SPRING ATHLETES - TAKE CARE OF THOSE HAMSTRINGS

Hamstring Muscle Injuries

Hamstring muscle injuries — such as a "pulled hamstring" — occur frequently in athletes. They are especially common in athletes who participate in sports that require sprinting, such as track, soccer, and basketball.

A pulled hamstring or strain is an injury to one or more of the muscles at the back of the thigh. Most hamstring injuries respond well to simple, nonsurgical treatments.

Normal Hamstring Anatomy

The hamstring muscles run down the back of the thigh. There are three hamstring muscles:

• Semitendinosus
• Semimembranosus
• Biceps femoris

They start at the bottom of the pelvis at a place called the ischial tuberosity. They cross the knee joint and end at the lower leg. Hamstring muscle fibers join with the tough, connective tissue of the hamstring tendons near the points where the tendons attach to bones.

The hamstring muscle group helps you extend your leg straight back and bend your knee.

Description

A severe hamstring injury where the tendon has been torn from the bone.

A hamstring strain can be a pull, a partial tear, or a complete tear.

Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily; a grade 3 strain is a complete tear of the muscle that may take months to heal.

Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibers join tendon fibers.

In the most severe hamstring injuries, the tendon tears completely away from the bone. It may even pull a piece of bone away with it. This is called an avulsion injury.

Cause

Muscle Overload

Muscle overload is the main cause of hamstring muscle strain. This can happen when the muscle is stretched beyond its capacity or challenged with a sudden load.

Hamstring muscle strains often occur when the muscle lengthens as it contracts, or shortens. Although it sounds contradictory, this happens when you extend a muscle while it is weighted, or loaded. This is called an "eccentric contraction."

During sprinting, the hamstring muscles contract eccentrically as the back leg is straightened and the toes are used to push off and move forward. The hamstring muscles are not only lengthened at this point in the stride, but they are also loaded — with body weight as well as the force required for forward motion.

Like strains, hamstring tendon avulsions are also caused by large, sudden loads. During sprinting, the hamstring muscles are lengthened and loaded as the back leg pushes off to propel the runner forward.

Risk Factors

Several factors can make it more likely you will have a muscle strain, including:

Muscle tightness. Tight muscles are vulnerable to strain. Athletes should follow a year-round program of daily stretching exercises.

Muscle imbalance. When one muscle group is much stronger than its opposing muscle group, the imbalance can lead to a strain. This frequently happens with the hamstring muscles. The quadriceps muscles at the front of the thigh are usually more powerful. During high-speed activities, the hamstring may become fatigued faster than the quadriceps. This fatigue can lead to a strain.

Poor conditioning. If your muscles are weak, they are less able to cope with the stress of exercise and are more likely to be injured.

Muscle fatigue. Fatigue reduces the energy-absorbing capabilities of muscle, making them more susceptible to injury.

Choice of activity. Anyone can experience hamstring strain, but those especially at risk are:

• Athletes who participate in sports like football, soccer, basketball
• Runners or sprinters
• Dancers
• Older athletes whose exercise program is primarily walking
• Adolescent athletes who are still growing

Hamstring strains occur more often in adolescents because bones and muscles do not grow at the same rate. During a growth spurt, a child's bones may grow faster than the muscles. The growing bone pulls the muscle tight. A sudden jump, stretch, or impact can tear the muscle away from its connection to the bone.

Symptoms

If you strain your hamstring while sprinting in full stride, you will notice a sudden, sharp pain in the back of your thigh. It will cause you to come to a quick stop, and either hop on your good leg or fall.

Additional symptoms may include:

• Swelling during the first few hours after injury
• Bruising or discoloration of the back of your leg below the knee over the first few days
• Weakness in your hamstring that can persist for weeks

Doctor Examination

Patient History and Physical Examination

In this severe tear of the hamstring tendon away from the bone, the muscle has balled up at the back of the thigh.

Reproduced from Frank RN, Walton DM, Erickson B, Nho SJ, Bush-Joseph CA, Verma NN: Acute proximal hamstring rupture: surgical technique. Orthopaedic Knowledge Online Journal 2014. Accessed July 2015.

People with hamstring strains often see a doctor because of a sudden pain in the back of the thigh that occurred when exercising.

During the physical examination, your doctor will ask about the injury and check your thigh for tenderness or bruising. He or she will palpate, or press, the back of your thigh to see if there is pain, weakness, swelling, or a more severe muscle injury.

Imaging Tests

Imaging tests that may help your doctor confirm your diagnosis include:

X-rays. An X-ray can show your doctor whether you have a hamstring tendon avulsion. This is when the injured tendon has pulled away a small piece of bone.

Magnetic Resonance Imaging (MRI). This study can create better images of soft tissues like the hamstring muscles. It can help your doctor determine the degree of your injury.

Treatment

Treatment of hamstring strains will vary depending on the type of injury you have, its severity, and your own needs and expectations.

The goal of any treatment — nonsurgical or surgical — is to help you return to all the activities you enjoy. Following your doctor's treatment plan will restore your abilities faster, and help you prevent further problems in the future.

Nonsurgical Treatment

Most hamstring strains heal very well with simple, nonsurgical treatment.

RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.

• Rest. Take a break from the activity that caused the strain. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
• Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
• Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
• Elevation. To reduce swelling, recline and put your leg up higher than your heart while resting.

Immobilization. Your doctor may recommend you wear a knee splint for a brief time. This will keep your leg in a neutral position to help it heal.

Physical therapy. Once the initial pain and swelling has settled down, physical therapy can begin. Specific exercises can restore range of motion and strength.

A therapy program focuses first on flexibility. Gentle stretches will improve your range of motion. As healing progresses, strengthening exercises will gradually be added to your program. Your doctor will discuss with you when it is safe to return to sports activity.

Surgical Treatment

Surgery is most often performed for tendon avulsion injuries, where the tendon has pulled completely away from the bone. Tears from the pelvis (proximal tendon avulsions) are more common than tears from the shinbone (distal tendon avulsions).

Surgery may also be needed to repair a complete tear within the muscle.

Procedure. To repair a tendon avulsion, your surgeon must pull the hamstring muscle back into place and remove any scar tissue. Then the tendon is reattached to the bone using large stitches or staples.

A complete tear within the muscle is sewn back together using stitches.

Rehabilitation. After surgery, you will need to keep weight off of your leg to protect the repair. In addition to using crutches, you may need a brace that keeps your hamstring in a relaxed position. How long you will need these aids will depend on the type of injury you have.

Your physical therapy program will begin with gentle stretches to improve flexibility and range of motion. Strengthening exercises will gradually be added to your plan.

Rehabilitation for a proximal hamstring reattachment typically takes at least 6 months, due to the severity of the injury. Distal hamstring reattachments require approximately 3 months of rehabilitation before returning to athletic activities - so come see us at Champion Performance and Physical Therapy! Your doctor and physical therapist will tell you when it is safe to return to sports.

Recovery

Most people who injure their hamstrings will recover full function after completing a rehabilitation plan. Early treatment with a plan that includes the RICE protocol and physical therapy has been shown to result in better function and quicker return to sports.

To prevent reinjuring your hamstring, be sure to follow your doctor's treatment plan. Return to sports only after your doctor has given you the go-ahead. Reinjuring your hamstring increases your risk of permanent damage. This can result in a chronic condition.

New Developments

Platelet-rich plasma (PRP) is currently being investigated for its effectiveness in speeding the healing of hamstring muscle injuries. PRP is a preparation developed from a patient's own blood. It contains a high concentration of proteins called growth factors that are very important in the healing of injuries.

A few treatment centers across the country are incorporating PRP injections into the nonsurgical treatment regimen for some hamstring muscle injuries. However, this method is still under investigation and more research is necessary to prove PRP's effectiveness.

PREVENTING BACK PAIN AT HOME AND AT WORK

Almost everyone will experience back pain at some point in their lives. Back pain varies from one person to the next. It can range from mild to severe, and can be acute or chronic, depending on the cause.

Preventing all back pain may not be possible. We cannot avoid the normal wear and tear on our spines that goes along with aging. There are, however, things we can do to lessen the impact of low back problems and adjust aspects of our daily routine to better prevent acute injuries from occurring. 

Having a healthy lifestyle is the first way to prevent back pain. 

• Exercise

Combine exercise, like walking or swimming, with specific core-strengthening exercises to keep the muscles in your back and abdomen strong and flexible.

• Weight

Maintain a healthy weight. Being overweight puts added pressure on your spine and lower back.  Quick weight gain without adjusting your daily exercise regime will usually cause problems in the low back, as the muscles require time to strengthen as your weight increases (body builders, pregnancy, etc.)

• Avoid Smoking

Both the smoke and the nicotine cause your bones, and more specifically, your spine to age faster than normal.  Smoking is a known catalyst of osteoporosis, which is will cause weakening of the vertebrae. 

• Proper Posture

Good posture is important to avoiding low back problems. How you stand, sit, and lift things has an increasing effect on your spine health.

• Drink Plenty of Water

Water is required for healthy function in every cell of the human body.  The spine, like all other joints, requires lubricant to allow pain-free movement. Drinking enough water each day can increase your body's natural lubricant production. 

Guidelines for Proper Lifting

• Plan ahead what you want to do and do not be in a hurry.
• Position yourself close to the object you want to lift.
• Separate your feet shoulder-width apart to give yourself a solid base of support.
• Bend at the knees.
• Tighten your stomach muscles.
• Lift with your leg muscles as you stand up.
• If an object is too heavy or is an awkward shape, do not try to lift it by yourself. Get help. 

Picking Up a Light Object

To lift a very light object from the floor, such as a piece of paper, lean over the object, slightly bend one knee and extend the other leg behind you. Hold on to a nearby chair or table for support as you reach down to the object, as necessary.

Picking Up a Heavy Object

Whether you are lifting a heavy laundry basket or a heavy box in your garage, remember to get close to the object, bend at the knees, and lift with your leg muscles. Do not bend at your waist.

When lifting luggage, stand alongside of the luggage, bend at your knees, grasp the handle and straighten up.  Do your best to keep your stomach tight while lifting the object.  This anatomical act of checks-and-balances will allow your core to split the opposing force between both sides of the body, and therefore, lessening the stress on the back, alone.  The checks-and-balances system includes the quadriceps and hamstrings, the biceps and triceps; or in other words, muscles that pull the body in the opposite direction from the other. 

Holding An Object

While you are holding the object, keep your knees slightly bent to maintain your balance. If you have to move the object to one side, avoid twisting your body or leaning backward. Point your toes in the direction you want to move and pivot in that direction. Keep the object close to you when moving, and again, keeping your stomach tight will lessen the stress on the low back and naturally force you to keep from leaning backward. 

Placing an Object on a Shelf

If you must place an object on a shelf, move as close as possible to the shelf. Spread your feet in a wide stance, positioning one foot in front of the other to give you a solid base of support. Do not lean forward and do not fully extend your arms while holding the object in your hands.

If the shelf is chest high, move close to the shelf and place your feet apart and one foot forward. Lift the object chest high, keep your elbows at your side and position your hands so you can push the object up and on to the shelf. Remember to tighten your stomach muscles before lifting.

Supporting Your Back While Sitting

When sitting, keep your back in a normal, slightly arched position. Make sure your chair supports your lower back. Keep your head and shoulders erect. Make sure your working surface is at the proper height so you don't have to lean forward. Once an hour, if possible, stand, and stretch. Place your hands on your lower back and gently arch backward.

Move Often

Allow yourself plenty of opportunities to move and stretch.  The recommended break time for students is 5 minutes for every 30 minutes studying, or 10 minutes for every 60 minutes.  It's proven to improve cognitive function and memory, as well as relieve tension in the muscles of the body. Think about it - how many times have you been "in the zone" writing a letter or typing an email, and when you press that send button, you feel your shoulders, neck, and back relax?  That tension over time will cause tight muscles.  When the muscles are tight, they pull on the bones.  When they pull on the bones so much, they can move the bones slightly out of place - but slightly is enough to feel it. Some companies are now allowing employees to inquire about a standing desk - one that can raise if you'd prefer to stand for part of your day. Make inquiries with your HR department if this interests you!

Need Help Adjusting?

 If you suffer from acute or chronic back pain, talk to your doctor about the possibility of starting physical therapy with us at Champion Performance and Physical Therapy. If some of these qualities sound oh-too-familiar and think you could use some overall strengthening exercises for your core to simply improve your quality of life, you are welcome to contact us and we'll see if you are eligible to come in we can see if you qualify to come in without a prescription from your doctor for a simple evaluation and exercise plan. 

Source: http://orthoinfo.aaos.org/topic.cfm?topic=A00175

RECOVERING FROM CHILDBIRTH - IS YOUR BODY HEALING PROPERLY?

Using MRI, researchers suggest that, after childbirth, up to 15% of women sustain pelvic injuries that don’t heal.

The researchers, from the University of Michigan, also note that women can take 8 months or longer to heal from pelvic injuries sustained during childbirth, and in some cases the Kegel exercises commonly prescribed don’t work at all, according to a media release from the university.

“If an athlete sustained a similar injury in the field, she’d be in an MRI machine in an instant,” says Janis Miller, PhD, RN, APRN, FAAN, associate professor at the U-M School of Nursing.

“We have this thing where we tell women, ‘Well, you’re 6 weeks postpartum and now we don’t need to see you—you’ll be fine.’ But not all women feel fine after 6 weeks nor are ready to go back to work, and they aren’t crazy,” she adds in the release.

Miller and a team of midwives, radiologists, and obstetricians studied a group of pregnant women at high risk for pelvic muscle tears, and used MRI to diagnose injury and track healing time, the release explains.

Medical experts previously thought that postpartum pelvic injuries were primarily nerve-to-muscle related.

However, the images in Miller’s study showed that one-quarter of the women studied had fluid in their pubic bone marrow or sustained fractures similar to a sports-related stress fracture, and two-thirds showed excess fluid in the muscle, which indicates injury similar to a severe muscle strain. Forty-one percent sustained pelvic muscle tears, with the muscle detaching partially or fully from the pubic bone, the release continues.

Miller stresses in the release that the study group was selected for high-risk factors of muscle tear, and isn’t representative of the population of expectant mothers. Most injuries, including all fractures, healed by the eight-month return visit time.

What Miller hopes is that this study helps to derail the one-size-fits-all approach to treating postpartum injuries—Kegel exercises are the most commonly prescribed—so that women can stop blaming themselves if problems linger.

“We’re not saying that every woman who gives birth needs an MRI, nor that women should not do Kegel exercises. A key point is that if a woman is sensing that she has delayed recovery or unusual symptoms of discomfort or feels she just can’t Kegel anymore, she should see a specialist,” Miller stresses in the release.

Here at Champion Performance and Physical Therapy, specialist Molly Sauder, PT focuses her treatment on coccygeal pain and pelvic floor, and Janice M. Bode, PT specializes in Women's Health.  If you are unsure your body is healing properly 6 weeks after giving birth, talk to your doctor about coming to see a specialist like Molly or Janice. We'll do our best to get you feeling back to normal!

[Source(s): University of Michigan, Science Daily]

WHAT TO EXPECT FOLLOWING A KNEE REPLACEMENT

Activities After Knee Replacement

After having a knee replacement, you may expect your lifestyle to be a lot like it was before surgery— but without the pain. In many ways, you are right, but returning to your everyday activities takes time. Being an active participant in the healing process can help you get there sooner and ensure a more successful outcome.

Even though you will be able to resume most activities, you may have to avoid doing things that place excessive stress on your "new" knee, such as participating in high-impact sports like jogging. The suggestions here will help you enjoy your new knee while you safely resume your daily activities.

Hospital Discharge

Your hospital stay will typically last from 1 to 4 days, depending on the speed of your recovery. Before you are discharged from the hospital, you will need to accomplish several goals, such as:

• Getting in and out of bed by yourself.
• Having acceptable pain control.
• Being able to eat, drink, and use the bathroom.
• Walking with an assistive device (a cane, walker, or crutches) on a level surface and being able to climb up and down two or three stairs.
• Being able to perform the prescribed home exercises.
• Understanding any knee precautions you may have been given to prevent injury and ensure proper healing.

If you are not able to accomplish these goals, it may be unsafe for you to go directly home after discharge. If this is the case, you may be temporarily transferred to a rehabilitation or skilled nursing center.

When you are discharged, your healthcare team will provide you with information to support your recovery at home. Although the complication rate after total knee replacement is low, when complications occur they can prolong or limit full recovery. Hospital staff will discuss possible complications, and review with you the warning signs of an infection or a blood clot.

Warning Signs of Infection

• Persistent fever (higher than 100 degrees)
• Shaking chills
• Increasing redness, tenderness or swelling of your wound
• Drainage of your wound
• Increasing pain with both activity and rest

Warning Signs of a Blood Clot

• Pain in your leg or calf unrelated to your incision
• Tenderness or redness above or below your knee
• Increasing swelling of your calf, ankle or foot
• Increased stiffness of the calf and hard-to-the-touch when palpated

In very rare cases, a blood clot may travel to your lungs and become life-threatening. Signs that a blood clot has traveled to your lungs include:

• Shortness of breath
• Sudden onset of chest pain
• Localized chest pain with coughing

Notify your doctor if you develop any of the above signs.

Recovery at Home

You will need some help at home for several days to several weeks after discharge. Before your surgery, arrange for a friend, family member or caregiver to provide help at home.

Preparing Your Home

The following tips can make your homecoming more comfortable, and can be addressed before your surgery:

• Rearrange furniture so you can maneuver with a cane, walker, or crutches. You may temporarily change rooms (make the living room your bedroom, for example) to avoid using the stairs.
• Remove any throw rugs or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
• Get a good chair—one that is firm with a higher-than-average seat and has a footstool for intermittent leg elevation.
• Install a shower chair, gripping bar, and raised toilet seat in the bathroom.
• Use assistive devices such as a long-handled shoehorn, a long-handled sponge, and a grabbing tool or reacher to avoid bending over too far.

Place items that you use frequently within easy reach.

Wound Care

During your recovery at home, follow these guidelines to take care of your wound and prevent infection:

• Keep the wound area clean and dry. A dressing will be applied in the hospital and should be changed as necessary. Ask for instructions on how to change the dressing before you leave the hospital.
• Follow your doctor's instructions on how long to wait before you shower or bathe.
• Notify your doctor immediately if the wound appears red or begins to drain. This could be a sign of infection.

Swelling

Mild to moderate swelling is normal for the first 3 to 6 months after surgery. To reduce swelling, elevate your leg slightly and apply ice. Wearing compression stockings may also help reduce swelling. Notify your doctor if you experience new or severe swelling, since this may be the warning sign of a blood clot.

Medication

Take all medications as directed by your doctor, and within your own limits. Home medications may include narcotic and non-narcotic pain pills, oral or injectable blood thinners, stool softeners, and anti-nausea medications.  Use caution when taking medications that may affect your vision, balance, or stability, as they may affect your ability to walk or drive.

Be sure to talk to your doctor about all your medications—even over-the-counter drugs, supplements and vitamins. Your doctor will tell you which over-the-counter medicines are safe to take while using prescription pain medication.

It is especially important to prevent any bacterial infections from developing in your artificial joint. Your doctor may advise you to take antibiotics whenever there is the increased possibility of a bacterial infection, such as when you have dental work performed. Be sure to talk to your doctor before you have any dental work done and notify your dentist that you have had a knee replacement. You may also wish to carry a medical alert card so that, if an emergency arises, medical personnel will know that you have an artificial joint.

Diet

By the time you go home from the hospital, you should be eating a normal diet. Your doctor may recommend that you take iron and vitamin supplements. You may also be advised to avoid supplements that include vitamin K and foods rich in vitamin K if you taking certain blood thinner medications, such as warfarin (Coumadin). Foods rich in vitamin K include broccoli, cauliflower, brussel sprouts, liver, green beans, garbanzo beans, lentils, soybeans, soybean oil, spinach, kale, lettuce, turnip greens, cabbage, and onions.

Continue to drink plenty of fluids, but try to limit coffee intake and avoid alcohol. You should continue to watch your weight to avoid putting more stress on the joint.

Resuming Normal Activities

Once you get home, you should stay active. The key is to not do too much, too soon. While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:

Driving

In most cases, it is safe to resume driving when you are no longer taking narcotic pain medication, and when your strength and reflexes have returned to a more normal state. Your doctor will help you determine when it is safe to resume driving.

Sexual Activity

Please consult your doctor about how soon you can safely resume sexual activity. Depending on your condition, you may be able to resume sexual activity within several weeks after surgery.

Sleeping Positions

After you are no longer using any ambulatory aides, you can safely sleep on your back, on either side, or on your stomach.  During the earliest stages of healing, however, your physician will instruct you through approved sleeping positions. 

Return to Work

Depending on the type of activities you do on the job and the speed of your recovery, it may be several weeks before you are able to return to work. Your doctor and physical therapist will advise you when it is safe to resume your normal work activities.

Sports and Exercise

Here at Champion Performance and Physical Therapy, we will instruct you through progressive stretching and strengthening exercises so as to help you return to performing all daily activities in a timely fashion.  Stationary biking is a great way to maintain muscle tone and allow some flexibility in the knee until your physical therapist and orthopedic surgeon approve swimming and other types of exercise and cardio. When riding stationary bicycles, try to achieve the maximum degree of bending and straightening possible.   Please consult us at Champion Performance and Physical Therapy prior to beginning any exercises listed above on your own.

After a few months,  your doctor and physical therapist will likely give you the go-ahead to return to many of the sports activities you enjoyed before your knee replacement.  

• Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist.
• Swimming is an excellent low-impact activity after a total knee replacement; you can begin as soon as the sutures have been removed and the wound is healed - seek approval from your physical therapist prior to swimming.
• In general, lower impact fitness activities such as golfing, bicycling, and light tennis will help increase the longevity of your knee and are preferable over high-impact activities such as jogging, racquetball and skiing.

Air Travel

Pressure changes and immobility may cause your knee joint to swell, especially if it is just healing. Ask your doctor before you travel on an airplane. When going through security, be aware that the sensitivity of metal detectors varies and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector. You may also wish to carry a medical alert card to show to the airport screener.

For more questions - ask our physical therapists here at Champion Performance and Physical Therapy! 

Please note, every person and body is different and rehabilitation may vary from person to person - this information does not replace medical advice from a licensed physician.  This published information is strictly for educational purpose. 

DON'T LET YOUR IT BAND HOLD YOU BACK FROM BEATING YOUR NEW YEAR'S RESOLUTIONS

 

January 13, 2016

 
More people each year are participating in local 5k's, 10k's, half-marathons, and beyond in hopes of reaching personal goals and maintaining a healthier lifestyle.  While the summer months usually have the most participants in local races, training for those events will likely begin during the winter months. Icy Kansas City temperatures during the winter months force runners to begin their training indoors on the treadmill, which can cause muscle imbalances that may eventually result in pain. Champion Performance and Physical Therapy would like to take this time to review some prevention and treatment concepts for a common overuse running injury referred to as Iliotibial Band Syndrome (ITBS), and help our local runners accomplish their goals this year!

What is the Iliotibial Band?

The IT band is a part of a group of muscles on the outside of the hip that serve to promote hip stability during running, restraining the leg from crossing midline when the foot hits the ground. The band starts at the hip area (the ilia) and crosses the outside of the knee joint to insert on the tibia (shin bone) of the lower leg.

How does ITBS occur?

If a runner has muscle imbalances due to weakness or tightness, abnormal running mechanics may occur. Altered running mechanics can cause the band to rub over the underlying bone with repeated knee flexion and extension. The resulting friction can lead to inflammation and irritation.

What are the causes of ITBS?

• As mentioned above, ITBS can be caused by muscle imbalances* such as excessive muscle tightness or weakness. 
• Training errors: A runner who increased mileage too quickly, does too many hills, or runs on one side of a beveled road (which is slanted for drainage) is at greater risk for ITBS
• Incorrect shoes: A shoes that does not adequately control pronation or supination can also be a cause of ITBS

*A muscle imbalance would mean that one group of muscles is too tight, too strong, or too weak to match that of it's counterpart/antagonist muscle group. 
A counterpart/antagonist muscle group would be the equivalent of what the triceps are to the biceps - the group of muscles that act on the bone, pulling in the opposite direction.

How can I prevent ITBS?

• Try changing your running routine. Instead of running only on a treadmill or a track, go for a run outdoors (if you can bare the weather), or run on a carpeted surface with more "give". Change the side of the street you run, cross training might also help to alleviate symptoms.
• Stick to a schedule for increasing mileage and remember: not too quickly!
• Stretch, stretch stretch!
• Change your shoes as needed to prevent stress to ankles, hips and knees and maintain integrity of the tread.

How can I treat ITBS if I have it?

• Self soft-tissue mobilization: Foam rollers, tennis balls, and lacrosse balls are good methods of improving soft tissue mobility.
• Include exercises in your training routine that will strengthen your hip abductors
•  If this strategy does not help, contact the experts at Champion Performance and Physical Therapy and we can assess your running shoes, flexibility, and strength and design a program to meet your individual needs.

BEST OF LUCK ACHIEVING YOUR GOALS THIS YEAR!

References
[i] Hamill J, Miller R, Noehren B, Davis I. A Prospective Study of Iliotibial Band Strain in Runners; Clinical Biomechanics [serial online]. April 2008.
[ii] van der Worp M, van der Horst N, de Wijer A, Backx F, Nijhuis-van der Sanden M. Iliotibial Band Syndrome in Runners: A Systematic Review; Sports Med [serial online]. 2012.
[iii] Baker R, Souza R, Fredericson M. Iliotibial Band Syndrome: Soft Tissue and Biomechanical Factors in Evaluation and Treatment; American Academy of Physical Medicine and Rehabilitation [serial online]. June 2011.

Cortisone Shots: What are they and what should I expect?

CORTISONE SHOTS: WHAT ARE THEY AND WHAT SHOULD I EXPECT?

HOPE HILLYARD, PT

Cortisone is a type of corticosteroid which reduces inflammation caused by a variety of diagnoses discussed below. Corticosteroids can be taken by the mouth (prednisone), given intravenously (solumedrol), or injected into the body (triamcinolone, kenalog, celestone, depomedrol). Corticosteroids are not pain relievers, but they reduce inflammation so if pain is reduced it is because inflammation was reduced. For the purpose of this blog, we will be discussing the corticosteroid injected into the body.

If you have developed…
● Bursitis
● Carpal tunnel syndrome
● Osteoarthritis
● Plantar fasciitis
● Rotator cuff injury
● Tendinitis
● Tennis elbow

…then a cortisone injection might be prescribed by your doctor. Your doctor might use the injection to make a diagnosis to rule conditions in or out, to provide rapid pain relief, and/or determine a treatment plan.

Benefits:
Cortisone injections can be easily administered at the doctor’s office. They provide rapid relief of localized inflammation and are more powerful than anti-inflammatory medications given by mouth. If given properly, cortisone injections are dependable and have minimal side effects. They are able to return function to a body or body part handicapped by inflammation. When used on conjunction with physical therapy, range of motion, stretching, and strengthening can be easier to accomplish.

Short-Term Side Effects
Although uncommon can include atrophy and discoloration of the skin around injection site, a bacterial infection if area is not cleaned properly, soreness at the injection site, or aggravation of the inflamed area due to reaction of medication (postinjection flare). If administered to patients with diabetes than temporary increased blood sugar in common.

Long-Term Side Effects
Depending on the dose and frequency of injections but can include easily bruising, thinning of skin, elevation of blood pressure, and degeneration of joint tissues. Repeated injections can cause deterioration of joint cartilage and weakening of the ligaments and tendons of the joint. For this reason, cortisone injections are typically limited to one every six weeks and no more than 3-4 times a year.

During Procedure
The area around the injection site should be cleaned. The doctor might provide a localized anesthetic to numb the area. Some injections will be guided by ultrasound or x-ray to determine the needle’s progress through the body to make sure the correct site is injected. You will most like feel pressure from the needle and the medication is injected into the inflamed site. Some injections will include an anesthetic to provide immediate pain relief.

After Injection
Your doctor may ask you to:
● protect the area for a day or two and limit activity to that joint
● Apply ice as needed to the injected site for further pain relief
● Watch for signs of infection that include redness, swelling, warmth, and increased pain

How can Physical Therapy Help?
Consistent findings of high-quality randomized control trials have shown that a cortisone injection in adjunct with PT have better long term outcomes than cortisone injection alone or a wait-and-see approach. Success rates for short term outcome measures benefited just the cortisone injection group however recurrence rate was high at long term for just the injection group.

If your doctor has recommended a cortisone injection then request a prescription for physical therapy to insure the best possible outcome. Contact the offices of Champion Performance & Physical Therapy for any questions or to schedule an appointment.

References:

Mayo Clinic “Tests and Procedures” Cortisone Shots http://www.mayoclinic.org/tests-procedures/cortisone-shots/basics/definition/prc-20014455

WebMD “Arthritis Health Center” Cortisone Injection (Corticosteroid Injection) of Soft Tissues & Joints http://www.webmd.com/arthritis/cortisone-injection-soft-tissues-joints
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; published online Oct 22. DOI:10.1016/S0140-6736(10)61160-9

Smidt N, Van der Windt D, Assendelft W, et. al, The Lancet, Volume 359, Issue 9307, Pages 657 – 662, 23 February 2002 Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial

Pelvic Floor Spasms

The muscles at the base of the pelvic floor are called the levators. They are two large “sling-like” muscles that suspend from the pubic bone in the front to the tail bone in the back. They hold everything up that is contained in the pelvic area. Sometimes these muscles will go into a spasm and cause very acute pain. Women often describe this pain as a heavy pressure feeling, almost as though something might “fall out.”

The spasm can sometimes create a sharp stabbing pain in the vagina, low back pain, as well as pain passing bowel movements and/or having sexual intercourse. This pain tends to get worse with prolonged sitting or standing leaving the individual with increased discomforts as the day wears on.

What can you do?

Let go! The spasm creates pressure or heavy feeling in the pelvis and many women will tighten the muscle involuntarily thinking it will help hold everything in. A vicious cycle gets created in which an already tight muscle is being made tighter which increases the pain, etc. When you feel the heavy pressure or back pain, try to mentally let go of it.

Do some reverse Kegel exercises. Many women learned Kegel exercises while pregnant to help prevent leakage of urine after delivery. The Kegel exercise involves tightening the levator muscles, holding them for a count of 10 slowly and then letting go. The goal of a Kegel is to strengthen the muscle. A reverse Kegel has the goal of teaching the muscle to relax. You can identify the muscle by thinking about why you do to hold back a bowel movement or prevent yourself from passing gas. Do the contraction, count to one, then exhale and relax the muscle counting to 10 slowly before you contract again. Do about 60 repetitions per day – but not all at once. Most women choose to do 20 three times a day or 15 four times a day.

Apply a heating pad to your low back when convenient. Soaking in a hot tub before bedtime will also help with relaxation. Many women do their reverse Kegels while soaking.

Physical Therapy. If you do not attain sufficient relief with the above measures, many physical therapists have expertise in working with this muscle group. Let us know if you need a referral.

OPEN HOUSE

We're excited to announce our new location will be open October 12th on the SW corner of 75th St and State Line Road in Prairie Village. Please stop in for our OPEN HOUSE Monday, October 12, 2015 between 12-7pm! 

Teen Female Athletes: At Risk?

Teen girls who are athletes face unique obstacles when it comes to their bodies and how well they perform.

Teen girls have their teen growth spurt at an earlier age than boys, and reach their adult height earlier. Teen girls have more body fat than teen boys because of higher estrogen levels. Teen boys have more lean body mass because of higher androgen levels. Teen girls, even after weight training, have less upper body strength than teen boys.

Estrogen appears to affect a female athlete's ligaments by making them more relaxed and boosting the risk for injury. The anterior cruciate ligament (ACL) in the knee seems particularly in danger of getting injured because of this. This is especially true at certain times during a teen girl's menstrual cycle.

Physical differences in teen girls also affect the ACL and the knee. There is less space in a teen girl's knee for the ACL. This puts more stress on the ligament, making it easier to tear. Teen girls have wider hips than teen boys. This difference in width puts more stress on the knees, particularly when landing from a jump. When a girl lands, she has more flex in her ankle and more foot roll out.

The highest-risk sports for ACL injury include: basketball, soccer, cheerleading, field hockey, singles tennis, lacrosse, and skiing. According to the American Academy of Orthopaedic Surgeons, nearly 200,000 ACL injuries are estimated to happen each year.

In addition to knee injuries, teen girls may be more likely to have problems with shoulder instability and ankle sprains because of their more relaxed ligaments.

Here are several suggestions for teen athletes:

• Strengthen leg muscles, particularly the hamstrings.

• Learn how to land properly after jumping, with knees bent and hips flexed forward.

• Strengthen core muscles in the trunk, hips, pelvis, abdomen and back.

• Warm up before beginning any activity, take rest breaks, and cool down and stretch after play.

http://www.alliancehealthmidwest.com/health-education/1,2810

Physical Therapy Direct Access

Direct Access in Kansas.

Kansas now has a direct access program that allows you to come directly to Physical Therapy without a prescription. 

What does this mean?

You no longer have to have a referral from your physician. Direct access removes unnecessary steps and related costs and puts the decision in the patient's hands. This is only available with certain insurance coverage though; Medicare still requires a doctor's referral. If you have questions about direct access please call and we will help to see if you are eligible.

"Kansas became the latest state to improve patient access to physical therapists when Governor Sam Brownback signed HB 2066 on March 28, 2013 legislation that will ease burdensome referral requirements that impede timely care from skilled physical therapists. Achievement of direct access in all 50 states has been a longtime and fundamental goal of APTA, and the organization supports this positive move in Kansas. " - American Physical Therapy Association. http://www.apta.org/Media/Releases/Legislative/2013/4/1/