THINKING F.A.S.T. KEY IN EARLY DETECTION OF STROKE

Fewer than 25% of individuals who suffer a stroke arrive at an emergency room within 3 hours of symptom onset. But a recent study published in the American Heart Association’s Strokejournal, suggests that education can improve an individual’s ability to recognize stroke symptoms to reduce the delay in care (“Stroke education aids in symptom recognition, faster responses” – June 11, 2015).

Stroke is the third leading cause of death in the United States, and is a leading cause of serious, long-term disability in adults. Stroke can happen to anyone at any time—regardless of race, sex, or even age—but more women than men have a stroke each year, and African Americans have almost twice the risk of first-ever stroke than whites do.

When someone experiences a stroke, the more time that passes, the more damage occurs in the brain. Emergency treatment with a clot-buster drug called t-PA can help reduce or even eliminate problems from stroke, but it must be given within 3 hours of when you start having symptoms.

Participants in the study received intensive education, but the American Heart Association and American Stroke Association offer a simple method for detecting signs of a stroke: think “F.A.S.T.”!

F = Face Drooping. Ask the person to smile. Is their smile uneven? Is one side of their face numb?
A = Arm Weakness. Ask the person to raise both arms. Does 1 arm drift downward? Is 1 arm weak or numb?
S = Speech Difficult. Ask the person to repeat a simple phrase. Does the speech sound slurred or strange? 
T = Time to call 9-1-1. If you observe any of these signs, even if the symptoms go away, call 9-1-1 and get the person to the emergency room.

Protect your loved ones and yourself by being able to recognize the signs!

UTILIZING EVIDENCE-BASED PHYSICAL THERAPY FIRST HELPS TO LOWER COST OF LOW BACK PAIN

According to the APTA, If you have low back pain, you should get evidence-based physical therapy right away. Otherwise, your costs are likely to go up, along with the potential use of opioid medications, spinal injections, surgery, and other treatments.

That’s according to the results of an award-winning study published in BMC Health Services Research that reviewed 122,723 Military Health System patient records (Implications of early and guideline adherent physical therapy for low back pain on utilization and costs – April 9, 2015).  

Researchers divided patients into 4 groups: those who received physical therapy within 14 days of a physician visit; those who received physical therapy after a wait of at least 14 days; those who received "adherent" physical therapy (reflecting evidence-based guidelines); and those who received "nonadherent" physical therapy.

The study contributes to a growing body of evidence demonstrating that early physical therapy for low back pain lowers costs, and that beginning low back pain treatment with advanced imaging increases costs.

"Physical therapy as the starting point of care in your low back pain episode can have significant impact," said lead author John D. Childs, PT, PhD, in a PT in Motion News article about the study ("Early Guideline-Based Physical Therapy Results in Health Care Savings for Patients With LBP" - April 9, 2015). "Receiving physical therapy treatment that adheres to practice guidelines even furthers that benefit."

TEENS NEED MORE EXERCISE IN SCHOOL (AND IN GENERAL)

On school days, young adolescents (12 to 16 years) get 55% of their physical activity on school grounds. But recent research suggests that’s not enough.

As reported by the Los Angeles Times (“More exercise at school may be key to improving teens’ health” – December 2015), only 8% of students get the recommended 60 minutes of exercise per day. To make up the difference, “a typical school would need to devote 7.5% of its instructional time to physical fitness,” instead of the 4.8% found to be the average in a recent study published in Pediatrics (“Locations of Physical Activity as Assessed by GPS in Young Adolescents” – January 2016).  

“Because adolescents spend so much time at school, even a small increase in the proportion of at-school time spent physically active could lead to meaningful increases in overall physical activity and metabolic health,” the study authors wrote.

So what can you do about it? Talk to your local high school about what hinders them from improving PE programs in their district; it is often correlated to lack of funds in, not just these programs, but sporting programs, in general. Speak to the representatives of your booster club and reach out to alumni of the programs to see if funding can be increased - or take it straight to the devil, himself - city council (for public schools). 

"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/

PHYSICAL THERAPY: A HISTORY, Q&A, AND DIRECT ACCESS

Physical Therapy has gone through a major, major expansion in the last 10 years. So much so, in fact, that as laws are trying to change quickly enough to keep up with our progress, our clientele is growing each and every year. Patients can now seek physical therapy treatment to some extent in all 50 states without a physician's referral. Although "to some extent" varies greatly throughout the states, progress is shifting forward to allow more individuals than ever the ability to seek physical therapy. 

I, myself, have encountered many "non-believers" in the concepts of physical therapy, so I decided to host a little questionnaire with a couple of patients to see what exactly it was that they were curious about.

"How long has physical therapy been around, and why is it I've never heard of it before?" 

Physical therapy was actually started as a "reconstruction aid" program during World War 1, back in the early 1900's - what's known today as the APTA was started shortly thereafter in 1921. In the 1960's, the APTA introduced the Physical Therapist Assistant (PTA) to aid with the serious lack of physical therapists required to handle the overwhelming number of patients that required treatment during the Korean War. So long-story-short, it's been around for quite some time, now.

"Why is it I've never heard of Physical Therapy before?" 

Why have you never heard it before? For the same reason you've never heard of an Otolaryngologist (more commonly known as an ear, nose, and throat specialist) until you actually needed one: visits to specialists require a physician's prescription. 

"What's the difference between a Chiropractor and a Physical Therapist?" 

Truth be told: we do something very similar, the difference is the method of approach. TYPICALLY (notice, I said typically), a chiropractor is going to provide fast, but short-term relief, whereas a physical therapist is going to provide slower, but long-term relief. 

For example, consider a patient who's primary concern is back pain due to a misaligned spine. One manipulation adjustment from a Chiropractor, that patient is suddenly pain-free and free to go about their day. However, pain can return as quickly as later that day, to months later. A physical therapist, on the other hand, while they may perform a manipulation to relieve the pain immediately, they're going to treat the muscles surrounding that area of the spine. The skeleton is nothing more than a lever system being controlled by the muscles, tendons, and ligaments that attach to it. If certain muscles are too tight, or certain muscles are too lax, that'll require stretching and strengthening to even the muscle tone surrounding those misaligned bones. Once the muscle tone is evened out, the bones will no longer be misaligned. So does it take longer? Yes. But does it last longer and give you the tools to prevent it from coming back? Yes. 

Keep in mind, your physician made their decision on which to send you to for a reason and it is of the utmost importance that you trust their judgement on which they've sent you to. Not all conditions can be treated by both specialties. Some conditions, in certain cases, can be ruled out by seeing one versus the other.

"How long do Physical Therapists have to be in school?"

Physical therapists are required by law to have graduated from an accredited (by CAPTE) Doctorate in Physical Therapy. It's 7 years including the undergraduate degree, and while residencies following the degrees are not required, they are highly recommended. 

"What is The Movement System?"

The Movement System is a term used to represent a collection of systems that must interact to the move the body or it's component parts. 

It is a method of approach adapted by the APTA within the last 5 years to allow physical therapists to encompass aspects of 7 different bodily systems that come together to form a comprehensive physical therapy diagnosis. It includes the musculoskeletal, nervous, pulmonary, cardiovascular, endocrine, and integumentary systems. 

Human movement is a complex behavior within a specific context. Physical Therapists provide a unique perspective on purposeful, precise, and efficient movement across the lifespan based upon the synthesis of their distinctive knowledge of the movement system and expertise in mobility and locomotion. 

NOTE: A physical therapy diagnosis is NOT the same as the medical diagnosis given to you by your physician. 

"What can we do if we want physical therapy?" 

In the state of Kansas, you can come in for physical therapy without a referral. The problem isn't always the state - it may be your insurance. Make sure to contact your insurance for details regarding your coverage and benefits. 

In the state of Missouri, you may be evaluated by a physical therapist without a prescription under 2 conditions:

1. Treatment for a condition that has already been diagnosed by a physician within the last 12 months, and the physical therapist must still send out for a prescription upon determination to continue from the evaluation with treatment, or

2. A consultation, education, or preventative program for asymptomatic individuals. 

Again, it is crucial that while the state may allow that you see a physical therapist without a prescription under certain conditions, it is imperative that you first, contact your insurance to verify that you are eligible for coverage without a prescription - no matter the reason. 

"What do we do if our insurance doesn't cover physical therapy?"

Just about every insurance plan available now includes physical therapy coverage. However, in certain situations, your plan may not have great coverage, or still may require a hefty out-of-pocket maximum or deductible to be met. We at CHAMPION Performance and Physical Therapy have what's called a self-pay option, where you pay entirely out of pocket for your appointment (the same way you'd pay for your lunch) if you're unable to utilize your insurance benefits, or simply do not want to. You'd pay each and every time before the start of your appointment, and we would not contact your insurance for reimbursement. 

SPORTS NUTRITION - ARE YOU FUELING YOUR BODY CORRECTLY?

Athletes who want a winning edge need the right nutrition. When you give your body the right fuel by drinking enough water and eating a balanced diet, you will make the most of your athletic talents and gain more strength, power, and endurance when you train.

This article contains some general sports nutrition guidelines. To achieve top performance, your diet should be based on a variety of factors including your age, weight, physical condition, and the type of exercise you are doing. Consult your doctor for individualized sports nutrition advice.

Here at Champion Performance and Physical Therapy, we have staff members who have first-hand experience in sports nutrition and what it takes to transform your body at a competitive level, and at a level purely for health purposes.  Call us today at 913-291-2290 to hear more about our nutrition coach, Kaitlin. 

Hydration

Water is the most important nutrient for athletes. Water comprises about 60% of body weight and is essential for almost every bodily function. Because your body cannot make or store water, you must replace the water that you lose in your urine and sweat.

Everyone should drink at least two quarts (64 oz.) of water each day—and athletes need even more. To stay hydrated and avoid overheating, drink plenty of fluids before, during, and after sports or exercise. When you work out or compete, especially in hot weather, try to replace the amount of water you lose in sweat by drinking the same amount of fluid.

Stay hydrated by drinking plenty of fluids before, during, and after exercise.

Drinking cool water is the best way to keep hydrated during workouts or events that last an hour or less. Sports drinks made up of 6% to 10% carbohydrates can help you stay hydrated during longer events. Most sports drinks should be diluted with approximately 50% water.

Because thirst is not a reliable way to tell if you need water, be sure to drink even if you are not thirsty. You will not start feeling thirsty until you have already lost about 2% of your body weight—enough to hurt performance. Also, if you stop drinking water as soon as your thirst is satisfied you will get only about half the amount you really need.

The following tips will help you stay hydrated:

• Drink small amounts of water frequently rather than large amounts less often.
• Drink cool beverages to lower your core body temperature and reduce sweating.
• Track your sweat loss by weighing yourself both before and after exercise. For every pound lost through sweat, drink 16 to 24 oz. of water. Your body weight should be back to normal before your next workout.
• Pay attention to the amount and color of your urine. A large volume of clear urine is a sign that you are well-hydrated. Smaller amounts or dark yellow urine can indicate dehydration.

Fuel Sources

A balanced diet is another key to sports nutrition. Eating the right combination of fuel (calories) from carbohydrates, proteins, and fats will give you energy for top performance.

Carbohydrates

Carbohydrates—the most important source of fuel—should provide about 60% to 70% of your daily calories. Carbohydrates are found in many foods, including:

• Fruits
• Vegetables
• Pasta
• Bread
• Cereal
• Rice

Eating fruit, or another food high in carbohydrates, will help you maintain energy during competition.

Your body converts the sugars and starches in carbohydrates into energy (glucose) or stores it in your liver and muscle tissues (glycogen). This gives you endurance and power for high-intensity, short-duration activities.

If your body runs out of carbohydrate fuel during exercise it will burn fat and protein for energy—causing your performance level to drop. This may happen if you start exercising without enough stored muscle glycogen or if you exercise intensely for longer than an hour without eating more carbohydrates. It may also happen if you do multiple repetitions of high-intensity, short-duration exercises or if you participate in multiple events or training sessions in a single day.

The following tips will help you maintain carbohydrate fuel so that you can stay energized and perform at your best:

• Start your exercise or competition with glycogen-loaded muscles by eating carbohydrates for at least several days before the event.
• To replenish energy and delay fatigue, eat additional carbohydrates when you exercise or compete for longer than one hour.

Proteins

Proteins should provide about 12% to 15% of your daily calories. Proteins are found in many foods, including:

• Meat
• Fish
• Poultry
• Eggs
• Beans
• Nuts
• Dairy products

Proteins give your body the power to build new tissues and fluids among other functions. Your body cannot store extra protein so it burns it for energy or converts it to fat. The amount of protein you need depends, in part, on your:

Good sources of protein include meat, cheese, eggs, and nuts

• Level of fitness. Physically active people need more protein than those who do not exercise. You also need more protein when you start an exercise program.
• Exercise type, intensity, and duration.Endurance athletes often burn protein for fuel, as do bodybuilders and other athletes who perform intense strength-building activities.
• Total daily calories. Your body burns more protein if you do not consume enough calories to maintain your body weight. This can happen if you eat too little or exercise too much.
• Carbohydrate intake. Your body may use protein for energy if you exercise with low levels of muscle glycogen or if you do repeated training sessions without eating more carbohydrates. When you start with enough muscle glycogen, protein supplies about 5% of your energy; otherwise, it may supply up to 10%.

Fats

Fats should provide no more than 20% to 30% of your daily calories. Saturated fats come from animal-based foods, such as meats, eggs, milk, and cheese. Unsaturated fats are found in vegetable products such as corn oil.

Your body needs small amounts of fat for certain critical functions and as an alternative energy source to glucose. Eating too much fat, however, is associated with heart disease, some cancers, and other major health problems. Also, if you are eating too much fat, it probably means that you are not eating enough carbohydrates.

How your body uses fat for energy depends on the intensity and duration of exercise. For example, when you rest or exercise at low to moderate intensity, fat is the primary fuel source. As you increase the intensity of your exercise your body uses more carbohydrates for fuel. If your body uses up its glycogen supply and you continue exercising you will burn fat for energy, decreasing the intensity of your exercise.

Nutrition Before Competition

What you eat several days before an endurance activity affects performance. The food you eat on the morning of a sports competition can ward off hunger, keep blood sugar levels adequate, and aid hydration. Try to avoid eating high-protein or high-fat foods on the day of an event since this can put stress on your kidneys and take a long time to digest.

To perform at your highest level, follow these general nutrition guidelines before an event:

• Eat a meal high in carbohydrates.
• Eat solid foods 3 to 4 hours before an event. Drink liquids 2 to 3 hours before an event.
• Choose easily digestible foods, rather than fried or high-fat foods.
• Avoid sugary foods and drinks within one hour of the event.
• Drink enough fluids to ensure hydration. A good guideline to follow is: Drink 20 oz. of water 1 to 2 hours before exercise and an additional 10 to 15 oz. within 15 to 30 minutes of the event. Replenishing fluids lost to sweat is the primary concern during an athletic event. Drink 3 to 6 ounces of water or diluted sports drink every 10 to 20 minutes throughout competition.
  
  Nutrition will vary depending upon the type of exercise you engage in, and the level of performance.  High level or performing at a competitive level will require a different kind of nutrition, as will many of the less common exercises, such as powerlifting, CrossFit training, and body building. 

Carbohydrate Loading

To avoid running out of carbohydrates for energy, some endurance athletes—including long-distance runners, swimmers, and bicyclists—load their muscles with glycogen. To do this they eat extra carbohydrates and exercise to energy depletion several days before an event. To "carbohydrate load" before an event:

• First, exercise to muscle fatigue. Your workout must be identical to the upcoming event to deplete the right muscles.
• Next, eat a high-carbohydrate diet (70% to 80% carbohydrates, 10% to 15% protein, and 10% to15% fat), and do little or no exercise for three days before the event.

Some endurance athletes believe that following this carbohydrate-loading regimen will ensure that muscles loaded with unused glycogen will be available to work for longer periods of time during competition. Consult your doctor for advice before trying a carbohydrate-loading diet.

BETTER LATE THAN NEVER

Happy Holidays from the Champion family to yours! 

We just celebrated the holidays as a company, since so many of us were out of town around those dates!

We were treated to a wonderful dinner at Brio with the management and treatment team, along our significant others/partners/spouses. There were even games and prizes to be won! 

May your 2017 be prosperous and full of joy (...and healthy bodies!) 

Love,

CHAMPION Performance and Physical Therapy

SNOW SHOVELING

HOPE YOU ALL HAD A WONDERFUL HOLIDAY WEEKEND! 

Snow shoveling is a repetitive activity that can cause muscle strain to the lower back and shoulders. Back injuries due to snow shoveling are more likely to happen to people who may not know that they are out of condition. Following these tips can help you avoid injuries:

• Lift smaller loads of snow, rather than heavy shovelfuls. Be sure to take care to bend your knees and lift with your legs rather than your back.
• Use a shovel with a shaft that lets you keep your back straight while lifting. A short shaft will cause you to bend more to lift the load. Using a shovel that’s too long makes the weight at the end heavier. Step in the direction in which you are throwing the snow to prevent the low back from twisting. This will help prevent “next-day back fatigue.”
• Avoid excessive twisting because the spine cannot tolerate twisting as well as it can tolerate other movements. Bend your knees and keep your back as straight as possible so that you are lifting with your legs.
• Take frequent breaks when shoveling. Stand up straight and walk around periodically to extend the lower back.
• Backward bending exercises while standing will help reverse the excessive forward bending of shoveling: stand straight and tall, place your hands toward the back of your hips, and bend backwards slightly for several seconds.
• If you or anyone you know is experiencing back pain, consult a licensed physical therapist.

BALANCE PROBLEMS?

Balance problems make it difficult for people to maintain stable and upright positions when standing, walking, and even sitting. Older people are at a higher risk of having balance problems; 75% of Americans older than 70 years are diagnosed as having "abnormal" balance. Older women are more likely than older men to develop balance problems, although the difference between the genders is small. Balance problems increase by almost 30% in people aged 80 years or more. Mexican-Americans have the highest rate of balance problems among all Americans. Physical therapists develop individualized physical activity plans to help improve the strength, stability, and mobility of people with balance problems.

What are Balance Problems?

A balance problem exists when an individual has difficulty maintaining a stable and upright position. A range of factors can cause balance problems, including:

• Muscle weakness
• Joint stiffness
• Inner ear problems
• Certain medications (such as those prescribed for depression and high blood pressure)
• Lack of activity or a sedentary lifestyle
• Simple aging

Balance problems can also be caused by medical conditions, such as:

• Stroke
• Parkinson’s disease
• Multiple sclerosis
• Brain injury
• Arthritis
• Spinal cord injury
• Cognitive diseases
• Diabetes

Balance problems occur when 1 or more of 4 systems in the body are not working properly:

• Vision
• Inner ear
• Muscular system
• Awareness of one's own body position (called “proprioception”)

Poor vision can result from age, eye tracking problems, or eye diseases. Inner ear problems, also called vestibular problems, can develop from trauma, aging, poor nutrition, or disease. Body-position sense can become abnormal as a result of trauma or a disease, such as diabetes. Muscle strength and flexibility can decline due to lack of exercise, a sedentary lifestyle, or disease.

The brain coordinates impulses from the eye, inner ear, and body-position senses, and sends signals to the muscular system to move or make adjustments to maintain balance. If one or more of the senses is not sending correct signals to the brain, or if the muscular system cannot carry out the necessary movements, a person may not be able to maintain or correct their balance.

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How Does it Feel?

A person with balance problems may experience tripping, swaying, stumbling, dizziness, vertigo, and falling. Although a person’s "static" balance may be fine when standing still or only performing a single task at a time, “dynamic” balance problems may become apparent when the person is moving about or trying to do more than 1 thing at a time (ie, walking, while turning the head to talk to another person), or when there is not much light (at night, or in a darkened room). If someone’s dynamic balance is abnormal, it can cause a fall and possible injury.

Balance problems can make a person fearful of performing simple daily activities. As a result, they may lose muscle strength and become frail because they avoid strenuous or challenging movements. A person who has balance problems may start to feel frustration about the condition, and become depressed.

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How Is It Diagnosed?

If you see your physical therapist first, the physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your condition, such as:

• How often do you experience problems with your balance?
• What are you doing when you experience balance problems?
• Is your balance worse at nighttime or in dark rooms?
• Does the room spin, or do you feel off-balance?
• How many times have you fallen in the past year?
• Have you suffered injuries from falling?
• Have you changed or limited your daily activities because of your balance problems?
• What medications do you take?
• Have you had a vision or ear checkup recently?
• Do you have difficulty with any daily activities?
• How much, and what kind of daily exercise do you get?
• Do you have any other medical conditions or problems?
• Are you under the care of a physician?
• What are your goals?

Your physical therapist will perform tests, such as motion, strength, coordination, visual tracking, and balance tests, to help assess your overall physical ability. Your physical therapist may collaborate with your physician or other health care providers, who may order further tests to rule out any underlying conditions that may exist.

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How Can a Physical Therapist Help?

Physical therapists offer numerous options for treating balance problems, based on each person’s needs. They are trained to evaluate multiple systems of the body, including the muscles, joints, inner ear, eye tracking ability, skin sensation, and position awareness in the joints (proprioception). Physical therapists are experts in prescribing active movement techniques and physical exercise to improve these systems, including strengthening, stretching, proprioception exercises, visual tracking, and inner ear retraining. 

Your physical therapist can help treat your balance problems by identifying their causes, and designing an individual treatment program to address your specific needs, including exercises you can do at home. Your physical therapist can help you:

Reduce Fall Risk. Your physical therapist will assess problem footwear and hazards in your home that increase your risk of balance problems or falling. Household hazards include loose rugs, poor lighting, unrestrained pets, or other possible obstacles.

Reduce Fear of Falling. By addressing specific problems that are found during the examination, your physical therapist will help you regain confidence in your balance and your ability to move freely, and perform daily activities. As you build confidence in your balance and physical ability, you will be better able to enjoy your normal daily activities.

Improve Mobility. Your physical therapist will help you regain the ability to move around with more ease, coordination, and confidence. Your physical therapist will develop an individualized treatment and exercise program to gradually build your strength and movement skills.

Improve Balance. Your physical therapist will teach you exercises for both static balance (sitting or standing still) and dynamic balance (keeping your balance while moving). Your physical therapist will progressively increase these exercises as your skills improve.

Improve Strength. Your physical therapist will teach you exercises to address muscle weakness, or to improve your overall muscle strength. Strengthening muscles in the trunk, hip, and stomach (ie, “core”) can be especially helpful in improving balance. Various forms of weight training can be performed with exercise bands, which help avoid joint stress.

Improve Movement. Your physical therapist will choose specific activities and treatments to help restore normal movement in any of your joints that are stiff. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises that you do yourself.

Improve Flexibility and Posture. Your physical therapist will determine if any of your major muscles are tight, and teach you how to gently stretch them. The physical therapist will also assess your posture, and teach you exercises to improve your ability to maintain proper posture. Good posture can improve your balance.

Increase Activity Levels. Your physical therapist will discuss activity goals with you, and design an exercise program to address your individual needs and goals. Your physical therapist will help you reach those goals in the safest, fastest, and most effective way possible.

Once your treatment course is completed, your physical therapist may recommend that you transition to a community group to continue your balance exercises, and maintain a fall-proof home environment. Many such community groups exist, hosted by hospitals, senior centers, or volunteer groups.

Your physical therapist may recommend that you consult with other medical providers, including:

• An eye doctor, to check your current vision needs.
• An ear doctor, to check your outer and inner ear status.
• Your personal physician, to review your current medications to see if any of them may be affecting your balance.

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Can this Injury or Condition be Prevented?

To help prevent balance problems, your physical therapist will likely advise you to:

• Keep moving. Avoid a sedentary lifestyle. Perform a challenging physical activity each day to keep your muscles strong and flexible, and your heart and lungs strong. Use your body as much as you can to walk, climb stairs, garden, wash dishes by hand, and other daily activities that keep you moving. If you work out or follow a fitness program, keep it up!
• Have yearly checkups for vision and hearing. Make sure your vision prescription is up-to-date.
• Carefully manage chronic diseases like diabetes, whose long-term side effects can include balance problems. These side effects can be greatly reduced by following the recommended diet and medication guidelines given to you by your physician.
• Monitor your medications. Make note of any medications that you think may be affecting your sense of balance, and talk to your physician about them.
• Report any falls to your physician and physical therapist immediately. They will evaluate and address the possible causes.

Your physical therapist will also prescribe a home exercise program specific to your needs to prevent future problems or injuries. This program can include strength and flexibility exercises, posture retraining, eye-tracking and vestibular exercises, and balance exercises.

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Real Life Experiences

Margaret is a 70-year-old retiree. She and her husband have lived in the same house for 30 years. Margaret is as active around the house as ever, taking care of all the household cleaning and maintenance, growing vegetables in her garden, cooking, and tackling light landscaping.

One night recently, Margaret tried to close the bathroom window when it turned chilly outside. She didn't bother to switch on the bathroom light. In order to reach the window, she had to step into the tub with her right foot. She found that she had to push harder on the stubborn window, and lifted her left leg to place it in the tub. The next thing she recalled was explosive pain in her ribs. She realized that she was on her side, sprawled half in and half out of the tub. She did not recall falling. Her husband got her to the doctor.

Margaret's doctor x-rayed her ribs, shoulder, and toe, and found no broken bones. He instructed Margaret on how to care for her many bruises. He bandaged a torn toenail on her right foot, and told Margaret that she would not be able to wear a closed-toe shoe for awhile.

When her doctor asked Margaret if she had fallen before, she admitted that she had lost her balance while going upstairs recently. She admitted that she felt more off-balance in the dark. Margaret also mentioned that she and her husband attended ballroom dancing sessions each week, and joked that she never could learn to “spot a turn.” The physician, knowing that the dancer technique of “spotting a turn” requires inner ear and vision function, recommended that Margaret consult with her eye doctor, and her physical therapist.

Margaret met with her eye doctor and got her vision prescription updated; she noted that she felt somewhat more balanced with proper eyeglasses. She then met with her physical therapist.

Margaret's physical therapist took her medical history and performed a full battery of tests, assessing Margaret's muscle strength, balance, body-position sense (proprioception), eye-tracking ability, and inner ear (vestibular) function.

She noted Margaret's bruises from her fall. In addition, she found that Margaret lacked the ability to keep her eyes focused on an object while turning her head, and that her balance was severely affected when her eyes were closed. She asked what Margaret's personal goals were for therapy; Margaret said she wanted to avoid falling, return to her normal vigorous household activities, and attend her ballroom dance sessions 3 times per week.

Margaret's treatment began with simple eye-tracking exercises, and moved on to standing and walking balance exercises. Her physical therapist then added specific strengthening exercises to the routine. She also performed hands-on therapy, somewhat like massage, to increase the healing speed of the shoulder and rib muscles that were bruised and strained. She also applied electrical stimulation and cold packs to those areas to reduce swelling and pain.

Margaret continued her physical therapy sessions for 4 weeks, increasing her exercises as her strength returned. She learned about fall-proofing her home, including installing night lights in the bathrooms, and about wearing proper footwear.

At the end of her treatment program, Margaret was able to return to all her household tasks, and maintain a home-based exercise program designed by her physical therapist. She reported that she felt much more confident about maintaining her balance, even at night. She and her husband returned to ballroom dancing—and she was able to gently “spot a turn” for the first time in her life!

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What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat balance problems. However, you may want to consider:

• A physical therapist who is experienced in treating people with balance or vestibular problems. Some physical therapists have a practice with a balance or vestibular focus.
• A physical therapist who is a board-certified clinical specialist, or who completed special training in vestibular physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people who have your type of problem.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

DISCOID MENISCUS #MaybeShe'sBornWithIt?

A discoid meniscus is an abnormally shaped meniscus (cartilage that cushions the bones of the knee) present in 1% to 3% of people born in the United States. The condition is the result of abnormal formation of the meniscus during development in the womb. While some people may be unaware of their discoid meniscus and never experience symptoms related to it, they live at a higher risk of injury than those born with a normal meniscus. A discoid meniscus is commonly detected in childhood or adolescence, and often requires surgical intervention. Physical therapists provide treatment prior to and following surgery, and for conditions not requiring surgery.

What is Discoid Meniscus?

Our knees contain 2 cushions between our thigh bone (femur) and shin bone (tibia), made of cartilage called meniscus. The meniscus is normally crescent-shaped. Its role is to provide stability to the knee joint and absorb forces when we stand and move. Both menisci are attached to the shin bone (tibia) by the meniscofemoral ligament.

A discoid meniscus is present at birth. It occurs when the cartilage does not properly develop, resulting in a thicker disc- or oval-shaped meniscus. The defect most often occurs in the meniscus on the outer (lateral) part of the knee joint. Approximately 20% of individuals diagnosed with a discoid meniscus have it in both knees.

There are 3 types of discoid menisci. The classifications are:

• Incomplete Discoid Meniscus. The shape of the meniscus is a bit wider and thicker than a normal meniscus.
• Complete Discoid Meniscus. The shape of the meniscus is significantly wider than a normal meniscus, covering the shin bone (tibia).
• Wrisberg-Ligament Meniscus. The normally present meniscofemoral ligament is absent.

Their abnormal shape and thickness make discoid menisci more prone to injury and tearing. The meniscus tissue is often not capable of healing itself due to its limited blood supply, which is required for tissue healing.

Meniscal injuries most commonly occur in activities that require sudden stopping, pivoting, and "cutting," such as in sports. Pain may also be present, sometimes without a specific injury to, or a tear in, the discoid meniscus.

In some cases, arthroscopic surgery may be required to reshape the abnormal meniscus to make it as normal as possible.

How Does it Feel?

With a discoid meniscus or torn discoid meniscus, you may experience:

• Pain in your knee, most often on the outer (lateral) side of the leg.
• Sharp pain with running, jumping, cutting, or deep squatting.
• Swelling in the knee.
• Tenderness on the outer side, or less commonly on the inner side, of the knee.
• Catching or locking of the knee while walking or squatting.
• Loss of knee motion, particularly getting "stuck," while fully bending or straightening the knee.
• Loss of strength in the quadriceps (thigh) muscle.
• Discomfort with daily activities, like walking up and down stairs.

How Is It Diagnosed?

Diagnosis of a discoid meniscus begins with a thorough medical history and physical examination. Your physical therapist will assess different measures of the knee area, such as motion, strength, flexibility, tenderness, and swelling. Your physical therapist will perform several tests specific to the knee joint, and may ask you to briefly demonstrate the activities or positions that cause your pain, such as walking, squatting, and stepping up or down stairs.

If your physical therapist suspects there may be an injury inside the knee joint, such as a discoid meniscus, the therapist will likely recommend a referral to an orthopedic physician for diagnostic imaging, such as ultrasound, x-ray, or MRI. An MRI, which looks at bones, muscles, and cartilage, is the best imaging source to identify a discoid meniscus and a tear in the meniscus.

How Can a Physical Therapist Help?

When you have been diagnosed with a discoid meniscus, your physical therapist will work with you to develop a plan to help achieve your specific goals. If surgery is needed, your physical therapist will work with you after surgery. To do so, your physical therapist will select treatment strategies in any or all of the following areas:

Range of Motion. An injury or surgery to the knee joint causes the joint to be irritated, often resulting in swelling and stiffness, resulting in loss of normal motion. While it is important to regain your normal knee motion, it is also important to allow your injury to heal, without placing excessive stress on the healing joint. Your physical therapist will assess your motion, design gentle exercises to help you regain normal range of motion, and establish a plan that will balance joint protection with motion restoration.

Strength Training. Your physical therapist will teach you exercises to strengthen the muscles around the knee, so that each muscle is able to properly perform its job, and stresses are eased, so the knee joint is properly protected.

Manual Therapy.Physical therapists are trained in manual (hands-on) therapy. If needed, your physical therapist will gently move your knee cap (patella) or patellar tendon and surrounding muscles to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own. 

Pain Management. Many pain-relief strategies may be implemented; the most beneficial with knee pain is to apply ice to the area, and decrease or eliminate specific activities for a certain length of time. Your physical therapist will help to identify specific movements or activities that continue to aggravate your knee joint, and will design an individual treatment plan for you, beginning with a period of rest, and gradually adding a return to certain activities as appropriate.

Functional Training.Physical therapists are experts at training athletes to function at their best. Your physical therapist will assess your movements, and teach you to adjust them to relieve any extra stress in your knee.

Education. Your physical therapist will work with you to identify and change any external factors causing your pain, such as exercise selection, footwear, or the amount of exercises you complete. Your physical therapist will develop a personal exercise program to help you return to your desired activities.

Can this Injury or Condition be Prevented?

A discoid meniscus is present at birth and, therefore, cannot be prevented. Maintaining appropriate lower-extremity mobility and muscular strength are the best methods for preventing any type of knee injury. Unfortunately, the structure of some individuals’ menisci can increase the risk of sustaining an injury. It is imperative to be aware of any knee pain that you experience, particularly with squatting, running, or cutting, as these are signs of a potential knee injury. Identifying and addressing these injuries early is helpful in their treatment.

Real Life Experiences

Ashleigh is a 15-year-old girl who has been playing soccer since she was in the first grade. She plays with her high school team during the week, and competes in tournaments with her club team on the weekends. Last weekend, while she was running and cutting in her soccer game, she felt a sharp pain in her right knee. She was able to finish playing, but after the game, she told her dad her knee was hurting. She said it had begun getting sore during one of the practices that week, but she didn’t want to tell her coach because she was worried she would not be allowed to continue to play. Now she said she felt like her knee was swollen. Her dad immediately called their local physical therapist.

Ashleigh's physical therapist performed a comprehensive health history and examination. The physical examination revealed that Ashleigh’s knee was tender, swollen, and that she had lost leg motion and strength. Because Ashleigh’s knee was so tender, her physical therapist referred her to an orthopedic surgeon. Her MRI results showed that Ashleigh had a discoid meniscus in her right knee that required surgery.

Ashleigh underwent an outpatient arthroscopic surgery, which required 2 small incision holes in the front of her knee. She was able to return home the same day. After her surgery, Ashleigh returned to physical therapy. Ashleigh used crutches for about 2 weeks after her surgery, until her leg was strong enough to walk without support. Together, Ashleigh and her physical therapist, father, and coach developed a treatment plan to help get her back on the soccer field. The treatment process began with exercises to regain motion and strength.

After about 2 months, when her knee was less tender and she had met some of the goals set in physical therapy, Ashleigh began light running, in preparation for her return to soccer. Throughout her rehabilitation, Ashleigh and her physical therapist worked together to improve the ways she moved, including her sqatting, running, and jumping form, in order to decrease the chance of her developing another knee injury. Along with her physical therapist, coach, and parents, Ashleigh developed a gradual reintegration plan for her return to soccer.

A month later, Ashleigh was back playing soccer! In order to minimize her risk of further knee problems, she continued to perform the daily exercises her physical therapist had prescribed. She also changed her routine to allow for adequate warm-up time before and after each practice. At the end of the season, thanks to Ashleigh’s goal scoring, her team won the high-school state championship!

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:

• A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, injuries.
• A physical therapist who is a board-certified specialist, or has completed a residency in orthopedic or sports physical therapy, as the therapist will have advanced knowledge, experience, and skills that apply to an athletic population.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping athletes with knee pain.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of discoid meniscus. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Sun Y, Jiang Q. Review of discoid meniscus. Orthorp Surg. 2011;3(4):219–223. Article Summary on PubMed.

Davidson D, Letts M, Glasgow R. Discoid meniscus in children: treatment and outcome. Can J Surg. 2003;46(5):350–358. Free Article.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.

Authored by Allison Mumbleau, PT, DPT, SCS. Reviewed by the MoveForwardPT.com editorial board.