Step Up to Relieve Big Toe Joint Pain
Wednesday, May 15th, 2013 | Ankle/Foot | No Comments
When you visited your doctor with pain in your big toe, it was diagnosed as hallux rigidus. Hallux rigidus is a form of degenerative arthritis (also called osteoarthritis) specific to the first metatarsophalangeal joint—the joint at the base of the big toe.
Similar to osteoarthritis, the root cause of the pain is a degeneration of the cartilage that cushions the bone ends within the joint. Additionally, bone spurs—unnecessary outgrowths of bone—can form in the joint, adding to stiffness and discomfort. The cause of hallux rigidus is not always known for certain, but a previous injury may lead to a predisposition to the condition.
Hallux rigidus can be particularly challenging and painful because so much weight is placed on the big-toe joint in every normal step we take. A natural reaction to alleviate such pain is to avoid putting undue pressure on the joint by modifying your gait. Such compensatory actions throw off your body mechanics, and you can develop other problems, such as low back pain. Thus, treating hallux rigidus quickly and effectively is quite important to your overall well-being. Strategies we might employ include
- ultrasound
- gait training
- ice and/or heat therapy
- mobilization to regain motion
It is also very important to modify your footwear. This may include wearing shoes with large toe boxes and stiff soles, adding orthotics and avoiding high heels. Nonsteroidal anti-inflammatory medications (if approved by your physician) and occasional corticosteroid injections may also help ease pain and swelling.
If these measures are not enough, surgery may be necessary to physically remove bone spurs and/or fuse or replace the joint. We can design a postsurgical rehabilitation plan to keep swelling to a minimum, help you learn to use crutches temporarily and, after fusion surgery, help you learn to walk without the benefit of a flexible big-toe joint.
Although hallux rigidus is not a household phrase, the condition is relatively common. Through exercises, we can make you feel more comfortable, help you to avoid other problems and walk more smoothly and without pain.
Straighten Out the Kinks After Knee Replacement
Wednesday, May 15th, 2013 | Knee | No Comments
After your knee replacement, you might think your knee will work just fine. Unfortunately, many people do not realize that straightening the knee after surgery is not as simple as they originally thought. Along with loss of strength, reduced extension is one of the most common complaints following knee replacement. Full motion of the knee can take three to six months to regain after surgery.
A customized physical therapy program will address residual stiffness by combining stretching, exercise and a steady, safe return to your daily activities. For some people, the challenge to get the knee extended properly after surgery can result from poor pain control,making it hard to move the knee; stiffness before surgery,which makes it more likely there will be stiffness afterward; heavy scarring because some people form scar tissue more readily than others; a poorly positioned replacement implant;and surgical complications,such as an infection.
Treatment depends on the cause of your stiffness. We can design a rehabilitation program that focuses on proper knee extension. In some cases the use of a dynasplint is a necessary adjunct to improve knee extension. More invasive surgical approaches involve breaking up scar tissue. However, if you start physical therapy early, it is unlikely this will be necessary.
Your personalized program will begin immediately after your surgery with simple movements such as knee extension and quadriceps exercises. Initial exercises will include
- isometric exercises to help improve circulation
- ankle pumps to strengthen calf muscles
- leg raises for strong leg and thigh muscles
- knee bending and straightening exercises to enhance range of motion
After surgery, you will begin physical therapy. This will provide you with the best chance of treating stiffness in your knee. You will regain proper extension in your knee and enjoy all your favorite physical activities once again.
Shrug Off Your Shoulder Pain
Wednesday, May 15th, 2013 | Spine | No Comments
Pain across the shoulder blades or weakness in the upper arms could be symptoms of C5 radiculopathy, a condition caused by the malfunction of a nerve in the neck that affects the shoulders and arms. Symptoms include pain of the shoulders and upper arms, and weakness in those areas, especially when you attempt movement. The pain may worsen over the course of a day and is sometimes described as sharp.
The C5 nerve can malfunction when inflamed, or when it is compressed or “pinched.” Both conditions result from a variety of causes, such as the sudden trauma ofan athletic injury or from heavy lifting and other stressful or repetitive activities. Often, degeneration of the spine due to aging or disease is a factor. All of these may result in a narrowing of the space around spinal nerves or a deterioration of the discs that provide cushioning of spinal bones, leading to pressure and pinching of the nerves.
With a physical examination, an x-ray or an MRI (magnetic resonance image), we can determine whether C5 radiculopathy is causing your shoulder pain and design a treatment plan to ease pain and restore function. Treatment usually involves
• rest
• pain medication
• anti-inflammatory drugs
• prescribed muscle relaxants
• controlled sleeping positions
- physical therapy
Wearing a neck collar to rest neck muscles not more than 2-3 days or using at-home traction to relieve compressed areas may be recommended. We may also prescribe massage, gentle manipulation and an exercise program to stretch and strengthen neck muscles.
To assist in your recovery and help maintain long-term spinal health, we will work with you to establish healthy daily habits, such as improving your posture. Most patients will see a usually go on to be symptom free after six to 12 weeks of treatment.
Do curve or breaking balls in Little League lead to shoulder or elbow pain?
Monday, April 8th, 2013 | Elbow, Shoulder | No Comments
Pitcher
- Previous injury increases risk of reinjury at shoulder and elbow 5 times
- Showcase and Select teams participation increased risk of shoulder and elbow injuries in Little League and High School Pitchers
- Must rapidly address subtle signs of injury or overuse
- Very difficult to control of the “volume of play” with multiple league play (ie select, travel teams, etc)
What can you do to prevent pitching injury?
- Insist on pitch counts that have decreased Little League injuries by %50
- Teach proper pitching technique
- Control “volume of play” with adequate rest is essential. Multiple league play (ie Select, travel teams, etc) makes controlling volume of play more difficult.
- Identify early, subtle signs of injury or overuse
- Education of coaches, parents, players on risks
As noted above, the study showed no evidence “curves” or “breaking” balls increased arm injuries in pitchers!
Many times my role as a sports and orthopedic physical therapist is educating the athletes on conditions that can lead to injury. Numerous times I have been asked to figure out how to rehabilitate an athlete in a very limited window of time. At times physical therapy visits have been cancelled or not scheduled because of conflicts with batting or pitching private lessons. I almost fall over when I have just discussed the overuse issues with the players and parents just prior to this.
The irony of this situation is that, as a small business owner in addition to a physical therapist, having more visits actually benefits my clinic. But if I contributed to the need for more visits by not trying to convince clients of the need for adequate rest, I would be doing a disservice to everyone I treat. Our aim at Apex is always to do what is best for our clients. I always note this paradigm when I feel I’m not being heard when talking to young athletes and parents.
I recently gave the Rutgers Coaches’ “Safety Talk” for the Wyckoff Recreation Department and provided them with a table on the probability of playing in college or professional sports. The statistics are pretty discouraging. Only a select few make it to the College level and fewer receive scholarships, let alone full scholarships. Student-athletes in demanding academic programs face a grueling college experience. Make sure your athlete is truly in it for the “love of the game”, not the scholarship or the promise of professional glory.
Is surgery better than physical therapy if you have arthritis and meniscal tears?
Wednesday, April 3rd, 2013 | Knee | No Comments
Absolutely NOT. In a recent report in the New England Journal of Medicine (Katz, J. N., Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. March 19, 2013 DOI:
knee pain
10.1056/NEJMoa1301408) researchers looked at over 351 patients 45 years or older that reported knee pain while suffering from meniscal tears and mild to moderate arthritis. Two groups were randomly assigned to either surgery followed by physical therapy or physical therapy alone. At 6 months there was no difference between the groups in functional outcomes and pain levels.
Sometimes, with simple activity modifications and rest, but no surgery or regimen of physical therapy, patients can see results with the passage of time. But, if after 2-3 months symptoms persist, I get more concerned that time and rest are not the solution. If you experience significantly reduced range of motion, severely altered gait and muscle atrophy, I recommend that you seek physical therapy and possibly orthopedic evaluation.
If your orthopedist suggests surgery, be sure to ask, “What are the risks if I wait to have the surgery performed?” Complications of any invasive procedure such as surgery vary but are always possible, so surgery is a risky alternative. Try physical therapy first. This research suggests that surgery for meniscal repair may not be helpful. However, with the improved durability of joint replacement materials and improved surgical techniques, knee replacement may be indicated.
Safety with elastic/tubing resistance bands
Wednesday, April 3rd, 2013 | Wellness | No Comments
A friend of mine who is a personal trainer recently got injured when a resistance band broke and damaged her eye. As a physical therapist I give out yards of these elastic tubing and bands. Please inspect this equipment for breaks or damage. If you see a defect in these bands or are unsure- be conservative about it and buy a new one or APEX will be glad to provide a new set of bands “on the house”. Be healthy and be safe!
Rutgers Safety Coaches Clinic in Wyckoff
Monday, April 1st, 2013 | Wellness | No Comments
We recently gave the Rutgers Safety Orientation and Training Skills Programs (S.A.F.E.T.Y) at the Wyckoff library on Thursday March 28th in coordination with the Wyckoff Recreation Department. In the fall we plan to give another clinic in addition to Wyckoff clinic at my physical therapy clinic Apex Orthopedic Rehabilitation in the Gabriel Realty building at One East Ridgewood Avenue in Paramus, NJ. If you have any questions please call the office at (201) 251-2422. Look for upcoming postings in the late summer! This clinic will have limited seating and will be open to anyone from the area in need of this certification.
Apex Orthopedic Rehabilitation Wellness Series in Paramus, NJ
Saturday, March 23rd, 2013 | Wellness | No Comments
As part of the Apex Orthopedic Rehabilitation Wellness Series we are having Christine M. Okezie, Natural Foods Chef & Holistic Health Counselor will be presenting a work shop at our clinic in Paramus, NJ this coming May. Look for future posts for time and date! The following an article on the Anti-Inflammatory Diet plus a recipe follows. You can also follow her thoughts and future talks on her web site at http://www.yourdeliciousbalance.com/.
Embarking on an Anti-Inflammatory Diet
Anti-Inflammatory Foods
By Christine M. Okezie, CHHC, Natural Foods Chef
We all know inflammation on the surface of the body as local redness, warmth, swelling and pain. It is the body’s normal response to injury and infection and a major component of healing. But when inflammation persists beyond its normal limits or is misdirected, it damages the body and causes illness. Chronic inflammation is the root cause of many degenerative diseases including coronary heart disease, inflammatory bowel disease, dementia, arthritis, Type 2 diabetes, and many cancers.
Learning how specific foods influence the inflammatory process is the best strategy for containing chronic inflammation and reducing long-term disease risks. Unfortunately though, most Americans are making food and lifestyle choices that promote inflammation as a result of their consumption of poor quality fats, refined sugars, appetite for processed convenience foods and failure to eat protective foods, such as high fiber anti-oxidant foods like whole grains, fruits and vegetables.
Some Simple Changes to Cool Inflammation
Get an Oil Change - Avoid hydrogenated oils, corn oil, cottonseed oil and soybean oil, which are found in many processed junk foods. These are chemical fats that increase our risk for heart disease and cancer. Avoid all margarines, vegetable shortening and artificial butter spreads. Instead, use coconut oil, olive oil and grape seed oil as your main cooking oils. Enjoy cold-water oily fish like wild salmon, sardines and mackerel, which are also rich in anti-inflammatory Omega 3 fats.
Cut Your Sugar – Refined sugars are not only devoid of vitamins, anti-oxidants and nutrients but regular ingestion of sugar causes the body to become resistant to insulin’s sugar clearing effects. Since insulin promotes the storage of fats, weight gain follows. Maintaining a healthy weight reduces inflammation.
Eat Your Fruits and Veggies: Choose green and brightly colored vegetables such as kale, spinach, broccoli, carrots, sweet potatoes and winter squash. They are super rich in vitamins, minerals, fiber, and disease-fighting phytochemicals. Whole fruits, especially strawberries and blueberries protect our cells against oxidative stress. Try to include at least one of these anti-inflammatory foods into every meal.
Try Superfoods: Spirulina Powder, a blue green algae is a potent anti-oxidant and anti-inflammatory supplement. Raw Cacao Powder, unprocessed dark chocolate is proven to have beneficial effects on cardiovascular health. Both can easily be added to smoothies to keep inflammation in check.
Go Nuts – Add nuts and seeds into your snacks and meals, especially walnuts, cashews, almonds, and nut butters made from these nuts. These fats boost your immune system and promote heart, brain and digestive health.
Get Less Refined – Swap out white rice, bread, bagels and pasta for high fiber grains like brown rice, quinoa, barley and millet. These high fiber foods keep blood sugar levels stable and decrease your risk for insulin resistance and Type 2 diabetes.
Spice It Up – Incorporate anti-inflammatory spices like turmeric, ginger, garlic and pepper.
So try incorporating some of these anti-inflammatory foods daily and cut out those toxic fats, sugars and refined grains altogether. Your body will thank you with multiple benefits including: increased energy, natural weight loss, less chronic aches and pains, improved digestion and stronger immunity.
Anti-Inflammatory Recipe:
Delicious Green Smoothie
Yield: Make 1-2 servings
Ingredients:
4 ice cubes (eliminate if using frozen fruit)
2-3 medium strawberries (fresh or frozen)
1-2 tablespoons walnuts (can also use cashews or almonds)
3 Kale leaves (remove stalk)
2 cups baby spinach
1 medium banana
½ cup unsweetened white grape juice
½ cup water
Procedure:
- In a blender, add all ingredients and process until liquefied.
- Feel free to adjust the proportion of the ingredients to suit your taste.
**For Added Nutritional Boost add any of the following:
1 teaspoons ground flax seeds or 1 tablespoon Flax Seed Oil
1 teaspoon chia seeds
1 teaspoon Spirulina Powder
Apex Orthopedic Rehabilitation located in the Gabriel Realty Building at One East Ridgewood Avenue in Paramus, NJ provides orthopedic and sports physical therapy services for the greater Ridgewood, Paramus, Oradell, River Edge, Westwood, Ho-ho-kus and Bergen County region. This blog is intended for informational purposes only and should not be used for diagnostic or prescriptive purposes. The views expressed here are the author’s views and should be taken as suggestions. Always consult your physician or healthcare practitioner before engaging in a orthopedic, cardiovascular or sports physical therapy rehabilitation program.
Fighting the Urge:Treating Incontinence with Paramus Physical Therapy
Tuesday, March 19th, 2013 | Wellness | No Comments
Urinary incontinence, which affects around 25 million people in the United States, is one of the most common health problems facing Americans—and one of the least discussed. Although it can be embarrassing to admit having trouble controlling your bladder, seeking help is imperative. There is no reason to live in uncomfortable silence when noninvasive and relatively easy treatment is available with the help of physical therapy.
Despite the television commercials that suggest adult diapers and medication as the only solutions for incontinence, studies show that physical therapy can often help patients reduce or overcome symptoms in a matter of months. The first step is to identify the type and cause of your incontinence, which is described by one of two ways:
- Stress incontinence is caused by weakened pelvic floor muscles, often due to pregnancy, childbirth, certain medications, prostate surgery or obesity. With stress incontinence, you may experience leakage of urine when coughing, sneezing or laughing—all activities which create abdominal pressure.
- Urge incontinence is also referred to as “overactive bladder,” because sufferers feel an intense and uncontrollable urge to urinate before making it to the bathroom. Causes of urge incontinence include nerve or muscle damage, nervous system disorders and bladder infections.
- It is important that you see your physician and rule out other underlying causes for your incontinence and to determine what type you are dealing with, so we can design a program to address your specific needs. For those with stress incontinence, this begins with pelvic floor training using Kegel exercises (repetitive contracting of pelvic floor muscles). We can also use biofeedback to help you identify and isolate the muscles needed for better bladder control. For urge incontinence, treatment might be a bit more intensive, utilizing behavior modifications, dietary changes and electrical stimulation to help reduce your sudden urges and train your body to hold urine more effectively.Even for those who do require additional treatment, physical therapy can speed up healing and the effectiveness of surgery or medications.
Apex Orthopedic Rehabilitation located in the Gabriel Realty Building at One East Ridgewood Avenue in Paramus, NJ provides orthopedic and sports physical therapy services for the greater Ridgewood, Paramus, Oradell, River Edge, Westwood, Ho-ho-kus and Bergen County region. This blog is intended for informational purposes only and should not be used for diagnostic or prescriptive purposes. The views expressed here are the author’s views and should be taken as suggestions. Always consult your physician or healthcare practitioner before engaging in a orthopedic, cardiovascular or sports physical therapy rehabilitation program.
Are epidural steroid injections safe?
Thursday, March 14th, 2013 | Spine | No Comments
Recent studies have called into question use of epidural steroid injections (ESI) for patients with spinal stenosis. Some patients, whether they required surgery or responded to non-surgical care (i.e. chiropractic, physical therapy, acupuncture, etc.) have seen better long-term outcomes without ESI. (Spine. February 15, 2013, volume 38-Issue 4, pp. 279-291).
Two key findings:
- For all patients in the study, ESI resulted in “less improvement” at four year follow-up compared to those who never received injections
- In cases of surgery the patients with ESI had more complications after surgery (ie longer hospital stays, etc)
Suspected contributors to worse outcomes:
- Damage to nerves and intervertebral disc cells may mask pain stimuli, risking further injury
- Increased volume in spine may cause a “crowding” of tissues, increasing pain response
Similar poorer outcomes with the use of steroid injections have been seen in patients with lateral epidcondylitis, also known as “tennis elbow.”
Further studies are necessary to determine effectiveness and safety of ESI use.
Please consult with your physician about the risks and benefits of any treatment. When considering treatment for myself or my patients, I always ask, ”What is the risk of waiting and allowing time to heal?”. If you are unsure about what type of treatment to pursue there are plenty of physical therapists and physicians to provide initial consultations or second opinions in the greater Paramus, Ridgewood and Bergen County area.
Apex Orthopedic Rehabilitation located in the Gabriel Realty Building at One East Ridgewood Avenue in Paramus, NJ provides orthopedic and sports physical therapy services for the greater Ridgewood, Paramus, Oradell, River Edge, Westwood, Ho-ho-kus and Bergen County region. This blog is intended for informational purposes only and should not be used for diagnostic or prescriptive purposes. The views expressed here are the author’s views and should be taken as suggestions. Always consult your physician or healthcare practitioner before engaging in a orthopedic, cardiovascular or sports physical therapy rehabilitation program.
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I'm happy to share my thoughts on physical therapy, rehabilitation and conditioning with you and look forward to hearing from you as well! - Tom Willemann, PT, MS, OCS
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