OVERTRAINING SYNDROME

What is it?
Overtraining syndrome occurs when an athlete’s training schedule is too much to allow for his/her body to recover. It often is the reason that the athlete’s performance declines despite increasing the training schedule and intensity of training. Poor performance continues even after weeks to months of recovery.

Risk Factors
• Early single sport specialization • Significant increase in training over a short period of time • Training for an important event • Excessive parental and/or coach pressure to succeed

Symptoms
• Increased fatigue • Decreasing performance • Sleep problems • Anxiety • More frequent injuries • Frequent illness • Bradycardia or tachycardia • Irritability • Weight loss • Depression • Lack of mental concentration • Vague muscle and/or joint pain

Sports Medicine Evaluation
The sports medicine physician will ask detailed questions about the athlete’s current training schedule and the actions that have been taken to help with the symptoms being experienced. He/ she will also obtain a dietary history. The physician will then perform a comprehensive physical exam. Depending on the findings of the comprehensive history and physical exam, the doctor may order laboratory studies, and ask the athlete to complete a questionnaire about mood and behavior. If overtraining syndrome is suspected and all other diagnoses are ruled out, a period of rest for 3-5 weeks is generally recommended, followed by a gradual return to full training over an additional 3 months. Alternatively, non competitive, low level recreational physical activity may be allowed during this modified rest period to maintain some cardiovascular fitness. Psychotherapy and counseling may also be prescribed as part of the treatment.

Injury Prevention
• A training log should be maintained. • Intense exercises with short rests, and frequent competition, should be avoided. • Weekly and yearly participation time should be limited. • Early morning heart rate should be monitored. • Sudden increases in training load should be avoided and a steady increase of 5% intensity per week should be followed. • Skill development, rather than competition and winning, should be emphasized with young athletes

Return to Play
A period of reduced training and competition stress is generally recommended for up to 4 months.

AMSSM Member Authors
Kristina Wilson, MD

ARE YOUR HIPS SNAPPING MORE THAN YOUR FINGERS?

What is Snapping Hip Syndrome?

Snapping hip occurs when a muscle, tendon, or ligament rolls over a bony prominence in the hip. Snapping hip can occur in different areas of the hip:

• Front. Snapping at the front of the hip can involve the hip flexor muscle rolling over the front of the hip bone, or the hip ligaments rolling over the thigh bone or tissues of the hip joint.
• Side. This condition involves the ITB (iliotibial band) rolling over the outer thigh bone or the big muscle on the back of the hip (gluteus maximus) sliding over the outer thigh bone.
• Back. This condition involves one of the hamstring muscles rolling over the bottom of the hip bone.

Snapping hip can occur when the hip muscles are excessively used and become fatigued, tight, and/or swollen.

Athletic activities like track and field, soccer, horseback riding, cycling, gymnastics, and dance can trigger the condition. It can also occur during everyday activities that require repeated forceful movement of the legs.

How Does it Feel?

Snapping hip causes a snapping sensation and sound that can be felt in the front, the side, or the back of the hip. Often, the snapping can be pain-free. If it causes pain, the pain usually ceases when the leg movement causing the snapping is stopped. In athletes and dancers, the snapping can be accompanied by weakness and may diminish performance.

The snapping is most commonly felt when kicking the leg forward or to the side, when bringing the leg behind the body, when rising from a chair, or when rotating the body or the leg.

Often, walking and running in a straight line are snap-free and pain-free, although in some people these activities are limited by the pain of the structure that is snapping.

Signs and Symptoms

With snapping hip, you may have:

• Snapping or popping in the front, side, or back of hip when lifting, lowering, or swinging the leg
• Weakness in the leg when trying to lift it forward or sideways
• Tightness in the front or back of the hip
• Swelling in the front or side of the hip
• Difficulty performing daily activities such as rising from a chair and walking

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 therapist will ask you:

• How you injured your hip and if you heard a pop when you suffered the injury
• If you feel snapping, popping, or pain
• Where you feel the snapping or pain
• If you experienced a direct hit to the leg
• If you saw swelling in the first 2 to 3 hours following the injury
• If you experience pain when lifting your leg forward or backward, walking, changing directions while walking or running, or when lifting the knee
• If you participate in any repetitive, forceful, or plyometric (quick explosive jumping) sport activities.

Your physical therapist also will perform special tests to help determine whether you have a snapping hip, such as:

• Asking you to lift your leg quickly
• Asking you to push against the physical therapist’s hand when he or she tries to push your leg outward, backward, and forward (muscle strength test)
• Gently feeling the muscle to determine the specific location of the injury (palpation)

Your therapist may use additional tests to assess possible damage to other parts of your body, such as your hip joint or lower back.

To provide a definitive diagnosis, your therapist may collaborate with a physician or other health care provider. The physician may order further tests—such as an x-ray or magnetic resonance imaging (MRI)—to confirm the diagnosis and also to rule out other potential damage. However, these tests are not commonly needed for snapping hip syndrome.

How Can a Physical Therapist Help?

Your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments you should perform 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 advise you to:

• Rest the injured hip by avoiding walking or any activity that causes pain. In rare cases, crutches may be recommended to reduce further strain on the muscles when walking.
• Apply ice packs to the affected area for 15 to 20 minutes every 2 hours.
• Consult with another health care provider for further services such as medication or diagnostic tests.

Reduce Pain

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

Improve Motion

Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might start with movements of the leg and hip joint that the therapist gently performs, and progress to active exercises and stretches. Treatment for snapping hip often involves 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 injury at each stage of recovery, and your physical therapist will choose and teach you the appropriate exercises that will restore your strength, power, and agility. These may be performed using free weights, stretchy bands, weight-lifting equipment, and cardio exercise machines such as treadmills and stationary bicycles. For snapping hip syndrome, muscles of the hip and core are often targeted by the strength exercises.

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, as well as design your plan of care to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will use hands-on therapy and teach you exercises and work retraining activities. Athletes will be taught sport-specific techniques and drills to help achieve sport-specific goals.

Prevent Future Re-injury

Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and core (abdomen) to help prevent future injury. These may include strength and flexibility exercises for the hip, thigh, and core muscles.

If Surgery Is Necessary

Surgery is rarely necessary in the case of snapping hip syndrome. If it 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?

Snapping hip syndrome can be prevented by:

• Warming up before starting a sport or heavy physical activity. Your warm-up should include stretches taught to you by your physical therapist, including those for the muscles on the front, side, and back of the hip.
• Gradually increasing the intensity of an activity or sport. Avoid pushing too hard, too fast, too soon.
• Following a consistent strength and flexibility exercise program to maintain good physical conditioning, even in a sport’s off-season.
• Wearing shoes that are in good condition and fit well.

POOL SEASON IS RIGHT AROUND THE CORNER

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

Preparing for the Pool

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

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

10 Excellent Exercises for the Pool

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

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

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

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

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

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

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

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

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

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

THE FIELD IS GROWING.... IS IT RIGHT FOR YOU?

There are many reasons you should consider a career in physical therapy. Could it be right for you?

Make a Difference. "Being a physical therapist is very rewarding. You will work with patients one-on-one, see them progress through treatment, and know that you are really making a difference in their lives," said APTA spokesperson Meredith Harris, PT, DPT, EdD. Whether the patient's problem is a result of injury or disease, the physical therapist is a rehabilitation specialist who fosters the patient's return to maximal function. Physical therapists also will work with individuals to prevent loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

Be a Movement Expert. Physical therapists are highly educated experts in the movement and function of the human body. The goal of a physical therapist is to promote the patient's ability to move, reduce pain, restore function, and prevent disability. Physical therapy is an essential element of patient care. Therapeutic exercise and functional training are the cornerstones of physical therapist treatment. Depending on the particular needs of a patient, physical therapists may "mobilize" a joint or massage a muscle to promote proper movement and function. Physical therapists may use other techniques such as electrotherapy, ultrasound (high-frequency waves that produce heat), hot packs, and ice in addition to other treatments when appropriate.

Enjoy Job Security. For Americans looking for a rewarding career in a struggling job market and down economy, a career in physical therapy could be the perfect answer. The soaring demand for physical therapists can be attributed to the aging American population, particularly baby boomers who are more vulnerable to chronic and debilitating conditions that require physical therapist services. According to the Bureau of Labor Statistics, the demand for physical therapists is expected to spike upward by an astonishing 34% between 2014 and 2024—a much quicker rate than average. Currently, there are approximately 210,900licensed physical therapists in the United States, and that number is expected to jump to 282,700 by 2024.

Love Your Job. Helping people to attain or regain the ability to walk and carry out daily life can lead to a great feeling of personal satisfaction. Physical therapists report one of the highest job-satisfaction levels in the country! Forbes ranked physical therapists as having 1 of "The Ten Happiest Jobs," according to articles published in 2013 and 2011. CNNMoney.com gave physical therapists a grade of “A” in Personal Satisfaction in 2012, as well as in its “Benefit to Society” categories. A National Opinion Research Center survey, which was chronicled in an April 17, 2007, article of the Chicago Tribune. With more than three-quarters of physical therapists polled reporting to be "very satisfied" with their occupations, PTs were second only to clergy, and were the only health care professionals in the top 5.

Choose Your Location. Physical therapists work with patients of all ages all across the country. Choose from a wide range of locations and work settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, employer settings, and nursing homes.

Be an Entrepreneur. Do you want to be your own boss? More than twenty-one percent (21.6%) of physical therapists are owners of, or partners in, a physical therapy practice.

COULD YOU HAVE PATELLOFEMORAL PAIN SYNDROME?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap (patella). PFPS is one of the most common types of knee pain experienced in the United States, particularly among athletes, active teenagers, older adults, and people who perform physical labor. Patellofemoral pain affects more women than men and accounts for 20% to 25% of all reported knee pain - and is very, very common in adolescence and young adulthood for active or athletic individuals. Physical therapists design exercise and treatment programs for people experiencing PFPS to help them reduce their pain, restore normal movement, and avoid future injury.

What is Patellofemoral Pain?

Patellofemoral pain syndrome (PFPS) refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint.) Pain occurs when friction is created between the undersurface of the kneecap and the thigh bone (femur). The pain also is usually accompanied by tenderness along the edges of the kneecap.

Current research indicates that PFPS is an "overuse syndrome," which means that it may result from repetitive or excessive use of the knee. Other contributing factors may include:

• Weakness, tightness, or stiffness in the muscles around the knee and hip
• An abnormality in the way the lower leg lines up with the hip, knee, and foot
• Improper tracking of the kneecap

These conditions can interfere with the ability of the kneecap to glide smoothly on the femur (the bone that connects the knee to the thigh) in the femoral groove (situated along the thigh bone) during movement. The friction between the undersurface of the kneecap and the femur causes the pain and irritation commonly seen in PFPS. The kneecap also may fail to track properly in the femoral groove when the quadriceps muscle on the inside front of the thigh is weak, and the hip muscles on the outside of the thigh are tight. The kneecap gets pulled in the direction of the tight hip muscles and can track or tilt to the side, which irritates the tissues around the kneecap.

PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, such as running, stair climbing, squatting, or repeated carrying of heavy loads. Older adults may experience age-related changes that cause the cartilage on the undersurface of the kneecap to wear out, resulting in pain and difficulty completing daily tasks without pain.

How Does it Feel?

People with PFPS may experience:

• Pain when walking up or down stairs or hills
• Pain when walking on uneven surfaces
• Pain that increases with activity and improves with rest
• Pain that develops after sitting for long periods of time with the knee bent
• A "crack" or "pop" when bending or straightening the knee

How Is It Diagnosed?

Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Your physical therapist also will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee.

Generally, X-rays are not needed to diagnose PFPS. Your physical therapist may consult with an orthopedic physician who may order an X-ray to rule out other conditions.

How Can a Physical Therapist Help?

After a comprehensive evaluation, your physical therapist will analyze the findings and, if PFPS is present, your therapist will prescribe an exercise and rehabilitation program just for you. Your program may include:

Strengthening exercises. Your physical therapist will teach you exercises targeted at the hip (specifically, the muscles of the buttock and thigh), the knee (specifically, the quadriceps muscle located on the front of your thigh that straightens your knee), and the ankle. Strengthening these muscles will help relieve pressure on the knee, as you perform your daily activities.

Stretching exercises. Your physical therapist also will choose exercises to gently stretch the muscles of the hip, knee, and ankle. Increasing the flexibility of these muscles will help reduce any abnormal forces on the knee and kneecap.

Positional training. Based on your activity level, your physical therapist may teach you proper form and positioning when performing activities, such as rising from a chair to a standing position, stair climbing, squatting, or lunging, to minimize excessive forces on the kneecap. This type of training is particularly effective for athletes.

Cross-training guidance. PFPS is often caused by overuse and repetitive activities. Athletes and active individuals can benefit from a physical therapist’s guidance about proper cross-training techniques to minimize stress on the knees.

Taping or bracing. Your physical therapist may choose to tape the kneecap to reduce your pain and retrain your muscles to work efficiently. There are many forms of knee taping, including some types of tape that help align the kneecap and some that just provide mild support to irritated tissues around it. In some cases, a brace may be required to hold the knee in the best position to ensure proper healing.

Electrical stimulation. Your physical therapist may prescribe treatments with gentle electrical stimulation to reduce pain and support the healing process.

Activity-based exercises. If you are having difficulty performing specific daily activities, or are an athlete who wants to return to a specific sport, your physical therapist will design individualized exercises to rebuild your strength and performance levels.

Fitting for an orthosis. If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by low or high arches.

Can this Injury or Condition be Prevented?

PFPS is much easier to treat if it is caught early. Timely treatment by a physical therapist may help stop any underlying problems before they become worse. If you are experiencing knee pain, contact a physical therapist immediately. 

Your physical therapist can show you how to adjust your daily activities to safeguard your knees, and teach you exercises to do at home to strengthen your muscles and bones—and help prevent PFPS.

Physical therapists can assess athletic footwear and recommend proper choices for runners and daily walkers alike. Wearing the correct type of shoes for your activity and changing them when they are no longer supportive is essential to injury prevention.

ADHESIVE CAPSULITIS

Often called a stiff or “frozen shoulder,” adhesive capsulitis occurs in about 2% to 5% of the general population. It affects women more than men and typically occurs in people who are over the age of 45. Of the people who have had adhesive capsulitis in one shoulder, 20% to 30% will get it in the other shoulder.

What is Frozen Shoulder (Adhesive Capsulitis)?

Adhesive capsulitis is the stiffening of the shoulder due to scar tissue, which results in painful movement and loss of motion. The actual cause of adhesive capsulitis is a matter for debate. Some believe it is caused by inflammation, such as when the lining of a joint becomes inflamed (synovitis), or by autoimmune reactions, where the body launches an "attack" against its own substances and tissues. Other possible causes include:

• Reactions after an injury or surgery
• Pain from other conditions—such as arthritis, a rotator cuff tear, bursitis, or tendinitis—that has caused you to stop moving your shoulder
• Immobilization of your arm, such as in a sling, after surgery or fracture

Often, however, there is no known reason why adhesive capsulitis starts.

How Does it Feel?

Most people with adhesive capsulitis have worsening pain and then a loss of range of movement. Adhesive capsulitis can be broken down into 4 stages, and your physical therapist can help determine what stage you are in:

Stage 1 - "Pre-Freezing"

During this stage, it may be difficult to identify your problem as adhesive capsulitis. You've had symptoms for 1 to 3 months, and they're getting worse. There is pain with active movement and passive motion (movements that a physical therapist does for you). The shoulder usually aches when you're not using it, but pain increases and becomes "sharp" with movement. You'll have a mild reduction in motion during this period, and you'll protect the shoulder by using it less. The movement loss is most noticeable in "external rotation" (this is when you rotate your arm away from your body), but you might start to lose motion when you raise your arm (called "flexion and abduction")or reach behind your back (called "internal rotation"). You'll have pain during the day and at night.

Stage 2 – "Freezing"

By this stage, you've had symptoms for 3 to 9 months, most likely with a progressive loss of shoulder movement and an increase in pain (especially at night). The shoulder still has some range of movement, but this is limited by both pain and stiffness.

Stage 3 – "Frozen"

Your symptoms have persisted for 9 to 14 months, and you have greatly decreased range of shoulder movement. During the early part of this stage, there is still a substantial amount of pain. Toward the end of this stage, however, pain decreases, with the pain usually occurring only when you move your shoulder as far you can move it.

Stage 4 – "Thawing"

You've had symptoms for 12 to 15 months, and there is a big decrease in pain, especially at night. You still have a limited range of movement, but your ability to complete your daily activities involving overhead motion is improving at a rapid rate.

How Is It Diagnosed?

Often, physical therapists don't see patients with adhesive capsulitis until well into the freezing phase or early in the frozen phase. Your physical therapist will perform a thorough evaluation, including an extensive health history, to rule out other diagnoses. Your therapist will look for a specific pattern in your decreased range of motion; it's called a "capsular pattern" and is typical with adhesive capsulitis. In addition, your therapist will consider other conditions you might have—such as diabetes, thyroid disorders, and autoimmune disorders—that are associated with adhesive capsulitis.

How Can a Physical Therapist Help?

Your physical therapist's overall goal is to restore your movement so that you can perform your activities and life roles. Once the evaluation process has identified the stage of your condition, your therapist will create an exercise program tailored to your needs. Exercise has been found to be most effective for those who are in stage 2 or higher.

Stages 1 and 2

Your physical therapist will help you maintain as much range of motion as possible and will help reduce the pain. Your therapist may use a combination of stretching and manual therapy techniques to increase your range of motion. The therapist also may decide to use treatments such as heat and ice to help relax the muscles prior to other forms of treatment. The therapist will give you a home exercise program designed to help reduce the loss of motion.

Stage 3

The focus of treatment will be on the return of motion, with your therapist using more aggressive stretching and manual therapy techniques. You may begin some strengthening exercises as well, and your home exercise program will change to include these exercises.

Stage 4

In the final stage, your therapist will focus on the return of "normal" shoulder body mechanics and your return to normal, everyday, pain-free activities. The therapist will continue to use stretching, strength training, and a variety of manual therapy techniques.

Sometimes, conservative care cannot reduce the pain. If this happens to you, your physical therapist may refer you for an injection of anti-inflammatory and pain-relieving medication into the joint space. Research has shown that although these injections don’t provide longer-term benefit for range of motion and don’t shorten the duration of the condition, they do offer short-term benefit in reducing pain.

Can this Injury or Condition be Prevented?

The cause of adhesive capsulitis is debatable, with no definitive cause, so there is no known method of prevention. The onset is usually gradual, with the disease process needing to "run its course."

Real Life Experiences

Cheryl L. is 47-year-old woman whose physical therapist has diagnosed her with adhesive capsulitis. She has no history of trauma and reports a slow onset of pain that increased over the past 6 months. She says that it significantly affects her sleep.

Her pain is accompanied by a loss of range of movement that has now progressed to the point where she can’t lift her arm to shoulder level. Her therapist provides heat treatments to relax her muscles and designs a home exercise program to help stall the loss of motion. He monitors Cheryl periodically, encouraging her to continue with the home exercises despite the pain. Treatment in the physical therapy clinic consists of stretches performed by the therapist, who also mobilizes the joint to help maintain its current range of motion. At this stage, the therapist focuses the manual therapy not on increasing range of motion but on mobilizing the joint to reduce pain and reduce the amount of range of motion that is lost.

When Cheryl progresses into stage 3 ("frozen"), her visits to the physical therapist are increased. The therapist uses stretching and manual therapy techniques to improve her range of motion. After 4 weeks of treatment, Cheryl reports minimal pain, and her range of motion is beginning to increase rapidly. Her therapy is reduced to weekly visits and then to twice monthly visits. Fourteen months after the onset of her condition, her range of motion returns to normal, and her pain has stopped. Cheryl's progress is rapid, and the therapist credits this to her full participation in her exercise program.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have frozen shoulder, or adhesive capsulitis. You may want to consider:

• A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedic 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:

• 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 with frozen shoulder.
• 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.

APTA'S HEALTH CENTER FOR CAREGIVERS

Although they make up 29% of the U.S. population, caregivers are an often overlooked, but vital, part of someone’s health care team.  They spend an average of 20 hours a week providing care for a chronically ill, disabled, or aged family member or friend during a given year. The demanding role often means that the caregiver themself is often in need of assistance.

Physical therapists often work with caregivers and see the toll it can take, which can ultimately turn the caregiver into a patient in need of care as well.  Visit the APTA website for more resources to help caregivers in their role, and tips on how to maintain health and happiness for themselves.

Did you know that caregivers for individuals with Alzheimer's, on average, require 46% more doctor's visits than their non-caregiver counterparts? Or that they require over 70% more prescription drugs? 

Physical therapists, who are experts in restoring and improving motion, recommend that elderly adults who use canes and walkers as walking aids be properly assessed and fitted by a physical therapist to avoid fall-related injuries.

With emergency rooms experiencing 47,000 fall-related visits annually from senior citizens due to improper use and fit of walking aids*, assessment by a physical therapist can help reduce the number of these dangerous incidents by ensuring appropriateness and proper fit of the walking device.

Tips for Using Walkers and Canes:

• The walker or cane should be about the height of your wrists when your arms are at your sides.
• When using a walker, your arms should be slightly bent when holding on, but you shouldn't have to bend forward at the waist to reach it.
• Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through.

Physical therapists also advise against borrowing walking aids from friends and family. This often leads to improper fit and misuse, and can result in further injury. Your physical therapist can also evaluate your walking aid and determine if it is in proper working condition.

SITTING OR PROLONGED PERIODS CAN BE HARMFUL TO YOUR HEALTH

Inactivity researchers are discovering that sitting isn't just harmful to your health, it's so detrimental that a little bit of exercise doesn't offset its negative effects.

As The Washington Post put it, "The message is clear: Sitting for hours at a time might be a health risk regardless of what you do with the rest of your day." ("Desk jobs can be killers, literally" - July 17, 2013).

The Post cited Alpa Patel's 2010 study, published in the American Journal of Epidemiology (Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults), which found a common link between physical inactivity and cardiovascular disease mortality even after adjusting for smoking, body mass index, and other factors.

"Up until very recently, if you exercised for 60 minutes or more a day, you were considered physically active, case closed," Travis Saunders, a PhD student and certified exercise physiologist told Runner's World ("Sitting is the new smoking-even for runners" - July 20, 2013). "Now a consistent body of emerging research suggests it is entirely possible to meet current physical activity guidelines while still being incredibly sedentary, and that sitting increases your risk of death and disease, even if you are getting plenty of physical activity."

Adding to the concern, a study published in the Journal of Physical Activity and Health found that sitting too much "may increase the risk of disability in people over the age of 60" for "activities of daily living such as bathing, dressing, and walking," USA Todayreported ("Don't just sit there! It could be harmful later in life" - February 19, 2014).

EXPECTATIONS DRIVE DOCTORS TO ORDER UNNECESSARY IMAGING

Despite knowing (and agreeing with) recommendations to not use imaging for low back pain without “red flag” indicators, doctors are still ordering unnecessary CTs and MRIs for patients. Most do so out of fear of upsetting the patient, and because there is not enough time to discuss the risks and benefits of the images with the patients, according to an October 17, 2016 study of Veteran’s Affairs health care professionals.

The study surveyed 579 VA clinicians, and included a hypothetical scenario in which a patient had requested imaging for nonspecific low back pain (without red flag symptoms). Only 3% of the responses thought that the patient would benefit from a CT scan or MRI. Almost 75% of the clinicians worried the patient would not be able to be referred to a specialist without an image, and more than half worried the patient would be upset to not receive the image.

The study confirms a concern highlighted by the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, that the use of unnecessary imaging, such as CTs, MRIs, and X-rays, can lead to other unnecessary tests or procedures, drive up patient costs, and expose the patient to unnecessary radiation.

“Our study showed that almost all clinicians were aware that an imaging test was not indicated for a patient with low back pain without danger signals of severe spinal problems, and agreed with the Choosing Wisely recommendations to not do testing,” said study coauthor Erika D. Sears, MD, MS, of the Veteran’s Affairs Center for Clinical Management Research, in Reuters Health News (“Doctors still order imaging for low back pain, against recommendations” – October 17, 2016).

Patient education is key to avoiding unnecessary and expensive medical interventions and tests. There is a growing body of evidence that demonstrates early physical therapy for low back pain lowers costs. 

“Patients should first have a thorough history and physical exam to rule out the presence of “red flag” symptoms, and are often first referred to physical therapy in the initial treatment period,” Sears said. “Because low back pain tends to come back, staying active through activities such as walking, yoga, and supervised training, on top of physical therapy, is key to warding off recurrence.”

WHO'S FEEDING THE OPIOID EPIDEMIC?

In 2015, almost 12 million Medicare beneficiaries received at least 1 prescription of opioids (OxyContin, Percocet, Vicodin, fentanyl or their generic equivalents), at an estimated cost of $4.1 billion, according to a June 2016 report from the US Department of Health and Human Services - that's nearly 1 in 3 people on Medicare receiving a prescription for opioids in 2015.

The report confirms that the opioid epidemic affects people of all ages. “It’s not just a young person’s problem,” said Frederic Blum, PhD, director of addiction research at the University of Michigan, in U.S. News & World Report (“Nearly 1 in 3 on Medicare Get Commonly Abused Opioids” – June 22, 2016).

Blum calls the magnitude of the opioid use among seniors “astounding.” Each Medicare beneficiary who was prescribed a commonly abused opioid received an average of 5 prescriptions a year.

In 2014, more people died of drug overdoses than any previous year on record, and opioids were associated in 60% of those deaths.

In March 2016, the Centers for Disease Control and Prevention (CDC) released new guidelines to address the opioid epidemic, recommending safe alternatives like physical therapy for most pain management.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page. There are SAFER ways to manage pain - by PHYSICAL THERAPY.