Tuesday, June 4, 2019

Full Count-Overuse Injuries in Baseball

The Importance of Pitch Counts in Baseball

Baseball season is in full bloom; from intramural level to major league to everything in between.  This season also brings a surge of throwing for youth sports.  With this surge of throwing, comes an increase in both shoulder and elbow pain.  According to the High School Sports-Related Injury Surveillance Study, the majority of shoulder and elbow injuries occurred in pitchers.  Twenty five percent of these injuries resulted in missed time and about eleven percent resulted in season ending injuries.

Due to the high prevalence of chronic overuse injuries experienced by pitchers, it is important to follow specific pitch count guidelines.  According to the National Federation of State High Schools, pitchers averaging eighty pitches a game result in being more than four times as likely to need surgery.  Pitchers throwing eight months during the year are five times more likely to receive surgery and pitchers who throw until fatigue regularly are thirty six times more likely to need surgery.  Along with these statistics, overuse injuries tend to occur most often in the first four weeks of the season, possibly due to poor conditioning in the off season.   

A simple pitch count recommended for high school includes: 1-25 pitches requires no day off from pitching, 26-45 requires one day off, 45-60 requires 2 days off, 61-85 requires 3 days off, and 86-110 requires 4 days off.  The pitcher should never exceed 110 pitches.  Additional measures to prevent shoulder and elbow injury include: watching for signs of fatigue (slower pitching and decreased correct form), avoiding pitching for multiple teams and overlapping baseball seasons, avoiding pitching and playing other positions in the same game, and performing in different sports.  This will prevent pitchers from straining one set of specific muscle groups. 

Finally and most importantly,  pitchers should never pitch through fatigue or pain until being medically evaluated (possibly by a physical therapist).  The Physical Therapy and Wellness Institute offers sports conditioning training to decrease the chances of overuse shoulder and elbow injuries especially in the first four weeks of the season.  If an injury does occur, our clinics have state of the art equipment to help you return to your full level of pitching prior to injury and help you stay in condition for future seasons.

PTW’s Bill Murrary , DPT is a Staff Physical Therapist at our Hatfield and Harleysville clinics. For an initial evaluation, call Bill at 267.932.9177  today! 

Thursday, May 2, 2019

Pain and the Older Adult

As we age, aches and pains tend to occur more frequently, last a little bit longer, and hurt a little bit more than they used to. A sore or stiff joint or muscle that we may not have thought twice about 5 years ago is now preventing us from living our lives to the fullest. As physical therapists, we are often asked by older adults in the clinic about various medical interventions that they hear about: “My sister told me viscosupplementation for her knee did wonders, should I go get it done?”, “My doctor told me I have arthritis, do I need a knee replacement?”, “I have diabetes, should I sleep upside down to reverse my neuropathy?” The reason we get so many questions is that there is such an influx of information from various sources that it becomes difficult to discern rubbish from solid medical advice.
One common source of health information older adults turn to for information is AARP’s monthly magazine. Its own editor-in-chief describes it as “the best-read magazine in America according to latest total audience stats.” Questions that I received regarding a particular article in April’s edition titled “The Latest Gains in Pain” led me to wish to summarize this article and offer any insights that I may.

The article states that many older adults live with chronic, daily pain without a specific cause or condition, because pain, as it explains, is its own disease. It is also incredibly common-about 1 in 2 individuals over the age of 65 suffer from chronic pain. It differentiates acute pain (which has the
purpose to avoid tissue damage) from chronic pain (which no longer has any physiological or survival purpose and hangs around after tissue healing ceases). Seemingly unrelated findings including stress, obesity, and anger can actually exacerbate symptoms, making what would be a minor ache feel like a major debilitating event. Lastly, the article supports the stance that often opiates are less effective than exercise and other non-pharmacological methods.

The statement that chronic pain can take place in the absence of an identifiable cause (having pain despite having no muscle tears or joint breakdown) is groundbreaking. This means you can have pain without a direct mechanical cause. Just because your arm hurts doesn’t mean your rotator cuff is torn; simply because your back hurts does not mean the degenerated disc found on your MRI (which could have been there for years without causing any problems) is directly causing your back ache. This finding gives hope for those who are living with daily OTC or prescription-pain killers for chronic pain just because your disc may still be affected does not mean your pain also has to stick around forever.

There is a plethora of new information coming out regarding pain science which aides to drive treatment and help those who are in pain every day of their lives. To those of us who may have seen this article in a widely distributed magazine, talk to your nearest healthcare provider (including the wonderful folks at one of the nearby 9 PTW locations) to get you back to living your best life.

PTW’s Matt Brennan PT, DPT is a Clinical Director at our Hatfield clinic. For an initial evaluation, call Matt at 215.855.3359 today! 

Wednesday, March 27, 2019

Think BIG! Physical Therapy for People with Parkinson’s Disease

How Physical Therapy Can Help Parkinson's Disease Patients

Any type of new medical diagnosis can be scary and confusing. In the fall of 2016, my grandfather began seeking answers for his slower movements and inability to participate in activities he used to love, such as chasing after all his grandchildren. After many doctor’s visits, he was diagnosed with Parkinson’s Disease. It was his difficulty coming to terms with the diagnosis which led me to search for what could best improve his symptoms and quality of life! After some research, I came across LSVT and knew that I needed to become certified and use my grandfather as my first test subject. As soon as I saw the positive results both physically and emotionally in my grandfather, I wanted to make sure I achieved those same results with all my patients.

What is LSVT BIG?
LSVT stands for “Lee Silverman Voice Treatment” and was developed in 1987 by Dr. Lorraine Ramig. She set out to improve Mrs. Silverman’s voice production by creating a standardized intervention that was later adapted from speech therapy into physical therapy. It incorporates all types of exercises that target key motor symptoms by using repetition that can drive changes in a person’s movement. This re-training of movement can strengthen weaker connections in the brain that are a result of changes due to the disease. The main goal of LSVT BIG is to “re-calibrate” how a patient perceives their motions by training them to recognize the amount of effort required to increase the amplitude of their mobility. It also helps with slower and smaller movements, impaired balance and coordination, forward leaning posture, and difficulties with activities of daily life.

How is it different than traditional PT?
This therapy is different than traditional PT because it is delivered specifically by an LSVT Certified Clinician.  Since it is a standardized program, backed by research, it is scheduled for 4 times a week for 4 weeks. It is also one-on-one with a physical therapist for 60 minutes so that constant feedback and cues can be given to the patient. The program also incorporates specific tasks to each patient that are important to them, or are currently difficult to them, that would be beneficial to practice daily.

When should I start?
The earlier the better! The best time to begin this program is in the early to middle stages of diagnosis. However, it is beneficial for all stages of Parkinson’s Disease and can be adapted to almost all levels of mobility. If you are unsure if this program is right for you or your loved one, please contact us and set up a consultation.

If you have questions or if you or someone you know has recently been diagnosed with Parkinson's Disease and would like to schedule an appointment with our LSVT BIG Certified Therapist Alex Taratuski, PT DPT call 215-855-1160 today!

Thursday, February 21, 2019

Pelvic Floor Therapy: More Than Just Kegels

As pelvic floor therapists, we offer a non-surgical approach to treating a variety of pelvic floor related disorders such as bladder conditions, pelvic organ prolapse, bowel conditions, pelvic pain, pain with sex and sexual dysfunction, diastases recti and many other correlated musculoskeletal dysfunctions. One of the most common pelvic dysfunctions that we see at PTW is urinary incontinence.
Q: What is Urinary Incontinence?
A: Urinary incontinence is known as the “loss of bladder control” or “urinary leakage”. The 3 most common types are:

Stress: loss of urine with activity, due to an increase in abdominal pressure.
Patients often report leakage with laughing, coughing, sneezing and/or while exercising.  This may be due to the bladder and urethra being hypermobile (moving too much) or the internal sphincter (the muscular ring which stops the flow of urine from the bladder to the urethra) is deficient.  Common causes of this are child birth/pregnancy and menopause. Child birth/pregnancy results in weakness of the pelvic floor, which causes leakages. While menopause, due to the reduction in the production of female hormone estrogen, weakens the urethral tissue.
Urge: loss of urine with the sudden urge to go to the bathroom. 
Most often patients have leakage while quickly trying to get to the bathroom and may have a sense of incomplete emptying.  There are often common triggers that your physical therapist can identify with you. Common triggers mentioned in the clinic are:
  • “Every time I get home and put the key in the door, I have to go”
  • “Each time I get in the car I need the bathroom”
  • “When it’s really cold out I really need the bathroom”

Often the cause is that your bladder contracts when you don’t want it to because it is overactive.

Mixed: This is usually a combination of both stress and urge.

Q: How common is Urinary Incontinence?A: Although both men and women often find it difficult to speak to their doctor about their incontinence, it is a lot more common than most people think. It affects around 25 million adult Americans each year.   In America, around 19.5 billion dollars are spent each year on incontinence diagnosis, with only 8% of this being spent on treatments such as physical therapy. 

Q: Hang on, isn’t leakage just part of getting old?A:  I am sure that you have all seen the television advertisements, and the numerous aisles with incontinence pads/liners/and underwear products in your local pharmacy and grocery store, but incontinence should not be accepted as a normal part of aging.  Incontinence affects all ages, and when not addressed, it increases the risk of other medical complications such as skin break down and infections. 

Q: How can physical therapy help?
A:  At PTW, pelvic floor treatments and assessments are an hour one-on-one with your therapist in a private room.  A thorough pelvic health history is taken and your personal goals are discussed followed by an examination of your lower back, hips, pelvis and peroneal area and muscles (if indicated).  From the examination findings, a treatment plan and goals will be developed by you and your therapist.  Your therapist may ask you to take a bladder diary home with you to complete so that your bladder habits can be looked at in more detail. 

Common treatments that may be performed:
Pelvic floor muscle training: It is NOT just doing Kegels.   Your therapist will instruct you on how to correctly train both the power and the endurance of your pelvic floor muscles, and most importantly how to relax the muscles.  These will be performed in positions where gravity is initially eliminated, then progressed to against gravity and finally with functional activities. 

Biofeedback:  This is used to help you learn how to contract and relax your muscles. Electrodes are placed over the muscles to measure muscle activity.  This information then links to a computer or a hand held monitor so that you can visually see when your muscles are activated.

Electrical stimulation: This is used to supplement Kegels to further strengthen the muscles.

Hip, core and lower back strengthening

Bladder retraining: By reviewing your bladder diary, your therapist will provide strategies on how to progress voiding intervals, for correct bladder emptying and education on healthy bladder habits.

Manual therapy:  Soft tissue mobilizations, visceral mobilizations, trigger point release, cupping, joint mobilizations and stretches will be performed to address any myofascial restrictions, tight or painful tissues or restricted joints.   

Tips for maintaining a healthy bladder:
  1. Do NOT perform Kegels while peeing
  2. Urinate every 3-4 hours,  5-7 times in 24 hours
  3. Sit on the toilet, take your time and do not strain
  4. No “just in case” peeing when you leave the house
  5. Pee before and after having sex
  6. Drink plenty of water to keep hydrated, approximately 50% of your body weight in ounces per day
  7. Avoid alcohol, caffeinated, carbonated and sugary drinks as these can irritate your bladder

If you have any questions in regards to your pelvic health or would like to schedule an appointment with our Pelvic Health Specialist Katie Barnett, PT DPT you can contact her at either our Lansdale location 215-855-9871 or at our Glenside location 215-887-2001.

Monday, January 21, 2019

Achilles Tendon Injury and Recovery for Eagles' Star Brandon Brooks

Achilles Tendon Injury and Recovery for Eagles' Star Brandon Brooks

The Eagles season did not end the way many had envisioned it and it does not look to be off to a good start next year either. Two- time pro-bowler, Brandon Brooks was carted off the field in the Eagles last playoff game against the New Orleans Saints and did not return. After the Eagles' unfortunate loss, news did not get any better, as it came out that Brandon Brooks had suffered a torn Achilles Tendon. The Eagles had an injury-riddled season which many fans believe had a lot to do with their up and down season. Now fans might be asking themselves, what exactly is a torn Achilles tendon? What is the recovery like? How long will the Eagles star player be out? And will this type of injury affect future performance?

An Achilles tendon tear is when the tendon at the back of your ankle breaks (complete tear) or rips (partial tear). This type of injury can occur in a few different ways; sudden bending up of the foot when the calf muscle is engaged, direct trauma, or chronic tendonitis. If you watch the video of the injury, you can see Brandon Brooks’ ankle is bent as he is attempting to push forward to drive his opponent backward, causing too much stress on his tendon and therefore rupturing.  A snapping sound, pain, lack of ability to push off with your foot, and bruising of your calf often accompany an injury like this. Now that we know what kind of injury we are dealing with we can look at the recovery process and when Brandon Brooks can get back on the field.
Protocols and timelines can vary from person to person and can depend on the exact type of surgery performed as well. The following is a general timeline for recovery. Initially after surgery the patient will be non-weight bearing for roughly 3 weeks and progress to full weight bearing in a boot around 6 weeks. Gentle active range of motion can start around 4 weeks and passive range of motion around 6 weeks. Strengthening of surrounding musculature can start around 6 weeks, but strengthening of involved musculature does not start until around 8 weeks. The reason for such a long, cautious recovery is to allow proper healing of the tendon to the bone since this is a powerful muscle that is used every time we stand, walk, run, and jump. Gradual progression of resistance/strengthening exercises occurs up to 6 months before starting more intensive sport specific strengthening. Most rehabilitation programs allow patients to return to physically demanding sports by 9 months.

Brandon Brooks experienced a very serious injury that will take a long time to recover, but a full recovery can be expected. After surgery, physical therapy will play a large role in monitoring and initiating appropriate stretching and strengthening exercises at the right time.  Progression will depend on the physiological healing of the tendon, and the amount of range of motion and strength that is gained each day of recovery. Once the tendon is deemed “well healed” by the surgeon, physical therapy will then be able to progress Brandon Brooks to sport specific strengthening exercises/activities that will allow him to get back on the field and help the Eagles back to the Super Bowl. If Brandon Brooks follows this general time line, Eagles fans can expect him to return to the field around October.

PTW’s AJ Moyer, PT, DPT is a staff physical therapist at our Souderton and Harleysville clinics. For an initial evaluation, call AJ at 267.382.0433 today! 

Friday, January 18, 2019

Beating the Winter Blues


Winter can be a very frustrating time for many people.   Activity level goes down because the temperature drops, days get shorter, and the weather can make it hard to get around.   Winter is actually known for being the highest time for being diagnosed with depression, hence “The Winter Blues”.   However, what if I told you there are some things anybody can do to “Beat the Blues”?   And, what if I told you that it is as simple as taking 25-30 minutes a day to just exercise?    It’s that simple!   Here’s the catch though.   Most people don’t know or understand how to safely exercise in their own homes.   I will give you a quick idea of how simple exercise can be to give you the boost you need this winter.  
First, you have to forget the concept that exercise has to be done with equipment or in a gym, and it doesn’t need to make you tired.   Moderate exercise is also known as “walk and talk” exercise.  You should be able to hold a conversation even though you are exercising.  This ensures that you are not pushing too hard and causing unnecessary fatigue.    And remember exercise is simply “planned activity”.   Exercise can be anything!  It can be going up and down your stairs, sitting and standing in your chair repeatedly, or just walking laps around your house.   The beauty of exercising is you can find what you like, and make it fun.  
Second, get yourself moving for those 25-30 minutes!  Studies by the Center for Disease Control (CDC) show that daily moderate exercise of 25-30 minutes lowers anxiety and depression, reduces risk of heart and brain conditions, decreases falls risk, and improves overall well being.   All of this is what helps you “Beat the Blues”.   Some options I already mentioned are just doing simple stair climbing, repeated sit to stands, or just walking.  Some other options include, marching in place, leg kick outs while sitting, push-ups (if able), or sit-ups (if able).  Remember these should all feel like a moderate intensity, not too hard and not too easy.   And they should never cause pain.  (Consult a physician or medical provider if pain limits your activity).

 Lastly, get your friends involved!  Group exercise is shown to improve the psychological benefits of exercise.   If the weather permits, meet us with your friends and walk in the mall or at the gym.   Or, just give them a call and exercise while talking on the phone.   This also helps you stay more compliant with the program, and it gives you a buddy to hold you more accountable.    According to the CDC’s Physical Activity Guide for Americans, group exercise not only improves your compliance to a program but also your desire to be active.  If you want to exercise, it is much easier to stay active, healthy, and “Beat the Blues”. 

So remember, all you need to do to “Beat the Blues” is get moving 25-30 minutes of your day! And grab a buddy for a little extra push!  It’s that easy!  

Brandon Lewandowski  PT, DPT is Clinical Supervisor of PTW's newest location in Horsham, PA! To schedule a visit with Brandon call 215.394.5893

Friday, December 7, 2018

What Is Wrong with Markelle Fultz?

Markelle Fultz and Thoracic Outlet Syndrome

Some Philly sports fans out there may have heard about Markelle Fultz’s new diagnosis of Thoracic Outlet Syndrome (TOS), which may be what is causing his shot to look awkward and unnatural. TOS is an injury in the area of the neck and shoulder that is classified as compression of nerves, arteries, and veins that travel through a small space called the thoracic outlet. At times one or all of these structures are being compressed. If the arteries or veins are obstructed than you can experience symptoms such as pain in the arm, numbness/tingling, discoloration, temperature changes, and a weakened pulse. When the nerves are affected symptoms involve muscle weakness, muscle wasting, numbness/tingling, and pain down the arm.

In Fultz’s case his nerves are being compressed, which makes it difficult for him to control the muscles needed to shoot a basketball due to the weakness and inability to coordinate the appropriate motions. The compression on these structures is caused by either tight muscles of the neck (scalenes) and/or the first rib or clavicle or also called collar bone. In rare cases an extra rib is present at birth, but this is not present in most of the population.

Fultz’s specialist has recommended physical therapy to help resolve this problem, which can help in a few different ways. One way is stretching of those particular neck muscles combined with soft tissue massage to increase flexibility and reduce the overall tension on the nuerovascular structures. A second way physical therapy can resolve TOS is by performing mobilizations of the first rib and clavicle to increase mobility and facilitate proper movement of the bones/joints, thereby relieving compression on the nerves or vascular structures. A third way physical therapy can help is by correcting poor posture which can be a contributing factor to the underlying issue. We can do this by educating patients on proper posture and certain stretching/strengthening techniques for affected muscles. Often times a combination of all three of these treatments techniques are used to help resolve the TOS. The report is that Fultz is going to be out 3-6 weeks while receiving physical therapy so that he can have sufficient time to address his specific deficits to reduce the compression on his nerves.

Mark Romano PT, DPT is the newest PTW Clinical Supervisor in  our Glenside location. To schedule an appointment or evaluation call Mark at (215) 887-2001 today!