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Free Physical Therapy Series
Vol. 1 - The "Ache" Neck Pain
Vol. 2 - Heel Pain
Vol. 3 - Low Back Pain
Vol. 4 - Knee Pain
Vol. 5 - Rotator Cuff Tendonitis
Vol. 6 - Carpal Tunnel of the Wrist
Vol. 7 - Ankle Sprains
Vol. 8 - Stretching for Runners
Vol. 9 - Achilles Tendonitis
Vol. 10 - Inline Skating (Proper Protective Gear)
Vol. 11 - Neck Pain
Vol. 12 - Heat vs. Cold

Over the past 20 years of business we have had the privilege to treat hundreds and hundreds of patients such as you. Throughout these 25 years of our professional staff of Physical Therapists have been asked numerous questions regarding what can be done at home for other problems and injuries.

With this in mind, we have put together our newsletter, FREE Physical Therapy. Every few months we will address different ailments and provide helpful advice through our newsletter. Even though Physical Therapy is much more involved in treating your problems, these simple exercises may get you started in the right direction to feeling better.

*All information is intended for your general knowledge and education only and is not a substitute for direct medical advice or treatment for specific medical conditions.

THE "ACHE" NECK PAIN

Primary Treatment
1. Heat: Take a hot shower and let the water run on your neck. Or place a heating pad or hot water bottle on your neck. Keep it on long enough to allow your skin to turn a little red and warm up.
2. Rest: Try to avoid movements which aggravate your symptoms.
3. Pillows: Try an orthopedic pillow if you normal sleep with more than one pillow. Sleeping with too many pillows can cause an increased amount of stress placed on the muscles, ligaments and facets which can cause neck pain. The pillow will keep the curve in your spine in its proper position while you sleep and hopefully help with your pain.

HEEL PAIN
Heel Pain (Plantar Fascitis)
Do you suffer from heel and/or arch pain that is at it's worst the first thing in the morning and when you get up from sitting after a period of time? Does it feel like you are being stuck in the foot with a hot poker? You could be suffering from plantar fascitis. Plantar fascitis (heel spur syndrome) is the inflammation of the thick, fibrous band of connective tissue located under your foot that originates at the calcaneous (heel bone) and radiates up toward the base of the toes. The body’s reaction to this inflammation may cause the formation of spike-like projections of new bone, commonly referred to as heel spurs. Heel spurs, despite common misconceptions, do not cause the initial pain, nor are they the initial problem. Heel spurs are the result of a problem. What causes this inflammation and, more importantly, what can you do to treat it? This article will discuss the most common causes, contributing factors and treatments of plantar fascitis.

Plantar fascitis can occur in people of either sex, usually over the age of 40, except in the case of people with very active lifestyles. It is commonly found in people whose occupation involves prolonged standing or walking. Sudden increases in activity level or weight gain can also contribute to the development of plantar fascitis. Bone structure of the foot also plays a big part in plantar fascitis. People with flat feet have excessive pronation. This excessive pronation causes a prolonged duration of pronation with walking which can lead to chronic irritation and possibly even microtears at the plantar fascia origin. On the opposite end of the spectrum, a cavus, high arched (supinated) foot usually has a tight plantar fascia, which subsequently doesn't have the ability to disperse the force that is placed on it. This supination results in an increased load on the plantar fascia, which can cause irritation and pain. A final contributing factor to the development of plantar fascitis is poor shoe support. The type of support and best shoe for you depends on your foot structure and activity level. Most specialty shoe stores are able to help you find the right type of shoe.

Treatment for plantar fascitis is directed at both a short-term goal to control inflammation and to relive stress on the fascia as well as on a long-term goal of correcting the mechanical contributing factors. Initial home treatments include rest, anti-inflammatory medications and ice.

Soft tissue stretching of the gastro (calf) muscles as well as the plantar fascia is also beneficial. Gastroc stretching can be performed in a lunge position by placing your sore foot behind and your non-affected foot in front. Place your hands on a wall/table and while keeping your back knee straight, gently lean toward the wall/table until a pull is felt in the calf of your back leg. Hold this stretch for 15-30 seconds and repeat 3-5 times at least 3 times a day.

Doctor frequently recommend physical therapy for this type of problem. Physical therapy can include a combination of whirlpool to decrease tightness, ultrasound with hydrocortisone cream to decrease inflammation, various massage techniques to break up scar tissue, stretching, strengthening and/or balancing exercises. Surgery to release the plantar fascia might also be recommended by your physician if the pain is still intense after several months of trying conservative treatments.

Plantar fascitis is a common problem that often requires persistent treatment on your own, possibly with assistance of physical therapy. Plantar fascitis can take up to a year to heal completely-so don't give up on your treatment and exercises. Be patient and hang in there!

*All information is intended for your general knowledge and education only and is not a substitute for direct medical advice or treatment for specific medical conditions.

LOW BACK PAIN
Low Back Pain
It is estimated that nearly 100% of the population with be afflicted with Low Back Pain at least once in their lifetime.Low Back Pain can come from a number of different sources (Disc bulge, SIJ dysfunction, Muscle strain, Joint impingement, Nerve impingement, or Poor Posture just to name a few).No matter what the cause, LBP can be debilitating. While some Low Back Pain will resolve on its own, there are a few things that can be done to help speed the recovery or even prevent the problem in the first place.

Proper Body Mechanics and good Posture are critical to preventing Low Back Pain.Most people know to use good posture and Mechanics when lifting heavy objects, but it is critical to use good mechanics for everyday activities as well.

Lifting Technique: Proper lifting technique involves keeping feet at least shoulder width apart, stick your rear end out and keep your chest up, squat using your hips, knees, and ankles.Keep the object close to your body and slowly rise up to standing.

Reaching Technique: When reaching for light objects on the floor, NEVER combine bending and twisting.Instead, face the object and reach down with one hand while slightly raising the opposite foot off the floor like a golfer retrieving a golf ball out of the hole.

Sliding Technique: When sliding a heavy object like a couch or table push, rather than pull, whenever possible.

Standing Technique: When standing for long periods of time, try to place 1 foot on a small step and then alternate feet every few minutes.This will ensure that one leg is not constantly holding your weight.

Sitting Technique: Proper sitting postureinvolves sitting with your back against the chair, maintaining a slight curve in you lower back (a lumbar support pillow may help with this).Both feet should be flat on the floor and your shoulders and head should not be slouched forward.

Good Flexibility in the legs and trunk is also an important part of Low Back health. Stretches and Strenghtening of the lower back musculature are good for preventing and rehabilitating for many low back conditions. After a thorough evaluation, your Physical Therapist will instruct you on proper stretches and strengthening exercises for you particular condition.

Heat and Cold can also be very useful in the treatment of Low Back Pain. Cold is usually more effective in the first day or two after an injury or if swelling is suspected. Heat is helpful in reducing pain and relaxing muscles after 48-72 hours have past.Heat or cold should only be left on 10-20 minutes at a time, and should not be used while sleeping.

If you pain persists for more than 1 week, or if you ever have pain or numbness or tingling down your legs-please consult your physician.

*All information is intended for your general knowledge and education only and is not a substitute for direct medical advice or treatment for specific medical conditions.

KNEE PAIN
There are a variety of reasons people may feel knee pain; a few possible causes include tendonitis, patello-femoral syndrome, overuse injury and arthritis. Tendonitis is inflammation of the tendon usually resulting from a strain of the tendon. Patello-femoral syndrome is kneecap pain that is caused by the patella (knee cap) rubbing against the femur (thigh bone). This is often caused by muscle imbalances of the quads or gluts, ITB, calf, or quads, or by overuse with activities such as running. Arthritis is caused by degenerative changes to a joint surface resulting in the loss (breakdown) of cartilage (or cushion) in a joint. This can lean to painful inflammation of the joint in later stages.

Characteristic symptoms of these problems are pain while descending stairs, after prolonged walking, throbbing pain, aching, swelling, stiffness after prolonged sitting and pain that decreases with rest or ice.

Some common treatments you may want to try include the following:

Ice: Try putting ice or frozen peas or corn on your knees for 10 to 15 minutes while resting.

Stretching: Hamstring Supporting thigh behind knee, slowly straighten knee until stretch is felt in back of thigh. Hold 15 seconds. Repeat 5 times per set. Do 3 sessions per day.

Stretching: Quadriceps (Standing)

Pull heel toward buttock until stretch is felt in front of thigh. Hold 15 seconds. Repeat 5 times per set. Do 3 sessions per day.

For a full evaluation contact your physician for a PT prescription. A PT evaluation may consist of assessment of postural alignment, muscle strength, muscle length, patellar tracking, gait analysis and range of motion measurements.

ROTATOR CUFF TENDONITIS
What is Rotator Cuff Tendonitis?
It is an inflammation of the rotator cuff tendons. There are four muscles that make up the rotator cuff: Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor.

What does the Rotator Cuff do?
The rotator cuff helps to provide stability to the joint, reduce strain on ligaments and other surrounding muscles, help with rotation and movement of the shoulder, and to provide strength to the shoulder.

How is this caused?
Multiple factors play a role in causing pain and symptoms.

• Occupation
• Overuse in sports
• Poor training techniques
• Unstable shoulder
• Impingement in shoulder
• Direct trauma; falling directly onto your arm
• Weakness in the rotator cuff itself

Repetitive overhead activities are one other major cause of symptoms of pain or discomfort. They may eventually cause damage to the tendons. Overtime, tendons may wear thin and a tear can develop. Repetitive activities may include: washing your car, throwing a ball, and reaching.

Symptoms
You may feel an "ache," in the front of your shoulder. You may also feel sharp pains in the front of your shoulder with performing overhead activities. Pain may also be felt with reaching behind your back, putting on a belt, lifting objects from a shelf, and fastening underclothes.

Treatment Options
Initially, you may want to rest the shoulder from any painful activities and use an ice pack for 10-15 minutes at a time. You may also want to try an over the counter anti-inflammatory.

If the pain continues, you may consult your doctor about different treatment options.

One option may be Physical Therapy.

In physical therapy, we would help to decrease pain and inflammation, while restoring movement and strength. On your initial visit, we will examine posture, muscle imbalances, along with strength and range of motion of the entire shoulder. A home exercise program will be initiated, along with some treatment. We will work together with you, the patient, towards your goal: pain relief, strengthening, and returning to all activities.

CARPAL TUNNEL OF THE WRIST
Carpal Tunnel Syndrome
Symptoms of carpal tunnel syndrome can include pain, weakness, numbness, and tingling in the fingers, thumb, wrist, and arm. These symptoms are the result of pressure on the median nerve that lies within the palm side of the wrist. The carpal tunnel is a small space formed by the bones and a ligament of the wrist, through which several tendons and the median nerve run from the forearm to the hand. The median nerve controls movements of the thumb and sensation to most of the thumb, index finger, middle finger, and part of the ring finger.

Problems
Patients usually complain of a "pins and needles" feeling in the first 3 or 4 fingers, the wrist, and possibly the forearm or shoulder. This feeling usually starts gradually, but can progress to a constant painful sensation. The pain is usually worse at night and can awaken the patient frequently. The patient may also report "clumsiness" when using the fingers.

Cause
Carpal tunnel syndrome is one of the most common work related injuries, is more common in women, and is most common after the age of 40. The specific cause often remains undetermined, but the condition may stem from decreased blood flow to the median nerve or direct pressure on the nerve as it passes through the tunnel. This can be the result of structural changes, cumulative effect of overuse, or direct trauma. The fluid changes that accompany pregnancy can also trigger carpal tunnel syndrome.

What Can I Do?
Avoid frequent, forceful hand and wrist movements or activities that require repeated/prolonged flexion of the wrist. Night splinting can counteract and help prevent the pain caused by excessive wrist flexion that often occurs in one's sleep pattern.

Ergonomic considerations, such as maintaining 90 degrees of elbow flexion when working at a desk, can prevent repetitive motion strain.

Strengthening and stretching exercises to consider include: wrist circles, thumb and finger stretches, finger-thumb squeezes, wrist curls with palm up and with palm down, arm curls, and shoulder shrugs.

Our goal in physical therapy is to decrease pain through the use of modalities and soft tissue mobilization; to increase flexibility and range of motion of the surrounding joints and musculature; exercises to increase grip, wrist, forearm, shoulder, and scapular strength; and proper postural education, which is key to the success of carpal tunnel syndrome treatment.

Ask your physician if physical therapy is right for you.

ANKLE SPRAINS
What are the symptoms of an ankle sprain?
You could experience pain on either side of your ankle, on the top of the ankle or even tenderness to touch around the ankle. Your ankle may appear swollen or bruising may appear. You may experience pain on uneven surfaces, with stairs, with walking for long periods or attempting to jog.

An ankle sprain occurs when one or more of the ligaments in the ankle are over-stretched or even torn. There are varying degrees of ankle sprains which can be diagnosed by a physician.

How to Treat an Acute Sprain:
Protection: Many braces are available over the counter to help support the ankle while it is unstable. Simply stepping off a curb may re-injure an unstable ankle.

Rest: Stay off of the ankle as much as possible for the first 24-48 hours. You may want to rent crutches from a local drugstore if you must be mobile.

Ice: It is important to reduce the swelling by applying cold treatments. You may use a cold pack from the store or a bag of frozen corn or peas conform well around the ankle and can be re-frozen for re-application. You should apply ice 10-15 mins and may ice as frequently as every hour.

Compression: It will be useful to wrap the ankle with an ace wrap or compression sleeve to reduce swelling.

Elevation: Try to elevate the foot above the heart to aid in reducing swelling.

Exercises for the Acute Sprain
Simply trying to maintain motion in the ankle is very important initially. Gently point your foot up and down holding 10 sec in each position. Next, gently turn your foot inward and outward holding 10 sec in each position. Repeat 5-10 times several times per day and follow with an ice treatment of 10-15 mins.

**If your symptoms persist more than 1-2 weeks, seek medical treatment from a physician and you may request physical therapy at that time.

Why is Physical Therapy Important?
An ankle sprain even in its mildest form can leave the ankle weak and unstable. Without proper strengthening, it is very likely you may re-strain the ankle with something as common as stepping off a curb. Physical Therapists will provide an evaluation and determine a personalized treatment program which may include whirlpools, ultrasound treatments, stretching, and strengthening regime for return to your previous fitness level.

STRETCHING FOR RUNNERS
Runners can incur a variety of injuries throughout their training. Some can be caused from over training, mechanical problems or even over eagerness. Most people today tend to have sedentary lifestyles that do not allow them to stretch and use their muscles like they should. Over time these muscles become shortened. When you then try to run on these shortened muscles you can stress and strain them. One way to avoid these stresses and strains during your training is through stretching.

Whether you are a seasoned runner, or new to the sport, stretching is extremely important. It is recommended that you warm up with a short walk or light jog for 5 to 10 minutes prior to stretching. This helps to increase the blood flow to the muscles before trying to elongate them. A few examples of stretches for runners are:

Gastroc
Stand with right foot back, leg straight, forward leg bent. Keeping heel on floor, turned slightly out, lean into wall until stretch is felt in calf. Hold 15 seconds. Repeat 5 times per set.

Hamstring (Supine)
Supporting right thigh behind knee, slowly straighten knee until stretch is felt in back of thigh. Hold 15 seconds.Repeat 5 times per set

Tensor
Cross right leg over the other, then lean to same side until stretch is felt on other hip. Hold 15 seconds. Repeat 5 times per set.

Make sure to repeat the above exercises equally on each leg.

You must remember that the legs, although probably the most important, aren't the only part of the body that you need to stretch. Runners need to stretch their neck, arms, shoulders and back too.

If you do get injured while running, seek medical advice. Find out whether you just overdid it or if your injury could be due to faulty mechanics. A thorough evaluation by a doctor and a physical therapist can help you either way. Therapists can make suggestions to correct your mechanics, show you exercises tailored to your specific needs and get you back on the road to recovery.

ACHILLES TENDONITIS
Achilles tendonitis is a common overuse injury that accounts for around 11% of all running injuries. The Achilles tendon is the large tendon at the back of the ankle that connects the calf muscles to the heel bone. The symptoms of Achilles tendonitis include pain, tenderness, stiffness, and/or swelling at the Achilles tendon at the back of the heel. One may also note decreased strength and movement at the ankle. The causes of Achilles tendonitis include:

• Overuse or repetitive movements-During work, at home, or while playing sports. This includes repeated push-offs or stop-and-go motions present in running drills, basketball, volleyball, tennis, and dancing.
• Sports training errors-Not warming up properly or changes in exercise training schedules such as increasing mileage or the amount of hill training suddenly or too quickly.
• Poor footwear-Overpronation (flat feet), poor arch supports, and wearing high heels consistently then running places an increased strain on the Achilles tendon.
• Lack of flexibility-Tightness in the gastrocnemius and soleus musculature (calf muscles)

The best treatment for Achilles tendonitis is prevention. This includes stretching, wearing proper footwear, and correcting foot mechanics with orthotics if needed. If you are already experiencing the symptoms of Achilles tendonitis the initial home treatments include rest, anti-inflammatory medication, and ice. Your doctor may also prescribe physical therapy to help you treat this problem. Physical therapy treatments may include moist heat, massage, ultrasound, and stretching and strengthening exercises. Call your doctor if your pain is sharp, if you are having numbness and/or tingling in your foot, or if you heard a pop in your Achilles tendon when it was injured.

This is a stretch to help relieve some of your symptoms. Place your injured leg behind the other. While keeping the back leg straight with your heel on the floor, lean into the wall until a stretch is felt in the calf. Hold for 15-30 seconds, repeat 3-5 times, 3 times a day.

INLINE SKATING, PROPER PROTECTIVE GEAR
Inline skating is a great way to train in the offseason for Hockey, but is also an excellent form of exercise. Inline skating is a low impact, aerobic form of exercise that can burn up to 600-700 kcal per hour. Inline skating strengthens your back, quads, hamstrings, hips and even shoulders.

It is estimated that approximately 17-18 million people try inline skating each year. While some may think that this is a dangerous activity, reported injury rates are only 3.4 per 1000 skaters (that compares to 4.1 per 1000 for bike riding). The most common injury site is the wrist at approximately 25% of all injuries. 1/3-2/3 of these injuries could be avoided or made less serious with the use of proper safety equiptment.

Proper safety equipment includes:

1. Helmet

• • with certification sticker form CPSC, ASTM, ANSI, Snell
• • should fit 1 inch above eyebrows to the ridge on the back of your skull
• • should fit snugly on your head
• • the straps from the front and rear of the helmet should form a “Y” just below and in front of your ears.

2. Wrist guards

• • should have a hard plastic shell on the palm to protect your hands when you slide
• • should have firm support to protect your wrist if you fall on an outstretched arm

3. Elbow pads

• • should have a hard plastic shell to protect your elbows when you fall
• • should be snug, without limiting your elbow mobility much

4. Knee Pads

• • should have a hard plastic shell to protect your knees when you fall
• • should fit snugly, without limiting your knee mobility much

Before Beginning inline skating, here are a few safety tips:

• • Buy well fitting skates and safety gear
• • Check your wheels and breaks for wear (rotate wheels regularly to limit wear)
• • Get a lesson if you’ve never skated before
• • Master a few basic moves like: braking, turning, going forward and backwards, & avoiding obstacles
• • Never lean back on your skates
• • Take time to stretch calves, hamstrings, quads, back and hips
• • Only skate on well-lit marked trails
• • Avoid hills until you are comfortable
• • Don’t skate faster than your skill level allows
• • Be alert for other pedestrians and Traffic
• • Watch for debris on the trail—it is the most common reason for falls

Following these tips can help keep you safe and injury free while enjoying this fun form of exercise.

NECK PAIN
Pain located in the neck is a very common and aggravating medical condition. Often this pain can radiate into shoulders and between shoulder blades. Neck pain can come from a number of disorders or diseases of any structure in the neck. This article is strictly going to discuss the importance of strengthening, importance of upright posture along with education in some basic exercises to get you started and on your way to becoming pain free.

There are 7 vertebrae in the cervical spine. Important structures include discs located between the vertebrae, nerves of the neck and other structures including the muscles.

Below are some answers to questions that may arise throughout this article.

What is considered poor posture?
Forward head, roundness of the shoulders and upper back, back slouched and sitting without equal weight in both hips. Long hours in front of a desk, computer, prolong driving can cause complications, even crossing your legs when seated or wearing a thick billfold in your back pocket can cause not only neck; but back complications.

When your shoulders round forward (slouching), your head automatically follows. Gravity falls and applies pressure directly below the natural curve on your cervical spine causing increased tension on the cervical musculature and surrounding structures. Slouching also creates tightness in the anterior chest due to shoulders drawing forward.

What is scapular musculature?
It is muscles that attach between your shoulder blades.

Weakness of these muscles makes it easy to slouch and way to hard to sit upright for long periods of time.

One of the most common attributes to neck pain is muscle imbalance. The upper trapezius is a very small muscle in comparison to surrounding muscles. It attaches at the nodule at the base of the skull and inserts at the tip of the scapulae. The primary function of this muscle is to elevate the shoulder as in a shoulder shrug. A sign of overuse of these muscles can be stress headaches, muscles spasms in your upper shoulder/neck. Do find your shoulders creeping up to your ears? This happens at times without you knowing. Talking on the phone without using your hands or elevating your shoulder to avoid your purse falling off your shoulders is just a couple of examples.

In most cases, many use the upper trapezius muscle as a primary mover to push, pull, lift etc. This is incorrect. Your upper trap is to assist your mid back or scapular muscles with these movements. This is considered a muscle imbalance, meaning the incorrect activation of a particular muscle group with activity or exertion. So now is the time to start focusing on better posture, stretching out your chest and cervical muscles and begin strengthening your scapular muscles.

HEAT VS. COLD
When to Use Heat

For relief of pain or muscle spasms

Prior to an exercise session

For joints or muscles that are stiff

Heat produces many benefits including an increase in blood flow, a sedative effect on pain nerve endings and the relaxation of muscles around a joint. Heating pads, hot showers, warm tub baths or whirlpools (98 to 102 degrees) are good sources of heat.

When to Use Cold

In acute inflammation (noted by heat, redness and swelling)

For relief of pain and muscle spasms

After an exercise session

If the addition of heat to a joint or muscle increases pain or swelling

Using cold helps to control inflammation and swelling, relieve pain and reduce muscle spasms. A crushed ice pack, commercial cold pack or a bag of frozen vegetables wrapped in a towel are good sources of cold.

Whether you use heat or cold, always protect the skin. Always place adequate toweling between your skin and a heating pad or cold pack. Do not apply heat or cold for longer than 20 minutes at a time. Never fall asleep while lying on a heating pad or using an ice pack. Tissue damage could result (i.e. burns or frostbite).

*All information is intended for your general knowledge and education only and is not a substitute for direct medical advice or treatment for specific medical conditions.

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