HOW CAN PT HELP WITH CANCER?

Physical therapists are trained and educated to understand all of your health conditions, including a cancer diagnosis. Your physical therapist will work with you to develop a specialized treatment program to address your specific needs and goals.

The American Cancer Society recommends people undergoing cancer treatment, and cancer survivors, perform consistent physical exercise to decrease fatigue, and improve the ability to perform normal daily activities. Studies show that exercise can improve an individual’s chances of surviving cancer. Physical therapists can design individualized exercise and treatment programs to reduce or prevent many cancer-related problems.

Physical therapists help people diagnosed with cancer before and after surgery. Before surgery, they evaluate individuals for any of the problems listed above, and help address them. After surgery, they can help with the healing of the incision site, improve circulation, reduce pain, and minimize scarring. They evaluate individuals for any physical therapy treatment needs, and, by designing individualized treatment programs, help them recover and heal faster than they would on their own.

Your physical therapist may work with you to improve your:

Comfort and well-being. Cancer and cancer treatments can cause symptoms such as pain, burning sensations, numbness, tingling (neuropathy), cramps, spasms, and weakness. Your physical therapist may apply hands-on techniques (manual therapy) or technologies like electrical stimulation to help decrease your pain and alleviate your symptoms. The physical therapist may teach you gentle exercises or techniques to perform at home to aid your recovery. All of these options may reduce or eliminate the need for opioid pain medication.

Aerobic capacity. Cancer or cancer treatment may have decreased your ability to process oxygen (aerobic capacity), causing fatigue. Research shows that aerobic exercise, such as walking on a treadmill for at least 20 minutes 3 times per week, may help improve aerobic capacity, reduce fatigue, and optimize healing. Your physical therapist can assess your aerobic capacity and determine the best aerobic activities for you.

Bone density. Lack of activity and certain cancer treatments can cause weakening of your bones, which could lead to bone fractures. Certain types of exercise can prevent bone loss and maintain bone strength. Your physical therapist can teach you safe and effective exercises to help steadily build your bone strength.

Lymphedema and swelling. Certain cancer treatments can result in lymphedema (swelling in the arms or legs) or other types of swelling. Your physical therapist can use several methods to reduce, control, and prevent lymphedema and swelling, such as specialized gentle massage, special movements and exercises, and application of compressive garments such as arm sleeves, gloves, and leg stockings.

Surgical incisions. Your physical therapist can help you care for any surgical incisions and sutured areas, by checking for infection and assisting with dressing changes. The physical therapist also can help prevent some kinds of scarring and skin tightness as the suture line heals. Your physical therapist can use very gentle massage or certain technologies to keep the skin as soft and pliable as possible.

Body weight. By creating an exercise and physical activity program tailored just for you, your physical therapist will help you reduce body fat and maintain a healthy body weight, which can improve your energy levels.

Mood. Exercise helps elevate mood and reduce depression in everyone, including cancer patients and survivors. A diagnosis of cancer, and cancer treatment, can be stressful and cause mood changes in anyone. Proper exercise, individualized for each person by a physical therapist, can help reduce stress and improve mood.

Brain fog. Exercise helps relieve brain fog. Your physical therapist can design an individualized program of exercise that can help reduce memory loss and brain fog.

Daily activities. Your physical therapist will discuss activity goals with you and use them to design your treatment program. Cancer survivors usually increase their physical activity gradually; your treatment program will help you reach your goals in the safest, fastest, and most effective way possible.

Walking. Your physical therapist will help improve your ability to walk using techniques such as strengthening exercises, walking training, and balance activities. If you have nerve damage (neuropathy), your physical therapist may provide bracing and other techniques to make it easier or safer for you to walk. Your physical therapist also may recommend using an assistive device, such as a walker or cane.

Sports training ability. Athletes undergoing cancer treatment can continue to train for their sport to a degree, depending on the type of cancer and treatment. Physical therapists design safe, challenging, sport-specific training programs to help athletes reduce loss of fitness and strength during cancer treatment.

Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises and stretches that you do yourself. You can perform these motions at home to help hasten healing and pain relief.

Flexibility. Your physical therapist will determine if any muscles are tight, start helping you to stretch them, and teach you how to stretch them at home.

Strength. If your physical therapist finds any weak or injured muscles, the physical therapist will choose, and teach you, the correct exercises to steadily restore your strength and agility.

Coordination. Your physical therapist will help you improve and regain your coordination and agility, so you can perform household, community, and sports activities with greater ease.

Balance. Your physical therapist will examine your balance, and choose specific exercises that you can perform in the clinic and at home to improve your balance and prevent falls. Your physical therapist may also teach you how to use a cane or walker to help maintain your balance when walking and standing.

Home program. Your physical therapist will teach you strengthening, stretching, and pain reduction exercises to perform at home. These exercises will be designed specifically for your needs.

Can the Risk of Cancer Be Reduced?

The risk of cancer can be reduced by:

• Maintaining a healthy diet
• Engaging in consistent exercise and physical activity throughout life
• Keeping your weight at a healthy level
• Avoiding tobacco in any form
• Avoiding too much sun exposure

More information on preventing cancer can be found at the American Cancer Society’s website.

Side effects of cancer treatment may be reduced or prevented by:

• Staying active every day
• Avoiding too much bedrest
• Keeping active and participating in activities and exercises that you like to do, as often and as vigorously as possible

 Your physical therapist can help you choose the safest, most effective exercises to perform before, during, and after cancer treatment.

10 Ways Exercise Helps During Cancer Treatment

Exercise supervised by a physical therapist can help anyone undergoing cancer treatment exercise safely and comfortably during treatment, and remain physically active. It also may relieve many of the side effects of cancer treatment.

With a physical therapist’s help, exercise during cancer treatment can:

1. Reduce fatigue 
Exercise helps boost energy and endurance during cancer treatment.

2. Maintain muscle strength 
Safe exercise can help keep your muscles strong.

3. Reduce stress 
Exercising during cancer treatment can help ward off anxiety, fear, and depression.

4. Prevent or reduce lymphedema and swelling 
Special physical therapy treatments address lymphedema and swelling.

5. Reduce pain 
Safe and comfortable exercise is proven to be effective in reducing pain.

6. Prevent and reduce weight gain
Staying physically active can help you maintain a healthy weight.

7. Reduce brain fog
Exercise has an immediate and long-lasting effect in reducing brain fog.

8. Reduce bone density lossCertain exercises done while standing and moving can stimulate your bones to stay healthy and strong, helping to avoid fractures.

9. Improve the survival rate
Research studies have suggested that consistent exercise during cancer treatment may have beneficial effects that improve the outcome of that treatment.

10. Assist athletes to continue sports training
Athletes undergoing cancer treatment may not have to give up their sport. A physical therapist can help design a special exercise plan that includes an athlete’s chosen sport, a modified version, or aspects of it.

By the APTA: Andrea Avruskin 

PREPARING FOR YOUR PT VISIT

Physical therapists are highly educated, licensed health care professionals who help patients improve or restore mobility, and in many cases helping patients reduce pain, and avoid the need for surgery and the long-term use of prescription medications and their side effects.

Physical therapists examine, evaluate, and treat patients whose conditions limit their ability to move and function in daily life. Your physical therapist's overall goal is to maintain, restore, or improve your mobility and help reduce your pain.

In most states, you can make an appointment with a physical therapist without a physician referral. Whether this is your first visit or you've been treated by a physical therapist in the past, there are things you can do to make your visit as successful as possible.

Before Your Visit:

Make a list of any questions that you have, to make the best use of your time with your physical therapist.

Write down any symptoms you've been having and for how long. If you have more than one symptom, begin with the one that is the most bothersome to you. For example, is your pain or symptom:

• Better or worse with certain activities or movements or with certain positions, such as sitting or standing?
• More noticeable at certain times of day?
• Relieved or made worse by resting?

Write down key information about your medical history, even if it seems unrelated to the condition for which you are seeing the physical therapist. For example:

• Make a list of all prescription and over-the-counter medications, vitamins, and supplements that you are taking.
• Make a note of any important personal information, including any recent stressful events, injuries, incidents, or environmental factors that you believe might have contributed to your condition.
• Make a list of any medical conditions of your parents or siblings.
• Consider taking a family member or trusted friend along to help you remember details from your own health history and to take notes about what is discussed during your visit. Make sure you can see and hear as well as possible. If you wear glasses, take them with you. If you use a hearing aid, make certain that it is working well, and wear it. Tell your physical therapist and clinic staff if you have a hard time seeing or hearing. If available, bring any lab, diagnostic, or medical reports from other health care professionals that may be related to your medical history or who have treated you for your current condition.
• Bring a list of the names of your physician and other health care professionals that you would like your physical therapist to contact regarding your evaluation and your progress.

When you call to make your appointment, ask whether you should wear or bring a certain type of clothing when you come for your first visit. You may want to avoid tight or formal clothes, in case the therapist wants you to engage in activities during the first session.

Financial Considerations

• Carefully review the clinic's financial policy prior to starting care. Be sure to ask questions if anything is unclear. If the financial policy is not presented at the time of your initial appointment, request it be provided and explained prior to the initiation of treatment.
• The physical therapy clinic will ask you to sign the financial agreement. Review the agreement carefully and ask questions if anything is unclear.
• Applicable deductibles and copayments will be requested prior to or upon completion of each appointment. It is important to pay the proper amounts at the time of service. This will help you to better manage your health care costs and avoid a large bill at the end of care.
• If the frequency of visits needs to be adjusted for financial reasons, discuss this directly with your physical therapist. In partnership with your therapist, you can explore alternatives and develop a workable plan.
• If you change insurance plans or lose insurance coverage for any reason, be sure to inform your therapist as well as the clinic’s front office staff.

What to Expect During Your First Visit:

Your physical therapist will begin by asking you lots of questions about your health and about the specific condition for which you are seeing the physical therapist. Detailed information about you and your condition will help the physical therapist determine whether you are likely to benefit from physical therapy and which treatments are most likely to help you.

Your physical therapist will perform a detailed examination. Depending on your symptoms and condition, the physical therapist might evaluate your strength, flexibility, balance, coordination, posture, blood pressure, and heart and respiration rates. Your physical therapist might use his or her hands to examine or "palpate" the affected area or to perform a detailed examination of the mobility of your joints, muscles, and other tissues.

Your physical therapist also might evaluate:

• How you walk (your "gait")
• How you get up from a lying position or get in and out of a chair ("functional activities")
• How you use your body for certain activities, such as bending and lifting ("body mechanics")

Your physical therapist might ask you specific questions about your home or work environment, your health habits and activity level, and your leisure and recreational interests so that the therapist can help you become as active and independent as possible.

Your physical therapist will work with you to determine your goals for physical therapy and will begin to develop a plan for your treatment. In many cases, the physical therapist will make a diagnosis and begin treatment almost immediately.

One of the main goals of treatment is almost always to improve or maintain your ability to do your daily tasks and activities. To reach this goal, the physical therapist may need to focus on pain, swelling, weakness, or limited motion. Your physical therapist will constantly assess your response to each treatment and will make adjustments as needed.

In most cases, an important aspect of your physical therapy treatment will be education. Your physical therapist might teach you special exercises to do at home. You might learn new and different ways to perform your activities at work and home. These new techniques can help minimize pain, lessen strain, avoid reinjury, and speed your recovery.

Your physical therapist will evaluate your need for special equipment, such as special footwear, splints, or crutches. If the evaluation indicates that you are at risk for falling, your physical therapist might recommend simple equipment to help make your home a safer place for you. The therapist will know what equipment you need and can either get it for you or tell you where you can find it. If you do need special equipment, your physical therapist can show you how to use it properly.

Your physical therapist will communicate the important information from your examination to your physician and to other health care professionals at your request.

Your physical therapist will continually recheck your progress and work with you to plan for your discharge from physical therapy when you are ready. Make sure you talk with your physical therapist about what you should do after discharge if you have questions, or if your symptoms or condition worsen.

Keeping Your Appointments

• Arrive for treatment sessions at the scheduled time or a few minutes early so you are prepared. Late arrival may affect not only your 1-on-1 time with the therapist, but that of other patients in the clinic.
• Actively participate in the discussion to determine visit frequency and work in partnership with the physical therapist to achieve your treatment goals.
• Show up for appointments. Failure to show for an appointment and not calling to cancel the visit may result in a fee and is disruptive to the physical therapist’s schedule. If an emergency prevents you from attending, try to provide adequate notice. It is important to review the facility’s financial and cancellation policy prior to the start of treatment.
• If you plan to discontinue therapy or change the frequency of treatment because of personal or financial considerations, discuss this with your physical therapist.

You will get out of therapy what you put into it. Sufficient effort, as agreed between you and the physical therapist, is necessary to maximize benefit from each treatment session.

Observe all precautions as instructed by your physical therapist. This may include modifying an activity, reducing weight on 1 limb while walking, avoiding certain movements, or restricting use of a specific body part. Lack of compliance with treatment precautions may cause injury and result in delayed recovery.

If special devices such as splints, walkers, canes, or braces are provided for home use, follow the physical therapist’s exact instructions. Be sure to ask questions if you are unclear, as incorrect use may be harmful.

The therapist may advise physical modifications in your home such as removing throw rugs, rearranging furniture, and installing safety rails. For your safety, it's essential to comply with these recommendations.

Follow the home program as instructed by the physical therapist. Your ongoing performance and commitment to the home program is essential to your recovery.

If the instructions are unclear, ask for clarification. Only perform exercises at the therapist-specified repetition, frequency, and resistance (such as weight or resistance band color). More is not always better and may cause injury!

After your physical therapy care is completed, continue to follow the after-care instructions provided by the physical therapist.

Changing the Rehabilitation Setting

Physical therapy can occur in a variety of settings including hospitals, skilled nursing facilities, rehabilitation facilities, at home or in an outpatient clinic. Depending on your condition and recovery, your medical team may recommend your transfer from one setting to another. For example, if you are discharged from the hospital, physical therapy treatment may be continued in an inpatient rehabilitation facility, your home, or an outpatient clinic depending on the level of care you need.

It is important that your rehabilitation be disrupted as little as possible during the change in setting. Case managers are available in most hospitals and rehabilitation centers to help ensure a smooth transition.

If you are returning home from another facility, ask the physical therapist what special equipment or family support is needed prior to the transfer.

EXTRA STEPS CAN HELP REDUCE RISK OF DIABETES AND STROKE

Individuals at risk for diabetes can cut their risk for heart attack or stroke by 8% by taking an extra 2,000 steps a day—equivalent to about 20 minutes of moderately paced walking—according to a study of more than 9,000 adults performed by researchers at the University of Leicester and published in the Lancet.

"Two thousand steps seemed to be the magic number," TIME reported ("How Many Steps Does it Take to Avoid a Heart Attack? Researchers Find Out" - December 19, 2013). "Even before the study began, for every 2,000 steps a day one participant tended to walk on average compared to another, he enjoyed a 10% lower rate of heart problems by the end of the year."

Visit www.apta.org for more information! 

8 MILLION AMERICANS DON'T KNOW THEY HAVE WHAT?!

According to the US Centers for Disease Control and Prevention (CDC), a quarter of those in United States living with diabetes do not know they have it. 

An estimated 29.1 million people (9.3%) in the US have diabetes, but roughly 8.1 million of them (27.8%) haven’t been diagnosed. This information, along with a number of other new diabetes statistics, is featured in the CDC’s 2014 National Diabetes Statistics Report, which is based on data from 2012.

The report also found that the diabetes rate for Hispanics (12.8%), non-Hispanic blacks (13.2%), and Native Americans/Alaska Natives (15.9%) were markedly higher than the 7.6% rate of non-Hispanic whites. The diabetes rate among Asians was 9%.

Type II Diabetes, or the type of Diabetes that's acquired by habits and lifestyle choices, is largely correlated with the obesity epidemic that's been taking over the United States for the past 30 years. According to NHANES, almost 70% of Americans are considered to be overweight or obese, as of 2014 - and almost 34% of children are considered to fall within the same category. In 2013, the CDC had to come up with a new category of obesity to accommodate the number of children who were so far off the chart for age and sex-related BMI statistics, that they had to create a "Severely Obese" category, in which children fall within 120 - 160% of the 95th percentile for weight in children their age and height. 

The obesity epidemic is REAL, and it's costing more lives than we realize. In 2015, life expectancy decreased for the first time in almost 40 years, and obesity plays a HUGE role in that. 

Being healthy is a lifestyle choice - one YOU can make for a better future for you and your children! 

PREVENTING LOW BACK PAIN DURING PREGNANCY

http://www.moveforwardpt.com/PatientResources/VideoLibrary/detail/back-preventing-low-pain-in-pregnancy

Attached above is a wonderful link provided by the APTA, or the American Physical Therapy Association, for women just like you to help prevent/manage back pain during pregnancy! Let us know what you think! 

WHAT CAN PT DO TO HELP YOU REACH YOUR WEIGHT LOSS GOALS

Obesity is a condition caused by the accumulation of excessive body fat. Nearly 100 million Americans are obese or overweight. Obesity is a worldwide epidemic.

A full 68% of the adult population in the United States currently is estimated to be overweight, and about 36% are obese. It is also estimated that 10% of children in the United States aged 2 to 5 years, 15% of children aged 6 to 11 years, and 16% of adolescents aged 12 to 19 years are overweight. Obesity increases the chance of early death; around 325,000 deaths in the United States each year are attributed to obesity, according to the CDC and NHANES.

Adults and children can be classified as normal, overweight, or obese by calculating their body mass index (BMI) based on their height and weight. For example, adults are considered overweight if their BMI is 25 to 29, and obese if their BMI is 30 or higher.

Obesity may be triggered by genetic, environmental, behavioral, social, physiological, and cultural factors. Sedentary lifestyles and surplus caloric intake are considered to be primarily responsible for the dramatic worldwide increase in obesity during the past 2 decades.

Obesity affects people of all ages, races, and socioeconomic levels. It contributes to many chronic diseases and can even cause early death. It can contribute to joint pain, due to increased stress that excess body weight puts on joints, muscles, and spinal discs. It can also cause a loss of "function"—the ability to perform simple daily activities like walking, climbing stairs, or doing household chores.

Numerous options for treating obesity are available today, including reduced-calorie diets, physical exercise, behavior modification, medication, and surgery. Physical therapists are experts in physical exercise, and can develop individualized physical activity plans for individuals who are overweight or obese to manage weight, prevent the development of obesity, or combat its effects.

What is Obesity?

Obesity is a condition involving the storage of excess body fat brought about by an imbalance between caloric intake (number of calories eaten) and energy expenditure (number of calories burned) occurring over an extended period of time. As little as 100 extra calories per day will lead to a 4.5 kg [10 lb] weight gain each year, which can lead to weight problems over time.

Obesity affects the body in many negative ways and can lead to other health problems, such as:

• cardiovascular disease
• stroke
• diabetes
• high blood pressure
• cancer (breast, liver, endometrial, prostate, and colon)
• osteoarthritis
• lymphedema (swelling of arms and legs)
• breathing problems, including asthma and sleep apnea
• depression

Obese people have difficulty engaging in daily activities due to the increased body weight they carry, their loss of physical conditioning, and their movement limitations.

Modern society, especially in the past 20 years, enables and encourages overeating and acceptance of overeating because there is an abundance of inexpensive, high-calorie foods with poor nutritional value available (i.e., “fast food” and “junk food”). We are also encouraged to consume unreasonably large portions of food with “supersized” fast food options, and advertising of food and eating as a way to bond and celebrate special occasions (“holiday feasting”) may also contribute. The growth of sedentary lifestyles or inactivity also contributes greatly to obesity. We spend more time playing video games instead of playing sports outside, working at desk jobs instead of performing manual labor, and riding in cars instead of walking.

How Does it Feel?

A person who is obese may experience:

• Fatigue when performing simple daily activities.
• Joint pain, especially in the legs and back from increased stress that excess fat and weight put on the joints and muscles of the body.
• Difficulty performing daily activities, such as walking, climbing stairs, or playing physically active games.
• Frustration or depression about the condition and the inability to lose weight.

How Is It Diagnosed?

If you see your physical therapist first, your 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:

• Do you have any joint pain?
• Do you have difficulty with any daily activities?
• How much daily exercise do you get?
• Do you have any other medical conditions or problems?
• Do you take any medication for your obesity or any other condition?
• Have you had any surgery related to your obesity?
• Are you under the care of a physician?
• What are your goals?

Your physical therapist will perform tests, such as motion, strength, coordination, and balance checks to help assess your overall physical ability. Your physical therapist may also perform specific obesity tests, such as calculating your BMI, or measuring your waist circumference, "skinfold" thickness, or percentage of body fat.

Your physical therapist may consult with your physician or other health care providers about your condition, who may order further tests to rule out other medical conditions that may affect the type of physical therapy you receive.

How Can a Physical Therapist Help?

Physical therapists can help people who are obese to be more physically active and fit by teaching them to exercise in pain free and fun ways. The right exercise is very important because it helps burn calories, get rid of fat, preserve muscle tissue, and protect your joints. When you start a fun exercise routine, it also helps you make better choices about your diet.

Your physical therapist will work with you to design a specific treatment program to address your needs, including exercises you can do at home. Aerobic exercise and strength training will likely be included in your program, as they both help in weight loss and weight control. Physical therapists are trained to create safe, effective physical activity programs for people of all ages and abilities, taking into account the Centers for Disease Control and Prevention physical activity recommendations for children and adults.

Physical therapists can also help individuals address any underlying reasons for their unhealthy behaviors; they are trained to identify any barriers to developing healthy habits, setting individual goals, and sticking to the program. Your physical therapist can help you:

Reduce pain. Your physical therapist will design a personalized exercise program to help you safely perform activities with the least amount of pain. Just getting up and getting moving can help relieve pain!

Improve cardiovascular fitness. Your physical therapist will design a "heart-healthy" aerobic exercise program for you, to elevate your body's metabolism and burn more calories. Physical therapists help people, including adults and children with disabilities find fun aerobic activities they can perform at their own comfortable level.

Improve strength. Your physical therapist will teach you exercises to address any muscle weakness you may have, or to improve your overall muscle strength. Building strength in muscles can help burn calories, make daily activities easier, and relieve joint pain. Gentle and low-impact forms of weight training performed with exercise bands can help avoid joint stress.

Improve movement. Your physical therapist will choose specific activities and treatments to help restore normal movement of stiff joints. 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. Your physical therapist will also assess your posture, and teach you exercises to improve your ability to maintain proper posture. Good posture can make difficult activities easier and less painful, and even improve your breathing.

Increase activity levels. Your physical therapist will discuss your activity goals with you, and design your 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.

If Surgery Is Necessary

Gastric bypass or bariatric surgery is sometimes chosen by patients and their doctors to treat severe obesity. Your physical therapist can help you prepare for and recover from surgery by designing and teaching you a preoperative and postoperative physical therapy program. Your physical therapist can guide you through each session, help you avoid injury to joints and muscles, and increase and adjust your program as needed. Preoperative programs often involve strength training and aerobic conditioning, while postoperative programs often start with deep breathing and lower-extremity (legs, ankles, feet) exercises, gently increasing to strength and aerobic training. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

To help prevent obesity or prevent weight gain after weight loss, your physical therapist will likely advise you to:

• Get moving! Include physical activities you enjoy into your daily routine so you can avoid returning to a sedentary lifestyle.
• Avoid watching TV more than 2 hours per day.
• Don’t use a computer longer than 1 hour without an exercise break. 
• 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.
• Educate yourself about nutrition, and especially about portion sizes, to help you understand and control your calorie intake.
• Exercise daily for at least 30 minutes (adults) or 1 hour (children). (This advice also applies to disabled individuals as well as those suffering from most medical conditions.) Always check with your physical therapist or a health care professional before beginning any exercise program.

Be sure to follow the special instructions your physical therapist gives you regarding your specific health conditions.

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, and aerobic conditioning.

PT's Guide to Lower Extremity Stress Fractures

Lower extremity stress fractures are a relatively common injury seen most often in athletes playing sports that require repetitive impacts (running and jumping). Stress fractures make up about 8% of all activity-related injuries of the lower extremities. Female athletes are about one-third more likely to develop stress fractures in the legs and feet. While athletes may be more susceptible to these types of injuries, individuals who walk, march, or spend much of their workday on hard floors are also at risk. A physical therapist can help with recovery after a stress fracture as well as identify potential risk factors for prevention of future stress fractures.

What is Lower Extremity Stress Fractures?

Stress fractures are tiny cracks that occur in bone, usually related to repetitive activities that impact the bone in a similar way over time. These stresses lead to change in the normal process of bone breakdown and reformation. Stress fractures are most common in the feet and legs as these structures bear weight during walking, running, and jumping.

How Does it Feel?

Stress fractures are characterized by a sharp pain in a very specific point over the top of a bone. Lower extremity stress fractures generally hurt when you are up walking, running, or jumping. You may also experience aching pain in the area after activity.

Signs and Symptoms

With activity-related lower extremity stress fractures, you may experience:

• Pain during activity (walking, running, or jumping)
• Sharp pain over a specific point on the bone (point tenderness)
• Swelling without bruising at the site of pain
• Aching pain after activity

How Is It Diagnosed?

If you see your physical therapist first, the therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist may ask whether you:

• Have increased your activity significantly over the past weeks or months
• Noticed an increase in pain with activity that slowly subsides after activity
• Can touch a specific area on the bone that hurts
• Experienced any specific event that caused your pain (fall, twist, collision)

Your physical therapist also will perform special tests to help determine the likelihood that you have an activity-related lower extremity stress fracture. For instance, the therapist may repeatedly bump on the bottom of your foot (called the "bump" test or the "percussion" test), MFPT.com Editorial Board Webinar or  gently push directly over the site of the injury or squeeze the bone. (You might feel some discomfort during these tests, which is normal.) Your physical therapist may use additional tests to assess possible damage to other parts of your legs.

To provide a definitive diagnosis, your physical therapist will collaborate with an orthopedic physician or other health care provider. The physician may order further tests, such as magnetic resonance imaging (MRI) or bone scan to confirm the diagnosis.

How Can a Physical Therapist Help?

Initial Treatment

Stress fractures are treated by resting the leg as much as possible. Whatever activities you are participating in that increase force in the legs (running, jumping or "cutting" in sports) must be stopped for at least 3 weeks in order for the bone to begin the healing process. Your physical therapist can decide whether you should use a compressive brace, crutches, or a walking boot to protect your bone while it is healing. Your therapist can design a specific treatment program for you to follow at home to help speed your recovery. Initial treatment will focus on muscle-strengthening exercises using bands rather than heavy weights.

As You Start to Recover

Your physical therapist's overall goal is to return you to your normal daily tasks at home, at work, and in the community. Without proper rehabilitation serious problems, such as chronic pain, swelling, weakness and more severe fracture, could arise further limiting your ability to perform your usual activities.

Your physical therapist will select from treatments including:

Range-of-motion exercises. Because you have been less mobile over the past few weeks, your range of motion may have decreased. A physical therapist teaches you how to perform safe and effective exercises to restore full movement in the joints of your legs.

Muscle-strengthening exercises. Even short-term inactivity weakens the muscles of the legs, increasing the potential for new injuries. Additionally, your stress fracture may have been related to some underlying weakness in the legs. Your physical therapist can determine which strengthening exercises are right for you based on the severity of your injury and where you are in your recovery.

Body awareness and balance training. Specialized training exercises help your muscles "learn" to respond to changes in your environment, such as uneven or unstable surfaces. When you are able to put full weight on your foot without pain, your physical therapist may prescribe these exercises to help you return to your normal activities. For instance, you might learn how to stand on 1 leg or stand on a wobble board, with or without your eyes closed, to challenge the muscles in your legs.

Functional training. When you can walk freely without pain, your physical therapist may begin "progressing" your treatment program to include activities that you were doing before your injury. This program will begin with slow, progressive weight-bearing activities, such as hopping and light jogging. Your physical therapist will create your own unique training program, based on the therapist’s examination of your legs, your goals, and your activity level and general health.

Activity-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation tailored for your job or sport. Your physical therapist can develop a program that takes all of these demands as well as your specific injury into account.

Can this Injury or Condition be Prevented?

While there are no guaranteed ways of preventing lower extremity stress fractures, there are a number of factors known to be associated with their occurrence. These include:

• Excessive impact physical activity (running, jumping, cutting) with inadequate rest
• Running more than 25 miles per week
• A sudden increase in physical activity
• Consumption of more than 10 alcoholic beverages per week
• Smoking
• Inadequate nutrition, including low calorie and Vitamin D intake

Real Life Experiences

Joan is a 27-year-old runner with no history of previous bone or joint disease. She has been training for her first marathon, and recently ran her longest distance of 15 miles last Saturday. About 9 miles into her run, Joan noticed some pain on the lower inside portion of her right shin. It increased over the next 6 miles, and by the end it was sharp and throbbing, and the area appeared slightly swollen. The site continued to be painful to touch; Joan had difficulty walking even short distances without pain. She decided to contact her physical therapist.

On her first visit, her physical therapist took measurements of her hip, knee, and ankle strength and range of motion. He gently pushed on her lower shin and bumped the bottom of her foot. Joan stated that both of these tests recreated her pain. Joan consulted with her physician, who agreed to order a bone scan of her lower leg. Joan was diagnosed with a lower extremity stress fracture.

Joan's physical therapist provided her with a walker boot and placed a compressive brace over her shin, which she wore for 4 weeks. During this time, her physical therapist taught her how to gently exercise on a stationary bike and complete specific leg strengthening exercises with elastic bands. She also swam periodically for exercise. Joan was instructed not to run or walk without the boot. After 4 weeks, the boot was discontinued and gradual weight-bearing activities were started (weight shifting, stair climbing, small hops). Over the next few weeks, Joan's physical therapist taught her additional specific lower-leg strengthening exercises and helped her slowly return to jogging—and eventually running. He monitored her running form and suggested any changes she should make in her training. Now, 2 months after her injury, Joan has resumed her training with more care and attention to preventing injury for her next marathon.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat activity-related lower extremity stress fractures. However, you may want to consider the following:

• Choose a physical therapist who is experienced in treating people with activity-related lower extremity stress fractures. Some physical therapists have a practice with a sports or running focus.
• Choose a physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in sports or orthopedic 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 therapists' experience in helping people who have stress fractures.
• 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.

For more information, visit www.apta.org/ 

PHYSICAL THERAPY AND A PELVIC FRACTURE

A pelvic fracture is a break in 1 or more bones in the pelvis. It is sometimes referred to as a "hip fracture" or "broken hip" because it occurs in the bones that make up the hip area. A pelvic fracture causes difficulty walking or standing. It can also cause abdominal pain, bleeding from pelvic cavities, and difficulty urinating. Pelvic fractures in the United States are relatively rare, making up 0.3% to 6% of all fractures. Pelvic fractures are most common in people 15-28 years of age. In people younger than 35, males suffer a higher incidence of pelvic fractures than females. In people older than 35, females suffer pelvic fractures more often than males.

Fractures of the neck of the femur are most common in postmenopausal women, as their estrogen levels decrease and the body naturally becomes less efficient at absorbing vitamins and minerals, such as calcium, vitamin D, and phosphates - and will increase the risk of osteoporosis and risk of future fractures. 

Spontaneous and mild-trauma (falling from standing height or less) fractures of the femur are clinical signs of osteoporosis. 

What is a Pelvic Fracture (Hip Fracture)?

A pelvic fracture is a crack or break in one or more of the pelvic bones, which are located at the base of the spine. The pelvis is often referred to as part of the hip. (When you "put your hands on your hips," your hands are actually resting on your pelvic bones.)

A pelvic fracture can result from a low-impact or high-impact event.

Low-impact pelvic fractures most commonly occur in 2 age groups: adolescents and the elderly. Adolescents typically experience fractures of the tips of 1 of the pelvic bones, resulting from an athletic injury (football, hockey, skiing) or an activity such as jogging. Pelvic fractures also can occur after minor falls in people with osteoporosis or even occur spontaneously when bones are weak. The elderly frequently suffer fractures of the thicker part of the pelvic bones. These "pelvic ring fractures" result from falling onto the side of the hip. These falls can be caused by balance problems, vision problems, medication side effects, general frailty, or unintended obstacles such as pets underfoot, slippery floors, or rumpled rugs. Low-impact pelvic fractures often are mild fractures, and they may heal with several weeks of rest. Physical therapy is very helpful in restoring strength and balance in these cases.

High-impact pelvic fractures most commonly result from major incidents such as a motor vehicle accidents, a pedestrian being struck by a vehicle, or a fall from a high place. These pelvic fractures can be life-threatening, require emergency room care, surgery, and extensive physical therapy rehabilitation.

How Can a Physical Therapist Help?

Pelvic fracture recovery often involves surgery or long periods of bed rest. In the case of athletes, avoidance of sport activities is recommended until pain has resolved. During these periods of rest, which are usually weeks to months, a person often loses strength, flexibility, endurance, and balance abilities.

Physical therapists can help you recover from a pelvic fracture by improving your:

• Pain level
• Hip, spine, and leg motion
• Strength
• Flexibility
• Speed of healing
• Speed of return to activity and sport

When you are cleared by your physician to begin physical therapy, your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments you should do at home. This program will help you return to your normal life and activities and reach your recovery goals.

The First 24-48 Hours

Your physical therapist may help you learn to use crutches so you can move around your home without walking on the leg of the injured side. This will more commonly apply to low-impact pelvic fractures, as in athletes. More severe pelvic fractures will require a wheelchair, in which your physical therapist can instruct your safe usage.

Reduce Pain

Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and special hands-on techniques called manual therapy that gently move your muscles and joints.

Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might start with passive motions that he or she applies to your leg and hip joint, and progress to active exercises and stretches that you perform yourself. Treatment can involve hands-on manual therapy techniques called "trigger point release" and "soft tissue mobilization," as well as specific stretches to muscles that might be abnormally tight.

Improve Strength

Certain exercises will benefit your healing at each stage of recovery, and your physical therapist will choose and teach you an individualized exercise program that will restore your strength, power, and agility. These exercises may be performed using free weights, stretch bands, weight-lifting equipment, and cardio exercise machines such as treadmills and stationary bicycles. For pelvic fractures, muscles of the hip and core are often targeted by the strength exercises.

Improve Balance

The hip area contains many muscles that are vital for balance and steadiness when walking or performing any activity. Your physical therapist will teach you effective exercises to restore strength and endurance to these muscles so that you can regain your balance.

Speed Recovery Time

Your physical therapist is trained and experienced in choosing the treatments and exercises to help you heal, get back to your normal life, and reach your goals faster than you might be able to on your own.

Return to Activities

Your physical therapist will collaborate with you to decide on your recovery goals, including return to work and sport. Your treatment program will be designed to help you reach these goals in the safest, fastest, and most effective way possible. Your physical therapist will use hands-on therapy and teach you exercises and work re-training activities. Athletes will be taught sport-specific techniques and drills to help achieve sports-specific goals.

Prevent Future Problems

Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and core to help prevent future problems, such as fatigue and walking difficulty. This program may include strength and flexibility exercises for the hip, thigh, and core muscles. Your physical therapist will also review with you and your family ways to prevent falls in your home. These fall-prevention strategies may include clearing the floors of loose obstacles (throw rugs, mats), using sticky mats or chairs in the shower, preventing pets from walking near your feet, and using non-slippery house shoes, as well as installing grab bars or rails for the shower, toilet, and stairs.

If Surgery Is Necessary

If surgery is required, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

Pelvic fracture can be prevented by:

• Warming up before starting any sport or heavy physical activity. Your warm-up should include stretches taught to you by your physical therapist, including stretches for the muscles on the front, side, and back of the hip.
• Increasing the intensity of an activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
• Following a reasonable and safe nutritional plan. Nutritional factors can contribute to osteoporosis, which can put you at higher risk of pelvic fracture.
• Maintaining good balance skills. Balance problems can increase the risk of falling and thus increase the risk of incurring a pelvic fracture. Physical therapy can help maintain and improve balance ability, which can help prevent falls.
• Driving safely to avoid motor vehicle accidents.
• Clearing your house of obstacles that you could trip over, and eliminating slippery walking surfaces.

HOW CAN A PHYSICAL THERAPIST HELP WITH CANCER?

Physical therapists are trained and educated to understand all of your health conditions, including a cancer diagnosis, and apply them to human movement - we are human movement specialists. Your physical therapist will work with you to develop a specialized treatment program to address your specific needs and goals.

The American Cancer Society recommends people undergoing cancer treatment, and cancer survivors, perform consistent physical exercise to decrease fatigue, and improve the ability to perform normal daily activities. Studies show that exercise can improve an individual’s chances of surviving cancer. Physical therapists can design individualized exercise and treatment programs to reduce or prevent many cancer-related problems.

Physical therapists help people diagnosed with cancer before and after surgery. Before surgery, they evaluate individuals for any of the problems listed above, and help address them. After surgery, they can help with the healing of the incision site, improve circulation, reduce pain, and minimize scarring. They evaluate individuals for any physical therapy treatment needs, and, by designing individualized treatment programs, help them recover and heal faster than they would on their own.

Your physical therapist may work with you to improve your:

Comfort and well-being. Cancer and cancer treatments can cause symptoms such as pain, burning sensations, numbness, tingling (neuropathy), cramps, spasms, and weakness. Your physical therapist may apply hands-on techniques (manual therapy) or technologies like electrical stimulation to help decrease your pain and alleviate your symptoms. The physical therapist may teach you gentle exercises or techniques to perform at home to aid your recovery. All of these options may reduce or eliminate the need for opioid pain medication.

Aerobic capacity. Cancer or cancer treatment may have decreased your ability to process oxygen (aerobic capacity), causing fatigue. Research shows that aerobic exercise, such as walking on a treadmill for at least 20 minutes 3 times per week, may help improve aerobic capacity, reduce fatigue, and optimize healing. Your physical therapist can assess your aerobic capacity and determine the best aerobic activities for you.

Bone density. Lack of activity and certain cancer treatments can cause weakening of your bones, which could lead to bone fractures. Certain types of exercise can prevent bone loss and maintain bone strength. Your physical therapist can teach you safe and effective exercises to help steadily build your bone strength.

Lymphedema and swelling. Certain cancer treatments can result in lymphedema (swelling in the arms or legs) or other types of swelling. Your physical therapist can use several methods to reduce, control, and prevent lymphedema and swelling, such as specialized gentle massage, special movements and exercises, and application of compressive garments such as arm sleeves, gloves, and leg stockings.

Surgical incisions. Your physical therapist can help you care for any surgical incisions and sutured areas, by checking for infection and assisting with dressing changes. The physical therapist also can help prevent some kinds of scarring and skin tightness as the suture line heals. Your physical therapist can use very gentle massage or certain technologies to keep the skin as soft and pliable as possible.

Body weight. By creating an exercise and physical activity program tailored just for you, your physical therapist will help you reduce body fat and maintain a healthy body weight, which can improve your energy levels.

Mood. Exercise helps elevate mood and reduce depression in everyone, including cancer patients and survivors. A diagnosis of cancer, and cancer treatment, can be stressful and cause mood changes in anyone. Proper exercise, individualized for each person by a physical therapist, can help reduce stress and improve mood.

Brain fog. Exercise helps relieve brain fog. Your physical therapist can design an individualized program of exercise that can help reduce memory loss and brain fog.

Daily activities. Your physical therapist will discuss activity goals with you and use them to design your treatment program. Cancer survivors usually increase their physical activity gradually; your treatment program will help you reach your goals in the safest, fastest, and most effective way possible.

Walking. Your physical therapist will help improve your ability to walk using techniques such as strengthening exercises, walking training, and balance activities. If you have nerve damage (neuropathy), your physical therapist may provide bracing and other techniques to make it easier or safer for you to walk. Your physical therapist also may recommend using an assistive device, such as a walker or cane.

Sports training ability. Athletes undergoing cancer treatment can continue to train for their sport to a degree, depending on the type of cancer and treatment. Physical therapists design safe, challenging, sport-specific training programs to help athletes reduce loss of fitness and strength during cancer treatment.

Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises and stretches that you do yourself. You can perform these motions at home to help hasten healing and pain relief.

Flexibility. Your physical therapist will determine if any muscles are tight, start helping you to stretch them, and teach you how to stretch them at home.

Strength. If your physical therapist finds any weak or injured muscles, the physical therapist will choose, and teach you, the correct exercises to steadily restore your strength and agility.

Coordination. Your physical therapist will help you improve and regain your coordination and agility, so you can perform household, community, and sports activities with greater ease.

Balance. Your physical therapist will examine your balance, and choose specific exercises that you can perform in the clinic and at home to improve your balance and prevent falls. Your physical therapist may also teach you how to use a cane or walker to help maintain your balance when walking and standing.

Home program. Your physical therapist will teach you strengthening, stretching, and pain reduction exercises to perform at home. These exercises will be designed specifically for your needs.