion, strength, and overall function of the shoulder joint and shoulder blade will be assessed. Specific exercises will be prescribed and most likely the therapist will perform joint mobilization which is a hands-on technique to improve the mobility of the shoulder joint. While it is true that physical therapy can be uncomfortable particularly while trying to regain joint mobility, therapy should never cause excruciating pain. Your therapist may use modalities such as moist heat, ultrasound, ice, etc, to help reduce your discomfort. Also other techniques can be used such as the therapist letting you know how long to count through each stretch, breathing techniques, and short breaks between each stretch. These techniques will help get you through the more uncomfortable aspects of regaining joint mobility and on your way to recovery.

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Tips for New Mothers:

I have a seven-month old baby who I breast feed and also carry frequently on one side or the other throughout the day. By night time, I have pain and burning in my mid-back area. What can I do to help reduce the discomfort?

What you are describing is very common among new mothers. First of all, the position of breast feeding tends to place the mother in a slumped posture with also the added weight of holding the baby. Some simple things you can do to reduce the stress on your back is to first make sure your feet are supported. This will help maintain the normal curve in the low back area and stabilize your pelvis. Using pillows is the next step to assure good positioning. Your arms must be able to rest comfortably with the weight of the baby, so place pillows under the baby and also under your arms so your elbows and forearms can rest easily. There are many commercial brands of nursing pillows available that you could try, or just plain bedpillows or throw pillows will work also. A pillow behind your back can assist in maintaining good posture so that breast feeding can be an enjoyable experience, not a painful one.

Carrying and lifting a baby frequently through your day can cause burning and aching throughout your mid to low back area. When you hold the baby on one side, it forces the hip to hike upward on that side and the spine to slump forward. This causes the spine to be held in an awkward, strained position. When the weight of your body leans off the vertical line, your muscles must work overtime to hold your body up and your joints will be loaded in imbalanced ways. This position, over time, can cause pain and discomfort. Obviously a mother will need to lift and hold her baby frequently, but there are some things you can do to minimize the stress placed on your back. The spine functions best when it is kept in good alignment with good posture. When holding your baby, maintain a balanced posture, particularly keeping your abdominals tightened and contracted. Even while indoors, wear comfortable shoes with good arch supports to improve shock absorption through the spine. Learn and practice correct lifting techniques for picking up your baby. If standing in one position, prop one foot up on a foot stool. This helps maintain the proper inward curve of your low back. Keeping your body fit with a walking or exercise program particularly after childbirth will also allow your body to withstand the strain of carrying your baby. If your symptoms persist, you will need to consult your physician.

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Sprained Ankle:

I first sprained my ankle as a teenager, but have sprained it many times since. I seem to sprain it so easily now and have to be very careful how I step to avoid injuring my ankle. My doctor recommended physical therapy to help my ankle. How will therapy help?

When you sprain your ankle, the ligaments and soft tissue are stretched beyond their normal limits. This leads to pain, swelling, and difficulty walking for several days. But, there is also injury to the joint “proprioceptors”. These receptors send a message to your brain to tell you where your body is in space. We know about other senses such as taste, hearing, and smell, but we also have a position sense – knowing where your body is in space. For instance, close your eyes and using your senses, “feel” where your foot is. Proprioception is the body’s ability to react appropriately to your position sense. With the ankle, this means that your foot and ankle can adjust to uneven surfaces such as walking on gravel or a grassy, bumpy yard without injury. When a joint is injured, there is a deficit in proprioceptive feedback to the brain. This leads to problems with balance and coordination which can cause recurrent ankle sprains. During physical therapy, the joint receptors can be re-trained by using specific exercises and activities that challenge the balance and reaction time of the injured joint. This rehabilitation will help to strengthen your ankle, improve proprioception, and reduce the risk of re-spraining the ankle.

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ACL Injury:

I have heard a lot about injury to the “ACL” during sports. What is an “ACL” injury?

In the knee, there are four main ligaments that hold the knee together and keep it stable. The function of a ligament is to hold bone to bone. The ACL is the Anterior Cruciate Ligament which is one of the ligaments inside the knee joint. This particular ligament prevents the lower leg bone, the tibia, from sliding too far forward or rotating on the thigh bone, the femur.The ACL can be injured during sports or activities that require excessive pivoting or twisting of the knee. The ligament can also be injured during hyper-extension or lateral trauma to the knee. The person may hear or feel a “pop” in the knee followed by swelling and difficulty continuing the sport or activity. The athlete may feel a sense of instability of the knee during activity. An evaluation by an orthopedist will determine if surgical reconstruction of the ligament is needed. If surgery is performed, the athlete usually spends several months in rehabilitation to regain full function of the knee in order to return to sports.

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Bulging Disc:

I have been diagnosed with a bulging disc in my low back. Will physical therapy help me or is surgery my only option?

The spine is comprised of 24 separate bones – 7 cervical (neck), 12 thoracic (chest), and 5 lumbar (low back) – called vertebral bodies and two fused bones at the base of the spine called the sacrum and the coccyx. Located between each of these vertebral bones is the inter-vertebral disc, which is a gelatin-filled structure that provides shock absorption and separation of the vertebral bones. The spinal cord which controls movement and sensation of the arms and legs travels through a canal within the vertebral column. The nerves exit from each level of the spine and travel into the extremities to provide motor and sensory function.

You may hear of disc injuries being referred to as a slipped disc, bulging disc, herniated disc, or disc protrusion. When a disc bulges, the jelly-like center pushes outward against the disc wall and places abnormal pressure against the spinal nerves. This can cause pain, numbness, tingling and weakness into the legs if it is a lumbar disc, and into the arms if it is a cervical disc. There are varying stages of disc injury from a mild bulge to complete herniation of the disc contents. After an evaluation by the physician is completed and the appropriate diagnostic studies are performed, physical therapy can be very beneficial particularly if the patient is treated during the early onset of symptoms. There are numerous occasions where physical therapy is successful in treating disc problems and surgery is prevented.

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Osteoarthritis:

I have been diagnosed with osteoarthritis. I have heard that exercise helps, but I am concerned that it will make my symptoms worse. How does exercise help?

Osteoarthritis, or degenerative joint disease, is one of the most common types of arthritis. It is characterized by wear and tear of the joint’s cartilage. Cartilage is the part of the joint that cushions the ends of bones. When the cartilage breaks down, it causes the bones to rub against each other, causing pain and loss of movement. For many years, it was thought that people with arthritis should not exercise because it would further damage the joints. Now doctors and therapists know that people with arthritis can improve their health through moderate exercise without hurting their joints. Exercise can be very beneficial. One slogan frequently used with arthritis is “motion is lotion”, meaning movement of the joint helps to lubricate it and keep it mobile. Exercise also keeps the muscles surrounding the joints strong which aids in protecting the joint. Other benefits of exercise include improving your energy level, helping you sleep better, and improving your sense of well-being. One general rule to follow is, if you have more than two hours of increased soreness or discomfort after exercise, then you have done too much. Back down on the amount of exercise during the next session. Along with your prescribed medications, rest and other parts of your arthritis treatment program, regular exercise can help keep your joints in working order so you can continue your daily activities.

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Stroke:

How does physical therapy help someone who has had a stroke?

A stroke, which medically is referred to as a cerebrovascular accident or CVA, is an injury to the brain. The injury can result from various conditions, including a bleed in the brain, lack of oxygen to the brain, or certain illnesses such as meningitis. The brain controls all functions of the body including your movement. One side of the brain controls the opposite side of the body. For instance, if a stroke occurs on the left side of the brain, it typically affects the right side of the body and may affect other functions such as speech and swallowing. Right-sided strokes can cause paralysis on the left side of the body, and can also cause problems with decision-making skills, analytical and perceptual tasks such as judging distance, position and performing fine motor skills.In physical therapy, the patient would undergo a comprehensive evaluation to determine the degree of impairment. The physical therapist will assist the patient in regaining skills that were lost due to the stroke. This can occur through re-training the muscles to perform their original function and by teaching compensatory techniques to make up for muscles that may no longer work. The physical therapist will address walking and balance skills, transferring from one position to another, improving strength and range of motion, and regaining overall mobility for daily activities. Depending on the severity of the stroke, the outcome may vary from a full recovery to a life-long impairment. The ultimate goal of physical therapy is to return the patient to their previous lifestyle.

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Tennis Elbow:

My doctor just told me I have tennis elbow, but I don’t even play tennis. What is tennis elbow and how does physical therapy help this condition?

Tennis elbow, which is referred to as lateral epicondylitis, is an injury to the muscles and tendons along the outside aspect of the elbow joint. This condition typically results from overuse or repetitive stress. This injury does not only happen to tennis players, but to people who perform repetitive movement of the elbow such as mechanics, cake decorators, butchers, gardeners, etc. The muscles involved are the ones that extend (backward bend) the wrist joint. The symptoms include difficulty gripping and lifting objects especially if the elbow is straight, pain and stiffness at the elbow joint, tightness and weakness of the forearm muscles, and tenderness along the outside of the elbow where the tendons attach to the bone.

Lateral epicondylitis can become a chronic problem if not treated properly. The initial phase of treatment attempts to decrease inflammation and pain by resting the joint and using modalities such as ice or iontophoresis. Iontophoresis is sometimes referred to as a “shot without the needle” as this modality uses an electrical current to push anti-inflammatory medication into the target area. It is a very effective tool to decrease swelling at specific areas. The next phase of rehabilitation targets improving flexibility, strength, and function of the elbow and forearm musculature by utilizing a therapeutic exercise program. The last phase of treatment emphasizes a gradual return to activity.

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