What is Physical Therapy?

By  aenriquez  published  January 21, 2020

Physical therapy involves the use of a variety of techniques designed to promote healing, reduce pain, or adjust behaviors and skillsets to adapt to a permanent condition that is affecting someone’s life.

Physical therapists deal with a lengthy variety of conditions that range from a sports injury to heart disease. They are the ground-level service providers for healing, conditioning, pain relief, and adaptation to unusual circumstances.

In so many words, your body is designed to heal from illnesses and injuries of all sorts. Your immune system fights off diseases and helps you recover from them. Your muscles and bones, when they are injured, are designed to recover, mending fractures and breaks and growing replacement tissue in many cases. A physical therapist has many techniques that accelerate the healing process. However, if a condition is permanent, like the loss of a limb or spinal cord paralysis, a physical therapist teaches ways to adjust to your disability so you can be as active and pain-free as possible.

You can view healing as one way your body reacts to pain; as such, healing is a process of returning function and to reduce pain. Since physical therapy can promote a speedier recovery, pain relief is an important goal in many physical therapy interventions.

It is impossible to list here all the conditions where a physical therapy strategy can be helpful. They help people learn to walk with a cane or braces; they help people relearn to walk; they help restore movement after a traumatic sports injury; they use a variety of massage techniques to promote deep healing and relaxation; they help women recover after giving birth, and they help people who aren’t injured learn how to do various activities in a safe manner to avoid or prevent an injury in the first place.

Many insurance policies allow people to go directly to a physical therapist – to make an appointment and start working with the PT. Other policies require patients to see a primary care doctor first so that they can make a proper referral to a physical therapist.

Perhaps the best scenario in this situation is to see a doctor in a clinic that already has a physical therapist (or more than one) on staff, so the referral is as good as done.

Goals

 A physical therapist’s goals are always to reduce pain, restore functionality, or prevent injury. Among the first steps in the process are for the physical therapist to measure your current functioning status and assess the level of pain you are suffering.

The physical therapist will then create a customized plan to address your issues. They will then walk you through the plan and teach it to you. Typically, a physical therapist will teach you stretching, relaxation, or exercising activities that you can do at home. They will then schedule a series of appointments with you to monitor your progress and teach new activities to move you to the next level of healing.

Appointments are also helpful for the physical therapist to conduct hands-on healing that is best done in the office, such as extensive massages or measuring your progress. As such, an appointment with a physical therapist often lasts much longer than the standard visit to a doctor’s office. The physical therapist is where the rubber meets the road, where the actual healing from many physical conditions begins. It can take some time for the magic to work. If you are committed to healing, a physical therapist can be a miracle worker.

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The New Epidemic: Sitting Down

By  aenriquez  published  January 17, 2020

There are several serious health risks that most adults already know. There’s are serious risks associated with obesity, smoking, addictions to many well-known substances (alcohol, illegal drugs, etc.) and exposure to various illnesses and carcinogenic substances. However, health officials are considering adding a new concern to our list of problematic behaviors: Prolonged sitting.

This brings health officials (and the general public) to weigh in on the following questions: How long do you have to sit each day for this to be deemed too long (or prolonged) and how dangerous is sitting?

These are reasonable questions and the answers fall mostly in the category of common sense. Many office workers, truck drivers, taxi drivers, telephone marketers and many others sit throughout their working day. Many others spend hours each day sitting and watching television or engaged in some activity on a computer. However, how long people sit and the risks associated with that can be put on a scale, rather than declaring a solid number. Certainly, sitting eight hours each day is concerning. However, if you sit eight hours each day, but those who use a bicycle to commute to their jobs or school and exercise daily and eat right will have less to worry about.

Without exercise, you could be in trouble. An analysis of several studies found that sitting eight hours per day with no exercise was the equivalent in terms of life expectancy as smoking or obesity. This makes sitting a national health concern.

There is a direct correlation between sitting and weight gain and a correlation between sitting and muscle loss. These factors are clear. By extension, then, there is a link between sitting and cardiovascular disease and diabetes. This certainly makes prolonged sitting a potential concern.

Further, it turns out that many people sit for longer – sometimes much longer – than eight hours a day. Many people sit at their jobs, sit down for lunch, sit in their car to commute and sit down to dinner and television in the evening. Ten or eleven hours a day of sitting is not uncommon.

There are also studies that show that sitting extended periods every day can bring on depression and anxiety. These studies show there is a difference in the quality of sitting. Those who sit and watch television tend to be more depressed and anxious than those who sit and read or study or somehow engage their minds with games or other diversions. 

What is the answer to this epidemic of sedentary lifestyles? The answer is within reach and it can be free and very portable. It’s called exercise.

You can exercise without joining a gym. You can walk, jog, take up a sport, or do calisthenics in your living room. You can do jumping jacks and sit-ups or push-ups with minimal space and no equipment at all. Of course, gyms are great options, too. 

Studies indicate that an hour to an hour and a half or moderate exercise – raising your heart rate for about half of this time – would counteract the effects of sitting eight hours each day.

In our modern society, it is certainly impossible for many people to avoid sitting for long periods of time. Work is work. School is school. Many activities are accomplished while sitting down. It’s unavoidable. 

If this defines your life, reach for the antidote: Move about, exercise, raise your heart rate a minimum of five times a week for at least 20 minutes to an hour. Get some fresh air – sweat a little. It will do you a world of good.

Help!

Any sprain, fracture or break should be seen by a doctor as soon as possible to prevent further injury. Let us help you return to a normal, active lifestyle with minimum pain. Call FXRX Orthopaedics and Bracing in Phoenix, Az., at 480-499-FXRX.

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Play Safe!

By  aenriquez  published  January 7, 2020

There are some rough sports associated with fall and winter. Football – ouch. This is frequently viewed as one of the most violent sports around, but football has plenty of rivals. There’s rugby, basketball, hockey and good old soccer isn’t for the faint of heart, either. Beyond that, any sport has potential injury associated with it. But fall and winter sports seem particularly risky. They play hockey on very slippery surfaces and they go awful fast and hard. Skiing is done on a slope and that slope is slippery, too.

 Maybe someone should rethink these games, but until then we’re stuck with the risks involved.

According to the Mayo Clinic, there are 3.5 million sports injuries that occur each year. We can’t ban all these sports, but Mayo Clinic specialists also say that many injuries are avoidable. Meanwhile, the list of common injuries is long and painful. Among the most common sports injuries are;

Shoulder and/or knee dislocation. This describes a joint in which the co-joined bones are pushed out of their normal position. Joints are held together by structures of muscle tendons and ligaments. 

Growing plate fractures are common in contact sports and gymnastics. These are injuries that impact the growth layer near the end of children’s bones.

Growth plate shoulder and elbow injuries are common with young pitchers of Little League age.

Sprains. Frequently referred to as a muscle sprain, sprains are, technically, an over-stretching of ligaments that connect bone to muscle. As such, a ligament is sometimes considered part of a muscle.

Patellar tendonitis is sometimes called jumper’s knee. It defines an injury to the ligament that runs from the shinbone to the kneecap. This is essential for many important leg functions, including walking, running or jumping. As such, tendonitis in this ligament is common in the sports of volleyball and basketball, where jumping frequently is required.

Torn ACL injuries are common in soccer, football, basketball and even dancing. These are more common among younger athletes (through college age) than older athletes. The ACL is the anterior (front) cruciate (crew-she-ate) ligament. It is a major ligament that supports the structure of the knee.

Shin Spits are common among athletes. This can occur after frequent running on hard surfaces (roads, as opposed to fields). This is a common injury in sports where running is a major part of the sport. These sports include long-distance running, track and field, basketball and soccer, among others. 

Sever’s disease is a condition that includes severe pain in the heel. It is most common amongst long-distance runners.

How To Avoid These Injuries

Avoiding sports injuries is partly about using the correct equipment, especially helmets and other padding. But it is also about conditioning and strength, making sure your muscles and tendons have been able to stretch prior to working them vigorously.

Furthermore – and this can be difficult for young children – it is recommended that children take two to four weeks off between team sports. This has to do with growing bones and muscles. An adult, when working out, is just using these structures, but a child is also growing. The growth plates near the end of bones and various soft tissues are either weaker or simply more fragile than an adult – and fragility and weakness are not the same thing. 

 We ask a lot of our young athletes. With luck, they will respond with great energy and enthusiasm. But a child is growing and parents and coaches and school systems should recognize this as they put together sports curricula. This is a case where an ounce of prevention may be worth a pound of cure. Some childhood injuries can be severe enough to impact growth or cause long-term health issues. Play safe, everyone … you are worth it.

Help!

Any sprain, fracture or break should be seen by a doctor as soon as possible to prevent further injury. Let us help you return to a normal, active lifestyle with minimum pain. Call FXRX Orthopaedics and Bracing in Phoenix, Az., at 480-499-FXRX.

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What’s Wrong If Your Knee Is Buring?

By  aenriquez  published  January 2, 2020

Burning knee pain is the sign that something is wrong that requires medical intervention. The burning feeling, usually accompanied by knee pain, could be the result of an injury to the front of the knee, the back of the knee or the side. The location of the pain will help your doctor narrow down possible diagnoses for the condition.

FRONT OF THE KNEE PAIN KNEE PAIN FRONT OF THE KNEE PAIN

Front of knee pain can be the result of several conditions. It could be from tendonitis, chondromalacia, patellofemoral pain syndrome, bursitis or arthritis.

n Tendonitis

As it sounds, this is a swelling of the tendon. A tendon is a band of tissue that connects muscle to bone. As such, tendons are important for proper function. They help hold the joint structure together but also provide a link between muscle and bone, which makes movement possible.

n Chondromalacia

Chondromalacia is a softening of the cartilage. Cartilage functions to support a joint, but also provides a cushion so that bone does not rub against bone when you move. Various breakdowns of cartilage through chondromalacia or long-term wear and tear or injury can create bone-on-bone friction, which can be painful.

n Bursitis

This is a swelling of the bursar, which are sacs that provide a lubricated cushion between a bone and surrounding soft tissue. This soft tissue could be skin, muscle, ligaments or tendons.

n Arthritis

There are many types of arthritis, some associated with injury and some associated with a disorder or an illness. Arthritis, in effect, means joint disease.

SIDE OF THE KNEE PAIN

 

Iliotibial band syndrome

 

This condition is marked by an overuse of the connective tissue that is situated on the outside (or lateral) side of the knee of thighs. The band, when healthy, moves forward across the condyle when the knee is extended.

 

Pes anserine bursitis

 

This is a specific bursitis condition that refers to swollen bursa located between the tibia (the shinbone) and the tendons of the so-called hamstring muscle. It is an overuse injury marked by too much fluid in the bursa that puts painful pressure on the knee.

 

Burning Pain in Back of Knee

 

Ligament tear

 

A ligament tear can be an overuse injury or it can be the result of a sudden traumatic injury. Often this is caused by a sudden twisting of the knee or a sudden extension of the leg when the ligament is not sufficiently stretched out to allow.

 

Cartilage tear

 

Cartilage, which inhabits the inner workings of a joint, residing between two bones, can also tear. You cannot sprain cartilage, but you can tear cartilage from overuse or from a sudden injury, although the former is more common.

 

Baker’s cyst

 

The space behind the knee is called the popliteal space. When this space becomes swollen, the condition is called a Baker cyst or a Baker’s cyst. The result of a Baker’s cyst is swelling and stiffness. It can be referred to as a popliteal cyst. 

Help!

Any sprain, fracture or break should be seen by a doctor as soon as possible to prevent further injury. Let us help you return to a normal, active lifestyle with minimum pain. Call FXRX Orthopaedics and Bracing in Phoenix, Az., at 480-499-FXRX.

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Treating Common Knee Injuries with PRP Therapy

By  david@ogrelogic.com  published  December 27, 2018

Meniscus tears are the most common knee injuries. These injuries can affect either the medial or lateral meniscus. Tears may occur because of a sudden, twisting motion resulting in –

  • pain
  • swelling
  • ‘catching’ or ‘locking’ sensation

If the physical examination by the orthopedic surgeon shows a torn meniscus, an MRI can be advised for confirmation.

Initially, meniscus tears are treated conservatively with rest, ice and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen, naproxen. It may be complemented with physical therapy for muscle strength and improved range of motion. Arthroscopic surgery may be recommended for severe cases.

However, now a highly effective, non-surgical intervention is available – PRP therapy. PRP or Platelet Rich Plasma therapy uses concentrated platelets from your own blood. With the help of ultrasound guidance, the injection is administered into the tear, allowing the tear to heal naturally. The injection is given under local anesthesia in an outpatient setting.

Other common knee injuries are –

  • ACL or Anterior Cruciate Ligament tear

This tear occurs as the result of a sudden stopping, sudden change in direction or hyperextension. This could be accompanied with a ‘popping’ sensation followed by deep pain, swelling, and instability.

  • PCL or Posterior Cruciate Ligament tear

The PCL can become inured due to a force to the anterior shin bone when the knee is flexed.

Both ACL and PCL tear can be treated with PRP therapy, stimulating the body’s natural healing mechanism.

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Wrist Splint for Fracture

By  aenriquez  published  December 18, 2018

The wrist is subject to fractures due to falling with outstretched or flexed hand. This can happen in a car, bike, skiing accident or with certain other sports activities. There are two bones in the forearm including the radius and ulna. The radius is on the thumb side. A fracture of the radius near the wrist is called a distal radius fracture.

 

Splinting is one choice for immobilizing the fracture and is commonly used for wrist fractures, reduced joint dislocations, sprains, soft tissue injury, and post-laceration repairs. Splints are mainly to immobilize and protect the injured wrist, aid in healing and decrease pain. Splints are primarily used for extremity injuries. Good anatomical fracture alignment is important.

 

There are a variety of splints used to treat fractures of the wrist and forearm. The splint used depends on the location of the fracture. These splints include:

  • Volar short arm splint
  • Dorsal short arm splint
  • Single sugar-tong
  • Long arm posterior
  • Double sugar-tong
  • Long arm

For immediate treatment, a splint may be applied to reduce pain and provide some comfort

There are two types of distal radius fractures called a Colles or Smith fracture. Determining the break depends on the angle at which the break occurs.

  • Colles fracture: results from a direct impact on the palm of the hand; a bump in the wrist results from the distal radius shifting toward the back of the hand.
  • Smith fracture is less common and can result from impact to the back of the wrist; a bump in the palm side of the wrist results when the distal radius shifts toward the back of the hand.

 

Wrist fracture symptoms include:

  • immediate pain when area is touched
  • bruising and swelling
  • deformity

 

Treatment for a distal radius fracture is dependent on several factors. For immediate treatment, a splint may be applied to reduce pain and provide some comfort. If the fracture is displaced it is put back into correct alignment under local anesthetic before application of the splint.  Additional factors influencing treatment are:

  • whether bones have shifted (displaced)
  • if there are multiple fractures presentation
  • involvement of the joint
  • ulnar fracture with injury to median nerve
  • whether it is the dominant hand
  • occupation and activity level

 

Once the fracture is in good position, a splint or cast is applied. The splint (or cast) will remain in place for approximately 6 weeks. A removable splint will be worn after that to allow physical therapy to regain proper wrist function and strength. X-rays may be taken at 3 weeks and 6 weeks to assess healing of fractures that were reduced or unstable.

 

It is still important to be aware of potential complications that require additional monitoring. Complications from immobilization include:

  • joint stiffness
  • muscle atrophy
  • complex regional pain syndrome

 

The fractured extremity should be immediately evaluated if:

  • pain worsens or does not improve after medications
  • cast or splint becomes damaged, breaks, or gets wet
  • hands/fingers feel numb or cold
  • hands/fingers turn blue or white
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Femur Fracture Complications

By  aenriquez  published  December 14, 2018

The femur is the biggest and generally the strongest bone in the human body. Fractures take a long time to heal. Normal activities of daily living are impacted as it is the main bone used for walking and standing.  Depending on the type of fracture and potential complications the impact will last a lifetime.

There are several types of fractures. Each has its own characteristics. Each fracture is dependent on the force that breaks the femur.

Elderly people are subject to femoral breaks from falling due to weak bones

These types of fractures include:

  • stable fracture – pieces of bone line up
  • displaced fracture – bone is out of alignment
  • closed fracture – the skin remains intact
  • open fracture – bone punctures the skin

 

Fractures are classified by:

  • location – distal, medial, proximal
  • pattern – bone breaks in different directions (crosswise, lengthwise, in the middle)
  • skin and muscle damage

 

The most common femoral shaft fractures include:

  • transverse – straight horizontal break across the shaft
  • oblique – angled line across the shaft
  • spiral – spirals the bone shaft caused by a twisting force
  • open – bone or fragments stick through the skin; also known as a compound fracture; there is damage to tissues, tendons, and ligaments. High risk of complications.
  • comminuted – bone breaks into three or more pieces

 

Common symptoms noted with a femoral break include:

  • immediate severe pain
  • cannot bear weight
  • injured leg appears to be shorter and/or looks crooked

 

A femoral fracture is normally found in severe accidents such as an automobile accident. Elderly people are subject to femoral breaks from falling due to weak bones. Hip fractures are also common with the elderly.

 

Common complications from femur fractures are related to the following:

  • the bone must be set properly – there’s a chance injured leg may become shorter and can cause chronic hip and knee pain; poor alignment can be painful
  • peripheral injury – muscles, ligaments, and tissues can be damaged
  • surgical – infection or blood clots, common surgical risks
  • Compartment syndrome

 

 

On a special note: Compartment syndrome is caused when increased pressure inside a closed space, that compromises circulation and function of surrounding tissues. Temporary or permanent damage to muscles and nerves may result in temporary or permanent damage.

Compartment syndrome may be:

  • Acute – most often caused by trauma, generally more minor. Prompt diagnosis and urgent treatment are required.
  • Chronic – usually caused by exercise. Symptoms begin with recurrent pain and disability. These symptoms may subside when the cause (usually running) is stopped and returns when activity is resumed.

The bones have many blood vessels that help promote healing. With time, the body will regenerate and further promote healing. Practice caution to prevent a re-fracture.

A diet that contains bone-boosting foods like calcium and vitamin D helps with healing, as well as, using protective gear that can help prevent future fracture.

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Reverse Shoulder Replacement Surgery

By  aenriquez  published  November 21, 2018

Reverse shoulder replacement surgery differs from standard replacement because the ball and joint of the shoulder switch places. In essence, the socket rotates on the outer side of the ball. This is a complicated surgery warranted by certain conditions. It provides significant pain relief and helps improve range of motion of the joint, although after surgery there is some limitation.

The main reason for this complex procedure is arthritis but, there are other reasons as well:

  • the rotator cuff tendons are gone or torn.
  • Shoulder remains painful after a routine shoulder replacement
  • Fracture in the proximal humerus (nearest the joint)
  • bone is shattered or splits into pieces
  • tumor in the humerus shaft or the ball of the humerus

In the event of torn or missing rotator cuff tendons, a person is unable to lift the arm enough to be functional. There may or may not be pain but the main reason for replacement is to regain functionality and motion.

There may or may not be pain but the main reason for replacement is to regain functionality and motion

There are instances when the procedure is not advised. Individuals should avoid this procedure if:

  • The socket bone of the shoulder blade (scapula) is too deteriorated that implants cannot be attached with screws or a bone graft is needed before placement can be done
  • ongoing infection in the shoulder
  • previous infection – increases post-operative risk of infection
  • rotator cuff cannot be repaired
  • complex fracture of the shoulder
  • other treatments did not work (meds, rest, etc)

Surgical risks include bleeding, nerve damage, and possible infection. There may be surgical complications such as:

  • humerus or arm portion (the socket) can become dislodged from the ball (the shoulder blade part) and the prosthesis is “dislocated.”
  • infection
  • the arm portion of the prosthesis can make contact with the bone of shoulder blade in certain positions
  • tingling, numbness and weakness with nerve damage
  • Injury to blood vessels
  • scaring
  • conditions, such as blood clots in the legs (deep venous thrombosis)
  • pulmonary embolus
  • heart attacks and strokes
  • drug or anesthetic reactions

After surgery, several doses of antibiotics are given to reduce the risk of infection. Pain medication will help relieve pain. Most patients can eat a solid diet and get out of bed the day after surgery. Discharge to go home is on the second or third day after surgery.

The arm will be in a sling on discharge from the hospital. The surgeon may provide instruction for gentle range of motion exercises to build mobility and endurance. Physical Therapy may also be ordered.

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What does your Knee Pain indicate?

By  david@ogrelogic.com  published  November 16, 2018

The Knee Joint

The knee is the largest bone joint in the body that allows you to run, walk, stand, sit, bend your legs, pivot, swivel and more. The knee joint consists of bones, cartilage, muscles, ligaments, and tendons, all working together. Three bones – the tibia (shinbone), the femur (thighbone) and the patella (kneecap) come together at the knee joint.

Knee Pain

Knee injuries are complicated because they can be the result of damage or injury to any of the several parts that make up the knee. It is also important to understand that the knee functions between two very mobile joints – the hip and the foot. Injury to the hip or foot can also affect the mobility of the knee.

With age, the strain on our knees increases and pain and discomfort become common complaints. However, the pain may also result from injury or an underlying condition, apart from aging. An experienced orthopedic doctor or surgeon can make an accurate diagnosis of the cause of knee pain and treat it.

Depending on its location, different problems can be responsible for knee pain.

  • Front of the knee – related to kneecap injury or damage
  • Inside or medial side of knee – related to medial meniscus tears, MCL injuries, and arthritis
  • Outside or lateral side of knee – often caused by lateral meniscus tears, LCL injuries, IT band tendonitis, and arthritis
  • Back of knee – due to the collection of fluid, also referred to as a Baker’s Cyst
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Nursing Management of Fracture

By  aenriquez  published  November 14, 2018

Fracture stabilization is the use of a variety of processes to enhance the healing of bone fractures. There are several methods including surgical, non-surgical, minimally invasive (vertebroplasty, fusion, kyphoplasty). Fracture stabilization gives pain relief and prevents further damage to soft tissue and bone.

 

There are closed and open fractures. With open fracture surrounding tissues and bone are visible. Fractures may include one or more bones and can be a clean break or shattered into numerous pieces. Breaks are a traumatic injury to the bone, tissues, and individual.

 

There are five classifications of fractures. These include:

  • Greenstick – found in children, incomplete fracture where the bone is bent
  • Transverse
  • Oblique – pattern of curves and slopes
  • Comminuted – bone breaks into pieces
  • Impacted/Buckle Fracture – bone ends are driven into each other

Early stabilization leads to better outcomes, such as less complications, shorter hospitalization, and lower cost

In addition, a pathological fracture is due to bone weakness, stress, and hairline fracture.

 

The doctor will diagnose the type of fracture by physical exam, x-ray, and MRI.

With a stable fracture, minimal treatment is required. In a stable fracture, the bone just breaks in one place and is easier to fix.

 

An unstable fracture can result from a car accident, falls, and other high impact situations. They may be accompanied by other serious injuries as well. Surgery is always required to fix the fracture. Symptoms of an unstable fracture include:

 

  • excruciating pain
  • bone showing through the skin
  • swelling and numbness

 

Early stabilization leads to better outcomes, such as fewer complications, shorter hospitalization, and lower cost. However, it may be contraindicated if there are head injuries, internal injuries, and other risk factors.

 

There are a number of options including the following:

  • External fixation -Pins and rods are placed outside the extremity
  • Internal fixation – Fracture is aligned and plates and pins are placed to hold the pieces together
  • Ring fixator or Taylor Spatial Frame – used if there is a deformity to be corrected

 

An unstable fracture is a severe injury. It is normally treated with the bone reduction and the bone may still slip out of place. This makes it difficult for the bone to be realigned. The bone is shattered into fragments, and it may not be possible to put all the broken pieces back in place.

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