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Every 25 seconds a youth athlete suffers an injury severe enough to require a trip to the emergency department, an August 2013 research report by Safe Kids Worldwide found.
Concussions account for 12% of those visits, with athletes aged 12 to 15 making up 47% of those cases-demonstrating the danger of concussions beyond high school football.
Meanwhile, knee injuries account for 10% of youth athlete emergency department visits, with female athletes up to 8 times more likely to have an anterior cruciate ligament (ACL) injury than males.
Concussions and ACL injuries have been topics of previous episodes of Move Forward Radio and are among the multitude of conditions for which physical therapists are part of the medical treatment team. Look into the APTA's website for more information!
Putting babies to sleep on their backs is preventing sudden infant death syndrome (SIDS), but too much time on their backs it might also be leading to an increase in flat spots on babies' heads.
As reported by NBC News (Nearly half of babies have flat spots, study finds - July 8, 2013), a recent study found that 46.6% of babies had some form of plagiocephaly ("oblique head").
The solution includes varying the side of the head that is placed down when the baby goes to sleep, and also increased "tummy time." Tummy time, even when infants are still very young, is so important. Babies come out flexed up into a ball, and as their muscles begin to relax and their bodies straighten out, tummy time helps the muscles in their neck become active. Babies can typically begin to lift their heads and clear their mouth/nose as early as 10 days after they're born! Within the 1st month, they should begin to get a little bit of clearance, within the 2nd month they should be able to lift their whole head off the ground, and by the 3rd month your baby should be able to hold their heads up and support themselves on their elbows. Once your baby can support their upper body on their elbows, they're typically within ~6 months of crawling!
Download Tummy Time Tools from the APTA's website for quick tips on how to position, carry, hold, and play with your baby to promote muscle development in the child's neck and shoulders and avoid the development of flat areas on the back of the baby's head.
Traumatic brain injury (TBI) occurs when a trauma causes damage to the way the brain functions. The most common causes of TBI are falls, car crashes, and blows to the head. Approximately 1.7 million TBIs occur each year in the US, resulting in 52,000 deaths and 275,000 hospitalizations.
Approximately 80% of individuals with TBI are treated and released from the emergency department because their injury is classified as a concussion or mild traumatic brain injury. TBI can occur at any age, to anyone, but certain groups are more likely to experience a brain injury. Children under the age of 4 are at risk of injury from falls and child abuse. Adolescents aged 15-19 are at an increased risk due to sports and car crashes. People aged 75 years and older are at risk from falls.
Physical therapists help people with TBI regain their physical abilities, re-learn daily tasks, and improve their strength and overall fitness.
Traumatic brain injury (TBI) occurs as the result of extreme force exerted on brain tissue. Common causes are falls, car crashes, or blows to the head. Movement of the brain that causes damage even though the skull is intact is called a closed injury. Damage caused by a wound that breaks through the skull, such as a gunshot or a puncture by a sharp object, is called a penetrating injury.
Those who sustain moderate-to-severe TBI require specialized hospital and rehabilitative care to address the serious physical, cognitive, and emotional changes that result from injury to the brain. Nearly half (43%) of those who need hospitalization for TBI will have some form of disability 1 year after the injury.
Severe TBI often causes a period of unconsciousness, called a coma, when the patient's eyes remain closed, and he or she is not responsive to outside stimulation. Consciousness may gradually improve, but many brain functions can be affected by the injury, including those guiding thought, movement, sensation, and behavior.
Because the brain controls our ability to move, think, sense, and socialize, the symptoms that result from TBI can vary widely. They may include:
Upon the patient's arrival at the hospital, an attending doctor will diagnose the level of the TBI by assessing factors such as the ability to open the eyes, to speak, and to move in response to a command.
In moderate or severe injuries, imaging studies will be conducted (such as MRI, CT scan) to determine what parts of the brain are injured or if there is any bleeding or fluid that could be pressing on the brain tissue. A physical therapist (PT) often works with the medical team to understand what areas of the brain are injured so that the PT evaluation can focus on potential problem areas.
With a severe injury, the patient may be in a coma; the eyes are shut and there is no response to external stimuli. Over time, the patient will likely be able to open his or her eyes. Sometimes eye opening is accompanied by rapid recovery of other abilities such as talking and physical movement. For other patients, recovery is slower.
When a patient is said to be in a vegetative state, some basic brain functions resume, such as eye-opening on a regular sleep/wake cycle, breathing, and digestive functions, but he or she is unaware of surrounding activity. During this phase, a physical therapist will help with positioning and equipment that will ensure proper posture and flexibility, reduce the likelihood of any problems such as bed sores, and encourage responsiveness to the environment.
When a patient is said to be in a minimally conscious state, he or she shows beginning signs of awareness (the ability to do purposeful things) but these responses are often not consistent. During this phase, a physical therapist will help with stretching, positioning, and equipment use while trying to increase consistent responses to commands for movement and communication.
By working with the patient and his or her family, goals are developed to improve physical independence. Physical therapists help patients with TBI regain functions such as getting in and out of bed and changing their position in bed, sitting down, rising to stand, walking, and using a wheelchair.
The physical therapist uses exercise and task-specific training to help the patient improve:
If limitations prevent the return to pre-injury activities, a physical therapist can help the patient improve mobility and master the use of equipment such as an ankle brace, a walker, or a wheelchair.
Traumatic brain injuries can be prevented by taking steps to protect the head when engaged in risky activities, and by lessening participation in those activities. Awareness of the signs and symptoms of injury can help quicken response time should a TBI occur.
Turf toe injury is an injury to the main joint of the big toe. The formal medical name for the condition is metatarsophalangeal (MTP) joint sprain. This injury occurs when the big toe is forced into extreme positions of hyperextension (where the toe moves back toward the top of the foot past its normal range of motion). It occurs primarily in athletic environments, particularly in football, such as when an athlete pushes off to sprint or is tackled with the front of the foot fixed and jammed into the ground, causing the toe to get stuck or caught in a hyperextended position. In most circumstances, a turf toe injury does not require surgery and can be treated effectively by a physical therapist.
There are 2 joints in the big toe. These joints allow the toe to move in an upward motion and bend in a downward motion. The big toe plays a significant role in our ability to walk and run; when the foot touches the ground and prepares to take another step, the big toe is the last joint through which the foot pushes off to move the body forward. The primary joint that this motion occurs through is the metatarsophalangeal joint, where the metatarsal, the first long, straight bone of the foot, attaches to the phalange, the first shorter bone of the toe.
If the big toe is forced into an extremely unnatural position, the MTP joint and surrounding structures may be injured. These structures may include ligaments, muscle tendons, or the small bones that sit under the big toe, called the sesamoid bones. All of these structures play a role in maintaining the integrity and function of the MTP joint; they are often grouped together and termed the plantar complex. Sometimes, 1 of the soft-tissue structures is simply stretched when the toe is bent back toward the top of the foot. However, a turf toe injury may involve a subluxation (where 1 bone of the joint slips out of place, but comes back to its normal position) or a dislocation (where the 2 bones of the joint are completely separated).
The most common symptoms associated with a turf toe injury are:
Turf toe injuries are typically classified into grades 1 to 3 to describe the severity of the injury and to guide treatment:
Diagnosis of turf toe injury starts with an interview to learn the mechanism of injury and your symptoms. Your physical therapist will perform a gentle clinical examination to assess the toe's movement and muscle function as well as to note any swelling or tenderness in the area. Your physical therapist may ask you if you are able to walk on your foot and, if so, will analyze your gait pattern. If your therapist suspects a fracture of 1 of the bones or a tearing of the muscle-tendon unit, your physical therapist may refer you to an orthopedic physician who specializes in foot and ankle injuries for diagnostic imaging (i.e., x-ray, MRI).
Immediately following a turf toe injury, the RICE protocol is recommended: Rest, Ice, Compression, and Elevation. The goal of the RICE protocol is to decrease pain and swelling and protect the joint from further injury until it can be more thoroughly assessed. Most turf toe injuries do not require surgery and are treated with physical therapy. The treatment depends on the severity of the injury.
In each case, your physical therapist will work with you to design an individualized treatment program specific to the exact nature of your condition and your goals. Treatment may include:
Range of Motion Exercises. It is important to regain a full range of motion of your big toe. Your motion may be limited after a turf toe injury, particularly one that requires immobilization in a brace or boot. Your physical therapist will teach you gentle stretching exercises to help regain motion.
Muscle Strengthening. It is common to lose strength in the muscles of your leg, particularly around your foot and ankle after a turf toe injury due to the limited weight-bearing and activity that is required to allow the injury to heal. Your physical therapist will determine which muscles are weak and teach you specific exercises to treat them, such as strengthening with resistance bands, balance activities, and functional activities, like stair climbing.
Manual Therapy. Many physical therapists use manual (hands-on) therapy to gently move and manipulate muscles and joints to improve their motion and strength. These techniques can target areas that are difficult to treat on your own. Manual therapy can be especially effective for joints that become stiff following immobilization; with turf toe injury, your physical therapist will use different techniques to mobilize your big toe as well as the other joints of your foot and ankle that may have become stiff during your recovery.
Patient Education. Your physical therapist will educate you on the dos and don’ts following turf toe injury to ensure that your recovery is a smooth one. Your physical therapist will work with you to develop an individualized rehabilitation program, including expected timelines and goals to give you a roadmap for your return to full activity.
There are certain external factors that may increase the risk of turf toe injury, such as competing on artificial turf surfaces and wearing shoes with highly flexible soles. Care can be made to ensure that your footwear is supportive and appropriate for the surface on which the sport is being played. Additionally, performing preventative flexibility and strengthening activities for the foot and ankle may improve your body's ability to withstand the stresses placed on the body during athletic activities.
America's opioid epidemic is being felt nationwide.
How bad is the problem? Here are some statistics via The Centers for Disease Control and Prevention (CDC), which released guidelines in March 2016 encouraging health care providers to pursue safer alternatives like physical therapy for most pain management:
1. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every American adult to have their own bottle of pills.
2. As many as 1 in 4 people who receive prescription opioids long-term for noncancer pain in primary care settings struggles with addiction.
3. Sales of prescription opioids have nearly quadrupled since 1999. More than 4 in 10 of long-term users say they started taking them for chronic pain (44%) while 25% say they started due to pain after surgery, and another 25% say they started for pain after an accident or injury.
4. Deaths related to prescription opioids have quadrupled.
5. Heroin-related overdose deaths more than quadrupled between 2002 and 2014, and people addicted to prescription opioids are 40 times more likely to be addicted to heroin.
6. Opioids killed more than 33,000 people in 2015, more than any year on record. Nearly half of those deaths involved prescription opioids.
7. Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.
Do you know someone in pain? Encourage them to talk to their physician or physical therapist about safe ways to manage pain.
The American Physical Therapy Association’s #ChoosePT campaign raises awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management.
It's been a good year for Move Forward Radio, our twice-monthly podcast. Catch up with our top 6 episodes from 2016:
Gabby Reece recounts her decision to participate in physical therapy—and her commitment to recovery without the use of drugs. Along the way, Reece explains how her path is 1 that could be considered by any individual facing decisions about what to do after surgery.
A Cleveland Clinic researcher on physical therapy as first-choice pain treatment
Andre Machado, MD, is leading an innovative pain treatment research project that puts a combination of physical therapy and behavioral therapy at the front lines of pain treatment, and takes a cautious approach to the use of opioids. Machado shares his thoughts on opioids and the need for a cultural shift on attitudes about pain.
Physical therapy's lifechanging effects on chronic pelvic pain
Erin Jackson's pelvic pain, a mysterious, stabbing pain, felt both internal and external, plagued her for over a decade. She saw multiple health care providers in multiple states. She was prescribed multiple medications, none of which worked. Then Jackson began working with a physical therapist who presented a new treatment approach for her pain—and things finally began to change.
The LA Lakers' "secret weapon" on the challenges of treating elite athletes
Judy Seto, PT, DPT, MBA, who has served as head PT for the Lakers for the past 5 years, talks about what's involved in making sure that Kobe Bryant and colleagues stay healthy through an 82-game regular season, plus preseason, postseason, and the offseason.
The latest on blood flow restriction training
Johnny Owens, PT, MPT, is a high-profile proponent of a relatively new training approach that involves applying a tourniquet to an injured limb to allow patients to make greater strength gains while lifting lighter loads (and reducing overall stress). Owens describes how it works, shares his vision for the potential of the technique within health care, and discusses where research is going.
A patient's journey out of extreme pain thanks to physical therapy
When Morgan Hay broke her big toe, she assumed it was a small injury. Weeks later, however, her foot was still discolored and swollen, and the pain was intense. Hay recounts misdiagnoses, multiple painkiller prescriptions, and finally, the physical therapy treatment that is helping her make real progress.
A pressure ulcer, sometimes called a "bed sore," is a skin injury that occurs in about 40,000 people every year. Usually, pressure sores happen when people are very ill for a long period of time and are not able to change their position in a bed or a chair. People who have conditions such as dementia and spend a lot of time in a bed or a chair might not even realize that they need to change their position.
Pressure ulcers are caused by forces that block the flow of blood to the skin:
Pressure ulcers can happen to:
Although pressure ulcers can develop anywhere on the body, they are more likely to occur on the buttocks of people who sit in a chair all day or in the heels, above the tailbone, and on the insides of the elbows of people who have to stay in bed all day.
Pressure ulcers can result from friction injuries to the skin when a person is being pulled across a surface, such as being pulled across a sheet when the bed is being made or being pulled out of a wheelchair.
Skin also can be injured by prolonged exposure to tape, urine, and feces, or it might be injured by tape removal. Although these injuries might look similar to a pressure ulcer, they often aren't. However, this kind of wound is more likely to become a pressure ulcer if the skin is exposed to too much or too little moisture, scrubbing, or temperatures that are too cool or too warm.
Many people with pressure ulcers don't know that they have one. Pressure ulcers might first be seen by a family member, a caregiver, or a physical therapist or other health care provider.
Pressure ulcers might be noticed when bathing or dressing someone who is at risk for developing them. A foul odor or the presence of yellow, brown, or gray mushy material on bedding or clothing might be noticed first and traced to an opening in the skin. Although pressure ulcers can be very painful, the person who has the ulcer might not notice any pain or might have pain but not be able to communicate it.
The physical therapist will conduct a full evaluation, including staging the pressure ulcer based on a system developed by the National Pressure Ulcer Advisory Panel (NPUAP):
These stages don't necessarily tell how severe a pressure ulcer is, and ulcers don't always progress from one stage to the next. What looks like a "simple" stage I ulcer might be a minor irritation of the skin—or might be hiding a large mass of injured tissue beneath.
If there are blood-filled blisters, or purple or maroon areas of what appears to be uninjured skin, that could mean the tissue beneath the uninjured-looking skin is dead. On the other hand, there might be extensive death of tissue such as muscle, but the skin might not look injured at all. This is why a large ulcer might seem to appear "out of nowhere" within a matter of a few days. Muscle and other tissue near bone may be damaged by pressure before the skin breaks down, revealing a large wound extending to the bone. Detailed examination by a physical therapist or other health care provider is needed.
Based on the examination, the physical therapist will decide whether any further testing or consultation with another health care provider is necessary. In some cases, surgery or the prescription of antibiotics by a physician may be necessary.
Osteopenia, now called low bone mass, is a term used to describe lower-than-normal bone density or thickness. Approximately 44 million adults in the United States have osteopenia.The condition is different than osteoporosis, which is a disease where normal bone structure becomes thinned out and porous.
Low bone mass can occur at any age, but noticeable and significant bone loss is most likely to occur in women during the 5 to 7 years following menopause. This group is also more likely to experience a bone fracture than someone with normal bone mass.
Low bone mass is a condition that develops when a person:
There are no specific symptoms oflow bone mass. You may have the condition and not know it. It is important to recognize your risk factors to prevent bone fracture. You should discuss any concerns with your health care provider and physical therapist.
Low bone mass is diagnosed through a quick and painless specialized scan ordered by aphysician. If you are seeing a physical therapist for rehabilitation, the therapist may confer with your physician when detecting a possible need for bone testing.
The results of the scan are reported using T- and Z-scores.
The T-score compares your score to that of healthy 30-year-old women. A T-score between -1 and -2.49 means that you have low bone mass. Those who have a T-score of -2.5 and lower have osteoporosis.
If you have a T score of -1 or less, you have a greater risk of experiencing a fracture. A person with a T-score of -2 has lower bone density than a person with -1.
The Z-score compares your bone mineral density to the average of peoplewho are of the same age, sex,weight,and race as you. A Z-score of -2 or lower might mean that something other than normal bone loss due to age is occurring. Your doctor will likely explore other health issues that might be causing the bone loss.
Other methods of screening bone density include x-ray, ultrasound, and CT scan.If you have risk factors that includecertain diseases, short- or long-term use of steroids, or a recent bone fracture, a DXA scan may be prescribed.
A physical therapist can help you prevent and treat low bone massat any age by prescribing the specific amount and type of exercise that best builds and maintains strong bones.
When you see your physical therapist, the therapist will review your health history, including your medical, family, medication, exercise, dietary, and hormonal history. Your physical therapistwill also conduct a complete physical therapy examination and identify your risk factors for low bone density.
It is important to exercise throughout life, and especially when you have been diagnosed with low bone mass in order to build and maintain healthy bones. Exercise can help to build bone or slow the loss of bone.
Your physical therapist is likely to prescribe 2types of exercise that are best to build strong bones:
Your physical therapist will design an individual exercise program for you based on your particular needs. Your physical therapist will test you to see how much resistance is needed and is safe for your specific bone density as well asother physical issues that you may have. Treatment starts at the level you can tolerate. Once you learn how to perform your program, your physical therapist may add more strenuous activity with physical effort to encourage your bones to grow stronger.
Your exercise prescription will include guidelines for weightbearing and resistance training for the hips, spine, shoulders, and wrists. The therapist will prescribe guidelines for the intensity, frequency, and progression of your exercises.
Exercise is only 1component of healthy bones. Your physical therapist will encourage you to pursue a healthy and varied diet, including foods rich in calcium, to reach the amount recommended according to your age and health status. Your physical therapist may recommend that you meet with a dietitian to learn about the many foods that contribute to bone health. Sometimes, medication or hormone replacement therapy may be recommended. Your physician will help guide you to find the best combination of exercise, diet, and medication to treat your condition.
Risk factors that you can avoid in order to lower your chances of developing low bone mass include:
Physical therapists treat people of all ages and abilities. Here are some ways a physical therapist can help you.
Pain-free movement is crucial to your quality of life, your ability to earn a living, and your independence. Physical therapists are movement experts who can identify, diagnose, and treat movement problems.
Physical therapists work collaboratively with their patients and clients. Treatment plans are designed for each person’s individual goals, challenges, and needs.
Opioid risks include depression, overdose, and addiction, plus withdrawal symptoms when stopping use. In some situations, dosed appropriately, prescription opioids are an appropriate part of medical treatment. However, the Centers for Disease Control and Prevention (CDC) is urging health care providers to reduce the use of opioids in favor of safe alternatives like physical therapy for most long-term pain.
Before you undergo expensive or invasive surgery, try physical therapy. For some conditions, including meniscal tears and knee osteoarthritis, rotator cuff tears, spinal stenosis, and degenerative disk disease, treatment by a physical therapist has been found to be as effective as surgery.
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