Thursday, April 24, 2014
Inquirer Daily News

Physical Therapy

POSTED: Thursday, April 10, 2014, 10:20 AM

My clinic sees a lot of athletes, and one question I ask every patient on their initial evaluation is, “What have you been doing at home?” The most common answer is, “Nothing.” 

Many people tell me that when they felt pain, weeks and even months ago, they just ran or exercised through it until it got bad enough that they could not do their sport anymore. So they rested for two weeks, four weeks, two months, then they went back to their sport and the pain came back. Sometimes, the pain comes back worse. No matter how long they rested, the pain returned and sometimes worse and in more spots then it was before they took time off.

Why doesn’t the pain stay away after a period of rest?

POSTED: Tuesday, April 1, 2014, 5:30 AM
Filed Under: Physical Therapy
Katrin Holtwick of Germany is taped during the London 2012 Olympic women's beach volleyball match between Germany and Czech Republic.

Shoulder pain is experienced by athletes at all levels and can be aggravated by something as simple as raising your arm or throwing. There are different therapies used to relieve shoulder pain. One such method, therapeutic taping (remember the colorful tape you‘ve seen athletes using at the Olympics and other sporting events?) continues to grow in popularity. But is all taping created equal?

Recently Billy Moore, PT, DPT, one of our outpatient physical therapists, helped present a study on the effectiveness of two specific taping methods in high school athletes. The study, part of his capstone project at the University of the Sciences in Philadelphia, took a look at 11 local athletes at Archbishop John Carroll High School in Radnor who were experiencing pain in their shoulder. The students came from baseball, softball, volleyball and lacrosse, all sports that require participants to use an overhead shoulder motion.

Two popular taping methods were tested, the Kinesio Taping Method and the McConnell Taping Technique. “While comparisons of these two methods have been done for knee and lower body injuries, there has been less research done on shoulder injuries—particularly those in high school age athletes,” notes Billy. “This study looked to not only compare the effectiveness of the two taping techniques to one another, but also to not using taping at all.”

POSTED: Tuesday, March 4, 2014, 4:00 AM
The arms race: Strengthening for the upper body (iStockphoto)

I am always amazed when athletes come to me who have done some of toughest races in the world and I ask them to do twenty push-ups and they cannot. People seem to ignore the arms and the upper body even though the lungs, which feed your muscles with oxygen and can only function at maximal capacity if the arms and shoulders are in the best shape possible, are housed in the rib cage supported by the muscles of the arms and the shoulders. Ignoring the arms does not allow the body to function at the most efficient and strongest that it can.

Working out the arms does not mean bench pressing the most you can or lifting as much weight over your head.  This can be detrimental to your athletic performance, instead of beneficial. The most effective exercises for the arms can most often be done with just your body weight, especially if you are not used to working out your arms.

The most important thing to remember when you are working out any body part is to watch your form.  Improper form can lead to incorrect training and injury. Many people when they lift their arms often use the upper trapezius muscles. The upper trapezius muscle is found on the top of the shoulder.  These are generally very strong and like to be active when moving the arms, especially if the arms are trying to lift too much weight. 

POSTED: Tuesday, February 25, 2014, 5:30 AM

More and more studies are showing the health risks of sitting at your desk for too long. Heart disease, diabetes and certain types of cancers have all been shown to increase in those individuals that lead a sedentary lifestyle. Studies are beginning to equate sitting to smoking in terms of harm to overall health.

Compound that with sitting at home and watching television when you get home and people fail to realize how long they are truly sitting in a day. Sitting for an hour can already start to have harmful effects. We have become a culture of sedentary individuals.

There are small things that you can do every day that will make you a less sedentary person. The difficulty for most people is getting started. However, once you used to doing these things then they will become habits as opposed to things that you constantly have to think about on a daily basis. Start small and work up to some of the ones that take more time and thought. Getting up for five minutes can change how your body is reacting.

POSTED: Thursday, February 13, 2014, 5:30 AM

Pain and dysfunction of any body part has many possible causes. I would venture to say that every single one of us can identify with nagging muscle pain or muscle “knots.” 

In medical terminology, this is a myofascial restriction of the actual muscle fibers and the connective tissue, fascia, that envelops them.  In my opinion, full healing is not possible without addressing this common soft tissue problem.  

There are several techniques available to address myofascial restrictions. I commonly utilize my hands for deep massage, myofascial release, acupressure and stretching. There also have been tools developed to accomplish muscle release when used by a skilled practitioner. 

In my office, we use HawkGrips tools for instrument-assisted soft tissue mobilization.  This allows the user to focus mechanical force along a small contact surface to treat the target tissue.  

HawkGrips are a surgical-grade stainless steel instrument designed to detect and treat soft tissue restrictions. We glide the tools over the skin and feel for any soft tissue adhesions. The tools actually transmit vibrations from the muscle and connective tissue to the instrument which can be felt and heard.  There are various different strokes applied for deep pressure to restricted tissue in order to break adhesions, soften tissue and promote oxygenation and circulation to the affected areas.

Performing tissue mobilization in this manner with my patients has resulted in reduced pain, improved range of motion, increased flexibility and overall enhanced performance. We have had great success in treating soft tissue restrictions of the neck, back, shoulders, knees and feet using HawkGrips in combination with therapeutic exercises, postural re-training and teaching optimal body mechanics.  

In general, soft tissue treatment, whether completed with hands or tools, is a highly effective hands-on approach in managing many acute and chronic pain syndromes, sports injuries, aging disorders, and traumatic and surgical scarring.  In my opinion, ignoring these soft tissue restrictions is the missing link in many people’s care.

POSTED: Thursday, January 30, 2014, 5:25 AM

You are 45 years old and the inside of your knee has been hurting during and after exercise. Recently, just walking is painful. After x-rays and an MRI, the orthopedic surgeon says you may need surgery but physical therapy may relieve your symptoms. You choose the surgery option—are you doing the right thing?

According to recent research in the New England Journal of Medicine, you might not.

The study revealed that after one year, patients with a meniscus tear who had "sham" surgery followed by physical therapy improved just much as patients who had meniscus surgery. The patient population included individuals between the age of 35 and 65 who have degenerative meniscal tears without knee joint osteoarthritis. “Sham” surgery refers to patient who had an arthroscopic exam of their knee but no trimming or removal of the meniscus.

Physical Therapy for Meniscal Tears - Penn Therapy & Fitness from Good Shepherd Penn Partners from Good Shepherd Penn Partners on Vimeo.

POSTED: Tuesday, January 28, 2014, 5:30 AM
DENVER, CO - DECEMBER 12: Quarterbacks Peyton Manning #18 and Brock Osweiler #17 of the Denver Broncos stretch before a game against the San Diego Chargers at Sports Authority Field Field at Mile High on December 12, 2013 in Denver, Colorado. (Photo by Dustin Bradford/Getty Images)

The newest buzz word on the field is dynamic stretching. I have seen many variations of this—some correct, some incorrect. Some people have taken to static stretching, bouncing a little bit and calling it dynamic stretching. Others are just flat out running and skipping and calling that dynamic stretching.

But what is dynamic stretching? Is it better than the static stretching that has been used for so many years?

First let me start by saying that static stretching, where you hold a position for more than 30 seconds in order to elongate the muscle, is still safe. In fact, it should be done AFTER the activity. These types of stretches are designed to target the muscle groups, one at a time and to lengthen them, not necessarily to do anything else. Once you have completed your sport, run, workout, it is good to go through some gentle stretches where you hold a position for 30 seconds or more, stretching a number of different muscle groups.

POSTED: Monday, January 27, 2014, 9:40 AM

My last blog was about basketball injuries. Now, let’s dive into the pool and talk about common swimming injuries.

Swimming Mechanics

Poor swimming mechanics may be a contributing factor in many swimming injuries. But assessing these mechanics is beyond the expertise of most sports medicine. Your swimming stroke should be assessed by your coach, taking into account your specific injury, in order to eliminate an underlying biomechanical cause. A team approach should be taken with swimming injuries incorporating these stroke changes along with a specific rehabilitation program from your athletic trainer or sports medicine provider.

About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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