FAQ OF YOUR 'HEP'

So you come to therapy. You're given a folder with exercise pictures, and bands to complete your resistance training when you're not at therapy; these exercises are a part of your "Home Exercise Program." 

Here at Champion, we expect you to do your exercises for 30 minutes, twice per day throughout the duration of your treatment. On the days you come to therapy, it's only necessary to do them once more, as you'll do them with us, as well. We suggest using ice for 15 minutes after each exercise session (at home and in-clinic.)

What happens after you've had a few sessions and you can no longer fit all of your exercises in within 30 minutes?

Get through whatever you can in 30 minutes, and do everything you didn't have time for in the second session of 30 minutes. If you get through all of your exercises in 45 minutes worth of time, start them over. 

What if I'm so sore from doing new exercises during a treatment session that I'm having problems doing them at home?

First thing you need to recognize is the type of pain you're having. If it's muscle soreness, do your best to push through it. If it's joint pain or localized pain right on an incision site or bony prominence associated with your diagnosis, either reduce the repetitions/sets, or reduce the weight you're performing the exercise with. The best way to describe the bad kind of pain is relating it to the symptoms you started therapy with; the pain you originally started therapy with. If the movement causes pain like that, anything above a 1-2/10, discontinue the exercise for the day. 1-2/10 may cause some discomfort at most, but this will be uncomfortable, at least slightly. 

Second thing you need to do is understand that we are going to progress you, just slightly, each time you come into the clinic. You will have some residual soreness from the increased stress on the body, and this can make it difficult to wrap your mind around continuing with your HEP. Your soreness should be gone within a couple of days, but we have to force that hypertrophy in your muscles to improve your symptoms. It's not an easy process.  If it's an exercise that causes lingering or sharp pains, stop. Our rule of thumb is no greater than a 4-5/10 on a pain scale. We want you around a 1-2, as far as pain goes. Please keep in mind, this does not include muscle soreness.

What if I forget how to do an exercise?

First suggestion would be to read the description under the photo - sometimes the description includes alternative options to performing the exercise that we used with you, and that version may not be the one depicted on your HEP sheets. 

Second suggestion would be to do your best to do the exercise as you remember, and make a note to yourself to remind us to review it with you and make notes on your HEP sheets for next time. 

Third suggestion, we're always just a phone call away. If you're really frustrated by an exercise, give us a call and we'll do our best to walk you through what we'd like for you to do. 

What happens when my bands get too light, or weights get too light? Should I push myself without being told and increase?

If you've been doing an exercise that feels too easy for you, try to increase your resistance or weight for one set. Most of the time, you'll be required to do 2 sets of an exercise, or at least 20 repetitions of an exercise.  Split your reps or sets in half, and try one at a higher resistance. If you don't have an increase in symptoms the next day, you're welcome to try to increase to doing all of your reps/sets at that higher level. If you do have some increased soreness, it's okay. Make sure to tell us that you tried, so we can make a note of it.  This will not slow you down, as long as you performed the exercise with the correct form - you'll likely just have some muscle soreness for the next couple of days. 

What happens when I'm finished with therapy, what do I do with my exercises?

It depends on what you were in therapy for.

Say you're an athlete who is post-surgical, you'll likely only be anywhere from 75-85% back by the time you're discharged.  Why? Because legally, therapy is prescribed based on medical necessity, and medical necessity is equivalent to functionality. According to insurance policies, you're entitled to be able to perform all daily activities that are related to your functionality as a person.  In other words, being able to cook, clean, bathe yourself, dress yourself, etc. As an athlete, being back to 100% means being able to return to play AND not feel limited by a prior injury; as if the injury never happened. You'll be discharged from therapy once you've met the functionality limitations, and can clear the specialized tests that are required to be cleared by a physician to return to play. However, there will still be aspects of your game that will be slacking, because you have to progress back up to higher level activity. 

In this case, you'll want to keep up with your exercises for a couple months until you're more comfortable playing again. From that point on, doing your HEP 3x/week should be enough. 

However, say you're in physical therapy for shoulder pain due to tendonitis, or impingement. By the time you're discharged, you'll likely already be rid of all your symptoms with most all activity. At your time of discharge, you'll be able to immediately switch to doing your HEP only 3x/week. If your symptoms return, even slightly, try to increase the number of times you perform your HEP before decreasing that activity that's causing the symptoms. 

What if I just do my exercises in therapy, since I'm so busy or don't like to exercise?

Your symptoms will only have slight relief. Unfortunately, by the time you've had pain severe and for long enough that you've seen a physician and scheduled therapy, your injury, whatever it is, has caused modifications in your lifestyle. Your body will make changes that modify daily activities to protect that injured area from increased pain - examples can vary from secondary muscle group activations to compensate, all the way to using the other hand for activities that require overhead movement. 

This requires completing your HEP religiously until at least some relief is felt. If you only do your exercises when you're here in the clinic, you'll likely see little to no progress. The interesting thing about physical therapy is it only works if you're willing to put the work in. 

TIPS FOR OUTDOOR EXERCISE DURING THE FALL

Let's be real, everyone: exercising outdoors during the fall is by far the easiest, as there isn't much rain, but you also aren't attempting to bare the temperature extremes. 

But, like always, there are always precautions you can incorporate into your routine that'll keep you on track with your exercise!

1. Reflectors

Get used to wearing reflectors, headlamps, or reflective clothing. The sun goes down earlier and earlier during the year, and running at 6 PM after work is going to go from blinding sunsets to complete darkness, and it's crucial that if you are going to exercise outdoors, that you give cars or other pedestrians an opportunity to see you with enough time to get out of the way. 

2. Stretch!

As the weather gets colder, it's necessary for you to remember to stretch before and after workouts. This doesn't go for just people exercising outdoors - you'd be surprised at how quickly you'll tighten up just walking from the gym to your car in low temperatures!

3. Utilize Schools Near You

Many high schools that have football fields, stadiums, or tracks allow the public to exercise on school grounds. Contact schools near you to figure out which locations are public-friendly, and which are not! 

4. Be Respectful

That being said, be respectful of those schools who do allow you to utilize their outdoor facilities, as they'll likely have fall sports teams practicing until around dinner time. It's necessary that their coaches be comfortable with having the public on the grounds during practice time, as it's possible that staff could confuse you with someone else. Many high schools have rules concerning scouting and filming for their athletes, and therefore, place restrictions on who is allowed on athletic grounds during practice times. 

5. Layer

It can be chilly, or even extremely warm during the fall, so it's best to dress in layers so you can add or subtract clothing as your workout progresses. It's better for your muscles to be warm than cold, but be sure to protect your body from overheating. If you start cold sweating, or get goosebumps in 90 degree weather, you're likely starting to overheat! Be sure to find some shade, drink some water if possible, and cool your body down before heading home.

6. Exercise With Others!

Get your friends to join - a new school year is a great opportunity to start new programs, form new habits, or inspire your kids to lead active and healthy lifestyles, as well. Take your kids!

7. Parents - Be Efficient

If you're a parent who happens to be off work in time to get your young children to practices, utilize that time while they're practicing to exercise in or near the same facility your child is at. That way you an be supportive and take them to practices, but still get your exercise in. Lead by example!

WHAT IS STRENGTH TESTING?

WHAT IS IT?

Strength testing, in a PT sense, is not the same as maxing out in the weight room. Strength testing, professionally known as Manual Muscle Testing (MMT) is a graded technique that provides the ability for a therapist to produce an objective measurement of perceived muscle strength based on a patient's ability to resist an opposing force. 

In Layman's terms, this essentially means your physical therapist is going to place a body part of yours in a specific position, and they're more than likely going to push against that same body part and ask you to resist that external force as best you can. With that numerical value, they'll be able to test continuously throughout your treatment to determine whether or not therapy is/has been beneficial for your specific injury.

SIDE NOTE: They are not going to push hard.

They're simply trying to determine whether or not you can withstand the force and maintain your position with only slight deviation, or whether or not your muscles give out due to weakness, or maybe even pain. 

HOW DOES GRADING WORK?

They are going to grade you on an integer - only, numerical scale, with 5 being the best. You may hear some therapists use terminology such as 4+ or 4- and that is more of a subjective notation for your therapist to notate smaller gains or regressions in strength or ability. 

SIDE NOTE: They do not share these tested scores with anyone aside from your referring specialist, as it is common lingo utilized to extend information across fields of medicine. 

CAN I DO THIS AT HOME?

No.

Simply put, Manual Muscle Testing seems like a simple concept, but your physical therapists complete a 3-year doctorate program to ensure that they're testing injured areas in the correct way, while respecting protocols instilled by your orthopedic specialists, or your surgeon. It's vital that you do not attempt to test yourself, whether alone or with a partner. 

SWIMMING INJURY PREVENTION

Swimming is among the most popular low-impact fitness activities, with more than a million competitive and recreational swimmers in the United States. More than one-third of these athletes practice and compete year-round. Elite swimmers may train more than five miles a day, putting joints through extreme repetitive motion. Most swimming injuries affect the shoulders, knees, hips, or back, depending on stroke.
 

WHAT CAUSES SWIMMING INJURIES?

With overuse comes fatigue and failure to adhere to proper stroke techniques. Often swimmers demonstrate tremendous flexibility or joint laxity, which can be normal. Slight injuries and micro-trauma can cause shoulders to become unstable and lead to shoulder pain and tendinitis. Other repetitive injuries include inner knee problems and hip problems from breaststroke kicking, and back injuries from dolphin kicks or dry-land cross-training.
 

WHAT ARE THE MOST COMMON SWIMMING INJURIES?

Swimmer's Shoulder

The shoulder is the joint most commonly affected by swimming injuries or overuse. Shoulder injuries may include rotator cuff impingement — pressure on the rotator cuff from part of the shoulder blade or scapula as the arm is lifted. Biceps tendinitis (painful inflammation of the bicep tendon) and shoulder instability, in which structures that surround the shoulder joint do not work to maintain the ball within its socket, all can result from fatigue and weakness of the rotator cuff and muscles surrounding the shoulder blade.

Lower Body Injuries

Knee injuries that involve the tendons and ligaments (breaststrokers' knee) are common. Breaststrokers may also experience hip pain from inflammation of the hip tendons. Back problems, including lower back disk problems or another problem at the junction between the spine and pelvis, termed spondylolisis, may be increased by the dolphin kick often used in competitive swimming.
 

HOW CAN SWIMMING INJURIES BE PREVENTED AND TREATED?

• Communication among athlete, parent, coach, and medical professional is critical to both swimming injury prevention and successful recovery
• Use good stroke technique
• Lessen repetitive strokes that are causing the overuse injury
• Perform core strengthening and cross-training exercises as part of pre and early season routines
• Consider alternative training techniques rather than training through an injury
• Use periods of rest to recover
• Focus rehabilitation efforts on rotator cuff and scapular strengthening for most shoulder injuries and pelvic and hip strengthening exercises for hip and knee injuries
• Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or prevention strategies

The following expert consultants contributed to the tip sheet:
Daniel J. Solomon, MD

Job Opening : Part-Time Women's Health Specialist in Pelvic Floor Dysfunction

JOB OPENING: Part Time Women's Health Specialist in Pelvic Floor Dysfunction

Champion is seeking someone who specializes with Pelvic Floor Dysfunction. This position specifically utilizes a variety of therapeutic techniques to assist in diagnosing and improving conditions. In support of our performance and mission, the Physical Therapist will help to provide more comprehensive healthcare and ensure that important patient needs are met. 

PHYSICAL THERAPIST RESPONSIBILITIES

Instruct patient in home exercise programs, transfer training, position, safety issues, modification and/or removal of architectural barriers and use of special devices, as necessary
Input of proper CPT and ICD codes for billing purposes regarding PFD treatments into EMR
Evaluation and assessment of pelvic floor dysfunction (PDF)
Treatment of pelvic floor dysfunction including but not limited to: Biofeedback, Connective Tissue Manipulation, Craniosacral Therapy, Electrical Stimulation, TENS (Transcutaneous Electrical Nerve Stimulation), Myofascial Release and Visceral Manipulation
Strictly adhere to HIPAA standards and regulations in managing or handling any patient information, patient inquiries and treatments

PHYSICAL THERAPIST QUALIFICATIONS

Graduate from an accredited Physical Therapy Education program and current KS licensure
Experience in treating Pelvic Floor Dysfunction
Knowledge of insurance policies and their coverage of PFD treatments
Experience with EMR, preferred
Embrace cultural differences and display sensitivity to them
Must be extremely dedicated to high quality patient care and maintain a positive attitude
Job Type: Part-time
Required experience: 2 years experience in treating Pelvic Floor Dysfunctions
Required license or certification: KS licensure

SOCCER INJURY PREVENTION

Soccer is one of the most popular sports in the world and the fastestgrowing team sport in the United States. Although soccer provides an enjoyable form of aerobic exercise and helps develop balance, agility, coordination, and a sense of teamwork, soccer players must be aware of the risks for injury. Injury prevention, early detection, and treatment can keep kids and adults on the field long-term.

Injuries to the lower extremities are the most common in soccer. These injuries may be traumatic, such as a kick to the leg or a twist to the knee, or result from overuse of a muscle, tendon, or bone.
 

WHAT ARE SOME COMMON SOCCER INJURIES?

Lower Extremity Injuries

Sprains and strains are the most common lower extremity injuries. The severity of these injuries varies. Cartilage tears and anterior cruciate ligament (ACL) sprains in the knee are some of the more common injuries that may require surgery. Other injuries include fractures and contusions from direct blows to the body.

Overuse Lower Extremity Injuries

Shin splints (soreness in the calf), patellar tendinitis (pain in the knee), and Achilles tendinitis (pain in the back of the ankle) are some of the more common soccer overuse conditions. Soccer players are also prone to groin pulls and thigh and calf muscle strains.

Stress fractures occur when the bone becomes weak from overuse. It is often difficult to distinguish stress fractures from soft tissue injury.

If pain develops in any part of your lower extremity and does not clearly improve after a few days of rest, a physician should be consulted to determine whether a stress fracture is present.

Upper Extremity Injuries

Injuries to the upper extremities usually occur from falling on an outstretched arm or from player-to-player contact. These conditions include wrist sprains, wrist fractures, and shoulder dislocations.

Head, Neck, and Face Injuries

Injuries to the head, neck, and face include cuts and bruises, fractures, neck sprains, and concussions. A concussion is any alteration in an athlete's mental state due to head trauma and should always be evaluated by a physician. Not all those who experience a concussion lose consciousness.

HOW ARE SOCCER INJURIES TREATED?

Participation should be stopped immediately until any injury is evaluated and treated properly. Most injuries are minor and can be treated by a short period of rest, ice, and elevation. If a trained health care professional such as a sports medicine physician or athletic trainer is available to evaluate an injury, often a decision can be made to allow an athlete to continue playing immediately. The athlete should return to play only when clearance is granted by a health care professional.

Overuse injuries can be treated with a short period of rest, which means that the athlete can continue to perform or practice some activities with modifications. In many cases, pushing through pain can be harmful, especially for stress fractures, knee ligament injuries, and any injury to the head or neck. Contact your doctor for proper diagnosis and treatment of any injury that does not improve after a few days of rest.

You should return to play only when clearance is granted by a health care professional.

HOW CAN SOCCER INJURIES BE PREVENTED?

• Have a pre-season physical examination and follow your doctor's recommendations
• Use well-fitting cleats and shin guards — there is some evidence that molded and multi-studded cleats are safer than screw-in cleats
• Be aware of poor field conditions that can increase injury rates
• Use properly sized synthetic balls — leather balls that can become waterlogged and heavy are more dangerous, especially when heading
• Watch out for mobile goals that can fall on players and request fixed goals whenever possible
• Hydrate adequately — waiting until you are thirsty is often too late to hydrate properly
• Pay attention to environmental recommendations, especially in relation to excessively hot and humid weather, to help avoid heat illness
• Maintain proper fitness — injury rates are higher in athletes who have not adequately prepared physically.
• After a period of inactivity, progress gradually back to full-contact soccer through activities such as aerobic conditioning, strength training, and agility training.
• Avoid overuse injuries — more is not always better! Many sports medicine specialists believe that it is beneficial to take at least one season off each year. Try to avoid the pressure that is now exerted on many young athletes to over-train. Listen to your body and decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury and help avoid "burn-out"
• Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or soccer injury prevention strategies
  
   

  CONTRIBUTING EXPERTS

  
  The following expert consultants contributed to the tip sheet:
  Rob Burger, MD
  Kenneth Fine, MD

JUST A LITTLE (BIG) UPDATE...

Sir Hartzell Leo is in the 95th and above percentile for height, weight, and head circumference at age 3 months (September 14th!) 

Too cute for words? We know. It's no secret - It's those little thigh rolls that make him extra adorable. 

Check out some of our photos from the holiday party, who do you think he looks more like? Hope or Nick? 

CHEERLEADING INJURY PREVENTION

Legend has it that cheerleading started with a University of Minnesota student standing up in the stands and leading his fellow students in "cheering" for their team during a football game. Cheerleading has morphed drastically since then. Today, it's considered an athletic activity that incorporates elements of dance and gymnastics along with stunts and pyramid formations. In 2002, an estimated 3.5 million people in the United States participated as cheerleaders, from six-year-olds to adults who cheerlead for professional athletic teams. While cheerleading is meant to support an athletic team, its intense competitions at the high school and collegiate levels have created a whole new dynamic, including increased risk for injury.

WHAT TYPES OF INJURIES ARE MOST COMMON IN CHEERLEADING?

The U.S. Consumer Product Safety Commission (CPSC) estimates that cheerleading led to 16,000 emergency room visits in 2002 (the latest year for data). While not as frequent as injuries in other sports, cheerleading injuries tend to be more severe, making up more than half of the catastrophic injuries in female athletes. Cheerleading injuries affect all areas of the body — most commonly the wrists, shoulders, ankles, head, and neck.
 

HOW CAN INJURIES BE PREVENTED?

Stunt Restrictions

In an attempt to curb the amount of catastrophic injuries in cheerleading, restrictions have been placed on stunts. They range from height restrictions in human pyramids, to the thrower-flyer ratio, to the number of spotters that must be present for each person lifted above shoulder level.

For example, the limit for pyramids is two body lengths for the high school level and 2.5 body lengths for the college level, with the base cheerleader in direct contact with the performing surface. Base supporters must remain stationary and the suspended person is not allowed to be inverted or rotate on dismount.

Basket toss stunts in which a cheerleader is thrown into the air (sometimes as high as 20 feet) are only allowed to have four throwers. The person being tossed (flyer) is not allowed to drop the head below a horizontal plane with the torso. One of the throwers must remain behind the flyer at all times during the toss.

Mats should be used during practice sessions and as much as possible during competitions. Cheerleaders should not attempt a stunt if they are tired, injured, or ill, as this may disrupt their focus and cause the stunt to be performed in an unsafe manner.
 

Training

The importance of a qualified coach is also critical. Coaching certification is encouraged. Precautions should always be taken during inclement weather for all stunts. Also, a stunt should not be attempted without proper training, and not until the cheerleader is confident and comfortable with performing the stunt.  Supervision should be provided at all times during stunt routines.

As with any sport, proper conditioning and training are important to minimize injury, including:

• Resistance exercises to gain strength in the lower back, stomach, and shoulders
• Regular stretching, yoga, or pilates instruction to improve flexibility
• Speaking with a sports medicine professional or athletic trainer if you have any concerns about injuries or cheerleading injury prevention strategies
• Returning to play only when clearance is granted by a healthcare professional
   

HOW ARE CHEERLEADING INJURIES TREATED?

One of the most common injuries cheerleaders suffer is an ankle or wrist sprain or strain. For treatment of a sprain or strain, remember RICE:

•  Rest the injured site for at least 24 hours
•  Ice the injury at least every hour for 10-20 minutes during the initial four hours after injury. Icing then can be done 10-20 minutes four times a day for two days
•  Compress the injured site with a snug, elastic bandage for 48 hours
•  Elevate the injured limb for at least 24 hours Immediate medical attention is required for any cheerleader with a suspected head or neck injury.
   

REFERENCES AND ADDITIONAL RESOURCES

Campbell, John D, and Barry P. Boden. Cheerleading Injuries. Sports Medicine Update. September/October 2008.

Boden BP, R Tacchetti, FO Mueller. Catastrophic cheerleading injuries. Am Journal of Sports Med. 31:881-888, 2003.

Shields BJ, GA Smith. Cheerleading related injuries to children 5 to 18 years of age: United States, 1990- 2002. Pediatrics. 117:122-129, 2006.

The following expert consultants contributed to the tip sheet:
John D Campbell, MD
Barry P. Boden, MD

MANAGING ARTHRITIC PAIN WITH EXERCISE

According to the National Center for Health Statistics, more than 50 million adults have some form of arthritis. The most common type is osteoarthritis — also known as "wear and tear" arthritis — which most often affects the weight-bearing joints in the knees, hips, neck, and lower back.

In osteoarthritis, the smooth cartilage that cushions our joints begins to wear away. Cartilage does not heal or grow back, and over time it can become rough and frayed. Without healthy cartilage, our bones can no longer smoothly glide across one another, and movement begins to cause pain and stiffness.

When it is very severe and there is no remaining cartilage cushion, the joint becomes bone-on-bone.

How Exercise Helps Arthritis Pain

It is not uncommon for arthritis pain to limit activity and slow most down - the body's natural reaction is to avoid movements that increase pain. Not exercising, however, can result in more problems. Recent research shows that not only do the compensations naturally adapted to limit pain during required daily movements (limping while walking, shuffling as opposed to stride walking), but also that over time inactivity actually worsens osteoarthritis pain, and puts adults at greater risk for eventual total loss of mobility.

Because exercise is painful for so many adults with arthritis, it may be hard to understand how exercise helps to actually relieve pain. First, exercise increases blood flow to cartilage, bringing it the nutrients it needs to stay healthy.

In addition, specific exercises will strengthen the muscles that surround your joints. The stronger your muscles are, the more weight they can handle without pain. As a result, the bones in your joints carry less weight, and your damaged cartilage is better protected.

Having strong muscles to support your joints is even more important if you are overweight. And exercise, of course, can help you with weight loss. Losing just a few pounds can make a big difference in the amount of stress you place on your weight-bearing joints, such as hips and knees.

Studies have also found that people who exercise are less likely to be depressed or feel anxious. Plus, exercise can help you manage stress and improve your sleep patterns. Getting a full night's sleep is especially important because arthritis symptoms often worsen when you are tired. With hip and knee arthritis, it can be helpful to sleep with a pillow under your knees or between your legs for comfort. 

Starting an Exercise Program

Of course, understanding how exercise can help is just the beginning. Starting an exercise program is the next step and often the toughest. Be sure to talk to your doctor first, especially if activity is painful for you or you have been sedentary for a long period of time.

Your doctor will talk to you about the types of exercises that would be best for you, depending on the severity of your arthritis - and they'll likely recommend you to physical therapy so you have medical oversight while adjusting to the exercise programs and increasing skeletomuscular strength - this is where we at Champion Performance and Physical Therapy come into play. Our staff maintains the perfect mix between experience, studying under some of Kansas City's longest-practicing physical therapists, and practicing based off of the most up-to-date research and developments. 

The program we would create would likely include three types of exercise:

• Range-of-motion exercises to improve your flexibility and reduce stiffness in your joints
• Strengthening exercises to help build muscle mass and protect your joints
• Some aerobic exercise to strengthen your heart and lungs, and improve your overall fitness. Aerobic exercise is key to controlling your weight, as well.

Even if pain does not prevent you from exercising, it is a good idea to talk to your doctor about your fitness program.

Moderate Exercise

Typically, doctors recommend a moderate, balanced fitness program. If you regularly do high-impact aerobic exercises, such as running or competitive sports, your doctor may recommend that you switch to low-impact activities that place less stress on your weight-bearing joints. Walking, swimming, and cycling are good alternatives. A stationary exercise bike, even a recumbent one, can provide aerobic exercise for those who cannot walk well or have balance problems. 

To help with balance, strength, and flexibility, your doctor or therapist may suggest you try yoga or tai chi, a program of exercises, breathing, and movements based on ancient Chinese practices.

Start Slowly

If it has been awhile since you have exercised, slow and steady is the safest and most effective way to begin a fitness program. Your goal is 20 to 30 minutes of aerobic activity, 3 to 4 times a week. If this is challenging for you, you can break it up into shorter segments, such as a 10-minute walk in the morning and a 10-minute walk in the evening.  We will likely focus on the first two of the three key exercises focuses - then when your pain dissipates enough to add aerobic activity back into your lifestyle, we'll provide the keys to upkeep on your own.

Strength exercises can be done every other day, and you can work on your range of motion every day. Always begin with a warm up to prepare your body for all types of exercise.

As you get stronger, gradually increase the duration of your aerobic exercise and the number of strength exercise repetitions. Be sure not to overdo it. You should not feel serious pain after exercise. It is typical to feel some muscle soreness the day after you exercise, but if you feel so sore that it is difficult to move, then you have overdone your exercise. You can reduce muscle soreness with a heating pad or a warm bath or shower. 

Talk to you doctor or therapist if you have any pain or are unsure about your fitness program. Your therapist may recommend assistive devices, such as braces or shoe inserts, to help reduce stress on your joints.

Living with osteoarthritis can be very challenging. Remember that there are many things you can do to lessen the impact arthritis has on your life. Regular, moderate exercise can help.

Call us at Champion Performance and Physical Therapy at 913-291-2290 with any questions.

Source: National Center for Health Statistics (NCHS), National Health Interview Survey 2010.

DISLOCATIONS DURING CHILDHOOD

Description

A joint dislocation, or subluxation, is the occurrence of one or more bones in a single joint being forced out of place, the most commonly known being the shoulder joint.  The shoulder joint includes 3 bones: the humerus (bone of the upper arm), the scapula (bone of the shoulder blade), and the clavicle (collar bone), the ball-and-socket formation being produced by the head of the humerus (the ball) and the glenoid fossa of the scapula (the socket). In a typical shoulder joint dislocation, the humerus is forcefully removed to the front of the joint, or anteriorly, from the socket formed by the scapula, surrounding tendinous musculature, and a protective, fibrous capsule. Close to 95% of subluxation in children occurs anteriorly. 

Joint dislocation is typically very painful, and can render the limb immobile until the subluxation is properly reduced, or in Layman's terms, until the bone is put back into place. 

Dislocations can occur at any joint in the body, the most frequent aside from the shoulder include digits (fingers), the patella (kneecap), the hip, the clavicle (collar bone), the mandible (jaw) or in certain cases where the child is being pulled on, the wrist and ankle. 

Negative Effects

The negative effects of subluxations during childhood are greater than that of an adult, as this significantly increases the risk for dislocating again - even with proper initial treatment.  When dislocation occurs, due to the sheer amount of force that's required to tear a bone from it's socket, it's likely that some of the ligaments, muscle tendons that insert on that joint, or cartilage will tear, and therefore, decrease stabilization. The tearing of stabilizing tendons or cartilage is called a Bankart lesion. 

Why Children?

While children and teens in their adolescence are notoriously resilient - their bodies recuperating faster than that of an adult - the increased risk comes from both an active or athletic lifestyle, and having many joints in which the protective capsules either have not yet fully formed, or fully stabilized, depending upon their age.  This joint flexibility is the same reasons kids can sit cross-legged whereas the average adult loses that capability with age. Joint flexibility is in it's prime during youth due to lack of stabilization in a joint because the fibrous protective capsules that surround the entire joint have not yet fully formed. This leads to an increased risk for subluxation and destruction of the joint capsule, which in turn, puts them at a higher risk for a second subluxation. A second subluxation is more often repaired via surgery, which will surgically create more stability. 

Higher Risk

Those children at a higher risk for a dislocation are those who are active, the most commonly reported being adolescent boys who play contact sports, but dislocations can occur due to a number of circumstances. Those high at risk include young children, children playing contact sports, children who live in a physical disciplinarian household, adolescents playing higher level contact sports, and those who have a higher risk of falls (skiers, gymnasts, kids who frequent jungle gyms, etc.)

Prevention

Preventative measures include proper strengthening, consistent work on range of motion, and using as much protective padding as possible. Specifically for active children or those with a high fall risk like gymnasts and skiers, it's also necessary to teach them how to land as safely as possible, either by rolling to lessen the force of the landing, or having as much protective padding on the body as possible to negate the natural reaction to slow down one's landing. Reaching arms out front of you (like a zombie) to catch yourself is at a lower risk of causing subluxation than does reaching your arms out to the side of your body, or reaching behind you. Another preventative measure parents can utilize in their daily lives while their children are still young is avoiding lifting the child by their hands or arms. Lifting a child by their hands, even in the most seemingly harmless way, puts the force of the child's entire body weight on a shoulder joint that has yet to solidify.

Treatment

Immediate treatment of a subluxation would be contacting your physician or visiting an urgent care or emergency room. It's imperative that parents or children DO NOT reduce or reset the dislocation themselves - please seek medical training immediately. Risks of reducing a subluxation include causing further damage to the joint, but more importantly, can trap nerves, blood supply, and muscle tendons. Trapping nerves can lead to possible nerve damage, trapping blood supply can lead to serious side effects such as tissue and bone death or clotting, and trapping small muscle tendons will require surgery - regardless of age. The limb may be braced or put into a sling for a short time, and then the injury will require physical therapy.  In certain circumstances, surgical procedures are recommended, but are more often than not minimally-invasive, arthroscopic procedures. 

Reaching behind is the most common cause of subluxation in adults, and happens frequently when an older individual falls, when skiers hit the water, or when snow skiers wipe out backwards and try to slow themselves down while going downhill.  Not only does landing with your arms reaching behind you have an increased risk of subluxation, but also frequently occurs with fractures to the bones of the hand, wrist, or possibly the elbow.