MUSCLE SORENESS v. JOINT PAIN

Many of our patients come into the clinic after a few sessions complaining that their joint pain has increased since their initial evaluation. This is not meant to whitewash those concerns, as an increase in joint pain due to a specific exercise is fairly common. However, typically the significant increases in joint pain will only come while performing that specific exercise, and subside significantly, if not entirely, a short time after. 

An increase in pain for longer periods of time, like 1-2 days, is more indicative of muscle soreness - not joint pain. While muscle soreness can be just as, if not more, debilitating compared to joint pain, muscle soreness is a good sign. 

Most of the time when patients come in with joint pain, they'll have been limiting activity that could increase that joint pain. For example: a patient comes in, chief complaint is knee pain, they'll likely have been avoiding stairs, bending down or squatting to pick something up or participate in hobbies, such as gardening, and moving slowly and cautiously. In physical therapy, to first lessen the pressure on the inflamed joint, we'll need to strengthen the muscles around the joint. To do so, patients will complete a number of exercises that don't necessarily aggravate those painful symptoms at the time, but can lead to soreness later. The soreness occurs because the muscles surrounding the joints are likely very out of practice - as your natural instinct to avoid an increase in pain is to minimize all causes of the pain. In turn, the muscle soreness will increase as they adapt to the newly added activities. 

Fortunately, muscle soreness doesn't last forever. It lasts a few days, maximum, and will decrease thereafter - usually leaving patients in less pain than they started. Patients need not worry that they'll reproduce that soreness each time, as each time they complete their Home Exercise Program, the muscles will continue to strengthen and therefore, adapt faster. Most of the time, patients will not be sore after a few visits to the clinic - given that they're doing their exercises as prescribed. Soreness from that point on will only increase as the intensity or difficulty of the exercises increase, but increases in difficulty means progression. 

Differences in joint pain versus muscle soreness include:

- Joint pain is sharp, stabbing, debilitating, while muscle soreness is dull, burning, achey

- Muscle soreness leads to problems you may not be used to: say your knee pain was below the kneecap, but now is above and on the sides of the kneecap

- Joint pain will increase during a specific movement, and decrease after the movement, whereas muscle soreness will decrease or become more manageable the more the movement is performed

- Muscle soreness only lasts 1-3 days, whereas joint pain will continue to hurt each time you do specific movements for an undefined amount of time, and can possibly even get worse

Still think it's joint pain? There are tests we can do here at CHAMPION Performance and Physical Therapy that can help us as professionals determine where the pain is stemming. It's our job as therapists to educate you on the circumstances of your pain.  Keep in mind, every patient is unique and your pain may continue to stem from the joint as we progress - and that's a bridge we'll cross when we get there. Our goal is to improve your quality of life back to functionality status at the very least, or in other words, give you the ability to do the things you love. 

PREVENTING OSTEOARTHRITIS IN THE KNEE

WHAT IS IT?

Osteoarthritis is the medical term for the more common "arthritis" and refers to the general deterioration of cartilage that leads to damage on articulating surfaces of joints. 

Osteoarthritis can occur in any joint, some as small as the bones in the hand/fingers, and as large as the hip and knee joints. 

Preventing osteoarthritis in the knee, or delaying onset, is a lifetime practice, as many of the causes that lead to deterioration of bone articulating cartilage are due to overuse during youth, adolescence, and early adulthood. Other increased risks come from lifestyles, and habits that are typically formed at a younger age. 

INCREASED LIFESTYLE RISK FACTORS INCLUDE, BUT ARE NOT LIMITED TO: 

• Extremely active lifestyle, where the joints take a beating
  • Participating in physical activity that heavily load the joint, such as running, put large loads onto the body that continuously put stress on the cartilage and articulations of joints, running the articulation cartilage thin.
• Extremely sedentary lifestyle, where the joints receive very little to no load
  • Sedentary lifestyles tend to lead to a decrease in bone density, and a decrease in bone density leads to an increase risk of osteoarthritis
• Ligament, tendon, or cartilage tears
  • Tearing your ACL, MCL, and PCL all show an increase risk for early onset osteoarthritis, as the joint lacks stability, and therefore overloads cartilage 
• Misalignments
  • Having leg length discrepancies, wearing shoes that lack arch/medial support, etc. lead to increased pressure on one side of the body compared to the contralateral side, and results in deterioration of cartilage
• Musculoskeletal discrepancies
  • Having weak muscles on one aspect of the leg compared to the other leads to decreased stabilization in the knee, which leads to increased load on one aspect of the joint. 
  • This is the highest, non-impact cause that is correlated with an increased risk of developing osteoarthritis in both adults and children

WHAT CAN YOU DO? 

Prevention is key. Having musculoskeletal evaluations, leg length, joint alignment measured by a physical therapist prior to your child starting physical activity is key to identifying potential problems early. Children are resilient, physically, but those same joints may not be so quick to heal at age 40, and like wearing sunscreen, it's extremely necessary to attempt prevention at a young age. 

Preventative physical therapists, including us here at CHAMPION, can take your children, or even you through preventative programs to help decrease risk, delay onset, or even delay surgical repair. 

HAMSTRING INJURIES RESPOND BETTER TO EXERCISE, ACCORDING TO APTA

Platelet-rich plasma injections might sound like cutting-edge treatment for hamstring injuries, but according to the APTA, a 2012 systematic review of 10 randomized clinical trials indicates that rehabilitation exercises actually have a superior effect on acute hamstring injuries (“Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis” – July 21, 2015).

Specifically, lengthening exercises and progressive agility and trunk stabilization exercises have been identified in previous studies as appropriate “for daily practice” to treat acute hamstring injuries. However, the authors of the above study discourage the use of platelet-rich plasma injections, in which a patient’s own platelet-enriched blood is injected into an injured part of the body with the intent to promote healing, finding that the injection is ineffective.

Hamstring injuries are one of the most common lower body injuries, particularly affecting athletes participating in sports, such as football, soccer, or track. After tearing a hamstring muscle, a person is 2 to 6 times more likely to suffer a subsequent injury. Participants from the reviewed studies were all associated with sports.

Physical therapists can design individualized treatment programs for hamstring injuries that may include range of motion, muscle strength, manual therapy, and function training.

POOL SEASON IS RIGHT AROUND THE CORNER

Pool (aquatic) exercise provides many benefits, including an ideal environment to exercise throughout the year. The buoyancy of the water supports a portion of your body weight making it easier to move in the water and improve your flexibility. The water also provides resistance to movements, which helps to strengthen muscles. Pool exercises can also improve agility, balance, and cardiovascular fitness. Many types of conditions greatly benefit from pool exercise, including arthritis, fibromyalgia, back pain, joint replacements, neurological, and balance conditions. The pool environment also reduces the risk of falls when compared to exercise on land. Below are some tips and tricks provided by the APTA as suggestions to get you started in the right direction.

Preparing for the Pool

Before starting any pool exercise program, always check with your physical therapist or physician to make sure pool exercises are right for you. A wonderful option is asking your physical therapist to take your home exercise program and adapt it so that it's possible to do in the water. Here are some tips to get you started:

• Water shoes will help to provide traction on the pool floor.
• Water level can be waist or chest high.
• Use a Styrofoam noodle or floatation belt/vest to keep you afloat in deeper water.
• Slower movements in the water will provide less resistance than faster movements.
• You can use webbed water gloves, Styrofoam weights, inflated balls, or kickboards for increased resistance.
• Never push your body through pain during any exercise.
• Although you will not sweat with pool exercises, it is still important to drink plenty of water.

10 Excellent Exercises for the Pool

1. Water walking or jogging: Start with forward and backward walking in chest or waist high water. Walk about 10-20 steps forward, and then walk backward. Increase speed to make it more difficult. Also, increase intensity by jogging gently in place. Alternate jogging for 30 seconds with walking in place for 30 seconds. Continue for 5 minutes.

2. Forward and side lunges: Standing near a pool wall for support, if necessary, take an oversized lunge step in a forward direction. Do not let the forward knee advance past the toes. Return to the starting position and repeat with the other leg. For a side lunge, face the pool wall and take an oversized step to the side. Keep toes facing forward. Repeat on the other side. Try 3 sets of 10 lunge steps. For variation, lunge walk in a forward or sideways direction instead of staying in place.

3. One leg balance: Stand on 1 leg while raising the other knee to hip level. Place a pool noodle under the raised leg, so the noodle forms a “U” with your foot in the center of the U. Hold as long as you can up to 30 seconds and switch legs. Try 1-2 sets of 5 on each leg.

4. Sidestepping Face the pool wall. Take sideways steps with your body and toes facing the wall. Take 10-20 steps in 1 direction and then return. Repeat twice in each direction.

5. Hip kickers at pool wall: Stand with the pool wall to one side of your body for support. Move 1 leg in a forward direction with the knee straight, like you are kicking. Return to start. Then move the same leg to the side, and return to the start position. Lastly, move that same leg behind you. Repeat 3 sets of 10 and switch the kicking leg.

6. Pool planks: Hold the noodle in front of you. Lean forward into a plank position. The noodle will be submerged under the water, and your elbows should be straight downward toward the pool floor. Your feet should still be on the pool floor. Hold as long as comfortable, 15-60 seconds depending on your core strength. Repeat 3-5 times.

7. Deep water bicycle: In deeper water, loop 1-2 noodles around the back of your body and rest your arms on top of the noodle for support in the water. Move your legs as if you are riding a bicycle. Continue for 3-5 minutes.

8. Arm raises: Using arm paddles or webbed gloves for added resistance, hold arms at your sides. Bend your elbows to 90 degrees. Raise and lower elbows and arms toward the water surface, while the elbows remain bent to 90 degrees. Repeat for 3 sets of 10.

9. Push ups: While standing in the pool by the pool side, place arms shoulder width apart on pool edge. Press weight through your hands and raise your body up and half way out of the water, keeping elbows slightly bent. Hold 3 seconds and slowly lower back into pool. (Easier variation: Wall push up on side of pool: place hands on edge of pool shoulder width apart, bend elbows, and lean chest toward the pool wall.)

10. Standing knee lift: Stand against the pool wall with both feet on the floor. Lift 1 knee up like you are marching in place. While the knee is lifted even with your hip, straighten your knee. Continue to bend and straighten your knee 10 times, and then repeat on the other leg. Complete 3 sets of 10 on each leg. For more of a challenge, try this exercise without standing against the pool wall.

PREVENTING SKIING-RELATED KNEE INJURIES

The most common injuries in skiing happen to the lower limb, most commonly the knee. The introduction of releasable bindings has decreased the rate of leg fractures by 90% in the past 30 years, but knee sprains (including ACL and/or MCL tears) are on the rise accounting for about 30% of all skiing injuries.

The most common injury is the medial collateral ligament (MCL) tear, which is typically treated without surgery.  In skiing, the MCL is often torn when the ski tips are pointed toward one another in a snowplow position (the common slow or stop position) and the skier falls down the hill. MCL tears are more common among beginning and intermediate skiers than advanced and elite skiers.  When skiing you may prevent an MCL tear by:

• Making sure that your weight is balanced when you are in the snowplow position.
• Sticking to terrain that is a comfortable challenge but not overwhelming.

The second most common injury is the anterior cruciate ligament (ACL) tear. Given the importance of the ACL to the functional stability of the knee, ACL tears often require surgery (however in some cases patients can avoid surgery). ACL tears are common in sports, but most of them are the result of "non-contact" injuries.

There are two ways that skiers most commonly tear the ACL:

• Landing a jump in poor form. When skiers land from a jump with their weight back, so the back of the boot is pushing on the calf, the force from landing can tear the ACL.  The best way to avoid this injury is to learn to land safely, with your weight forward, by starting with simple jumps and gradually advancing to more difficult jumps.
• The "phantom foot" phenomenon often happens when skiers try to stand up to prevent an unavoidable fall. As the skier falls, all the weight goes on the outside of one ski, and the arms and trunk rotate away from that leg. When a skier falls into this position, an ACL injury is often the result. Avoid this position by never trying to stand up during a fall and accepting an unavoidable fall. Skiers should "go" with the momentum of a fall and maintaining good ski technique.

Preventing injury on the slopes

• Remember the keys to effective skiing technique: hands and weight forward, legs parallel, and hips, knees, and ankles flexing equally.
• Stay on marked trails: Going off trail can take you into ungroomed territory with many possible obstacles (such as trees and rocks) that can contribute to injuries.

Getting ready for the slopes:

• Prepare your body. A few simple exercises (listed below) can prepare your core and lower extremities for skiing. Three to four weeks of aerobic training such as walking, elliptical, or biking can be excellent ways to help you tolerate a full day on the slopes.
• Ensure you have proper equipment: Make sure ski boots, bindings, and ski length are fit and appropriate for your height and skill level. Wear a helmet. Wrist guards are a good idea if snowboarding.
• Learn proper technique: Take a skiing technique class with a professional before you hit the slopes.
• Rest: If you are tired, rest.  Injuries happen more commonly when skiers are fatigued.

Exercises to Condition Core and Lower Extremities

The exercises below are not intended as a substitute for care from a health care professional. If you experience pain or other signs and symptoms of injury or pain, you should seek the advice of a physical therapist or other health care professional.

Double Leg Squats

Place your feet shoulder width apart. Squat down, keeping your heels on the floor. Keep your feet and knees facing forward. Stick your bottom out and don't let your knees go too far forward. Focus on using your gluteal muscles (buttock muscles) to lift and lower your weight. Your shins should be parallel to one another, with your knees no farther forward than your toes, just like in good skiing technique. Do 10-15 repetitions, then hold midway in the squat until you are fatigued. Repeat 3 times.

Single Leg Squats

Stand on one leg. Use a chair or counter to place a hand or few fingers to help you keep your balance at first. Work towards squatting without any help balancing. Keep your pelvis level and squat down. Just like in the double leg squat, keep your heel on the ground with your foot and knee facing forward. Make sure your pelvis is level; that it isn’t dropped down on the leg that is unsupported. Do 10-15 repetitions on each leg, and repeat 3 times.

Side-to-Side Skaters

Stand on one leg and take a large step to the side with your other leg. Stand on that leg, and then take another large step back to where you were. Make sure that your pelvis stays level and that your knee doesn’t buckle inward. You can make this more difficult by wrapping a resistance band around your waist. Work up to doing this for 2 minutes. Don't rush. The slower you go, the more difficult this exercise is.

Side plank

Lie on your side with your knees bent, and prop up on one elbow. Lift up your hips and push them forward, so you make a straight line from your shoulders to your knees. Slightly lift the top leg up. You should feel this working your hip and core muscles on the side that is down. These are the muscles that keep your knee from falling inwards. Make the exercise more difficult by starting with your knees straight so only your forearm and the outside of your foot are touching the ground.

UT COMPENSATION

WHAT IS IT?

UT compensation, or Upper Trap compensation, is the overuse of the upper fibers of the trapezius muscle due to injury or weakness.

WHY DOES IT HAPPEN?

Supraspinatus Injury:

The most prominent injury leading to UT compensation is a rotator cuff tear - most often, the supraspinatus muscle. The supraspinatus is primarily responsible for abduction of the shoulder, and stabilization of the humeral head (top of the arm bone) in the glenoid fossa (socket). Abduction of the shoulder joint is the arm moving out to the side, and away from the body - as if you are doing a jumping jack. Once the arm reaches shoulder height, the deltoid muscle takes over and continues abduction by raising the outstretched arm the rest of the way to get entirely overhead. 

When an injury occurs in the supraspinatus, the deltoid immediately becomes responsible for abduction - however, it still is unable to raise the arm in abduction before it reaches shoulder height entirely on it's own - so the UT raises the entire shoulder, not just the arm, to help the arm reach higher without the supraspinatus muscle. 

Scapular Weakness:

The other common reason for UT compensation is scapular weakness and instability. The scapula is the bone that creates your shoulder blade, as well as the socket portion of the ball-and-socket shoulder joint. Multiple muscles attach to the scapula from all different aspects that work together help to control the strength and mobility of the shoulder. 

When there is weakness present in the elevators (function to lift up) and retractors (function to pull back, like you're puffing out your chest) of the scapula, the UT activates to help the scapula maintain it's range of motion, so as to allow the shoulder joint to maintain it's normal range of motion. 

WHAT HAPPENS NEXT?

It is not uncommon for UT compensation to go unnoticed for weeks, to months, to even years. Some individuals with plenty of strength elsewhere may get away with it for longer, some individuals with less functional strength may notice it immediately. Common symptoms are elevated shoulders, stiff/tight muscles in the neck/upper back, and residual pain in the shoulder.

IS IT CURABLE? 

The longer you wait to talk to your doctor, the longer it will take to reverse the symptoms and retrain your body to activate your muscles properly. With effort and hard work, prognosis is usually fair to excellent. Talk to your physical therapist about performing a screening or evaluation to identify if UT compensations are occurring due to a larger issue in your upper extremities. 

Ask us at CHAMPION today!

"SPECIALIZED" HIGH SCHOOL ATHLETES MORE LIKELY TO REPORT HIP AND KNEE INJURIES

...according to the APTA, and a University of Wisconsin study published in Women's Health.

The study was small, but the results lined up with what many health care professionals have been saying for years: youth athletes who specialize in a single sport may be at a higher risk for injury.

In a study published in The American Journal of Sports Medicine (Prevalence of Sport Specialization in High School Athletics: A 1-Year Observational Study-February 26, 2016), athletes from 2 high schools were more likely to report knee injuries and hip injuries.

“There are so many great aspects to sports participation, and we don’t want this information to scare athletes or parents,” said study author David Bell of the University of Wisconsin-Madison, in a press release from the university. “We just want them to be wise consumers and to participate as safely as possible.”

Physical therapists typically encourage athletes of all ages to diversify their exercise to avoid injury, but it can be particularly important for young athletes.

According to physical therapist Sue Falsone, PT, ATC, MS, the former head physical therapist for the Los Angeles Dodgers, in an interview with Move Forward Radio (Avoiding Baseball Injuries-May 8, 2014), “Sometimes we ask the immature body to do things that they just physically can’t handle. And even if you’re getting through it at that time, it’s usually something that might break down later on.”

Attached is the URL to the Women's Health article.

http://www.womenfitness.net/news-flash/specialized-high-school-athletes/

APTA'S INTERACTIVE BODY

The American Physical Therapy Association (APTA)'s MOVE FORWARD - Physical Therapy Brings Motion to Life campaign just released the Interactive Body model, for both men and women, to help them research conditions they've already been diagnosed with by their physician. With the help of a physical therapist, these conditions and their symptoms are manageable and many patients find success in relieving their symptoms. 

Remember, early treatment gives you the best results! You don't have to live in pain this year - let CHAMPION Performance and Physical Therapy help you put this behind you and #MOVEFOWARD.

Copy and paste the link below into your URL search box for access to APTA's Interactive Body: http://www.moveforwardpt.com/InteractiveBody.aspx

LOW BACK PAIN: WHY YOU SHOULD GET PHYSICAL THERAPY FIRST

Over any 3-month period, about 25% of Americans will have low back pain. In most cases, it is mild and disappears on its own. But sometimes the pain lingers, returns, or worsens, leading to a decrease in function and quality of life.

In an era when back pain is often over-treated, due in part to unhelpful imaging scans (like x-rays) that may lead to unnecessary surgery, narcotics, and higher costs, physical therapy is a proven and cost-effective treatment option that you should consider as a first choice.

Studies show that early physical therapy for low back pain significantly lowers the total scope and cost of care.

Here's why you should consider getting physical therapy first:

Back Pain Often Leads to Missed Work and Overly Expensive Treatment

• According to the most recent news release (December 2014) Employee Cost Index from the Bureau of Labor Statistics, more than 200,000 incidents related to back injury were reported in 2013, causing an average of 7 days of missed work.
• Direct costs to treat back problems totaled $30.3 billion in 2007. Of that, $4.5 billion was spent on prescription medications. The average expenditure per person for treatment was $1,589, and $446 for prescription medications.

Physical Therapy Is An Effective, Cheaper First Choice

• Scientific research overwhelmingly points to the effectiveness of conservative treatments, such as physical therapy, for low back pain. Despite this, and published guidelines suggesting conservative treatment as the best first option, physicians still often order imaging scans (like x-rays), prescribe narcotics, and refer patients to other physicians, including surgeons.
• A September 2013 study found that there was no significant difference in outcomes between patients who chose spinal fusion surgery, as compared to those who chose the nonoperative treatment (physical therapy).
• An award winning 2015 study demonstrated substantial potential for lowered costs and reduced health care utilization for patients who received, and adhered to, early physical therapy for low back pain.

9 PHYSICAL THERAPIST'S TIPS TO HELP YOU #AGEWELL

We can't stop time. Or can we? The right type and amount of physical activity can help stave off many age-related health problems. Physical therapists, who are movement experts, prescribe physical activity that can help you overcome pain, gain and maintain movement, and preserve your independence—often helping you avoid the need for surgery or long-term use of prescription drugs.

Here are nine things physical therapists want you to know to #AgeWell. 

1. Chronic pain doesn't have to be the boss of you.
Each year 116 million Americans experience chronic pain from arthritis or other conditions, costing billions of dollars in medical treatment, lost work time, and lost wages. Proper exercise, mobility, and pain management techniques can ease pain while moving and at rest, improving your overall quality of life.

2. You can get stronger when you're older.
Research shows that improvements in strength and physical function are possible in your 60s, 70s, and even 80s and older with an appropriate exercise program. Progressive resistance training, in which muscles are exercised against resistance that gets more difficult as strength improves, has been shown to prevent frailty.

3. You may not need surgery or drugs for low back pain.
Low back pain is often over-treated with surgery and drugs despite a wealth of scientific evidence demonstrating that physical therapy can be an effective alternative—and with much less risk than surgery and long-term use of prescription medications.

4. You can lower your risk of diabetes with exercise. 
One in four Americans over the age of 60 has diabetes. Obesity and physical inactivity can put you at risk for this disease. But a regular, appropriate physical activity routine is one of the best ways to prevent—and manage—type 1 and type 2 diabetes.

5. Exercise can help you avoid falls—and keep your independence
About one in three U.S. adults age 65 or older falls each year. More than half of adults over 65 report problems with movement, including walking 1/4 mile, stooping and standing. Group-based exercises led by a physical therapist can improve movement and balance and reduce your risk of falls. It can also reduce your risk of hip fractures (95 percent of which are caused by falls).

6. Your bones want you to exercise.
Osteoporosis or weak bones affects more than half of Americans over the age of 54. Exercises that keep you on your feet, like walking, jogging, or dancing, and exercises using resistance, such as weightlifting, can improve bone strength or reduce bone loss.

7. Your heart wants you to exercise.
Heart disease is the No. 1 cause of death in the US. One of the top ways of preventing it and other cardiovascular diseases? Exercise! Research shows that if you already have heart disease, appropriate exercise can improve your health.

8. Your brain wants you to exercise. 
People who are physically active—even later in life—are less likely to develop memory problems or Alzheimer's disease, a condition which affects more than 40% of people over the age of 85.

9. You don't "just have to live with" bladder leakage.
More than 13 million women and men in the US have bladder leakage. Don't spend years relying on pads or rushing to the bathroom. Seek help from a physical therapist.