Alliance Physical Therapy

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Contents
1 2011 7
1.1 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
About (2011-04-20 12:49) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.2 May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
HAND THERAPY (2011-05-10 05:49) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.3 June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Are you suering from back pain? Are you looking to get rid from back pain? (2011-06-30 11:15) 10
1.4 July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Are you in Pain? Do You Need a Physical Therapist? (2011-07-23 07:50) . . . . . . . . . . 13
Do you have neck pain that keeps you from being as energetic as you would like?
(2011-07-23 07:56) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.5 August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Foot Pain? (2011-08-26 06:45) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Wrist Pain (2011-08-26 07:05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1.6 November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Arthritis Types, Symptoms, Causes and Treatment (2011-11-22 10:50) . . . . . . . . . . . . 20
1.7 December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Treat Herniated Disk with Physical Therapy.. (2011-12-08 07:05) . . . . . . . . . . . . . . . 23
Treat Spondylolysis and Spondylolisties With Physical Therapy... (2011-12-13 10:11) . . . . 24
2 2012 27
2.1 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Are You Suering from Your Hip Joint..??? (2012-01-14 11:33) . . . . . . . . . . . . . . . . 27
Physical Therapy Treatment for Injuries Around The Ankle Joint (2012-01-20 10:27) . . . . 29
2.2 March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Injuries Around the Elbow (2012-03-12 10:36) . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Archillies Region - Types,Causes & Treatment (2012-03-23 13:05) . . . . . . . . . . . . . . . 38
2.3 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
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Ankle Fractures (2012-04-07 11:49) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
2.4 May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Sports Injuries (2012-05-08 11:26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Stress Fracture (2012-05-30 12:03) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
2.5 June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Treatment of Lumbar Disk Disease and Spinal Canal Stenosis (2012-06-12 08:59) . . . . . . 53
Distal Forearm Fractures (2012-06-21 10:34) . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Disorders of the Hand (2012-06-22 11:58) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
2.6 July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Congenital Disorders of Upper Limb (2012-07-04 09:39) . . . . . . . . . . . . . . . . . . . . 63
Shin Pain (2012-07-11 10:06) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
ANTERIOR KNEE PAIN (2012-07-18 05:16) . . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.7 August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Cervical Headache (2012-08-11 06:53) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
The Benets of Physical Activity in the Elderly (2012-08-28 12:07) . . . . . . . . . . . . . . 75
Chronic Fatigue Syndrome (CFS) (2012-08-31 12:23) . . . . . . . . . . . . . . . . . . . . . . 77
2.8 September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Diabetes Mellitus Treatment (2012-09-12 10:10) . . . . . . . . . . . . . . . . . . . . . . . . . 80
Lateral Ankle Pain (2012-09-27 09:32) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
2.9 October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Rotator Cu Injuries (2012-10-04 08:46) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Hand and Finger Injuries (2012-10-23 12:00) . . . . . . . . . . . . . . . . . . . . . . . . . . 91
2.10 November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Acute Wrist Injuries (2012-11-06 08:57) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
How to Recognize a Condition Masquerading as a Sports Injury? (2012-11-21 10:46) . . . . 97
How we get relief from Minimizing Extent of Injury (RICE)? (2012-11-29 06:21) . . . . . . 102
2.11 December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Are you being aected by Lower Back Pain? (2012-12-17 07:01) . . . . . . . . . . . . . . . . 105
How to Prevent Patella Fracture? (2012-12-27 07:46) . . . . . . . . . . . . . . . . . . . . . . 107
How to treat Longstanding Groin Pain? (2012-12-31 10:57) . . . . . . . . . . . . . . . . . . 110
3 2013 115
3.1 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
How to Care for Muscle Injury Pain? (2013-01-03 12:14) . . . . . . . . . . . . . . . . . . . . 115
How we treat Fracture of Femur? (2013-01-10 11:26) . . . . . . . . . . . . . . . . . . . . . . 121
How to get comfort from Thoracic Outlet Syndrome (Neck Tingling)? (2013-01-22 10:36) . 124
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3.2 February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
How Foot and Ankle Discomfort is treated? (2013-02-04 06:17) . . . . . . . . . . . . . . . . 128
How to cure Ankle Tibial Nerve? (2013-02-22 10:13) . . . . . . . . . . . . . . . . . . . . . . 130
How do you heal OLECRANON BURSITIS? (2013-02-27 07:19) . . . . . . . . . . . . . . . 132
3.3 March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
How to get relief from Wrist Joint Pain? (2013-03-13 04:43) . . . . . . . . . . . . . . . . . . 133
How to prevent Foot Bone Injury? (2013-03-26 05:31) . . . . . . . . . . . . . . . . . . . . . 135
What are the classications of Capitellum (Elbow) Fracture? (2013-03-30 06:17) . . . . . . 136
3.4 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
How to cure Wrist Bone Fracture? (2013-04-19 10:40) . . . . . . . . . . . . . . . . . . . . . 138
Physical Therapy treatment for Back Pain (2013-04-25 10:32) . . . . . . . . . . . . . . . . . 140
Mechanisms of Spinal Cord Injury (2013-04-27 07:18) . . . . . . . . . . . . . . . . . . . . . 142
3.5 May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
How to get Relaxation from Neck Pain? (2013-05-07 10:34) . . . . . . . . . . . . . . . . . . 144
What are the Causes of Achilles Tendonitis (Heel Pain)? (2013-05-24 05:15) . . . . . . . . . 147
How to Recover from Knee Injuries? (2013-05-29 10:26) . . . . . . . . . . . . . . . . . . . . 149
3.6 July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
How to cure Foot Pain? (2013-07-15 09:03) . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
3.7 August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
What are the Symptoms of Trigger Finger? (2013-08-28 09:15) . . . . . . . . . . . . . . . . 154
3.8 September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
How to cure Plantar Fasciitis? (2013-09-17 04:20) . . . . . . . . . . . . . . . . . . . . . . . . 156
3.9 October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Physical Therapy Post Knee Replacement (2013-10-09 09:25) . . . . . . . . . . . . . . . . . 157
3.10 November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Vestibular Rehabilitation Therapy (2013-11-15 06:49) . . . . . . . . . . . . . . . . . . . . . 159
3.11 December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Identifying and Treating Cluster Headaches (2013-12-20 09:50) . . . . . . . . . . . . . . . . 161
4 2014 165
4.1 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Skiers Thumb: Causes, Symptoms and Treatments (2014-01-20 09:37) . . . . . . . . . . . . 165
4.2 March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Anterior Knee Pain (2014-03-31 10:32) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
4.3 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Becker Muscular Dystrophy (2014-04-09 11:33) . . . . . . . . . . . . . . . . . . . . . . . . . 170
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Knobby Knees (2014-04-19 12:11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
4.4 May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Alliance Rehab & Physical Therapy Clinics oer Treatments for Auto- Accident Injuries
(2014-05-22 11:05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
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Chapter 1
2011
1.1 April
About (2011-04-20 12:49)
At Alliance Rehab & Physical Therapy we provide 24/7 access to online appointments, with most of the re-
quests scheduled in less than 48 hours. With eight convenient locations in the Metro Area, we are able to serve
the Northern VA and DC region. We are located in [1]Alexandria-near Alexandria Hospital, [2]Alexandria-
Mount Vernon, [3]Fairfax, [4]Leesburg-Lansdowne, [5]Springel d, [6]Tysons Corner,[7] Woodbridge and
downtown[8]Washington DC.
Rehab Programs
Physical Therapy, Orthopedic Rehabilitation, Neurological Rehabilitation, Hand Therapy, Vestibular Reha-
bilitation, Womens Health Programs, Industrial Rehabilitation, Functional Capacity Evaluations and Work
Hardening Program.
Rehab Benets at Alliance
[9]SAME DAY scheduling available
[10]Physical Therapy Expert especially in WORK INJURIES, AUTO INJURIES and SPORTS IN-
JURIES
[11]Early Morning, Late Evening, and Weekend appointments available
[12]Over 90 % of our referrals come from local physicians
[13]BILINGUAL Sta
Treatments
[14]Low Back Pain
[15]Neck Pain
[16]Muscle Strain/Joint Sprains
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[17]Post Surgical Rehab
[18]Chronic Pain
[19]Athletic and Sports Injuries
[20]Heel Pain / Plantar Fasciitis
[21]Ergonomics
[22]Gait Instability
[23]Tendonitis / Bursitis
[24]Vestibular Rehab
[25]Neurological Impairment/Injuries
[26]Workers Comp Injuries
[27]No-Fault Injuries
[28]Auto Injuries
1. http://www.alliancephysicaltherapyva.com/Physical-Therapy-Alexandria-Virginia.aspx
2. http://www.alliancephysicaltherapyva.com/Physical-Therapy-Alexandria-Virginia-Mt-Vernon.aspx
3. http://www.alliancephysicaltherapyva.com/Physical-Therapy-Fairfax-Virginia.aspx
4. http://www.alliancephysicaltherapyva.com/Physical-Therapy-Leesburg-Lansdowne-Virginia.aspx
5. http://www.alliancephysicaltherapyva.com/Physical-Therapy-Springfield-Virginia.aspx
6. http://www.alliancephysicaltherapyva.com/Physical-Therapy-Tysons-Corner-Vienna-Virginia.aspx
7. http://www.alliancephysicaltherapyva.com/Physical-Therapy-Woodbridge-Virginia.aspx
8. http://www.alliancephysicaltherapyva.com/Physical-Therapy-Washington-DC.aspx
9. http://www.alliancephysicaltherapyva.com/Benefits-At-Alliance-Physical-Therapy.aspx
14. http://www.alliancephysicaltherapyva.com/Treatments-Backpain-Neckpain.aspx
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1.2 May
HAND THERAPY (2011-05-10 05:49)
Does your [1]hand hurt? Have you noticed symptoms of pain, discomfort, fatigue and weakness in one or both
of your hands? Are your ngers locking and unable to extend, without assistance from the other hand? Have
you experienced numbness and tingling that has gotten progressively worse? Does your hand feel clumsy
and are you noticing that you drop things from your hand more frequently or are unable to pick up things
or open containers with your hands? If so, you may be suering from one or more of the following chronic
hand and upper extremity [2]conditions such as arthritis, tendinitis, or nerve conditions such as carpal tunnel
syndrome.
Has your hand or upper extremity been aected by an accident or trauma leaving you with wounds, scars,
burns, injured tendons or nerves, fractures, dislocations or amputations of your ngers, hand or arm? Have
you undergone prolonged casting or underwent a surgical procedure? Are you now experiencing severe [3]pain
and limitations in motion and function, associated with your injuries?
Whether you are suering from a [4]chronic hand and upper extremity condition or recently experienced an
acute injury, you may be a candidate for hand therapy. If your physician has not already recommended it,
you should ask him for a referral so that you can expedite your recovery process.
What is [5]hand therapy? Hand therapy is specialized therapy that focuses specically on conditions
aecting the hand and upper extremity. It can be performed by an [6]Occupational Therapist or Physical
therapist who has a high degree of specialization that requires continuing education and often advanced
certication.
What can hand therapy do for me?
" Provide preventative , Non-operative or conservative treatment
" Manage acute or chronic pain
" Provide wound care to include care of open and or sutured wounds (prevention of infection and assistance
in healing)
" Control hypertrophy (raised and/or swollen) scars or hypersensitive scars
" Reduce swelling
" Instruct in desensitization and sensory re-education following nerve injury or trauma
" Fabricate splints for prevention or correction of injury or to protect surgical sites or to increase movement
" Design and implement home exercise programs to increase motion, dexterity, and/or strength
" Train in the performance of daily life skills through adapted methods and equipment
" Conditioning prior to returning to work
What is a [7]Certied Hand Therapist?
A Certied Hand Therapist (C.H.T.) is an occupational/physical therapist who specializes in the treatment
of hands.
They must have a minimum of 5 years postgraduate experience with at least 4,000 hours in hand therapy
and have successfully challenged the Hand Therapy Certication Commission exam in order to obtain these
credentials. [8]CHTs are dedicated professionals who have a commitment to meet the highest standards of
their profession. The hand and arm have an extremely intricate anatomy and complexity. Rehabilitation of
the hand and arm requires in-depth knowledge and up-to-date techniques. Certied Hand Therapists have
the highest level of competence in the rehabilitation of upper extremity injuries.
Certied Hand Therapists are able to initiate treatment immediately following surgery often while stitches
are still in place. Early referral to a hand therapist is eective in preventing further surgeries and obtaining
9
an optimal outcome.
Hopefully, this information helps you to make the right decision, when consulting your medical special-
ist.
[9]Restoring life back into your hands
1. http://www.alliancephysicaltherapyva.com/
1.3 June
Are you suering from back pain? Are you looking to get rid from back pain?
(2011-06-30 11:15)
Overview:
[1]Back pain is becoming one of the most common American health problems, aecting around 80
% people at some point during their lives. It could be from minor pain, regular pain to sudden become
chronic and severe pain. The pain can be acute if for few days but consider [2]chronic if more than four to
six weeks.
Anatomy:
There are numerous complications on [3]spine and complaints about back pain can be categories
based on the spinal column curvature and understand the 33 [4]vertebras. The neck pain ([5]Cervical: 1-7
vertebras), upper back pain ([6]Thoracic: 8 to 19 vertebras), lower back pain ([7]lumbar: 20-25 vertebras)
and tailbone ([8]pelvic: 26-31 vertebras) and two (32-33)[9] coccygeal vertebrae rarely focused.
10
[10] [11]
[12]
Causes:
Usually, [13]back pain originates from the muscles, nerves, bones, joints and some time from the
other structures in the human spine. Back pain can be divided into [14]neck pain, [15]upper back pain, and
[16]lower back pain. Back pain can be occur due to various reasons like muscle strain, sprain or slipped disc.
There are many causes of Back Pain but one of the most common reason of back pain is doing work with
which you are not used to, like carrying heavy things, engaging in strenuous physical work and so on.
So the most common cause in back pain is wrong posture, auto or work injury and if your cause is
over-weighted then back pain can be worst.
Demography:
Mostly, younger people (30 to 60 year old) can suer from back pain which originates from the
disc space itself. Older adults (e.g. over 60) can suer from Back Pain which is related to joint degeneration.
Diagnosis/Symptoms:
See your doctor without any delay in case of any pain in spine. Get plenty of rest and use regular
an anti-inammatory medicine to relieve pain. If your pain is severe, lost feeling see your doctor or go to the
emergency room or call 9-1-1 right away. X-rays is the basic option for radio-graphic assessments for low
back pain. You doctor may suggest you other diagnosis in cases in of congenital defects, trauma, metastatic
cancer or bone deformity as a cause of lower back pain.
Treatment and Precautions:
11
There are various benets that are provided by the [17]physical therapy and [18]rehabilitation for
back pain and other spine related problems. The goals of physical therapy are to reduce your pain, and
educate you not only in your daily and work routine but also maintain treatment program so that further
recurrences can be prevented. There are many dierent types of treatments provided by physical therapy for
back pain. Actually, the physical therapist may focus on reducing pain with passive physical therapy. These
are the considered passive therapies because they are done to the patient by the therapist. In addition to
passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine and restore
your daily routine.
If you are suering from Back Pain and want to get rid of this Pain then search physical therapy
clinic near you and consult only professional, licensed and experienced [19]physical therapist today.
EMERGENCY
IN CASE OF LIFE THREATENING AUTO ACCIDENT OR WORK INJURIES;
Call 911 for an ambulance right away. Do not try to drive to the emergency room, and try to move as little
as possible.
10. http://alliancephysicaltherapy.files.wordpress.com/2011/06/back-pain9.jpg
Webbers (2011-07-01 07:42:12)
I have gone through many articles and glog on the internet. I would like to appreciate the author of back pain article
here. Thanks Webbers
12
1.4 July
Are you in Pain? Do You Need a Physical Therapist? (2011-07-23 07:50)
[1]Physical therapy is the procedure of analysis and healing from your injury or physical disorder. If you have
an injury or inrmity that results in physical destruction or loss of function, then a [2]physical therapist can
help you. A Physiotherapist is a skilled expert to help renovate your potency, motion and activity. After
understanding the mechanics of your body he designs a [3]treatment program for you. You can learn specic
stretches, exercises and other specialized techniques to recover your body. [4]Physiotherapists make use of
many dierent techniques to decrease your pain of your body and inexibility. He improves motion, potency
and mobility.
[5]Physical Therapy For Low Back Pain
The most common analysis seen in several [6]physical therapy clinics is Lower Back Pain. Mostly it happens
due to poor sitting position, [7]muscle sprain, lifting weighty objects, and forward bending. Physical therapy
can help you to remain as active as possible. Low back pain can be a severe trouble and it is enormously
recommended to seek advice from a [8]physician or [9]physiotherapist.
[10]Physical Therapy For Knee Pain
The human knee is a hinge joint (turning point) that is comprised of the tibia (shin) and the femur
(thigh). [11]Knee Pain can be caused by repetitive trauma and twist or by wound. Occasionally it occurs
for no apparent reason. When [12]knee pain occurs, you may experience practical limitations that include
diculty in walking, rising from sitting, or going upstairs. If you refer [13]physical therapy for the [14]knee
pain, the early visit is important to ensure correct analysis and proper supervision. During this visit, your
physiotherapist will discuss with you to collect information about the history of your trouble, about the
irritating and relieving factors, and about any past medical history that may give the overall problem. From
the gathered information, a focused inspection will be conducted.
[15]Physical Therapy For Hip Pain
The hip is actually close to the low back, and it can be complex to conclude if your [16]hip pain is ac-
tually coming from hip or coming from your low back. If this pain remains for more than 2 or 3 weeks or
occurs as the consequence of major trauma, a visit to a physician, physiotherapist, or healthcare provider is
recommended. The physiotherapist may use physical agent like heat or ice help with inammation. Exercises
to improve hip muscle or mobility may be started. You also may have to perform movements or workout at
home every day.
[17]Physical therapy is benecial in treating many diverse medical disorders. [18]Sport and orthopedic
injury, [19]neurological and [20]muscular inrmity, [21]cardiopulmonary diseases are only a few [22]pathologi-
cal situations in which physical therapy plays a vital treatment role.
13
Do you have neck pain that keeps you from being as energetic as you would like?
(2011-07-23 07:56)
Did you get up this morning with a sti painful neck?
Are you ready to be completely cured of neck pain forever?
If fair enough, then you must appoint a [1]physiotherapist. [2]Physical Therapy is the best and cost eective
solution for neck pain.One of the supplest regions of the spine is the neck (cervical) region, which consists of
vertebrae, seven shock-absorbing discs, muscles, and [3]vertebral ligaments to clutch them in consign. The
primary [4]cervical disc connects the top of the spinal column to the bottom of the skull. The [5]spinal cord,
which sends nerve impulses to each part of the body, runs through a canal in the cervical vertebrae and
continues all the way down the spine. Pain in the [6]cervical area can cause arm pain as well as the ache in
the neck.
[7]TREATMENT
Several physical therapists prefer ice (cold therapy) because of its eciency in diminishing pain and tender-
ness. Heat (heat therapy) also provides release to some people, but should be used with care because it can
sometimes make an inamed region inferior. Apply warmth or ice for 15-20 minutes at a moment, and give
yourself a 40-minute break among applications. [8]Treatments may comprise [9]manual therapy, ultra sound,
[10]cervical traction, TENS, exercises, myofacial release.
[11]How Physical Therapy Can Help With Neck Pain?
[12]Physical therapy always begins with a complete history and valuation of the trouble. Your physi-
cal therapist will take many things into story, including your age, general health, work, and way of life. If
major strain or disease is concerned, your [13]physical therapist will work with you in discussion with a
physician.
14
1.5 August
Foot Pain? (2011-08-26 06:45)
The [1]foot is one of the most complex parts of the body, consisting of 28 bones linked by several [2]joints,
[3]tendons, [4]muscles and [5]ligaments. Foot is the foundation of athletic movements of the lower extremity.
Pain indicates that there is something wrong with the interaction of internal structures of the foot.
Causes:
[6]Foot pain frequently cause by inappropriate foot function. Improperly tted shoes can make it worse and
in some cases, cause foot harms. Shoes that t properly and give good arch support can avoid irritation
to the foot joints and skin. There are lots of foot problems that inuence the heels, toes, nerves, tendons,
ligaments, and joints of the foot. Foot pain may be caused by many unusual conditions or injuries. [7]Acute
or repeated trauma is the most frequent cause of foot pain. [8]Trauma is an outcome of forces external to the
body either directly impacting the body or forcing the body into a situation where a particular or mixture of
forces result in damage to the structure of the body. Wearing shoes that are too tight or high heels can cause
pain in the region of the balls of the feet and the bones in that part. Shoes that are tied too tightly may
cause pain and bruising on the top of the foot.
Anatomy of Foot:
Your foot consists of 28 bones. These are
7 [9]Tarsal Bones
5 [10]Metatarsal [11]Bones
5 [12]Proximal Phalanges
4 [13]Middle Phalanges
5 [14]Distal Phalanges
2 [15]Sesamoid Bones
15
[16]
Symptoms:
[17]Pain and point tenderness are the instant indicators that somewhat is wrong in a specic region. When the
[18]pain begins to obstruct with your activities of everyday or if you cannot act upon your desired activities
without pain, you should consider seeking medical attention. Indicators that you should seek medical care are
if the area looks distorted, you have loss of function, large amount of swelling with pain, prolonged change
of skin or toenail color, change of sensation, the aected area becomes warmer than the adjacent areas or
becomes tender to the touch.
Physical Therapy for Foot Pain
[19]Physical therapy is frequently one of the most important ways to treat the symptoms of [20]foot pain.
Gentle stretching of the foot helps to improve the uneasiness felt due to foot pain. Rarely with [21]plantar
fasciitis a brace is worn at night to remain the foot in a stretched situation. Following are the ve simple and
easy movements or exercises to stretch the structures of the foot:
The Long Sitting Stretch
Achilles Stretch
Stair Stretch
16
Can roll
Toe Stretch
[22]Physical Therapy is vital in retuning a patient rapidly to their daily routine as well as athletic activities.
Restoring proper mobility of the dierent ankle bones in addition to strengthening of the ankle is necessary
in preventing future injuries to the foot, knees, hip and back.
Calcaneus
Talus
Medical Cuneiform
Intermediate Cuneiform
Lateral Cuneiform
Cuboid
Navicular
16. http://alliancephysicaltherapy.files.wordpress.com/2011/08/ei_1268.gif
How to cure Plantar Fasciitis? | Alliance Physical & Physical Therapy (2014-04-05 12:24:50)
[&] Sometimes plantar fasciitis can be associated with heel spurs. These spurs are outgrowths of bone on the calcaneus
(heel bone). They are sometimes painful and may occasionally require surgical treatment. [&]
How to cure Plantar Fasciitis? | Alliance Rehab and Physical Therapy (2013-09-17 04:56:47)
[&] plantar fasciitis can be associated with heel spurs. These spurs are outgrowths of bone on the calcaneus (heel
bone). [&]
How to cure Plantar Fasciitis? Alliance Rehab & Physical Therapy Blog (2013-09-17 04:57:59)
[&] plantar fasciitis can be associated with heel spurs. These spurs are outgrowths of bone on the calcaneus (heel
bone). [&]
17
Wrist Pain (2011-08-26 07:05)
[1]Wrist pain is any pain or discomfort that occurs in the wrist. The wrist contains many small bones,
cartilage, muscles, blood vessels, and tendons, and is particularly vulnerable to injury. Wrist pain is
commonly caused by soreness or injury but may also arise from infectivity or a [2]tumor on the wrist.
Wrist pain is particularly general complaint, and there are many common causes of this problem.
It is important to make an accurate opinion of the cause of the symptoms so that suitable action can be
directed at the cause.
[3]Causes for wrist pain:
[4]Tendonitis
Tendonitis is a standard problem that causes wrist pain and enlargement. This is due to swelling
of the ligament cover. Wrist pain treatment which is caused by tendonitis does not need surgical procedure.
[5] Sprain
Wrist sprains are regular injuries caused to the ligaments around the wrist joint. Sprains can ori-
gin problems by restraining the use of our hands.
[6] Carpal Tunnel Syndrome
Carpal tunnel disorder is the state that results from dysfunction of one of the nerves in the wrist.
In carpal tunnel syndrome the median nerve is squeezed together or strained o, as it pass through the wrist
joint.
[7]Arthritis
Arthritis is one of the troubles that can originate wrist pain and complexity in performing daily or
general activities. There are a number of causes of arthritis and luckily there are a lot of wrist arthritis
treatments.
[8]Ganglion Cyst
A ganglion cyst is a type of swelling that frequently occurs over the back of the hand or wrist.
These are a sort of uid-lled capsules. Ganglion cysts are not cancerous. They will not enlarge and they
will not spread to other parts of your body.
[9]Gout
This occurs when there is too much production of uric acid and a waste product. This forms crys-
tals in joints rather than being excreted in the urine.
18
[10]Pseudogout
This occurs when calcium deposit in the joints (wrists or knees) causing ache and enlargement.
[11] Fractures
A wrist fracture is a general orthopedic injury. Patients with a broken wrist may be treated in a
cast, or they may need surgical treatment for the fracture.
When do you need to [12]call your physician about your wrist pain?
If you are not condent about the cause of your wrist pain, or if you do not know the denite cure
recommendations for your condition, you should seek medical consideration. Treatments for these situations
must be directed at the specic cause of your problem.
Some [13]symptoms seen by a physician include:
Inability to carry objects
Injury that causes deformity of the joint
Wrist pain that occurs at night or while sleeping
Wrist pain that persists beyond a few days
Failure to atten the joint
Swelling or major bruising around the joint
Symptoms of an infection, including fever
Any other strange symptoms
What are the[14] best treatments for wrist pain?
The treatment of wrist pain depends completely on the cause of the problem. Thus, it is very impor-
tant that you understand the cause of your symptoms before you decide for a treatment plan. If you are
uncertain for your diagnosis or for the severity of your condition, you should look for medical guidance before
the start of any treatment.
All treatments listed here are not appropriate for every situation, but may be helpful in your situation.
[15] Rest Activity Modication:
19
The rst treatment for many common conditions that cause wrist pain is to relax the joint and allow the
acute swelling to drop. It is important, however, to use warning when relaxing the joint, because causing no
motion to the joint can result a sti joint. Adjusting your activities so as not to disturb the joint can help
prevent worsening of wrist pain.
[16]Ice and Heat Application:
Usually Ice and heat pads are commonly used for treatments of wrist pain. But the question arises, which
one is the right one to use, ice or heat? And how long should the ice or heat treatments last? Read on for
more information about ice and heat treatment or consult your physician.
[17]Wrist Support:
Support braces can aid patients who either had a recent [18]wrist sprain injury or those who tend to hurt
their wrists easily. These braces act as a tender support to wrist activities. They will not avoid severe injuries,
but may help you to carry out simple activities while rehabilitating from a [19]wrist sprain.
1.6 November
Arthritis Types, Symptoms, Causes and Treatment (2011-11-22 10:50)
Literally, many elder people have [1]arthritis, but today its not just a problem of the old. Some forms of
arthritis aect kids still in diapers, while thousands of people are suering in the prime of their lives. The
general denominator for this condition is [2]joint and musculoskeletal pain, which are grouped together as
20
[3]arthritis. Often that pain is a result of [4]swelling of the joint lining. [5]Arthritis is the most common
cause of inability in the USA.
Types of [6]Arthritis:
[7]Arthritis is of two types. One is [8]Osteoarthritis Arthritis and other on is [9]Rheumatoid Arthri-
tis.
[10]Osteoarthritis Arthritis is local or generalized degeneration of the articular cartilage and the for-
mation of lips and spurs at the edges of [11]Joints. An exaggeration of the normal aging process.
[12]Rheumatoid Arthritis is an inammatory disease involving the synovial membranes and the par-
ticular structures.
[13]Symptoms:
The main [14]symptoms of Osteoarthritis are:
" Progressive pain
" Joint enlargement
" -lived stiness in morning
" Diculty moving
" A grating or crackling sound or sensation in your joints
The main [15]symptoms of Rheumatoid Arthritis are:
" Joint swells with redness and tenderness
" Symmetrical joint involvement is common
" Migrate from joint to joint
" Inammation around the joints and in other areas
[16]
Causes:
[17]Arthritis is cleanly dened as [18]swelling in the joints. There are dierent types of [19]arthri-
tis, but the two most common types are [20]rheumatoid arthritis and [21]osteoarthritis. [22]Joint stiness
and joint pain are the two most common symptoms of [23]arthritis. Those with [24]arthritis may experience
more than one [25]inamed joint. Main [26]Causes are:
" Main Cause of this disease is Inammation of synovial membrane tissue. This tissue lining the [27]joints in
human body and when this tissue becomes [28]swollen, it results to severe pain and stiness in that body
part.
" Being inexible, unwilling to change, fear, anxiety, depression, deep shock all these are [29]Arthritis
Psychological Causes.
" Poor digestion, Hyperacidity, Enzyme deciency, Poor Skin, Kidney, Gallbladder and Liver activity, spinal
imbalance causing reex conditions as above leading t accumulated toxins which cause an inammation
reaction.
" Excessive use of Meat, soda drinks, coee, salt, excess rened carbohydrates, sweets, raw vegetable
deciency all these cause [30]arthritis.
" Fatigue can enhance the feeling of pain and more fatigue increase in [31]arthritis pain.
[32]Treatment:
21
" Raw Vegetable and Juice fasting is the fastest method of attaining result. Fasting period de-
pends upon the patients and conditions and may range from 7-21 days.
" Take Raw Non Citrus Vegetarian diet and avoid coee, tea, alcohol, sweets etc.
" And one of the best treatment for this is [33]Physical therapy and Hydrotherapy like Hot and cold showers
to stimulate general circulation and act as general tonic, Hot compress, Cabinet Bath, Sauna bath, Paran
bath etc.
" [34]Daily Massage with olive and peanut oil.
" Or sometimes [35]Joint replacement surgery may be required in eroding forms of [36]arthritis.
Best treatment for [37]arthritis is [38]Physical exercise. [39]Low impact aerobic exercise is best.
Talk to your medical professional regarding which types of exercises are ideal for you. And people who are
suering from [40]Arthritis due to Physiological cause they must laugh, shed their stress, loose weight, and
have more intimacy with outer world. And do regular exercise.
22
Dave (2011-11-25 04:46:02)
The article has valuable information. The way you write and guide about the arthritis was easy to understand. Thanks
for wonderful posting and Thanks for helping community.
1.7 December
Treat Herniated Disk with Physical Therapy.. (2011-12-08 07:05)
Sandwiched between each of the [1]vertebrae in your [2]spinal column is a disk of [3]cartilage that acts as a
[4]shock-absorbing pad. These disks have a soft, jellylike center and a tough, brous outer layer. A tear in
this outer layer will allow some of the soft center to [5]bulge out. This bulge on the nerve roots emerging
from the spine in the region of the damaged disk.
CAUSES
Any activity that puts increased [6]pressure on the disks of your [7]spine can lead to a disk hemlation.This
can occur in the [8]cervical spine, or, more commonly in the [9]lower back. He general gear and tear that
comes with age can also contribute, making middle-aged people susceptible to if they bend suddenly or lift
an awkward weight.
SYMPTOMS AND DIAGNOSIS
Depending on the location of the herniated disk, symptoms can vary, but there is usually [10]severe pain and
restriction of movement. In the [11]lower back, the pain tends to be a deep [12]unrelenting ache, which may
radiate out to your hips; groin buttocks and legs. You may also develop sciatica-a sharp pain, radiating down
one leg accompanied by numbness or tingling. [13]Herniated disks can also occur in the [14]neck, causing
[15]severe pain that may spread into your [16]shoulders, arms and hands, making it dicult to turn your
head or move it backward or forward. You will usually [17]feel pain in only one side of your body. Your
doctor will make a [18]diagnosis by performing a physical examination; if your symptoms persist, he may
order further tests, such as an [19]MRI or [20]CT scan.
RISK AND DISCOVERY
Recovery from a [21]slipped disk usually takes 4-6 weeks .However if a [22]disk herniated protrudes fully
into the [23]spinal curial; it can compress the caudal equine and damage the [24]nerves leading to your legs,
[25]bladder and Bowles. This may result [26]weakness and [27]numbness in both legs and the lower part of
your body, loss of bladder and bowel control, and even impotence. Although this rarely happens, it is an
[28]emergency and you should seek immediate [29]medical help.
23
Mubeen (2011-12-08 07:51:19)
During my sciatica, I found physical therapy of stretches best. But the problem was, how to imitate exercises. This
sciatica relief app helped me to remove pain through stretches. http://itunes.apple.com/tw/app/id457029203?mt=8
Treat Spondylolysis and Spondylolisties With Physical Therapy... (2011-12-13 10:11)
[1]SPONDYLOLYSIS AND SPONDYLOLISTIES
These linked conditions generally aect your [2]lower back but may occur in may part of your
[3]spine.[4]Spondylolysis occurs when a defect or weakness in a vertebrae develops into a [5]fracture. The
vertebra is then at risk of slipping out of line with the vertebrae adjacent to it, leading to [6]spondylolosthesis,
which can be debilitating and [7]painful, or may be painless and go unnoticed.
CAUSES
[8]Spondylolysis may start with a minor [9]crack the narrow arch of bone in a vertebra,known as the usually it
is the result of a fall or due to strain and overuse .some sports such as cricket and soccer repeatedly put stress
on the [10]arches of the vertebrae ,which can lead to minor [11]cracks or [12]breaks.[13]Spondylolisthesis gen-
erally develops from [14]spondylolysis ,with the crack widening to a complete break due to further [15]stresses
and [16]strains .This break allows the damaged vertebra to slip out of line, which can irritate the linked
[17]facet joints and ligaments and possibly trap a nerve.
SYMPTOMS AND DIAGNOSIS
24
The [18]pain from a displaced vertebra due to [19]spondylolisthesis depends on the degree of slippage. A
slight slip may cause little or no [20]pain, while a greater degree of slippage can lead to more [21]intense pain
because of the irritation to the spinal joints and ligaments .If your nerve is trapped, there may be some pain
numbness, or [22]pins and needless in one or both of your legs. Your doctor will make a diagnosis through
a [23]physical examination and testing including on [24]X-ray, [25]MRI scan and myelogram.
RISKS AND RECOVERY
Back strengthening [26]exercises can help stabilize your posture, but where vertebrae have severely slipped,
nerve entrapment can develop that may require [27]surgery. Young people [28]diagnosed with spondylolisthesis
should avoid contact sports and activities with a high risk of [29]back injury .A young person who is still
growing should be [30]monitored every six months, using X-rays to detect further movements and shift in the
[31]spinal column. Once growth stops, the [32]vertebrae are unlikely to slip any farther.
19. file://localhost/mnt/ext/blogbooker/tmp/5wzhtcn0/SpondylolysisandSpondylolisties
25
26
Chapter 2
2012
2.1 January
Are You Suering from Your Hip Joint..??? (2012-01-14 11:33)
[1]Injuries around the [2]hip constitute one of the most dicult injuries to treat and predict the outcome.
But the best way to treat your [3]pain is by [4]Physical Therapy without any Burn and Injury. In dashboard
injuries, the impact is driven to the knee of the patient which passes on the energy of [5]hip joint causing
posterior dislocation of hip.
Examination
Inspection
Attitude: The examination of attitude in a [6]hip joint injury is very useful. In posterior dislocation of hip,
the hip will be in [7]exion, adduction and internal rotation. In intracapsular fracture neck of femur, the
lower limb lies in external rotation and minimal shortening. In [8]trochanteric fractures, the lower limb lies
in complete external rotation and the limb appears shortened. In anterior dislocation of [9]hip, there will be
exion, abduction and external rotation deformity.
Swelling: In dislocation of hip, the femoral head may be felt either in the [10]gluteal region or in the
perineal region or [11]iliac region. In trochanteric fracture, there will be diuse swelling around the [12]hip
and thigh.
Palpation
The bony landmarks to be palpated are:
1.Greater trochanter: The position of greater trochanter helps us in the [13]diagnosis of fractures around the
hip. The greater trochanter, anterior superior iliac spine (ASIS) and [14]ischial tuberosity have a constant
relationship to each other which will be altered in aections of hip joint and [15]proximal femur. Bryants
triangle is formed by a line connecting ASIS and greater trochanter, line dropped from the ASIS perpendicular
to the oor and the line connecting the greater trochanter and the perpendicular line. The base of the
Bryants triangle is measured and compared with opposite side. In fractures of the [16]neck and dislocations
of hip, the base will decrease to the [17]proximal migration of the trochanter. In posterior [18]dislocations
of hip, the greater trochanter will be more anteriorly felt near the ASIS. In anterior dislocations, it will be
felt more posteriorly. It should be palpated for tenderness, thickening or irregularity. In [19]subtrochanteric
fractures, Bryants triangle will not be altered but there will be loss of transmitted movements between the
proximal and distal femur.
2.Head of femur: Normally, the [20]femoral arterial pulsation is felt against the head of femur. In dislocations,
this resistance is lost thereby altering the intensity of pulsation. The femoral head may be felt posteriorly or
anteriorly depending on the type of dislocation. A smooth round bony hard mass which moves with rotational
27
movements of the shaft of femur is nothing but the head of [21]femur. The medial surface of the medial
femoral condyle is in the same direction as that of the head of femur. This gives a rough guidance to locate
the head in an intact femur.
Neurological examination
In posterior [22]dislocations of hip, the nerve to be commonly aected is the [23]sciatic nerve. The common
peroneal part of the sciatic nerve is most often involved than the tibial part manifesting as foot drop.
So Treat your problem of [24]Hip Joint with Physical Therapy at [25]Alliance Rehab And Physical Therapy
which is located in eight prime locations in Northern VA and DC region.[26]http://www.alliancephysicaltherap-
yva.com/
28
Physical Therapy Treatment for Injuries Around The Ankle Joint (2012-01-20 10:27)
[1][2][3] [4]Injuries Around the Ankle Joint& [5]Ankle sprain is
an extremely common complaint with many causes. An ankle sprain occurs when the ligaments surrounding
the [6]ankle joint are stretched or torn as the [7]ankle joint and [8]foot is turned, twisted or forced beyond
its normal range of motion. The most common cause of an ankle pain in athletes is a missed step or a
missed landing from a jump or fall. [9]Ankle sprains vary in severity and are classied by the degree of
severity. History The usual mechanism of injury to the[10] ankle joint is a rotational violence in which the
body swings around a trapped foot. Depending on the quantum of force, there may be ligamentous injury or
[11]bony injury around the ankle. The exact position of the foot at the time of [12]injury is elicited. [13]Ankle
injuries are usually classied by the direction of the force and the position of the [14]foot at the time of
injury. Following a tibial plateau fracture or talar fracture, the ankle and [15]subtalar joint may go in for
secondary degenerative arthritis, which can present as [16]chronic pain and recurrent eusions of the ankle
joint. Presence of knee pain and hip pain should be asked for as the foot and [17]ankle disorders can alter
the biomechanics of the limb predisposing the knee and hip to degenerative osteoarthritis. Examination
Inspection The foot,[18] ankle and the leg are completely exposed. The position of the foot in relation to
the leg is determined. The [19]foot may be displaced anteriorly, posteriorly or sideways depending on the
type of injury. The foot is usually displaced laterally in external rotation injuries. It may be displaced
medially in adduction injuries and displaced upwards and laterally in vertical compression [20]injuries. In
vertical compression injuries with diastasis of inferior tibiobular joint, the ankle may appear broadened. In
fracture dislocation of the talus, the displaced fragment may stretch the skin of the dorsum of the ankle and
may impend rupture of the skin. Palpation The bony points palpated are: Lower end of tibia and bula
including the malleoli: As these bones are subcutaneous, it is easy to nd out any [21]fractures, irregularity
abnormal mobility. In ligamentous [22]injuries around the ankle, the insertion sites of these ligaments such as
anterior talobular ligament, deltoid ligament may be tender to palpation. To demonstrate the ligamentous
injury further, the ankle joint is stressed by giving valgus and varus forces to it. Any abnormal opening out
can be demonstrated both clinically and radiologically. Tarsal bones: The calcaneum is palpated bidigitally
on either side to demonstrate tenderness or thickening or irregularity. In chronic degenerative arthritis of
[23]subtalar joint, tenderness and restriction of movements of subtalar joint will be present. Metatarsal bones:
In Jones fractures the base of the Vth metatarsal is avulsed due to the pull of the peroneus brevis muscle.
Fractures of the shaft of the metatarsals are demonstrated by eliciting tenderness on axial pressure over
the metatarsal head. Diuse swelling over the [24]tarsometatarsal joints may be seen in Lanfrancs fracture
dislocation. In march fracture, there will be diuse swelling over the neck of lInd metatarsal with [25]pain.
Muscular compartment: Tendo-Achilles which gets inserted in the calcaneum is frequently injured resulting
in loss of active [26]plantar exion. Thompsons test: Squeezing the calf muscle will cause plantar exion
of the [27]ankle joint. When there is a discontinuity in the tendon, this manoeuvre will not cause plantar
exion. Movements: In acute injuries, active movements may not be possible. Measurement The leg segment
is measured from the medial joint line to the malleolus.The vertical height of the heel is measured from the
tip of the medial malleolus to the oor in a standing patient. In [28]fractures of the talus and calcaneum,
this height may be decreased. The longitudinal measurement of the foot from the tip of the [29]heel to the
29
tip of great toe and then to the tip of the little toe are measured. Circumferential measurement of the foot
at the level of the ankle joint, at the level of maximum arch and at the level of the metatarsal heads are
measured and compared with the normal side. Neurovascular examination [30]Ankle injuries may rarely be
associated with posterior tibial artery and nerve [31]injuries. In Lanfrancs fracture dislocation, the digital
arteries and nerves may get damaged and careful animation is needed to diagnose this. The chronically
disabled group usually suers from the sequelae of old [32]trauma or inammatory infective or degenerative
or neoplastic causes. These patients need to be examined by proper history, detailed examination of the
individual bone and joints. After eliciting a detailed history, the examiner should arrive at a provisional
dierential diagnosis based from the history and then proceed to physical examination. This will help in
nding the subtle signs of the disease. Clinical Features The Patient typically present with a twisting injury
of the foot following which they complain of inability to bear weight, pain around the [33]ankle and very often
swelling around the ankle. Clinically the stability of the ankle joint must be tested by valgus and varus stress
under anaesthesia, Associated injury to the tendons and the neurovascular bundles, which run in close vicinity
to the [34]joint, has to be ruled out. The state of skin must be checked. The skin over the deformed ankle
may get unduly stretched, resulting into necrosis, if not reduced immediately. [35]Physical therapy modalities
(such as ultrasound) and manual therapy modalities (such as friction massage) are often used when the acute
phase is over.A Physical Therapistis a specialist trained to work with you to restore your activity, strength
and motion following an [36]injury or surgery. Physical therapists can teach specic exercises, stretches
and techniques and use specialized equipment to address problems that cannot be managed without this
specialized physical therapy training.
3. http://alliancephysicaltherapy.files.wordpress.com/2012/01/ankle-joint-pain.jpeg
30
Dave (2012-01-20 19:36:28)
This is one of the best article for Ankle injury and pretty much guidelines for the physical therapy. Thanks for porting
this articles. Keep continue with healthy articles like this.
2.2 March
Injuries Around the Elbow (2012-03-12 10:36)
[1] Our elbow joint is made up of bone, cartilage, ligaments and uid.
Muscles and tendons help the elbow joint move. When any of these structures is hurt or diseased, you have
elbow problems.Our [2]elbow joint is made up of bone, cartilage, ligaments and uid. [3]Muscles and tendons
help the elbow joint move. When any of these structures is hurt or diseased, you have elbow problems.
Many things can make your elbow hurt. A common cause is [4]tendinitis, an inammation or injury
to the tendons that attach muscle to bone. Tendinitis of the elbow is a [5]sports injury, often from playing
tennis or golf. You may also get tendinitis from overuse of the elbow
The injuries around the elbow will be described under the following heads:
Fractures of the distal end of the humerus
Dislocation of the elbow
Fractures of the proximal ends of the radius and ulna.
Fractures of the distal end of humorous:
Supracondylar fracture
31
Intercondylar fracture
Fracture of the lateral epicondyle
Fracture of the medial epicondyle
Fracture of the capitellum.
Supracondylar Fracture Of The Humerus
[6]Supracondylar fracture of the humerus is one of the most common fractures in the children, and oc-
curs in the age group of 3-13 years.
Mode of Injury
This fracture is caused by a fall on the outstretched hand.
Displacements
The fracture line runs transversely just above the [7]condyles of the humerus. On the basis of the displace-
ments, fracture is classied into two types:
Extension type: In this type the [8]distal fragment is displaced posteriorly.This is the most common
type and discussed here.
Flexion type: In this rare type, the fragment is displaced anteriorly. Most of the fractures are displaced
fractures. In an extension type the distal fragment is:
(i) Displaced posteriorly
(ii) Tilted posteriorly
(iii) Titled medially
(iv) Internally rotated.
32
Clinical Features
The child complains of severe pain and [9]swelling in the elbow following a history of fall. The child holds the
elbow in a exed position and resists any movement to the elbow. When brought early, the swelling is less
and the following signs can be elicited:
There is tenderness over the distal end of humerus,
[10]Crepitus can be elicited, although it causes pain and therefore should be avoided,
Since the fracture line is above the condyles, and the whole of the distal end of humerus carrying the
[11]elbow joint is displaced backwards, normal three bony point relationships is maintained.
When presented late, gross, tense swelling sets in which lls up the hollows around the elbow and obscures
the bony landmarks. Sometimes even [12]blisters develop over the elbow. In such a situation the fracture
signs cannot be elicited. At the time of injury the distal fragment is displaced posteriorly there by pulling
the brachial artery and the median nerve against the sharp distal end of the proximal fragment. This may
cause injury to the brachial artery and/or the median nerve. It is therefore important to feel the [13]radial
pulse and test the nerve functions at the time of initial examination and make a record of it.
If the distal circulation is aected due to an [14]arterial injury, the following features (5 Ps) may be seen:
Pain- severe
Pallor
Pulselessness
Paraesthesia, and
Paralysis.
Investigations
Anteroposterior (AP) and lateral view radiographs of the elbow are essential. The AP view shows the fracture
line which runs transversely just above the condyles. The distal fragment is displaced and rotated. The
lateral view shows the posterior displacement of the distal fragment.
Treatment
33
An undisplaced fracture is treated above-elbow PoP slab for 3 weeks. A displaced fracture can be treated by
one of the following methods:
Closed reduction: The fracture is reduced by closed manipulation under general[15] anesthesia. The
reduction is obtained by gentle traction to the forearm, manual manipulation of the fragments to
align them properly, and then exing elbow a little beyond 90. If the radial pulse becomes feeble or
disappears during exion of the elbow, then the elbow is extended gradually till the pulse reappears.
The [16]fracture is then immobilized with the elbow in the same position. The fracture may be stabilized
by passing.
K-wire percutaneously. The extension type of the fracture is immobilized in an above-elbow PoP slab with
the [17]elbow in exion, whereas the exion type (less common) of the fracture is immobilized with the elbow
in extension. In either case, the plaster is removed after 3 weeks.
Traction: The cases which report late (more than one week) with marked [18]swelling and blisters etc.
are treated by continuous (Dunlop) traction for 3 weeks.
Open reduction: Open reduction of the fracture is indicated when:
The closed manipulation fails,
The brachial artery is injured and needs exploration, and
There is an associated nerve palsy which needs exploration.
After open reduction the fracture fragments are xed internally with Kirschner wires-(commonly called
K-wires)
Early complications
These complications occur at the time of injury immediately after.
1. Injury to the brachial artery: This is the most dreaded complication; the brachial artery is injured
by the sharp edge of the proximal fragment. The artery may actually be lacerated, thrombosed or may just
go into spasm. The blood supply to the[19] exor muscles of the forearm may be aected resulting into
Volkmanns ischaemia. This requires immediate[20] treatment.
Volkmanns ischemia: Injury to the brachial artery leads to impairment of circulation to the forearm and
hand. There occurs ischemia of the deeper muscles of the exor compartment of the [21]forearm, such as
exor pollicis longus and exor digitorum profundus. The muscle ischemia, in turn, leads to compartment
syndrome.
34
Diagnosis:
There is severe, sudden increase in pain in the forearm
Stretch pain.
There is [22]severe pain in the exor aspect of the forearm when the ngers are passively extended. This is
the most important test and is pathognomonic of muscle ischaemia.
Treatment: The case of Volkmanns ischaemia must be handled as an absolute [23]emergency because changes
may soon become irreversible.
Remove tight bandage/splints/plasters etc. immediately.
The forearm is elevated and hot bottles are applied to the other three limbs to promote general
vasodilation.
If no improvement occurs within 2 hours, the operation of [24]fasciotomy is undertaken, if the exor
compartment is tight. In this operation an incision is made from skin down to the deep fascia to
decompress the compartment.
If the injury to the brachial artery is established by angiography/Doppler, exploration of the brachial
artery is undertaken.
2. Injury to the nerves: Median, radial and ulnar nerves may be injured, in that order. In majority of the
cases the nerve palsy recovers spontaneously.
Late complications
Malunion: Malunion is the most common complication of [25]supracondylar fracture of the humerus
and results in a cubitus varus deformity. This deformity occurs if the fracture has been allowed to unite
with appreciable medial and internal rotation of the distal fragment.
Treatment: If the deformity is unacceptable cosmetically, a corrective osteotomy in the supracondylar
area is performed (French osteotomy).
Myositis ossicans: Myositis ossicans is ectopic new bone formation around the elbow. This is a
common complication which occurs following massage to the elbow after the injury and results in
[26]stiness of the elbow.
35
Treatment: In the acute painful stage, the elbow is immobilized in an above-elbow plaster slab for about 3
weeks. Otherwise, the main treatment is mobilization of the elbow, despite some pain.
Volkmanns ischaemia contracture (VIC): Volkmanns ischaemia, if not treated in time, gradually progresses
to Volkmanns ischaemia contracture.
The ischemic muscles are gradually replaced by brous tissue, which contracts and draws the wrist and ngers
into exion. If the [27]peripheral nerves are also damaged by ischaemia, there will be sensory and motor
paralysis in the forearm and hand.
Diagnosis: There is marked atrophy of the forearm muscles. There is the characteristic deformity of exion
of the wrist and ngers.
Volkmanns sign: This sign is characteristic of VIC where the ngers cannot be fully extended passively with
the wrist extended: but when the [28]wrist exed, the ngers can be fully extended passively. This happens
because the shortened/contracted exor muscle-tendon units do not permit full extension of the ngers and
wrist simultaneously.
Treatment: In established cases to normal is impossible because irreversible damage has occurred to the
import and nerves. However, reconstructive [29]surgery can only improve some function of the hand.
Mild cases can be treated by:
(i) Stretching exercises by a [30]physiotherapist and also by the use of
(ii) Turnbuckle splint which gradually stretches the contracted muscles.
Moderate cases require a muscle slide surgical operation where the exor group of the muscles is released
from their origin from the[31] medial epicondyle of the humerus and ulna.
Severe cases can be treated by shortening of the forearm bones, proximal row carpectomy and wrist
arthrodesis etc.
Considerations
Even after the[32] fracture has healed, full motion of the elbow may not be possible. In most of these cases,
the patient cannot fully straighten his or her arm. Typically, loss of a few degrees of straightening will not
36
have an impact on how well the arm will work in the future, including for sports or heavy labor. So treat
your problem of [33]Elbow Injury with Physical Therapy. [34]Physical Therapy is the best treatment for the
Elbow Injury.
1. http://alliancephysicaltherapy.files.wordpress.com/2012/03/a00029f01b3.jpg
2. http://www.alliancephysicaltherapyva.com/Our-Staff.aspx
4. http://www.alliancephysicaltherapyva.com/Certified-Hand-Therapists.aspx
7. http://www.alliancephysicaltherapyva.com/Programs-Physical-Therapy-Orthopedic-Neurological-Hand-Therapy.
aspx
aspx
aspx
Dave (2012-03-27 04:38:56)
Good and knowledge article. Keep continue on it. Thanks
37
Archillies Region - Types,Causes & Treatment (2012-03-23 13:05)
[1]Achilles is a common overuse [2]injury that occurs in people of all tness levels. The causes can be variable,
but one factor that seems to be consistent with all cases is stress to the gastroc and soleus [3]muscles in
the calf region with irritation and loading at the tendon insertion at the heel bone. This stress may be a
result of continued forces placed through the tendon structure from activities ranging from standing, walking,
[4]exercise, to recreational activity or sport.
[5]
History
The [6]athlete with overuse tendinopathy not ices a gradual development of symptoms and typically
complains of [7]pain and morning stiness after increasing activity level. Pain diminishes with walking about
or applying heat (e.g. a hot shower). In most cases, pain diminishes during training, only to recur several
hours afterwards.
The onset of pain is usually more sudden in a partial tear of the [8]Achilles tendon. In this uncom-
mon condition, pain may be more disabling in the short term. As the histological abnormality in a partial
tear and in overuse [9]tendinopathy are identical. We do not emphasize the distinction other than to suggest
that time to recovery may be longer in cases of [10]partial tear. A history of a sudden, severe pain in the
[11]Achilles region with marked disability suggests a complete rupture.
Types of Achilles
Midportion Achilles tendinopathy
It is important to distinguish between [12]midportion and insertional Achilles tendinopathy as they
dier in their [13]prognosis and response to treatment. We briey review the pathology of Achilles
tendinopathy, list expert opinion of the factors that pre dispose to [14]injury, and summarize the clinical
features of the condition. The subsequent section details the [15]treatment of midportion tendinopathy.
38
Treatment of Midportion Archillies
[16]Archillies tendinopathy Level 2 evidence -based treatments for Achilles tendinopathy include
heel-drop exercises, nitric oxide donor therapy (glyceryl trinitrate [GTN] patches), sclerosing injections and
micro current [17]therapy (see below), In addition, experienced clinicians begin conservative treatment by
identifying and correcting possible etiological factors. This may include relative rest, orthotic [18]treatment
(heel lift, change of shoes, corrections of malalignment) and stretching of tight muscles. Whether these
commonsense interventions contribute to outcome is unlikely to be tested. The sequence of management
options may need to vary in special cases such as the elite [19]athlete, the person with acute tendon pain
unable to fully bear weight, or the elderly patient who may be unable to complete the heel-drops. As always,
the clinician should respond to individual patient needs and modify the sequence appropriately.
Insertional Achilles tendinopathy, retrocalcaneal bursitis and Haglunds disease
These three [20]diagnoses are discussed together as they are intimately related in pathogenesis and
clinical presentation.
Relevant anatomy and pathogenesis
The [21]Achilles tendon insertion, the bro cartilaginous walls of the retrocalcaneal bursa that ex-
tend into the tendon and the adjacent calcaneum form an enthesis organ. The key concept is at this site
the tendon insertion, the bursa and the bone are so intimately related that a prominence of the calcaneum
will greatly predispose to [22]mechanical irritation of the burs a and the [23]tendon. Also, there is signicant
strain on the tendon insertion on the posterior aspect of the tendon. This then leads to a change in the
nature of those tissues, consistent with the biological process of [24]mechanotransduction.
Treatment
[25]Treatment must consider the enthesis organ as a unit, isolated treatment of insertional Tendinopathy is
generally unsuccessful. For example, Alfredsons pain, full heel-drop protocol (very eective in midportion,
tendinopathy) only achieved good clinical results in approximately 30 %ofcases of insertional tendinopathy.
Patients with more than two years of [26]chronic insertional tendinopathy, sclerosing of local neo vessels with
polidocanol cured eight patients at eight -month follow-up.
Other Causes of pain in the Achilles region
[27]Achilles bursitis is generally caused by excessive friction, such as by heel tabs, or by wearing
shoes that are too tight or too large. Various types of rather sti boots (e.g. in skating, cricket bowling) can
cause such friction, and the pressure can often be relieved by using a punch to widen the [28]heel of the boot
and providing donut protection to the area of bursitis as it resolves. Referred pain to this region from the
[29]lumbar spine or associated neural structures is unusual and always warrants consideration in challenging
cases.
Clinical perspective
[30]Acute tendon rupture is most common among men aged 30- 50 years (mean age, 40 years); it
causes sudden severe disability. Overuse Achilles tendon injuries-tendinopathy may arise with increased
training volume or intensity but may also arise insidiously. Because the prognosis for [31]midportion Achilles
tendinopathy is much better than for insertion tendinopathy, these conditions should be distinguished
clinically. Most textbooks suggest that rupturelim its active plantar exion of the aected leg- but beware,
39
the patient can often [32]plantarex using an intact [33]plantar is and the long toe exors. The condition
that was previously called Achilles tendinitis is not truly an inammatory condition and, thus, should be
referred to as [34]Achilles tendinopathy pathology that underlies the common tendinopathy.
Whether you [35]treat an Achilles tendon rupture with surgery or use a cast, splint, brace, walking
boot, or other device to keep your lower leg from moving (immobilizing your leg), after treatment its
important to follow the [36]rehabilitation program prescribed by your doctor and [37]physical therapist. This
program helps your tendon heal and prevents further injury. [38]http://www.alliancephysicaltherapyva.com/
2. http://www.alliancephysicaltherapyva.com/Locations-Physical-Therapy-Clinics-Virginia-DC.aspx
5. http://alliancephysicaltherapy.files.wordpress.com/2012/03/achilles_tendon.jpg
7. http://www.alliancephysicaltherapyva.com/Contact-Alliance-Rehab-Physical-Therapy.aspx
aspx
40
2.3 April
Ankle Fractures (2012-04-07 11:49)
[1]Broken Ankle (Ankle Fracture) - Types, Treatments, Complications
[2]Ankle [3]fractures are the fractures involving the distal end of tibia and bula. Ankle fractures are
[4]common injuries and can vary from a stable fracture to a complex, unstable fracture dislocation.
Mechanism of Injury:
[5]Fractures of the ankle can result from low-or high-energy forces. Fractures due to low-energy
forces may be caused by one of the following mechanisms:
1. Rotational stresses to the ankle caused by twisting forces at the[6] ankle joint while walking,
running etc. This is the most common mode of injury.
2. Axial stress on the ankle joint results in[7] fracture involving tibial plafond
The high-energy forces, such as road trac accidents, cause severe injuries, usually[8] fracture dislo-
cations. The pattern of [9]ankle injury depends upon a combination of:
(i) The position of the foot at the time of injury
(ii) The deforming force.
The position of the foot at the time of injury can be supination or pronation and is described rst.
The deforming force, which can be adduction, abduction, external rotation and vertical loading; is described
next. Twisting force produces external rotation. Fall to one side produces adduction or [10]abduction injury.
The four most common deforming forces are: supination/external rotation, pronation/external rotation,
supination/adduction and pronation/abduction.
Classications of Ankle Fractures
Lauge-Hansen classied the [11]ankle fractures based on the pathogenesis or the deforming force
(i.e. the mechanism of injury). This classication helps in the manipulative reduction of the fracture, if the
displacement is understood correctly. The rst part of the classication species the position of foot during
injury and second part of the title species the deforming force, for example:
1. Supination-external rotation injury (most common mechanism of injury)
2. Supination-adduction injury
3. Pronation-external rotation injury
4. Pronation-abduction injury
5. Vertical-compression injuries.
41
However, there is another classication by Danis and Weber which is relatively simple.
Modied Danis-Weber classication: This is based upon the level of bular fracture and is purely a
radiological classication. In this classication, the bula is considered as the key to the [12]ankle stability.
The higher the bular fracture, the more extensive is the damage to the tibiobular ligaments and thus
greater the instability of the ankle mortise.
Type A: Fibular fractures below the level of inferior tibiobular syndesmosis
Fibula: Transverse avulsion fracture at or below the level of ankle joint: or rupture of the lateral
ligament complex.
Medial malleolus: Intact or sheared, with almost a vertical fracture.
Posterior malleolus: As a rule intact.
Syndesmosis (Tibiobular ligament complex): Always intact.
Type B: Fractures at the level of inferior tibiobular bular syndesmosis.
Fibula: Oblique fracture of the bula at the level of the ankle joint.
Medial malleolus: Avulsion fracture (fracture line horizontal) or rupture of the deltoid ligament.
Posterior malleolus: Either intact or sheared o as a posterior lateral fragment.
Syndesmosis: Usually, intact or partial rupture.
Type C: Suprasyndesmotic bular fractures unstable injury.
Fibula: Shaft fracture anywhere between the syndesmosis and the head of bula.
Medial malleolus: Avulsion fracture or rupture of the deltoid ligament.
Posterior malleolus: Either intact or pulled o.
Syndesmosis: Always disrupted.
Clinical Features:
The[13] patient typically present s with a twisting injury to the foot following which they com
plain of inability to bear weight, pain around the ankle and very often[14] swelling around the ankle.
Clinically the stability of the ankle joint must be tested by valgus and varus stress under anesthesia.
42
Associated injury to the tendons and the neurovascular bundles, which run in close vicinity to the joint, has
to be ruled out. The state of the skin must be checked. The skin over the deformed ankle may get unduly
stretched, resulting into necrosis, if not reduced immediately.
Radiological Features
Antero posterior, lateral and mortise view must be taken to dene the exact[15] fracture pattern.
Management
The ankle fractures must be reduced accurately. Since ankle is a major weight joint, any incon-
gruity of the articular surface, or tilt or disruption of the ankle mortise can lead to early [16]osteoarthritis.
The aim of the treatment in ankle fractures therefore is:
1. Anatomical positioning of the talus.
2. To obtain a smooth articular alignment of the ankle mortise.
For management and prognosis, ankle fractures may be grouped into stable and unstable fractures,
depending upon the position and the talus, and its instability on light stress. This classication is of
importance in treatment and prognosis.
Conservative treatment
Conservative[17] treatment is suggested in treating stable fractures viz. isolated bular fractures
without a medial side injury. These fractures can be treated by below-knee plaster casts for 4-6 weeks
followed by graduated weight bearing In unstable fractures with displaced talus closed reduction is achieved
by manipulating talus under anesthesia and protecting it with above knee plaster cast for 4-6 weeks.
Open reduction and xation: This is advocated in unstable injuries and in those injuries where the
[18]ankle joint is not properly aligned.
Internal xation is achieved by
1. Tension band wiring
2. Malleola screws
3. Plate and screw xation for lateral malleolus.
Complications
Major injuries of the ankle may be associated with the following complications:
1. Non union: Neglected fracture of the medial malleolus may go into nonunion. In old injuries
reduction of the [19]fracture and the ankle mortise may be dicult impossible.
2.[20] Stiness of the ankle.
3. Osteoarthritis: If the fracture has not been treated properly leading to incongruity of the articu-
43
lar surface, early osteoarthritis may set in. The patient has[21] chronic pain and [22]swelling of the ankle
necessitating ankle arthrodesis.
1. http://anklefractures.blogspot.in/2012/04/broken-ankle-ankle-fracture-types.html
aspx
9. http://www.alliancephysicaltherapyva.com/FAQ-Physical-Therapy-Rehab-Body-Parts.aspx
aspx
aspx
aspx
2.4 May
Sports Injuries (2012-05-08 11:26)
Sports Injuries and Its Classications:
INTRODUCTION:
[1]Sports medicine, like all other branches of medicine, aims at the complete physical, mental and
spiritual well-being of a sportsperson. A healthy mind in a healthy body is a concept, which is more true to
a sportsperson than anybody else is. Positive thinking, fair play and sportsmanship should be the hallmark
of a true sportsman. We, the doctors and the[2] therapists, aim to keep a sportsperson physically t so that
the rest of the objectives mentioned above are attained automatically.
44
Like in other branches of medicine so in sports medicine, prevention is better than cure. To pre-
vent sports injuries, the rst step is to ascertain whether a person choosing sports is t to take it. An unt
person taking up sports is a sure prescription for future[3] sports injuries. A tness testing for those who
wish to take up sports, as their career should include various relevant parameters
However, one has to remember that [4]tness testing is not done only at the initial stages but
needs to be done repeatedly at every stage of an athlete or a sportspersons life. The second stage of
prevention of sports-related injuries is assessing whether a sportsman is t enough to resume the sporting
activity after the initial layo. There is nothing more dangerous than an unt or partially t person resuming
the sporting activity. It may spell a doom to his otherwise ourishing career in sports. A[5] sportsperson has
to satisfy certain norms before he can nally be sent back to the eld.
CLASSIFICATION OF SPORTS INJURIES
Among the various classications proposed for sports injuries, the one proposed by Williams (1971)
is widely used and recommended.
Williams Classication:
[6]
45
Among the Consequential Injuries
Primary Extrinsic
This is further subdivided into:
Human: Black eye due to direct blow.
Implemental: May be incidental (as in blow from a hard ball) or due to overuse (blisters from oars).
Vehicular: Clavicle fracture due to fall from cycle, etc.
Environmental: Injuries in divers.
Occupational: Jumpers knee in athletes, chondromalacia in cyclists, etc
Primary Intrinsic
This could be acute or chronic.
Incidental: Strains, sprains, etc.
Overuse:
1. Acute, e.g. acute tenosynovitis of wrist extensors in canoeists.
2. Chronic, march fracture in soldiers, etc.
Secondary
Short-term: For example, quadriceps weakness.
Long-term: Degenerative [7]arthritis of the hip, knee, ankle, etc.
No Consequential Injuries
These are not related to sports but are due to injuries either at home or elsewhere and are very not
connected to any sports (e.g. slip and fall at home).
COMMON SPORTS INJURIES
[8]Sports medicine usually deals with minor orthopedic problems like soft tissue trauma. Very rarely,
there may be serious fractures, head injuries or on the eld deaths. There is nothing unusual about these
46
injuries except that a sportsperson demands a 100 percent cure and recovery while an ordinary person is
satised and happy with a 60-80 percent recovery. The dierence is because of the desire of the sports person
to get back to the sport again, which requires total tness.
The following are some of the most common sports -related injuries one encounters in clinical practice.
[9]
Upper Limbs
47
Shoulder complex
1. [10]Rotator cu injuries
2. Shoulder dislocations
3. Fracture clavicle
4. Acromioclavicular injuries
5. Bicipital tendinitis or rupture.
Elbow
1. Tennis elbow
2. Golfers elbow
3. Dislocation of elbow.
Wrist
1. [11]Wrist pain
2. [12]Carpal tunnel syndrome
Hand
1. Mallet injury
2. Baseball nger
3. Jersey thumb
4. Injuries to the nger joints.
Lower Limb
Hip
1. Iliotibial or tract syndrome
2. Quadriceps strain
3. [13]Hip pain
4. Groin pain due to adductor strain
Knee Joint
48
1. Jumpers Knee
2. Chondromalacia
3. Fracture patella
4. Knee ligament injuries
5. Meniscal injuries.
Legs
1. Calf muscle strain
2. Hamstrings sprain
3. Stress fracture tibia
4. Compartmental syndrome of the leg.
Ankle Injuries
1. [14]Ankle sprain
2. Injuries to Tendo-Achilles
3. Tenosynovitis.
Foot
1. March fracture
2. Jones fracture
3. Forefoot injuries
4. Injuries of sesamoid bone of the great toe.
Head, Neck, Trunk and Spine
1. Head injuries
2. Whiplash injuries
3. Rib fractures
4. Trunk muscle strains
5. Abdomen muscle strain
6. Low backache
49
All these injuries have been discussed in relevant sections.
Investigations
These are the same as for any ortbopedic-resared disorders and consist of plain X-ray, CT scan, bone
scan, MRI, arthroscopy, arthrography, stress X-rays etc.
TREATMENT OF SPORTS INJURY
This is discussed under three headings prevention, treatment proper and training.
Preventive Measures
The best way to treat a sports injury is to prevent it from happening. Nothing is better than prevent-
ing the injury.
Treatment
Treatment of individual [15]sports-related disorders is discussed under suitable sections. However, a mention
is made here of the general principles of treatment which is applicable to all sports injuries.
General Principles
Concept of RICEMM: This sums up the early treatment methodology of sports injuries and consists of:
R-Rest to the injured limb
I-Ice therapy
C-Compression bandaging
E- Elevation of the injured part
M- Medicines like painkiller s, etc.
M- Modalities like heat, straps, supports, etc.
After immobilization and rest, early vigorous exercises should be commenced at the earliest to prevent
muscle weakness and atrophy.
To prevent[16] joint stiness, early mobilization ha s to be done rst by passive movements and later
by active movements. To improve the strength, resistive exercises are added.
Unlike the conventional once a day treatment, a sportsperson needs to be seen at least 2-3 times a day.
As mentioned earlier, allow resumption of sporting activity only after the sportsperson assumes 100
percent[17] tness.
Mind training is as important as physical training. By repeated counseling, improve the psychological
status of the patient to avoid depression, anxiety and negative attitudes, which may develop during the
injury.
50
Orthopedic and surgical treatment to be undertaken at appropriate situations.
Training
The physiotherapist has to train a sportsperson in various exercises to enable him to keep his tness
level very high. After conducting a tness testing, the[18] therapist has to subject an athlete to various forms
of exercises to increase the endurance, strength, running, weight bearing, etc. The following are the various
forms of exercises.
Measures of Relaxation
After the vigorous workout mentioned above, the sportspersons are taught methods of relaxation and
body stretches. Before an athlete or a sportsperson resumes his sporting activities, a tness testing is carried
out and only then, he is allowed to take to the sports provided he is 100 percent t.
6. http://alliancephysicaltherapy.files.wordpress.com/2012/05/sports-injury-classication1.jpg
9. http://alliancephysicaltherapy.files.wordpress.com/2012/05/common-sites-of-sports-tissue-injury-in-sports.
jpg
Stress Fracture (2012-05-30 12:03)
How Physical Therapy Treatment Works With Bone Injury
[1]Stress fractures, a common [2]injury among sportspeople, were rst reported in military recruits in
the 19
th
century. A stress fracture is a [3]microfracture in bone that results from repetitive physical loading
below the single cycle failure threshold. Overload stress can be applied to bone through two mechanisms:
1. The redistribution of impact forces resulting in increased stress at local points in[4] bone.
2. The action of [5]muscle pull across bone.
Histological changes resulting from [6]bone stress occur along a continuum beginning with [7]vascular con-
gestion and thrombosis. This is followed by osteoclastic and osteoblastic activity leading to rarefactio ,
51
weakened trabeculae and microfracture and ending in complete fracture. This sequence of events can be
interrupted at any point in the[8] continuum if the process is recognized. Similarly ,the process of [9]bony
remodeling and stress fracture in athletes is recognized as occurring along a clinical continuum with [10]pain
or radiographic changes presenting identicable markers along the continuum. Since radioisotopic imaging
and MRI can detect changes in bone at the phase of accelerated remodeling, these investigations can show
[11]stress-induced bony changes in the continuum. Stress fractures may occur in virtually any bone in the
body. The most commonly [12]aected bones are the tibia, metatarsals, bula, tarsal navicular, femur and
pelvis. A list of sites of stress fractures and the likely associated sports or activities . The diagnostic features
of a [13]stress fracture. It is important to note that a, [14]bone scan although a routine investigation for
stress fractures, is non-specic, and other [15]bony abnormalities such as[16] tumors and osteomyelitis may
cause similar pictures. It may also be dicult to localize the site of the area of increased uptake precisely,
especially in an area such as the foot where numerous [17]small bones are in close proximity. [18]Diagnostic
Features
1. Localized pain and tenderness over the [19]fracture site.
2. A history of a recent change in training or taking up a new activity.
3. X-ray appearance is often normal or there may be a [20]periosteal reaction.
4. Abnormal appearance on radioistopic bone scan (scintigraphy), CT scan or MRI.
MRI is being increasingly advocated as the investigation of choice for stress fractures. Even though MRI
does not image fractures as clearly as do computed tomography (CT) scans, it is of comparable sensitivity to
radioisotopic bone scans in assessing bony damage. The typical MRI appearance of a stress fracture show
[21]speriosteal and marrow edema plus or minus the actual fracture line. The [22]treatment of stress fractures
generally requires avoidance of the precipitating activity. The majority of stress fractures heal within six
weeks of beginning relative rest. [23]Healing is assessed clinically by the absence of local tenderness and
functionally by the ability to perform the precipitating activity without pain. It is not useful to attempt to
monitor healing with X-ray or radioistopic bone scan. CT scan appearances of healing stress fractures can be
deceptive as in some cases the fracture is still visible well after clinical healing has occurred. The return to
spot after [24]clinical healing of a stress fracture should be a gradual process to enable the bone to adapt
to an increased load. An essential component of the management of an over use injury is identication and
modication of risk factors. There are, however, a number of sites of stress fractures in which delayed union
or non-union of the fracture commonly occurs. These fractures need to be treated more aggressively. The
sites of these fractures and the recommended treatment.
3. http://http//www.alliancephysicaltherapyva.com/Treatments-Backpain-Neckpain.aspx
aspx
aspx
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2.5 June
Treatment of Lumbar Disk Disease and Spinal Canal Stenosis (2012-06-12 08:59)
Do you want to get relief of your Lower Back Pain ?
SPINAL CANAL STENOSIS
[1]Spinal canal stenosis is narrowing of the spinal canal and the consequent compression of the cord and the
nerve roots. It may aect the [2]cervical thoracic or lumbar spine.
[3]Canal stenosis is common in[4] lumbar vertebrae. One or more roots of the cauda equina may be af-
fected due to the constriction in spinal canal before it exits through the foramen. This condition was rst
described by Portal in 1803.
LUMBAR CANAL STENOSIS
[5]Lumbar canal stenosis is a cauda equina compression in which the lateral or anteroposterior diame-
ter of the spinal canal is narrow with or without a change in the cross-sectional area. The [6]nerve root canals
and the IV foramen may also be narrowed.
Patient may present with [7]low backache, neurological symptoms in the [8]lower limbs and bladder, bowel
dysfunctions in extreme cases
CLASSIFICATION
1. Generalized/localized
2. Segmental (local area of each vertebral spinal segment is aected).
53
Central
Lateral Recesses
Foraminal
Far Out
1. Anatomical area:
Cervical (seen)
Thoracic(rare)
Lumbar (most common)
CAUSES
1. Pathological:
Congenital , For Example. Achondroplasia
Acquired- degenerstive , iatrogenic, and spondylitic.
2. Other Causes:
Pagets Disease
Flurosis
Kyphosis
Scoliosis
Fracture Spine
DISH (Diuse idiopathic skeletal hyperostosis) syndrome.
3. Latrogenic causes ,For Example, hypertrophy of posterior bone graft, incomplete treatment of stenotic
condition, etc.
Degenerative [9]lumbar disk disease leading to thickening and narrowing of the spinal canal is the most
common cause.
CLINICAL FEATURES
[10]Lumbar canal stenosis is common in males above 50 years. Usually, the symptoms are fewer in number,
but the patient may complain of low backache.
Cauda equina claudication is the common symptom. Here, the patient complains of pain in the but-
tocks and legs after walking, which decreases sitting, rest and forward bending. Patient may complain of
54
[11]hypoesthesia and [12]paresthesia. Usually, the patient nds no problem walking uphill or riding a bicycle.
Nerve root entrapment in the lateral recess causes claudication and sciatica.
INVESTIGATIONS
Radiographs of the [13]lumbar spine consisting of AP, lateral and oblique views are recommended. However
radiology may not show stenosis. The following points are looked for:
Reduced interpedicle distance.
AP or midsagittal diameter of the aected vertebra (Normal-15 mm), absolute midsagittal diameter of
the canal is decreased.
Measurement of the lateral sagittal diameter.
Hypertrophy and sclerosis of the facet joints.
Reduced interlaminar space and short, stout spinous process.
Associated features like presence of [14]listhesis, prolapsed disk, [15]osteophytes, etc.
TREATMENT
Conservative Methods
This aims at symptomatic relief of [16]pain.
Drug therapy like the NSAIDs, etc.
Epidural steroids may help in some cases.
Physiotherapy with heating modalities helps.
Pelvic traction may help relieve compression.
Exercises: General conditioning exercises like walking, swimming and exion-oriented exercises are
useful.
Deweighted Treadmill Ambulation: This consists of applying vertical traction with a harness while
doing the treadmill exercises. This oers twin benets of both exercises and traction.
Belts and corsets (soft): These may oer some relief.
Surgical Methods
Most of the [17]surgical methods described for lumbar canal stenosis aim at decompressing the constricted
lumbar canal. Laminectomy is useful in central canal stenosis. Diskectomy and osteotomy of inferior articular
process to remove the hypertrophic elements help.
For lateral canal stenosis laminotomy, disk excision, partial medial facetectomy and foraminotomy help.
[18]Spinal fusion to stabilize the [19]lumbar spine is usually not required as instability is less commonly seen
in lumbar canal stenosis.
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It should be noted that neurogenic claudication responds poorly to the conservative treatment but responds
well to surgical decompression.
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Distal Forearm Fractures (2012-06-21 10:34)
Treatment of Hand and Wrist Fracture:
[1]Colles Fracture
This is also called as Poutteaus fracture in many parts of the world. Abraham Colles rst de-
scribed in the year 1814.
Denition
It is not just [2]fracture lower end of radius but a fracture dislocation of the inferior [3]radioulnar
joint. The fracture occurs about 11/2 (about 2.5 cm) above the carpal extremity of the radius.
Following this fracture, some deformity will remain throughout the life but [4]pain decreases and
movements increase gradually.
Mechanism of Injury
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The common mode of [5]injury is fall on an outstretched hand with dorsiexion ranging from 40-
900 .The force required to cause this fracture is 192 kg in women and 282 kg in men.
Fracture pattern: It is usually sharp on the palmar aspect and comminution on the dorsal surface
of the [6]lower end of radius.
Clinical Features
Usually, the patient is an elderly female in her 60s and the history given is a trivial fall on an out-
stretched hand. The patient complains of pain, [7]swelling, deformity and other usual features of fracture at
the lower end of radius. Though dinner fork deformity is a classical deformity in a Colles fracture, however,
it is not found in all cases but seen only if there is a dorsal tilt or rotation of [8]Colles Fracture.
Styloid Process Test
Normally, the[9] radial styloid process is lower by 1.3cm when compared to the ulnar styloid pro-
cess. In Cones both radial and ulnar styloid processes are at the same level and are found in all displacements
of Colles fracture. Hence, this is a more reliable sign than dinner fork deformity.
Radiology
Radiographs of the wrist both AP and lateral views of the aected [10]wrist and lower end of the
radius are taken. The Points noted in the AP view are metaphyseal comminution, fracture line extending
into the radiocarpal or inferior radioulnar joint and fracture of the [11]ulnar styloid process (seen in about 60
% of the cases). In the lateral view, the points noted are dorsal displacement and dorsal tilt of the distal
fragment, sharp palmar surface and dorsal comminution of the lower end of radius, distal radioulnar joint
subluxation, etc.
Classication
Contrary to popular belief, Colles fracture is both intra-articular and extra-articular and not only
[12]extra-articular. Frykmanns classication takes into consideration both and the fracture of [13]ulna.
Treatment Methods
Aim: The aim of treatment is to restore fully functional [14]hand with no residual deformity. The
treatment methods include Conservative methods, Operative methods and External xators.
Conservative Methods
Here fracture reduction is carried out by closed methods under general anesthesia (GA) or local
anesthesia (LA). The examiner holds the hand of the patient as if to shake hand. With an assistant giving
counteraction by holding the[15] forearm or arm of the patient, the examiner gives traction in the line of the
forearm. This disimpacts the fracture and the examiner corrects the other displacements of the fracture.
At the end of the procedure, styloid process test is carried out to check the accuracy of reduction. If the
level of the styloid processes is restored back to normal, it indicates that the reduction has been achieved
satisfactorily. Then the limb is immobilized by any one of the methods in the table above (mainly Cones
cast) and a check radiograph is taken. The plaster cast is removed after 6-8 weeks and [16]physiotherapy is
begun.
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The common causes for failure of reduction are incomplete reduction of the palmar fracture line
and dorsal comminution of the lower end of radius.
Operative methods
Operative treatment is rarely required for Colles fracture and may be required in the following sit-
uations:
Indications: Extensive comminution, impaction, median nerve entrapment and associated injuries in
adults.
Modalities of operative treatment: Depending upon the degree of comminution and the intra-articular
extensions, one of the following [17]surgical methods is chosen:
Closed reduction and percutaneous pinning with K-wires: Here, after closed reduction by the usual
methods the fracture fragments are held together by percutaneous pinning by one or two K-wires.
Arm control: This method is known to prevent collapse and gives good results in a few select cases.
Open reduction: in certain fractures involving of the distal articular surfaces (Bartons variety open
reduction and [18]plate xation (Ellis plate) is advocated.
Indications: Same as for external xation and for marginal volar or dorsal Bartons fractures.
Advantages
Provides buttress
Resists compression
Load sharing
Early mobilization
External xators
These are found to be extremely useful in highly comminuted fractures, unstable fractures , compound
fractures and bilateral Colles fracture. Through a lightweight UMEX frames, two pins are placed in the
[19]forearm bones and two pins in the metacarpal [20]bones of the hand. These pins are then xed to an
external frame and the fracture fragments are held in position by ligamentotaxis. The frame should be applied
after obtaining closed reduction by the usual method.
Complications
The important complications of Colles fracture are listed in. Few signicant complications are discussed
here.
Malunion: This is the most common complication of Colles fracture. Six important causes are
responsible for it.
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Improper reduction: If the fracture is not reduced properly, in the initial stages it may result in
mal-union later.
Improper and inadequate immobilization: This fracture needs to be immobilized at least for a period of
six weeks failing which malunion results.
Comminuted dorsal surface: Due to extensive comminution, the [21]fracture collapses and recurs after
reduction and casting.
[22]Osteoporosis may lead to collapse and recurrence.
Recurrence: This is due to extensive comminution and osteoporosis.
Rupture of the distal radioulnar ligament: This usually goes undetected in the initial stages of [23]treat-
ment and is responsible for the later recurrence.
Treatment
There are six options of treatment in a malunited Colles fracture:
No treatment is required if the patient has no functional abnormality.
Remanipulation is attempted if [24]fracture is less than 2 weeks old.
Darrachs operation is more often indicated if the patient complains of functional disability.
Corrective osteotomy and grafting if the patient wants cosmetic correction and if the patient is young
(Fernandez and Campbell). Fernandez is a dorsal wedge osteotomy and Campbell is a lateral wedge
osteotomy.
Arthrodesis (for intra-articular fracture): The patient complains of pain in the [25]wrist joint due to
traumatic osteoarthritis following an intra-articular fracture. In these patients, [26]arthrodesis of the
wrist in functional position is the surgery of choice.
Combination of these like Darrachs operation with osteotomy, etc. is also tried in some situations.
Rupture of extensor pollicis tendon: This occurs due to the attrition of the tendon as it glides over the sharp
fracture surfaces. This usually occurs after 4-6 weeks and may be repaired or left alone with no residual
disability.
Sudecks osteodystrophy: This is due to abnormal sympathetic response, which causes vasodilatation and
osteoporosis at the fracture site. The patient complains of pain, swelling, [27]painful wrist movements and
red-stretched shiny skin. Treatment consists of immobilization of the aected part with plaster splints,
injection of local anesthetics near the sympathetic ganglion in the axilla or [28]cervical sympathectomy in
extreme cases.
Frozen hand shoulder syndrome: This is a troublesome complication, which develops due to unnecessary
voluntary [29]shoulder immobilization by the patient on the aected side for fear of fracture displacements.
It is said that the patient has performed a mental amputation and kept the [30]limb still.
Carpal tunnel syndrome: Malunion of Colles fracture crowds the carpal tunnel and compresses the [31]median
nerve.
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Nonunion: This is extremely rare in Colles fracture because of the cancellous nature of the [32]bone,
which enables the fracture to unite well. However, [33]soft tissue interposition may cause this problem. The
[34]treatment consists of open reduction, rigid internal xation and bone grafting.
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Disorders of the Hand (2012-06-22 11:58)
Symptoms And Treatment of Hands Infection:
[1]Hand is a very important organ of the body. Disorders aecting the hand could lead to loss of
hand function in various forms and degrees. Thumb itself accounts for over 40 percent function of the hand.
It is imperative that the problems aecting the hand should be diagnosed and managed correctly. The
following are the various disorders aecting the hand.
CONGENITAL ANOMALIES OF THE HAND:
Some of the important [2]congenital anomalies of the hand are:
Polydactyly: It is a duplication of one or more digits and may require amputation for cosmetic
purposes.
Syndactyly: This is fusion of digits and usually occurs between the middle and ring [3]ngers and
is 3 times more common in males.The fusion may be only in the skin or all the structures. In the latter case,
[4]surgery is done early at 18 months age and in the less severe former case, surgery is done after 5 years.
Macrodactyly: This is a rare congenital anomaly and is characterized by enlargement of all struc-
tures especially of the [5]nerves of a single or more digits. It is often associated with neurobromatosis,
lymph-angioma, arteriovenous malformation, etc.
Congenital trigger digits: [6]Thumb is more commonly involved. It is frequently bilateral and is
due to exion contracture of the [7]distal joint of the thumb. More than 30 percent of these cases resolve
after rst year and the remaining may require surgical release after 2 years of age.
Streeters dysplasia: This is a syndrome of congenital constrictions, which may aect any part of
the body. In the[8] hand, it may range from simple constriction to congenital amputation. To prevent distal
circulatory compromise, it frequently requires surgical release by Z-plasty.
Camptodactyly: This is a exion contracture of the proximal interphalangeal joint especially of the
little nger. It may rarely be seen in other [9]ngers too. Severe deformity in older patients requires tendon
lengthening procedures. Clinicodactyly is angulation of the nger in radioulnar direction. Mild clinicodactyly
is seen in normal children, while the severe ones are associated with mental retardation.
Cleft hand (also called Lobster claw hand): This is frequently bilateral and is associated with [10]cleft foot,
[11]cleft lip, cleft palate, etc. There are two varieties: in the rst type, a deep palmar cleft separates the two
central metacarpals; and in the second type, the central rays are absent .Both the varieties require surgical
excision and Z- plasty.
Mirror Hand (reduplication of ulna): Here the [12]ulna and [13]carpus are reduplicated and there
may be seven or eight ngers with no thumb. Pollicisation of a nger solves the problem of the absent thumb.
Congenital absence of radius or ulna: Congenital absence of radius is more common than that of
ulna. The radius may be completely absent or in parts. The [14]forearm is short, wrist is highly unstable and
the hand is deviated radially. It requires complex and dicult surgical corrections. This deformity of radius
absence is also called radial club hand and the absence of ulna is called the [15]ulnar club hand.
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Kirners deformity: This is a spontaneous injuring of the terminal [16]phalanx of the fth digit. It
is a rare disorder and is more often seen in females.
Infections of the Hand
The eects of hand infection can be as devastating as major [17]trauma. Trivial injuries like a
scratch, a prick, small punctured wounds, etc. cause [18]hand infections. Staphylococcus aureus (80 %)
,Streptococcus pyogenes and gram-negative bacilli are the famous trio who inict the infective unmitigated
disaster in the hand. The sequelae of these infections are edema, abscess, necrosis, brosis and lastly
contractions leading to a grotesque, debilitating hand. The presence of an abscess seems to send a message
to the surgeons, Drain me Ill drain Myself! Hence, an abscess caused should be drained; the surgeon only
has to decide the proper time and incisions. Early use of potent antibiotics has considerably downed the
threat of serious hand infections.
Treatment
As elsewhere before we delve into the discussions on individual hand infections, it helps consider-
ably to know the principles of [19]treatment:
Hands should be kept elevated to facilitate gravity to drain and thereby prevent edema and [20]swelling
of the hand.
Following the treatment, the hand needs to be placed in functional position for optimum results.
Early and appropriate use of IV antibiotics prevents pus formation (within 24-48 hours).
If pus is formed, let it out through proper incisions at the appropriate time.
Local anesthetic may help the spread of [21]infection and adds more uid to the already existing swelling.
Hence, general anesthesia or regional block is preferred.
Tourniquet is indicated, but exsanguinations are not preferred as it helps spread the infection (alterna-
tively, elevation of hand for three minutes is ideal).
Do not forget the all important hand aftercare, which has a direct bearing on the outcome of the hand
function.
With the principles of treatment as a backdrop, let us now consider the important [22]hand infections in
order of importance.
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2.6 July
Congenital Disorders of Upper Limb (2012-07-04 09:39)
WRYNECK : Causes, Symptoms and Treatment
[1]Congenital disorders are dened as those abnormalities of development that are present at the time
of [2]birth. It is quite a common problem exceeded in frequency only by those of CNS and CVS systems.
Congenital disorders can be placed in three groups.
Those easily noticed by the mother, e.g. clubfoot.
Those not readily noticed, e.g. congenital dislocation of [3]hip (CDH).
Those clinically undetected but diagnosed radiologically, e.g. spondylolisthesis.
Congenital disorders are more prevalent in diabetic mothers, multiple pregnancies, older mothers, etc. Male
and female have equal predilection.
Causes
The exact cause is not known. Most congenital disorders begin early in the life of the embryo when
cell division is most active. Although a few congenital disorders may be due to uterine malposition, most are
believed to be due to [4]genetic defects, environmental inuences or a combination of both.
Genetic Factors
[5]Defects in the chromosomes of sperm and ovum result in specic disorders ,which follows Mendels
law.
Embryonic Trauma
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Congenital disorders can also result from [6]injury to the developing embryo at the time of dierentia-
tion of embryonic tissue into specic tissues by extraneous factors.
CONGENITAL TORTICOLLIS (WRYNECK)
[7]Congenital torticollis is a condition where the sternocleidomastoid muscle of the [8]neck undergoes contrac-
tures pulling it to the same side and turning the face to the opposite side. The exact cause of this condition
is unknown; but hypothetically, it may be due to bromatosis within the sternomastoid muscle.
Etiology
Middle part of the sternomastoid is supplied by an end [9]artery, which is a branch of the superior
[10]thyroid artery that is blocked due to trauma, etc.
Birth trauma-Breech delivery, improper application of forceps, etc. may cause [11]injury to the
sternomastoid muscle.
The above two reasons can result in sternocleidomastoid muscle ischemia, necrosis and brosis later on.
Clinical Features
Deformity is the only complaint initially. Later, facial changes and macular problems in the retina may
develop.
Radiograph
Plain X-ray of the neck AP and lateral views are essential to detect any congenital abnormality of the
[12]cervical vertebra that could lead to this condition.
Treatment
Principles
During infancy, conservative treatment consists of stretching of the sternomastoid by manipulation and
[13]physiotherapy. Excision is unjustied in infancy.
[14]Surgery is delayed until broma is well-formed. The muscle may be released al one or both ends
and the muscle may be excised as a whole.
If the muscle is still contracted at the age of 1 year, it should be released.
If [15]wryneck is persistent for I year, it will not resolve spontaneously and needs to be interfered
operatively.
[16]Exercise program is successful:
1. When restriction of motion is less than 30 degree.
2. When there is no facial asymmetry.
64
Non-operative [17]treatment after 1 year is rarely successful.
Any permanent torticollis becomes worse during growth. Head is inclined towards the aected side,
face is turned towards the opposite side, ipsilateral [18]shoulder is elevated and the fronto-occipital
diameter is increased.
Surgical Method The most commonly employed surgical method is subcutaneous tenotomy of the clavicular
attachment of the sternomastoid muscle. This procedure is inaccurate and dangerous as there could be an
injury to the external jugular vein and phrenic [19]nerve. Hence, release from its attachment on the mastoid
process is also tried. Open tenotomy if done before the child is 1 year old, tethering of the scar takes place.
If the surgery is done between 1 and 4 years of age, tilt of the head and facial asymmetry are corrected less
satisfactorily. If done after 5 years of age, the secondary deformities are less corrected. For older children or
after failed operation, bipolar release of the [20]muscle from both sides, Ferkels modied bipolar release or
Z-plast of the muscle is tried.
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Shin Pain (2012-07-11 10:06)
How you get relief from Stress Fracture of the Tibia?
Symptoms:
65
[1]Stress fractures are more commonly a cause of [2]shin pain in athletes in impact, running and jumping
sports. Overall [3]limb and [4]foot alignment as well as limb length discrepancy may also play a role. The
incidence of stress fractures is increased by playing on more rigid, unforgiving surfaces.
Approximately 90 % of tibial [5]stress fractures will aect the postero-medial aspect of the tibia, with the
middle third and junction between the middle and distal thirds being most common. Proximal metaphyseal
stress fractures may be related to more time loss from [6]sports as they do not respond as well to functional
bracing, which allows earlier return to play.
Stress fractures on the anterior edge of the [7]tibia, the tension side of the bone, are more resistant to
[8]treatment and have a propensity to develop a non-union when compared to the risk of posteromedial stress
fractures. A simple memory tool for the problematic [9]anterior tibial stress fracture is anterior is awful.
A classic case presentation for a routine postero-medial stress fracture is as follows:
Gradual onset of [10]leg pain aggravated by exercise.
[11]Pain may occur with walking, at rest or even at night.
Examination-localized tenderness over the [12]tibia.
Biomechanical examination may show a rigid, cavus foot incapable of absorbing load, an excessively
pronating foot causing excessive [13]muscle fatigue or a leg length discrepancy.
Tenderness to palpation along the medial border with obvious tenderness. A stress fracture of the
posterior cortex produces symptoms of [14]calf pain.
[15]Bone scan and MRI appearances of a stress fracture of the tibia. MRI scan is of particular value as
the extent of edema and cortical involvement has been directly correlated with the expected return to
sport.
A CT scan may also demonstrate a stress fracture.
Treatment:
Prior to initiating [16]treatment or during the treatment plan, it is important to identify which factors
precipitated the stress fracture. The most common cause is an acute change in training habits, such as a
signicant increase in distance over a short period of time, beginning double practice days after lying o
training for a season, or a change to a more rigid playing surface. Shoe wear, biomechanics and repetitive
impact sports such as running and gymnastics have also been implicated. The [17]athletes coach can play a
key role in modifying training patterns to reduce the risk of these [18]injuries. In women, reduced bone density
due to hypoestrogenemia secondary to athletic amenorrhea (the female athlete triad) may be a contributing
factor. All female athletes with a rst-time stress fracture should be screened for the female athlete triad.
The classic treatment plan is as follows:
Initial period of rest (sometimes requiring a period of non-weight-bearing on crutches for [19]pain relief)
until the [20]pain settles.
66
The use of a pneumatic brace has been described. Studies have shown a markedly reduced return to
activity time with such use compared with average times in two of three studies and compared with
a traditional [21]treatment group in the third. In this latter study the brace group returned to full,
unrestricted activity in an average of 21 days compared with 77 days in the traditional group. The brace
should extend to the knee as the mid-leg version may actually increase the stresses across a mid shaft
stress fracture. Once a stress fracture is clinically healed the athlete is advised to use the brace during
practise and competition. Clinical healing implies minimal to no palpable [22]pain at the fracture site
and minimal to no [23]pain with activities in the brace. Using this plan, there have been no reported
cases of progression to complete catastrophic fracture of the tibia.
If pain persists, continue to rest from sporting activity until the bony tenderness disappears (four to
eight weeks).
Once the patient is pain-free when walking and has no [24]bony tenderness, gradually progress the
quality and quantity of the exercise over following month. The athlete should be asked to continue to
use a pneumatic brace to complete the current season until an appropriate period (four to eight weeks)
of rest can occur.
Cross training with low impact [25]exercises, including swimming, cycling and deep water running,
maintains conditioning and reduces risk of recurrence.
Pain associated with soft [26]tissue thickening distal to the fracture site can be treated by soft tissue
techniques.
General principles of return to activity following overuse [27]injury should be followed.
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ANTERIOR KNEE PAIN (2012-07-18 05:16)
Symptoms And Treatment of Knee Pain :
[1]Anterior knee pain is the most common presenting symptoms in many [2]physiotherapy and sports
physician practises.1 It contributes substantially to the 20-40 % of family practise consultations that relate to
the musculoskeletal system. Two common causes of anterior knee pain in [3]sports people are patellofemoral
pain and patellar tendinopathy.
We rst outline a practical approach to assessing the patient with anterior knee pain particularly
with a view to distinguishing the common conditions; we then detail their [4]management. These concludes
with an outline of other cause of anterior knee pain such as fat pad impingement, which may mimic features
of both patellofemoral [5]pain and [6]patellar tendinopathy.
Clinical approach
Distinguishing between patellofemoral pain and patellar tendinopathy as a cause of [7]anterior knee
pain can be dicult as their clinical features can be similar. Furthermore, on occasions, the two conditions
may both be present.
History
There are a number of important factors to elicit from the history of a sportsperson with the gen-
eral presentation of anterior knee pain. These include the specic location of the [8]pain, the nature of
aggravating [9]activities, the history of the onset and behaviour of the pain and any associated clicking,
giving way of [10]swelling.
Although it may be dicult for the [11]patient with anterior knee pain to be specic, the area of
pain often gives an important clue as to which structure is contributing to the [12]pain .For example,
retropatellar or peripatellar pain suggests that the patellofemoral [13]joint (PFJ) is a likely culprit, [14]lateral
pain localized to the lateral femoral epicondyle indicates iliotibial band friction syndrome and inferior patellar
pain implicates the patellar tendon or infrapatellar fat pad. The patient presents with bilateral knee pain is
more likely to have patellofermoral pain or tendinopathy than an interal derangement of both knees.
The onset of typical patellofemoral pain is often insidious but it may present secondary to an [15]acute
traumatic episode (e.g. falling on the knee) or post other [16]knee injury (e.g. meniscal, ligament) or [17]knee
surgery. The patient presents with a diuse ache, which is usually exacerbated by loaded activities, such as
stair ambulation or running. Sometimes patellofemoral pain is aggravated by prolonged sitting (movie-goers
knee), but sitting tends to aggravate pain of patellar tendinopathy so is not diagnostic of patellofemoral
pain. Pain during running that gradually worsens is more likely to be of patellofemoral origin, whereas pain
68
that occurs at the start of activity, settles after warm-up and returns after activity is more likely to be
patellar tendinopathy. To clinical dierentiation of patellofemoral pain, patellar tendinopathy and fat pad
impingement. As these conditions can coexist, accurate [18]diagnosis can be challenging.
A history of recurrent crepitus may suggest [19]patellofemoral pain. A feeling that the patella moves laterally
at certain times suggests recurrent patellofemoral instability. An imminent feeling of giving way may be
associated with patellar subluxation, patellofemoral pain or meniscal abnormality, although frank, dramatic
giving way is usually associated with anterior cruciate [20]ligament instability. Nevertheless, giving way due
to [21]muscle inhibition, or due to pain, is not uncommon in anterior knee pain presentations.
Examination
Initially, the primary aim of the clinical assessment to determine the most likely cause of the pa-
tients since location of tenderness and aggravating factors are integral to the dierential diagnosis, it is
critical to reproduce the patients [22]anterior knee pain. This is usually done with either a double- or
single-[23]leg squat. A squat done on a decline may make the test more specic to the anterior knee. The
clinician should palpate the anterior knee carefully to determine the site of maximal tenderness.
Examination includes:
1. Observation
standing
walking
supine
2. Functional tests
squats
step-up/step-down
jump
lunge
double-then single - leg decline squat
3. Paplation
patella and inferior pole
medial lateral retinaculum
patellar tendon
infrapatellar fat pad
69
tibial tubercle
eusion
4. PFI assessment
static assessment of patella position
superior
inferior
medial
lateral glide
dynamic assessment of patella position
assessment of vasti function
5. Flexibility
lateral soft tissue structures
quadriceps
hamstring
iliotibial band
gastrocnemius
Investigations
Imaging may be used to conrm a clinical impression obtained from the history and examination. Structural
imaging includes conventional radiography, ultrasound, CT and MRI. Occasionally, radionuclide [24]bone
scan is indicated to evaluate the metabolic status of the [25]knee (e.g. after trauma, in suspected [26]stress
fracture).
The majority of patients with patellofemoral [27]pain syndrome will require either no imaging, or plain
radiography consisting of a standard AP view, a true lateral view with the knee in 300 of exion, and an axial
view through the knee in 300 of exion. Plain radiography can detect bipartite patella and [28]osteoarthritis,
provide evidence of an increased likelihood of Sinding-Larsen-Johansson lesions as well as rule out potentially
serious complications such as [29]tumor or infection .Although CT and three dimensional CT have been used
to assess the PFI ,MRI is gaining increasing popularity as an investigations of patellofermoral pain, and the
unstable patella because of its capacity to image the patellar articular cartilage.
Treatment
[30]Treatment of patellar tendinopathy requires patience and a multifaceted approach, which is outlined.
It is essential that the practitioner and patience recognize that tendinopathy that has been present for
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months may require a considerable period of [31]treatment associated with [32]rehabilitation before symptoms
disappear. Conservative management of patellar tendinopathy requires appropriate strengthening exercises,
load reduction, correcting biomechanical errors, and [33]soft tissue therapy. An innovation has been the use
of sclerotherapy of neovessels with polidocanol.
[34]Surgery is indicated after a considered and lengthy conservative program has failed. This section outlines
the [35]physical therapy approach of correction of biomechanics that might be contributing to excessive load
on the tendon, targeted exercise therapy and soft tissue treatment before outhning [36]medical treatments
including medication, sclerotherapy and surgery.
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2.7 August
Cervical Headache (2012-08-11 06:53)
Treatment of Headache:
[1]Cervical or cervicogenic [2]headache is a term used to describe headache caused by abnormalities
of the [3]joints, muscles, [4]fascia and neural structures of the cervical region. There are a number of
classications for cervical or cervicogenic headache with diering criteria for physical dysfunction.
Mechanism
The mechanism of production of [5]headache from abnormalities in the cervical region is variable.
It may be primarily referred [6]pain caused by irritation of the [7]upper cervical nerve roots. This may be due
to damage to the atlantoaxial joint or compression of the nerves as they pass through the muscles. Headache
emanating from the [8]lower cervical segments probably originates from irritation of the posterior primary
rami, which transmit sensation to the spinal portion of the trigeminocervical nucleus.
Commonly, pain may also be referred to the [9]head from active trigger points. Frontal headaches
are associated with trigger points in the suboccipital [10]muscles, while temporal headaches are associated
with trigger points in the upper trapezius, splenius capiitis and cervicis, and sternocleidomastoid muscles.
Clinical Features
History
A [11]cervical headache is typically described as a constant, steady, [12]dull ache, often unilateral
but sometimes bilateral. The patient describes a pulling or gripping feeling or, alternatively, may describe a
tight band around the [13]head. The headache is usually in the suboccipital region and is commonly referred
to the frontal, retro-orbital or temporal regions.
Cervical headache is usually of gradual onset. The patient often wakes with a headache that may
improve during the day. Cervical headaches may be present for days, weeks or even months. There may be a
history of acute trauma, such as a whiplash [14]injury sustained in a motor accident, or repetitive [15]trauma
associated with work or a sporting activity.
Cervical headache is often associated with neck pain or stiness and may be aggravated by [16]neck
or head movements, such as repetitive jolting when traveling in a car or bus. It is often associated with a
feeling of light-headedness, dizziness and tinnitus. [17]Nausea may be present but vomiting is rare. The
patient often complains of impaired concentration, an inability to function normally and depression. Poor
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posture is often associated with a cervical headache. This may be either a contributory factor or an eect
of a [18]headache. The abnormal posture typically seen with cervical headache is rounded [19]shoulders,
extended neck and protruded chin. This results in tightness of the upper cervical extensor muscles and
weakness of the cervical exor muscles.
[20]Stress is often associated with cervical headache. It may be an important contributory factor
to the development of the [21]soft tissue abnormalities causing the headache or may aggravate abnormalities
already present. Thus, it is important to elicit sources of stress in the clinical history.
Exercise-Related Causes of Headache
Benign Exertional Headache
Benign [22]exertional headache (BEH) has been reported in association with weightlifting, running
and other [23]sporting activities. The IHS criteria include that the headache:
Is specically brought on by physical exercise
Is bilateral, throbbing in nature at onset and may develop migrainous features in those patients
susceptible to [24]migraine
Lasts from 5 minutes to 24 hours
Is prevented by avoiding excessive exertion
Is not associated with any systemic or intracranial [25]disorder.
The onset of the headache is with straining and [26]Valsalva maneuvers such as those seen in weightlifting
and competitive swimming. The major dierential diagnosis is subarachnoid hemorrhage, which needs to
be excluded by the appropriate investigations. It has been postulated that exertional headache is due to
dilatation of the [27]pain-sensitive venous sinuses at the base of the [28]brain as a result of increased cerebral
arterial pressure due to exertion. Studies of weight- lifters have shown that systolic blood pressure may reach
levels above 400 mmHg and diastolic pressures above 300 mmHg with maximal lifts.
A similar type of headache is described in relation to sexual activity and has been termed benign sex
headache or orgasmic cephalalgia (IHS 4.6). The [29]management of this condition involves either avoiding
the precipitating activity or drug treatment, for example, indomethacin (25 mg three times a day). In practise,
the headaches tend to recur over weeks to months and then slowly resolve in some cases they may be lifelong.
Treatment
[30]Treatment of the patient with cervical headache requires correction of the abnormalities of joints,
muscles and neural structures found on examination as well as correction of any possible precipitating
factors such as postural abnormalities or emotional stress.
[31]Treatment of cervical intervertebral joint abnormalities involves mobilization or manipulation of the
Cl-2 and C2-3 joints.
Stretching of the cervical extensor muscles and strengthening of the [32]cervical exor muscles are
important.
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[33]Soft tissue therapy to the muscles and the fascia of the cervical region is aimed at releasing generally
tight muscles and fascia (commonly the cervical extensors).
Active trigger points should be treated with spray and [34]stretch techniques or dry needling.
Cervical muscle retraining has been shown to be benecial by itself and in combination with manipulative
[35]therapy in reducing the incidence of cervicogenic headache.
This includes retraining of the deep cervical exors ,extensors and scapular stabilizers.
Postural retraining is an essential part of treatment. The patient must learn to reduce the amount of
cervical extension by retracting the chin.
Identication and reduction of sources of stress to the patient should be incorporated in the[36] treatment
program.
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The Benets of Physical Activity in the Elderly (2012-08-28 12:07)
Physical Health Benets of Exercise:
[1]Physical activity benets all body organs as well as the psyche. The most dramatic benets have been
found in the [2]cardiovascular system. Exercise interventions in older patients with coronary [3]heart disease
decreased morbidity, mortality and symptoms, and reduced cardiac re-hospitalizations.
Benets of Exercise
Numerous mechanisms may contribute to these [4]benets. Increased demand on the myocardium im-
proves oxygen utilization. Capillaries dilate and multiply to improve the delivery of oxygen and other
nutrients to [5]muscles. The myoglobin content of muscle is increased, thus improving the transfer of oxygen
from the red blood cells to muscle cells. Inside the cell, the number of mitochondria increases, enhancing
aerobic metabolism. There is also an increase in the glycogen storage sites of muscle. Here following are the
[6]exercise benets:
Exercise tends to lower the resting [7]heart rate and the resultant increased diastolic time allows
improved coronary blood ow. Stroke volume increases.
[8]Exercise also has an eect on blood lipid levels, raising levels of high-density lipoprotein cholesterol,
the cardio protective lipid, and lowering levels of low-density lipoprotein [9]cholesterol.
Exercise lowers blood pressure and reduces obesity. A combination of these two factors, in addition to
the reduction in cholesterol, decreases the risk of ischemic heart disease.
Exercise may also improve exercise tolerance in older people with [10]chronic obstructive pulmonary
[11]disease. They will also benet from the associated benets of aerobic [12]tness.
Exercise may improve blood sugar control in people with diabetes by decreasing insulin resistance, and
may reduce the need for medication.
Resistance training and high-impact activities help maintain bone mass in the [13]elderly.
An exercise program may also be benecial for older people with [14]osteoarthritis by improving joint
mobility and increasing muscle strength.
Exercise in the form of strength and balance training has been shown to reduce an older persons risk
of falling.
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Along with the [15]physical benets of exercise, the older athlete benets from improved sleep, cognitive
function and mood.
The muscle control and weight loss associated with exercise may lead to improvements in body image
and reverse the elderly persons fear of [16]activity.
Exercise reduces [17]anxiety in elderly patients, especially in those recovering from illness.
Exercise can lessen depressive symptoms and perhaps even reduce the risk of developing depression.
Risks of Exercise in the Elderly
The risks associated with a sedentary lifestyle are well known although dicult to quantify objectively
and compare with the risks associated with exercise in later years. Underlying co-morbidity is often cited as
a reason to preclude exercise despite the overwhelming evidence to support the benets of exercise in many
common and [18]chronic diseases.
From a safety standpoint, clinicians prescribing exercise for older people are concerned that exercise may
induce [19]myocardial ischemia and, in turn, precipitate myocardial infarction or sudden death. Gill and
colleagues have provided recommendations regarding precautions that can be taken to minimize the risk
of serious adverse cardiac events among previously sedentary older persons who do not have symptomatic
[20]cardiovascular disease and are interested in starting an exercise program.
Reducing the Risks of Exercise
Before starting an exercise program, all older persons should have a complete history and physical ex-
amination performed by a [21]physician. Contraindications to exercise outside of a monitored environment
include: myocardial infarction within six months, angina or physical [22]signs and symptoms of congestive
heart failure, and a resting systolic blood pressure of 200 mmHg or higher. A functional test of cardiac
capacity is to ask the patient to walk 15 m (50 ft) or climb a ight of stairs. A resting ECG/EKG should be
reviewed for new Q waves, ST segment depressions or T-wave inversion.
Persons who have features of cardiovascular disease should be referred for appropriate management. If
the patient has no overt cardiovascular disease, and no other medical or [23]orthopedic contraindications to
exercise, he or she can begin a low-intensity [24]exercise program.
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Chronic Fatigue Syndrome (CFS) (2012-08-31 12:23)
Symptoms and Causes of Chronic Fatigue Syndrome:
[1]Chronic Fatigue Syndrome (CFS) is a controversial condition, the existence of which is hotly debated within
the medical profession. The term itself was rst used in 1988 but the syndrome has existed for much longer.
It has previously been known as neurasthenia and myalgic encephalomyelitis (ME). The term CFS has been
adopted to dene a suciently homogeneous group of patients to allow research into etiology, pathogenesis,
natural history and [2]management. As the word syndrome suggests, CFS is not recognized as a distinct
[3]disease process.
Denition
A number of denitions of CFS have been proposed. All include the concept of [4]fatigue that interferes with
activities of daily living and is of at least six months duration. The Center for Disease Control (CDC) in
Atlanta has dened CFS as the presence of:
1. Clinically evaluated, unexplained, persistent or relapsing fatigue that is of new or denite onset; is not
the result of ongoing [5]exertion; is not alleviated by rest; and results in a substantial reduction of
previous levels of occupational, educational, social or personal [6]activities.
2. Four or more of the following [7]symptoms that persist or recur during six or more consecutive months
of illness and that do not predate the fatigue:
Self-reported impairment in short-term memory or concentration
[8]Sore throat
Tender cervical or axillary nodes
[9]Muscle pain
Multi -joint pain without redness or swelling
Headaches of a new pattern or severity
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Un-refreshing sleep
Post-Exertional malaise of at least 24 hours
Symptoms
The most prominent [10]symptom of CFS is usually overwhelming fatigue, especially after exercise.
Other [11]common symptoms include headaches, sore throat, enlarged lymph nodes, muscles pain
especially after exercise, un-refreshing sleep, chest and abdominal [12]pains.
The diagnosis of CFS is dicult to conrm in the absence of any denitive sign or test.
It is often a [13]diagnosis of exclusion.
The other problem with the diagnosis of CFS is that there are a number of conditions whose symptoms
overlap with those of CFS.
The two most signicant are bromyalgia and [14]depression.
The major presenting symptom in bromyalgia is usually widespread muscle and [15]joint pain but
fatigue is nearly always present.
[16]Fibromyalgia is characterized by the presence of multiple tender points in the muscles.
Trigger points are also frequently seen in patients with CFS and form an important part of the treatment.
Fatigue is often the primary presenting symptom in patients with depression and many of the symptoms
described in CFS are found in depressive patients.
Management
[17]Management of the patient with CFS (or bromyalgia and depression) is a considerable challenge for
the practitioner. The natural history of CFS is of a very gradual improvement over a period of months and
sometimes years.
[18]Treatment should be oriented towards psychological support and symptom relief.
It is essential that the treating practitioner acknowledges that the patient has a real problem and is
prepared to give the patient a diagnosis.
It is important to give the patient plenty of time and both the patient and those close to her (or him)
will have many questions.
We recommend seeing the patient at least weekly in the initial treatment phase and later on a less
frequent but still regular basis.
Exercise is the cornerstone of treatment of [19]chronic fatigue.
This may seem strange when one considers that post-exercise fatigue and muscle pain are two of the
most signicant features of the [20]disease but a slow, graduated increase in activity is an essential part
of management.
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The exercise program may have to commence at a ridiculously low level considering the history of
some athletes.
But it should commence at a level that the patient can achieve comfortably with minimal or no adverse
eects in the 24-48 hours post-exercise.
The increase in activity should be very gradual and if adverse symptoms develop, the patient should
return to the previous level of [21]activity and build up even more slowly.
In a six-month randomized blinded prospective trial in individuals with CFS, it was found that a graded
exercise program signicantly improved both health perceptions and the sense of fatigue whereas the
use of an antidepressant (uoxetine) improved depression only.
Another study of 66 patients with CFS also demonstrated a positive eect with graded aerobic [22]ex-
ercise.
Many [23]drug treatments have been advocated but with little evidence of their ecacy.
Simple analgesics may be helpful and we recommend the use of a tri- cyclic antidepressant (e.g.
amitryptiline 10-25 mg) in a single nocte dose.
This drug seems to improve sleep quality and patients will usually wake up more refreshed as a result.
Many nutritional supplements have also been advocated but again there is no evidence of their ecacy
we have found the [24]treatment of muscle trigger points with dry needling to be helpful in reducing
muscle pains and headaches in a number of patients with CFS.
Other Causes of Tiredness
A number of psychological problems are associated with a feeling of excessive tiredness. The two most
common states are [25]anxiety and depression. These problems may be related to the athletes sporting
endeavors or, alternatively, may be quite unrelated.
The presence of eating disorders such as [26]anorexia, nervosa and bulimia should also be considered.
Hypothyroidism is more common than most realize, occurring in 1 % of adults, with subclinical disease
in Solo. The condition can aect any organ system.
Hypothyroidism is characterized by a general slowing of body processes and can present as chronic
fatigue, cold intolerance, weight gain and, in women, menorrhagia.
It is often associated with high [27]cholesterol levels.
An elevated serum [28]thyroid stimulating hormone level is a sensitive indicator and patients with this
condition generally respond well to treatment with levothyroxine.
Diabetes, neuromuscular disorders and [29]cardiac problems are all associated with excessive tiredness.
Exercise induced as the major symptom rather than the more typical cough, chest tightness or shortness
of [30]breath post exercise.
A number of medications may cause excessive tiredness.
These include beta-blockers, [31]antihistamines, diuretics, anticonvulsants, sedatives and muscle relax-
ants.
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2.8 September
Diabetes Mellitus Treatment (2012-09-12 10:10)
Exercise of Type 1 Diabetes and Type 2 Diabetes Disease:
Firstly, the adjustments the athlete with [1]diabetes might make if he or she wishes to [2]exercise and,
secondly, what the risks and benets are, both in the short term and long term, of exercise to the patient
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with diabetes.
There are many examples of athletes with diabetes who have been extremely successful. British rower
Steven Redgrave developed diabetes at the age of 35 having won gold medals at each of the previous four
Olympic Games. Following his diagnosis he was able to continue training and competing and won a fth
consecutive gold medal in the Sydney Olympics Games 2000.
There are two distinct types of [3]diabetes mellitus:
1. Insulin-Dependent (Type 1)
2. Non-Insulin-Dependent (Type 2)
Type 1 Diabetes
Type 1 Diabetes(Insulin-Dependent Diabetes Mellitus, IDDM), previously known as juvenile-onset dia-
betes, is thought to be an inherited [4]autoimmune disease in which antibodies are produced against the beta
cells of the pancreas. This ultimately results in the absence of [5]endogenous insulin production, which is
the characteristic feature of type 1 diabetes. The incidence of type 1 diabetes varies throughout the world
but represents approximately 10-15 % of diabetic cases in the western world. The onset commonly occurs in
childhood and adolescence but can become symptomatic at any age. Insulin administration is essential to
prevent ketosis, [6]coma and death. The aims of [7]treatment are tight control of blood glucose levels and
prevention of micro vascular and macro vascular complications.
Type 2 Diabetes
Type 2 Diabetes (Non-Insulin-Dependent Diabetes Mellitus, NIDDM), previously know maturity-onset
or adult-onset diabetes, is a disease as the former names suggest, of later onset ,linked to both [8]genetic and
lifestyle factors. It is characterized by diminished insulin secretion relative to serum glucose levels in conjunc-
tion with [9]peripheral insulin resistance, both of which result in chronic hyperglycemia. Approximately 90 %
of individuals with diabetes have [10]type 2 diabetes and it is thought to aect 3-7 % of people in Western
countries. The prevalence of type 2 diabetes increases with age. The pathogenesis of type 2 diabetes remains
unknown but it is believed to be a heterogeneous disorder with a strong genetic factor. Approximately 80 %
of individuals with 2 diabetes are obese.
Type 2 diabetes is characterized by three major [11]metabolic abnormalities:
Impairment in pancreatic beta cells insulin secretion in response to a glucose stimulus.
Reduced sensitivity to the action of insulin in major organ systems such as [12]muscle, [13]liver and
adipose tissue.
Excessive [14]hepatic glucose production in the basal state.
Exercise and Diabetes:
The [15]sports physician should be encouraged to work closely with the endocrinologist when consider-
ing [16]exercise prescription for a diabetic patient. The target of an adult should be to achieve at least 30
minutes of continuous moderate activity, equivalent to brisk walking ve or six days a week, with the exibility
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of shorter bouts of more intense activity being considered important. This is provided that [17]cardiovascular
and hypertensive problems are taken into account. [18]Heart rate may be an unreliable indicator of exertion
because of autonomic [19]neuropathy, and the rating of perceived exertion scales may be more useful.
Although exercise in conjunction with a proper diet and medications is the cornerstone in the treatment of
diabetes, special care must be taken in those taking insulin. Both insulin and exercise independently facilitate
glucose transport across the [20]mitochondrial membrane by promoting GLUT4 transporter proteins from
intracellular vesicles. The action of insulin and exercise is also cumulative. As such, an exercising type 1
diabetic will have lowered insulin requirements, and may notice up to a 30 % reduction in insulin requirements
with exercise. Importantly, in the person with [21]type 1 diabetes, glycemic control may not be improved
with regular exercise if changes in the individuals diet and insulin dosage do not appropriately match exercise
requirements. In the absence of exercise, even for a few days, the increased insulin sensitivity begins to
decline.
All patients with diabetes should carry an identication card or bracelet identifying them as having di-
abetes. They should be educated to be alert to the early signs of [22]hypoglycemia for at least 6-12 hours
after exercise. It is essential that they carry glucose tablets or an alternative source of glucose with them
at all times. [23]Dehydration during exercise should be prevented by adequate uid consumption. It is also
recommended that the diabetic athlete exercise with somebody else, if possible, in case of adverse reactions.
Benets of Exercise:
The [24]benets of exercise in type 1 diabetics include improved insulin sensitivity, improved blood lipid
proles, decreased heart rate and blood pressure at rest, decreased body weight and possible decreased
risk of coronary heart disease.
It does not appear that exercise improves glycemic control; however, insulin requirements may be
decreased slightly.
While exercise may not improve glucose control, the benets of exercise in those with diabetes occur
mainly through reducing the risk factors for cardiovascular disease.
People with type 1 diabetes typically live longer if they participate in regular [25]physical activity as a
part of their lifestyle.
It is well recognized that exercise reduces the risk of developing type 2 diabetes. There are also
considerable benets for those with type 2 diabetes.
A program of regular physical activity can reverse many of the defects in metabolism of both fat and
glucose that occur in people with type 2 diabetes.
As noted above, Hb is used as an index of long term blood glucose control. The lower the value, the better.
Hb is reduced by chronic exercise in people with type 2 diabetes. The evidence for improvement of Hb with
exercise in type I diabetes is not as convincing.
Exercise and Type 1 Diabetes
Control of blood glucose is achieved in a patient with type 1 diabetes through a balance in the [26]car-
bohydrate intake, exercise level and insulin dosage. The meal plan and insulin dosage should be adjusted
according to the patients response to exercise. Unfortunately a degree of trial and error is necessary for
type 1 diabetics taking up new activities. Frequent self-monitoring should occur, at least until a balance is
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achieved among diet, exercise and insulin parameters. Those with blood glucose levels less than 5.5 mmol/L
(100 mg/dL) require a pre-exercise carbohydrate snack (e.g. sports drink, juice, glucose tablet, fruit).
Exercise of 20-30 minutes at less than 70 % VO (e.g. walking, golf, table tennis) requires a rapidly
absorbable carbohydrate (15 g fruit exchange or 60 calories) before exercise but needs minimal insulin
dosing adjustments.
More vigorous activity of less than I hour (e.g. jogging, swimming, cycling, skiing, tennis) often requires
a 25 % reduction in pre-exercise insulin and 15-30 g of rapidly absorbed carbohydrate exchange before
and every 30 minutes after the onset of activity.
If early morning activity is to be performed the [27]basal insulin from the evening dose of intermediate-
acting insulin may need to be reduced by 20-50 %, with checking of the morning blood glucose level.
The morning regular-acting insulin dose may also need to be reduced by 30-50 % before breakfast, or
even omitted if exercise is performed before food.
Depending on the intensity and duration of the initial activity and likelihood of further activity, a
reduction of 30-50 % may be needed with each subsequent meal.
After exercise hyperglycemia will occur, but insulin should still be decreased by 25-50 % (because
insulin sensitivity is increased for 12-15 hours after activity has ceased).
Consuming carbohydrates within 30 minutes after exhaustive, glycogen-depleting exercise allows for
more ecient restoration of [28]muscle glycogen.
This will also help prevent post-exercise, late-onset hypoglycemia, which can occur up to 24 hours
following such exercise.
If exercise is unexpected, then insulin adjustment may be impossible. Instead, supplementation
with 20-30 g of carbohydrate, at the onset of exercise and every 30 minutes thereafter, may prevent
hypoglycemia.
In elite athletes and with intense bouts of exercise, reductions in insulin dosage may be even higher
than those listed above.
During periods of inactivity (e.g. holidays, recovery from injury), increased insulin requirements are to
be expected.
Exercise and Type 2 Diabetes
Those patients with type 2 diabetes who are managed with diet therapy alone do not usually need to
make any adjustments for exercise.
Patients taking oral hypoglycemic drugs may need to halve their doses on days of prolonged exercise or
withhold them altogether, depending on their[29] blood glucose levels.
They are also advised to carry some glucose with them and to be able to recognize the symptoms of
hypoglycemia.
Hypoglycemia is a particular risk in those people with diabetes taking sulfonylureas due to their long
half lives and increased endogenous insulin production.
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[30]Biguanides provide less of a problem as they do not increase insulin production.
Exercise and the Complications of Diabetes:
Exercise is often neglected when the secondary complications of diabetes occur. Some unique concerns
for the patient with diabetes that warrant close scrutiny include autonomic and [31]peripheral neuropathy,
retinopathy and [32]nephropathy. Poor glucose control appears to be associated with an increased occurrence
of neuropathy.
Abnormal autonomic function is common among those with diabetes of long duration.
The risks of exercise when autonomic neuropathy is present include hypoglycemia, abnormal heart
rate and [33]blood pressure responses (e.g. postural drop), impaired sympathetic and parasympathetic
nervous system activity and abnormal thermoregulation.
Patients with autonomic neuropathy are at high risk of developing complications during exercise.
Sudden death and [34]myocardial infarction have been attributed to autonomic neuropathy and diabetes.
High-intensity activity should be avoided, as should rapid changes in body position and extremes in
temperature. Water activities and stationary cycling are recommended.
Peripheral neuropathy (typically manifested as loss of sensation and of two point discrimination) usually
begins symmetrically in the lower and upper extremities and progresses proximally.
Podiatric review should occur on a regular basis, and correct footwear can prevent the onset of [35]foot
ulcers.
Regular close inspection of the feet and use of proper footwear are important and the patient should
avoid exercise that may cause [36]trauma to the feet.
[37]Feet and toes should be kept dry and clean and dry socks should also be used.
Non-weight-bearing activities, such as swimming, cycling and arm exercises, are recommended in those
with insensitive feet.
Activities that improve balance are appropriate choices.
Diabetics with proliferative retinopathy should avoid exercise that increases systolic blood pressures to
170 mmHg and prolonged Valsalva-like activities.
Exercise that increases blood pressure may worsen retinopathy.
Exercise that results in a large increase in systolic pressure (such as weightlifting) can cause retinal
hemorrhage.
Exercise for these patients could include stationary cycling, walking and swimming. If possible, blood
pressure should be monitored during the exercise program.
Exercise is contraindicated if the individual has had recent photocoagulation [38]treatment or [39]surgery.
These include lifting heavy weights and high-intensity [40]aerobic activities. Activities that are weight-
bearing yet low impact are preferable.
It is important to wear well-cushioned shoes. Renal patients should be fully evaluated before commencing
an exercise program. Fluid replacement is extremely important in these patients. Specic training
programs for patients undergoing hemodialysis are advised.
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david (2012-09-12 15:22:18)
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Lateral Ankle Pain (2012-09-27 09:32)
Clinical Features, Causes And Treatment of Ankle Pain:
[1]Lateral ankle pain is generally associated with a biomechanical abnormality. The two most common
causes are [2]peroneal tendinopathy and sinus tarsi syndrome.
Examination
Examination is as for the patient with [3]acute ankle injury with particular attention to testing resisted
eversion of the peroneal tendons and careful palpation for tenderness and crepitus.
Peroneal Tendinopathy
The most common overuse [4]injury causing lateral [5]ankle pain is peroneal tendinopathy. The peroneus
longus and peroneus brevis tendons cross the [6]ankle joint within a bro-osseous tunnel, posterior to the
lateral malleolus. The peroneus brevis tendon inserts into the tuberosity on the lateral aspect of the base of
the fth metatarsal. The peroneus longus tendon passes under the plantar surface of the [7]foot to insert
into the lateral side of the base of the rst metatarsal and medial cuneiform. The peroneal tendons share
a common tendon sheath proximal to the distal tip of the bula, after which they have their own tendon
sheaths. The peroneal [8]muscles serve as ankle dorsi exors in addition to being the primary evertors of the
ankle.
Causes
Peroneal Tendinopathy may either as a result of an acute ankle inversion [9]injury or secondary to an
overuse injury. Soft footwear may predispose to the development of peroneal tendinopathy. Common
[10]causes of an overuse injury include:
Excessive eversion of the foot such as occurs when running on slopes or cambered surfaces.
Excessive pronation of the foot.
Secondary to tight ankle [11]plantar exors (most commonly soleus) resulting in excessive load on the
lateral muscles.
Excessive action of the peroneal (e.g. dancing, basketball, volleyball).
An inammatory [12]arthropathy may also result in the development of a peroneal tenosynovitis and subse-
quent peroneal tendinopathy. It has been suggested that peroneal tendinopathy may be due to the excessive
pulley action of, and abrupt change in direction of, the peroneal tendons at the lateral malleolus.
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There are three main sites of peroneal tendinopathy:
Posterior to the lateral malleolus
At the peroneal trochlea
At the [13]plantar surface of the cuboids.
Clinical Features
The athlete commonly presents with:
Lateral ankle or [14]heel pain and swelling which is aggravated by activity and relieved by rest.
Local tenderness over the peroneal tendons on examination sometimes associated with [15]swelling and
crepitus (a true paratenonitis).
Painful passive inversion and resisted eversion, although in some cases eccentric contraction may be
required to reproduce the [16]pain.
Possible associated [17]calf muscle tightness.
Excessive subtalar pronation or stiness of the subtalar or [18]midtarsal joints that is demonstrated on
biomechanical examination.
Investigations
MRI is the recommended investigation and shows characteristic features of [19]tendinopathy-increased
signal and tendon thickening.13 If MRI is unavailable, an ultrasound may be performed. If an underlying
inammatory arthropathy is suspected, obtain blood tests to assess for [20]rheumatologic and inammatory
markers.
Treatment
[21]Treatment initially involves settling the pain with rest from aggravating activities, analgesic medica-
tion if needed and soft tissue therapy and [22]physical therapy.
Stretching in conjunction with mobilization of the subtalar and Midtarsal joints may be helpful.
Footwear should be assessed and the use of lateral [23]heel wedges or orthoses may be required to
correct biomechanical abnormalities.
Strengthening [24]exercises should include resisted eversion (e.g. rubber tubing, rotagym), especially in
plantar exion as this position maximally engages the peroneal muscles.
In severe cases, [25]surgery may be required, which may involve a synovectomy, tendon debridement or repair.
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Jayson Gelger (2013-01-29 17:21:52)
diabetes mellitus is quite hard on the patient and anyone suering from it., Most recently released content on our own
internet site http://www.healthmedicinecentral.com/chest-cold-symptoms/
2.9 October
Rotator Cu Injuries (2012-10-04 08:46)
Causes And Treatment of Rotator Cu Tendinopathy:
[1]Rotator cu tendinopathy is a common cause of [2]shoulder pain and impingement in athletes. In this
condition, the rotator cu tendons become swollen and hyper cellular, the collagen matrix is disorganized
and the tendon weaker. Studies in running rats and in human swimmers suggest the major determinant of
the onset of tendinopathy is the volume (e.g. distance swum, time running) of work. Apoptosis (programmed
cell death) and associated pathways are increased in overuse [3]tendinopathy and may play a role in the
pathogenesis of tendinopathy.
Clinical Features
The athlete with rotator cu tendinopathy complains of [4]pain with overhead activity such as throw-
ing, swimming and overhead shots in racquet [5]sports. Activities undertaken at less than 90 degree of
88
abduction are usually pain-free. There may also be a history of associated symptoms of instability, such as
recurrent subluxation or episodes of dead [6]arm.
On examination, there may be tenderness over the supraspinatus tendon proximal to or at its insertion into
the greater tuberosity of the humerus. Active movement may reveal a [7]painful arc on abduction between
approximately 70 degree and 120 degree. Internal rotation is commonly reduced. The most accurate method
to clinically assess rotator cu strength is to measure developed resistance when the [8]scapula is stabilized
in a retracted position.
For the athlete with rotator cu tendinopathy, symptoms can be reproduced with impingement tests,
as well as pain at the extremes of passive exion. Pain will also occur with resisted contraction of the
supraspinatus, which is best performed with resisted upward movement with the [9]shoulder joint in 90 degree
of abduction, 30 degree of horizontal [10]exion and internal rotation .The investigation of choice in rotator
cu tendinopathy is MRI. These examinations may also demonstrate the presence of a partial tear of the
rotator cu.
Treatment of Rotator Cu Tendinopathy
The[11] treatment of rotator cu tendinopathy should be considered in two parts.
The rst part is to treat the tendinopathy itself. The patient should avoid the aggravating activity and
apply ice locally.
There is no level 2 evidence to support NSAIDs, ultrasound interferential stimulation, laser, magnetic
eld therapy or local massage.
There is level 2 evidence to support nitric oxide donor [12]therapy (glyceryl trinitrate [GTN] patches
applied locally at 1.25 mg/day) and for a single corticosteroid injection.
Glyceryl trinitrate patches come in varying doses: a 0.5 mg patch should outcomes occurred at three to
six months, so patients need to have this explained.
A corticosteroid injection into the subacromial space may reduce the athletes symptoms suciently to
allow commencement of an appropriate [13]rehabilitation program.
It has been reported that the second part of the treatment of rotator cu tendinopathy should be the
correction of associated abnormalities.
These include glenohumeral instability, [14]muscle weakness or in coordination, soft tissue tightness,
impaired scapulohumeral rhythm and training errors.
Impaired scapulohumeral rhythm may predispose to rotator cu tendinopathy and must be assessed
and treated.
The treatment of scapulohumeral rhythm abnormalities is considered.
Decreased rotator cu strength or an imbalance between the internal and external rotators of the
shoulder also predisposes to the development of rotator cu tendinopathy.
Treatment involves strengthening of the external rotators as they are usually relatively weak compared
with the internal rotators.
An exercise program to strengthen the rotator [15]cu muscles is described.
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Posterior capsular tightness is commonly associated with decreased internal rotation and reduced rotator
cu strength.
Stretching of the posterior capsule is helpful. [16]Instability is a common cause of rotator cu tendinopa-
thy and must be considered in any patient who presents with symptoms typical of rotator cu tendon
problems.
If the presence of instability is not recognized, rotator cu tendinopathy is likely to recur upon return
to sport.
While it is possible that correction of any of these disorders may improve tendinopathy, there is no level
2 evidence to support any particular rehabilitation strategy or regimen for managing supraspinatus
tendinopathy.
This provides fertile ground for novel clinical research trials.
Tightness and focal muscle thickening of the rotator cu muscle hems may also predispose to the
development of rotator cu tendinopathy.
These changes reduce the ability of the musculotendinous complex to elongate and absorb shock. They
may also alter biomechanics by reducing the full range of motion and impairing scapular control.
These [17]soft tissue abnormalities should be corrected. Abnormalities along the kinetic chain must be
identied and corrected.
Technique faults, for example, in throwing or swimming, should be corrected with the aid of a coach.
Training errors need to be corrected.
Overuse should be avoided.
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Hand and Finger Injuries (2012-10-23 12:00)
Symptoms and Treatment of Hand Pain:
[1]Hand and nger injuries nger injuries are extremely common in sport and, although the majority
require minimal treatment, some are potentially serious and require immobilization, precise splinting, or
even surgery. Finger injuries are often neglected by [2]athletes in the expectation that they will resolve
spontaneously. Many present too late for eective [3]treatment. The importance of early assessment and
management must be stressed so that long-term deformity and functional impairment can be avoided. Many
hand and nger injuries require specic [4]rehabilitation and appropriate protection upon resumption of
sport. [5]Joints in this region do not respond well to immobilization, therefore, full immobilization should be
minimized.
Mechanism of Injury:
The mechanism of injury is the most important component of the history of acute [6]hand injuries. A
direct, severe blow to the ngers may result in a [7]fracture, whereas a blow to the point of the nger
may produce an interphalangeal [8]dislocation, joint sprain or long exor or extensor tendon avulsion. A
punching injury often results in a fracture at the base of the rst metacarpal or to the neck of one of the
other metacarpals usually the fth. An avulsion of the exor digitorum profundus tendon, usually to the
fourth nger, is suggested by a history of a patient grabbing an opponents clothing while attempting a tackle.
Associated features such as an audible crack, degree of pain, [9]swelling, bruising, and loss of function should
also be noted.
Signs and Symptoms:
Carefully palpate the [10]bones and soft tissues of the hand and ngers, looking for tenderness. The
examiner should always be conscious of what structure is being palpated at any particular time. The joints
should be examined to determine active and passive range of movement and stability. Stability should be
tested both in an anteroposterior direction and with [11]ulnar and radial deviation to assess the collateral
[12]ligaments. The cause of any loss of active range of movement should be carefully assessed and not
presumed to be due to swelling. Normal range of motion for the second to fth digits is approximately 80
degree of exion at the DIP, 100 degree of exion at the PIP and 90 degree of exion at the MCP joint. A
common injury site that can be overlooked is the volar plate, a thick brocartilagenous tissue that reinforces
the phalangeal [13]joints on the palmer or volar surface.
The extensor tendons of the hand are often divided into six compartments. At the [14]wrist on the dorsal
side of the hand, the [15]tendons are encased in synovial sheaths as they pass under the extensor retinaculum.
When palpating in the most radial of the distal end of the radius. The extensor pollicis longus angles sharply
around the [16]bony prominence and can damage or even rupture the tendon after a serious [17]wrist fracture.
The anatomical snubox is composed of the extensor pollicis longus and brevis and abductor pollicis longus.
The oor of the snubox is the carpometacarpal joint of the thumb. Clinically this is a signicant region
for several reasons. Tenderness may suggest scaphoid fracture. The deep branch of the radial arterial passes
through as well as the supercial branch of the radial [18]nerve; consequently, if a cast or splint is applied too
tightly, it can lead to numbness in the thumb.
Examination Involves:
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1. Observation and sensation testing as per the [19]wrist. Special note should be made of the [20]hand
arches and any deformities at the proximal or distal interphalangeal joints.
Hand at rest
Hand with clenched st
2. Active movements-ngers (all Joints)
Flexion
Extension
Abduction
Adduction
3. Active movements-[21]thumb
Flexion
Extension
Palmar abduction
Palmar adduction
Opposition
4. Resisted movements (tendons)
Flexor digitorum profundus
Flexor digitorum supercialis
Extensor tendon
5. Special test
Ulnar collateral ligament of the rst MCP joint
IP joint collateral ligaments
Diagnosis of Hand Injuries:
Routine radiographs of the hand include the PA, oblique and lateral views. All traumatic [22]nger injuries
should be X-rayed. Ideally, dislocations need to be [23]radiographed before reduction to exclude fracture
and after reduction to conrm relocation. Even when pre-reduction radiographs are not performed because
reduction has occurred on the eld, post-reduction lms should be obtained after the game. Care should be
92
taken with lateral views to isolate the aected nger to avoid bony overlap. The use of more sophisticated
investigation techniques is usually not required.
Treatment of Hand Injuries:
The functional hand requires mobility, stability, sensitivity, and freedom from [24]pain. It may be
necessary to obtain stability by surgical methods.
However, conservative [25]rehabilitation is essential to regain mobility and long-term freedom from pain,
Treatment and rehabilitation of hand injuries is complex.
As the hand is unforgiving of mismanagement, practitioners who do not see hand injuries regularly
should ideally refer patients to an experienced [26]hand therapist, or at least obtain advice while
managing the patient.
Inammation and swelling are obvious in the hand and ngers.
During the inammatory phase, the [27]therapist must aim to reduce [28]edema and monitor progress
by signs of redness, heat and increased pain.
During the regenerative phase (characterized by proliferation of scar tissue), the [29]therapist can use
supportive splints and active exercises to maintain range of motion.
During remodeling, it is appropriate to use dynamic and serial splints, and active and active assisted
exercises, in addition to heat, stretching and electrotherapeutic modalities.
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2.10 November
Acute Wrist Injuries (2012-11-06 08:57)
Diagnosis and Treatment of Wrist Injuries:
The [1]wrist joint has multiple axes of movement: exion-extension and radial ulnar deviation occur at
the radiocarpal joints, and pronation-supination occurs at the distal and proximal radioulnar joints. These
movements provide mobility for [2]hand function. Injuries to the wrist often occur due to a fall on the
outstretched hand. In sportspeople, the most common [3]acute injuries are fractures of the distal radius or
scaphoid, or damage to an intercarpal ligament. Intercarpal [4]ligament injuries are becoming more frequently
recognized and, if they are not treated appropriately (e.g. including surgical repair where indicated), may
result in long-term disability. The anatomy of the [5]wrist and hand is complex and therefore a thorough
knowledge of this region is essential to diagnose and treat sports injuries accurately. The bony anatomy
consists of a proximal row and a distal row, which are bridged by the scaphoid [6]bone. Normally, the distal
[7]carpal row should be stable; thus, a ligamentous injury here can greatly impair the integrity of the wrist.
Here a ligamentous injury disrupts important kinematics between the scaphoid, lunate, and triquetrum,
resulting in carpal instability with potential weakness and impairment of hand function.
History:
It is essential to determine the mechanism of the [8]injury causing wrist pain. These injuries are com-
monly encountered in high-velocity activities such as snowboarding, rollerblading, or falling o a bike. A
patient may [9]fracture the hook of hamate while swinging a golf club, tennis racquet or bat and striking a
hard object (e.g. the ground). It is very useful to determine the site of the [10]pain; the causes of volar pain
are dierent from those of dorsal wrist pain.
Other important aspects of the history may include:
Hand dominance
Occupation (computer related, manual labor, food service industry)
History of past upper extremity fractures including childhood fractures/injuries
History of [11]osteoarthritis, [12]rheumatoid arthritis, thyroid dysfunction, diabetes
Any unusual sounds (e.g. clicks, clunks, snaps, etc.)
94
recurrent [13]wrist swelling raises the suspicion of wrist instability
Musician (number of years playing, hours of practise per week, change in playing, complex piece, etc.)
Examination Involves:
1. Observation
2. Active movements
[14]Flexion/ extension
Supination/pronation
Radial/[15]ulnar deviation
3. Passive movements
Extension
Flexion
4. Palpation
Distal forearm
Radial snubox
Base of [16]metacarpals
Lunate
Head of ulna
Radioulnar joint
5. Special tests
Watsons test for scapholunate injury
Stress of triangular brocartilage complex
Grip- Jamar dynamometer (may be contraindicated if a maximal eort is not permitted, e.g. after
[17]tendon repair)
Dexterity- Moberg pick-up test
Sensation- Semmes Weinstein monolament testing
[18]Nerve entrapment- Tinels sign
95
6. Standardized rating scales
Several valid and reliable assessment scales can quantify function of the wrist specically or the upper
extremity after an Injury.
Diagnosis of Wrist Injuries:
Plain Radiography
If [19]ligament injury is suspected, also obtain a PA view with clenched st. A straight lateral view of the
wrist, with the dorsum of the distal forearm and the hand forming a straight line, permits assessment of the
distal radius, the lunate, the [20]scaphoid, and the capitate and may reveal subtle instability. The lateral
radiograph of the normal wrist can be. These bones should be aligned with each other and with the base of
the third metacarpal. A clenched st PA view should be taken if scapholunate instability is suspected.
Special Imaging Studies
The combination of the complex anatomy of the wrist and subtle wrist injuries that can cause substantial
morbidity has led to development of specialized wrist imaging techniques. A [21]carpal tunnel view with
the wrist in dorsiexion allows inspection of the hook of hamate and ridge of the trapezium. For suspected
mechanical pathology, such as an occult ganglion, an occult fracture, non-union or [22]bone necrosis, several
modalities are useful (e.g. ultrasonography, radionuclide bone scan, CT scan or MRI). [23]Ultrasonography
is a quick and accessible way to assess soft tissue abnormalities such as tendon injury, synovial thickening,
ganglions, and synovial cysts. Bone scans have high sensitivity and low specicity; thus, they can eectively
rule out subtle fractures.
Treatment of Wrist Injuries:
Treatments for wrist problems vary greatly. [24]Treatment for wrist injury may include rst aid mea-
sures. Treatment depends on:
The position, type, and seriousness of the injury.
How long ago the injury happened.
Your age, [25]health problem and actions (such as work, sports, or hobbies).
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How to Recognize a Condition Masquerading as a Sports Injury? (2012-11-21 10:46)
Conditions Masquerading as Sports Injury:
[1] Not every patient who presents to the [2]sports
medicine clinician has a sports-related condition. Sports medicine, like every branch of medicine, has its
share of conditions that must not be missed but appear at rst to be rather benign conditions. The aim
of this article is to remind you that the patient with the minor [3]calf strain may, in fact, have a deep
venous thrombosis, or that the young basketball player who has been labeled as having Osgood - Schlatter
[4]disease because of playing may actually have an[5] osteosarcoma. The rst part of the article outlines a
clinical approach that should maximize your chances of recognizing a condition that is masquerading as a
sports-related condition. The second part of the article describes some of these conditions and illustrates how
they can present in the sports medicine setting.
Examination
The key to recognizing that everything is not as the rst impression might suggest is to take a
thorough history and perform a detailed [6]physical examination. If the clinician has not recognized a
masquerading condition from the history and examination, it is unlikely that he or she will order the
97
appropriate investigations to make the diagnosis. For example, if a patient presents with tibial pain and
it is, in fact, due to [7]hypocalcaemia secondary to lung cancer, a bone scan of the tibia looking for stress
fracture will usually not help with the diagnosis, but a history of weight loss, occasional hemoptysis and
associated shoulder pain, the history of associated [8]arm tightness and the physical nding of prominent
supercial veins are more important clues to axillary vein thrombosis than would be a gray-scale ultrasound
scan looking for [9]rotator cu tendinopathy.
If there is something about the history and examination that does not t the pattern of the com-
mon conditions, then consider alternative, less common conditions. To be able to make the diagnosis
of a rare or non-[10]musculoskeletal condition, you must ask yourself, Could this be a rare condition or
unusual manifestation? Then other options are entertained, and the appropriate diagnosis can be conceived.
Thus, successful [11]diagnosis of masquerading conditions requires recognition of a discrepancy between the
patients clinical features and the typical pattern that one is familiar with from clinical experience.
Bone and Soft Tissue Tumors
Primary malignant [12]tumors of bone and soft tissues are rare but when they occur it is most
likely to be in the younger age group (second to third decade). Osteosarcomata can present at the distal
or proximal end of long bones, more commonly in the [13]lower limb, producing joint pain. Patients often
recognize that pain is aggravated by activity and hence present to the sports medicine clinic. The pathological
diagnosis of osteosarcoma is dependent on the detection of tumor producing bone and so an X-ray may reveal
a moth eaten appearance with new bone formation in the soft tissues and lifting of the periosteum (Codmans
triangle) .In young patients, the dierential diagnosis includes [14]osteomyelitis. It is recommended that any
child or adolescent with [15]bone pain be X-rayed. Surgery is the preferred treatment.
Synovial sarcomata frequently involve the larger lower joints such as the [16]knee and [17]ankle.
Patients present with pain, often at night or with activity, maybe with instability and swelling.
Synovial chondromatosis and pigmented villonodular synovitis are benign tumors of the synovium
found mainly in the knee, which present with mechanical [18]symptoms.
Osteoid osteoma is a benign bone tumor that often presents as exercise-related bone pain and ten-
derness and is, therefore, frequently misdiagnosed as a [19]stress fracture. The bone scan appearance is
also similar to that of a stress fracture, although the isotope uptake is more intense and widespread. This
condition is characterized clinically by the presence of night [20]pain and by the abolition of symptoms with
the use of aspirin. The tumor has a characteristic appearance on CT scan with a central nidus.
Ganglion cysts are lined by connective tissue, contain mucinous uid and are found mainly around
the [21]wrist, hand, knee and foot. They may be to a joint capsule or [22]tendon sheath and may have
a connection to the synovial cavity. They are usually asymptomatic but can occasionally cause pain and
deformity.
Rheumatological Conditions
These are dealt with in greater detail in the section on multiple joint problems. Patients with in-
ammatory musculoskeletal disorders frequently present to the sports medicine clinic with a masquerading
traumatic or mechanical condition. Low back pain of ankylosing [23]spondylitis, psoriatic enthesopathy or
early rheumatoid arthritis is common examples.
In patients presenting with an acutely swollen knee without a history of precipitant trauma or
98
[24]patellar tendinopathy without overuse, the clinician may be alerted to the possibility that these
are inammatory in origin. Prominent morning joint or [25]back stiness, night pain or extra-articular
manifestations of rheumatologlcal conditions (e.g. skin rashes, nail abnormalities), bowel disturbance, eye
involvement (conjunctivitis, iritis) or urethral discharge may all provide clues.
Disorders of Muscle
[26]Dermotomyositis and polymyositis are inammatory connective tissue disorders characterized by
proximal [27]limb girdle weakness, often without pain Dermatomyositis, unlike polymyositis, is also associated
with a photosensitive skin rash in light-exposed areas (hands and face). In the older adult, dermatomyositis
may be associated with malignancy in approximately 50 % of cases. The primary malignancy may be easily
detectable or occult. In the younger adult, weakness may be profound (e.g. unable to rise from the oor) but
in the early stages may manifest only as under-performance in training or competition.
Dermatomyositis and [28]polymyositis may also be associated with other connective tissue disorders
such as systemic lupus erythematosus or systemic sclerosis, and muscle abnormality is characterized by
elevated creatine kinase levels and electromyography (EMG) and [29]muscle biopsy changes.
Regional dystrophies such as limb girdle dystrophy and facio-scapulo-humeral dystrophy may also
adults. They are also associated with characteristic changes.
Endocrine Disorders
Several endocrine disorders, for example, hypothyroidism and hyperparathyroidism, may be associ-
ated with the deposition of calcium pyrophosphate in joints. Patients may develop acute pseudo gout
or a [30]polyarticular inammatory [31]arthritis resembling rheumatoid arthritis. X-rays of the wrists or
knees may demonstrate chondrocalcinosis of the menisci or triangular bro cartilage complex. Adhesive
capsulitis or septic arthritis may be the presenting complaint in patients with diabetes mellitus and those
with other endocrine disorders such as acromegaly may develop premature osteoarthritis or [32]carpal tunnel
syndrome. Patients with hypocalcaemia secondary to malignancy (e.g. of the lung) or other conditions such
as hyperparathyroidism can present with bone pain as well as constipation, confusion and renal calculi. A
proximal myopathy may develop in patients with primary Cushings syndrome or after [33]corticosteroid use.
Vascular Disorders
Patients with venous thrombosis or arterial abnormalities may present with limb pain and swelling
aggravated by exercise. [34]Calf, femoral or [35]axillary veins are common sites for thrombosis. While a
precipitant cause may be apparent (e.g. recent surgery or air travel), consider also the thrombophilias such
as the antiphospholipid syndrome or deciencies of protein C, protein S, anti thrombin III or factor V Leiden.
The [36]Claudicant pain of peripheral vascular disease is most likely to be rst noticed with exer-
cise and so patients may present to the sports medicine practioner. Remember also that arteriopathy can
occur in patients with diabetes. Various specic vascular entrapments are also found, such as popliteal
[37]artery entrapment, which presents as exercise related calf pain, and thoracic outlet syndrome.
Genetic Disorders
Marfans syndrome is an autosomal dominant disorder of bril in characterized by musculoskeletal,
cardiac and ocular abnormalities. Musculoskeletal problems are common due to joint hyper mobility, ligament
laxity, scoliosis or [38]spondylolysis. In patients with the Marfanoid habitus, referral for echocardiography
99
and ophthalmological opinion should be considered as sudden carac death or lens dislocation may result.
Hemochromatosis is an autosomal recessive disorder of iron handling, which results in iron overload.
Patients may present with a calcium pyrophosphate arthropathy with characteristic involvement of
the second and third [39]metacarpophalangeal joints and hook-shaped osteophytes seen on X-ray of these
joints. While ferritin levels are raised in patients with hemochromatosis, it is important to remember that
ferritin is also an acute-phase protein and so levels can be elevated in response to inammatory arthropathy.
Infection
[40]Bone and joint infections, while uncommon, may have disastrous consequences if the diagnosis
is missed. Bone pain in children, worse at night or with activity, should alert the clinician to the possibility
of [41]osteomyelitis. Bone infection near a joint may result in a reactive joint eusion. Septic arthritis is rare
in the normal joint. In arthritic, recently arthrocentesed or diabetic joints, sepsis is much more common.
Rapid joint destruction may follow if left untreated.
Even though Staphylococcus aureus is the causative organism in more than 50 % of cases of acute
septic joints, it is imperative that joint aspiration for Gram stain and culture and blood cultures are taken
before commencement of antibiotic [42]treatment. Once only or repeated joint lavage may be considered in
patients receiving intravenous antibiotic treatment. The immune compromised patient may present with a
[43]chronic septic arthritis. In this situation, tuberculosis or fungal infections should be considered.
Regional Pain Syndromes
[44]Complex regional pain syndrome type 1 (formerly known as reex sympathetic dystrophy [RSD]) is
a post-traumatic phenomenon characterized by localized pain out of proportion to the injury, vasomotor
disturbances, edema and delayed recovery from injury. The vasomotor disturbances of an extremity manifest
as vasodilatation (warmth, redness) or vasoconstriction (coolness, cyanosis, mottling). [45]Early mobilization
and avoidance of surgery are two important keys to successful management.
[46]Myofascial pain syndromes develop secondary to either acute or overuse trauma. They present
as regional pain associated with the presence of one or more active trigger points.
Fibromyalgia is a chronic pain syndrome characterized by widespread pain, [47]chronic fatigue, de-
creased pain threshold, sleep disturbance, psychological stress and diusely tender muscles. It is often
associated with other symptoms, including irritable bowel syndrome, dyspareunia, headache, irritable bladder
and subjective joint swelling and pain. Fibromyalgia is diagnosed on the examination nding of 11of 18
specic tender point sites in a patient with widespread pain. Current treatment evidence is for a stepwise
program emphasizing education, certain medications, exercise and cognitive [48]therapy. Chronic fatigue
syndrome has many similarities to bromyalgias and may be the same disease process. It may present as
excessive post-exercise muscle soreness but is always associated with excessive fatigue. Behavioral therapy
and graded exercise therapy have shown promise as [49]treatment.
At [50]Alliance Rehab & Physical Therapy we provide 24/7 access to online appointments, with
most of the requests scheduled in less than 48 hours. For More Information Call Now at: [51]703-751-1008
[52]http://www.alliancephysicaltherapyva.com/
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How we get relief from Minimizing Extent of Injury (RICE)? (2012-11-29 06:21)
Meaning of R.I.C.E.[1]
The most important time in the [2]treatment of acute soft tissue injuries is in the 24 hours immediately
following [3]injury. When soft tissue is injured, [4]blood vessels are usually damaged too.
Thus, blood accumulates around damaged tissue and compresses adjoining tissues, which causes secondary
hypoxic injury and further tissue damage. Consequently, every eort should be made to reduce bleeding at
the site of injury. The most appropriate method of doing this is summarized by the letters[5] RICE.
R - Rest
I - Ice
C - Compression
E - Elevation
Rest
Whenever possible following injury the athlete should cease activity to decrease bleeding and [6]swelling. For
example, with a thigh contusion, bleeding will be increased by contraction of the [7]quadriceps muscle during
running. Where necessary, complete rest can be achieved with the use of crutches for a lower limb injury or a
sling for [8]upper limb injuries.
Ice
Immediately after injury, ice is principally used to reduce tissue metabolism. Ice is also used in the later
stages of [9]injury treatment as a therapeutic modality.
Ice can be applied in a number of forms:
102
Crushed ice can be wrapped in a moist cloth or towel and placed around the injured area, held in place
with a crepe bandage.
Reusable frozen gel packs.
Instant ice packs that do not need pre-cooling.
Ice immersion in a bucket (useful for [10]treatment of injuries of the extremities).
Cold water and cooling sprays, which are often used in the immediate treatment of injuries but are
unlikely to aect deeper tissues.
Although there is no high-quality evidence for how long, and how often, to apply ice after an acute injury,
a systematic review suggested that intermittent 10-minute [11]ice treatments are most eective at cooling
injured animal tissue and healthy human tissue. Many practitioners apply ice for 15 minutes every I -2 hours
initially and then gradually reduce the frequency of application over the next 24 hours.
Ice should not be applied where local tissue circulation is impaired (e.g. in Raynauds phenomenon,
[12]peripheral vascular disease) or to patients who suer from a cold allergy. Other adverse eects of
prolonged ice application are skin burns and [13]nerve damage.
Compression
[14]Compression of the injured area with a rm bandage reduces bleeding and, therefore, minimizes
swelling. Compression should be applied both during and after ice application; the width of the bandage
applied varies according to the injured area.
The bandage should be applied rmly but not so tightly as to cause [15]pain. Bandaging should
start just distal to the site of bleeding with each layer of the bandage overlapping the underlying layer by
one-half. It should extend to at least a hands breadth proximal to the injury margin.
Elevation
[16]Elevation of the injured part decreases hydrostatic pressure and, thus, reduces the accumulation
of interstitial uid. Elevation can be achieved by using a sling for upper limb injuries and by resting lower
limbs on a chair, pillows or bucket. It is important to ensure that the lower limb is above the level of the
[17]pelvis.
Other minimizing factors
In the initial phase of injury (rst 24 hours), heat and heat rubs, alcohol, moderate/intense activ-
ity and vigorous [18]soft tissue therapy should all be avoided? Whether or not electrotherapeutic modalities
(e.g. magnetic eld therapy, interferential stimulation, TENS) provide eective [19]pain relief and reduction
of swelling in the initial period is a subject of debate.
It is usually suggested to exercise R.I.C.E. at duration of 4 to 6 time for up to 48 time after an
damage. Heat therapies are appropriate for some accidents, but should only be regarded after swelling has
receded, roughly 72 time after an damage. If the part of ones body does not reply to [20]R.I.C.E. treatment
within 48 time, it would be sensible to seek advice from your doctor in the occasion a serious damage has
happened such as inner blood loss or a damaged cuboid.
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At [21]Alliance Rehab & Physical Therapy Our team works with individuals who have undergone a
total hip or knee replacement with arthroscopic or other surgeries, sustained trauma to a bone, or have a bone
or soft tissue disease. We focus on helping patients regain their strength, mobility and endurance so they can
return home and resume their regular routines.For More Information Call At: [22] 703-205-1919
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2.11 December
Are you being aected by Lower Back Pain? (2012-12-17 07:01)
Spondylolisthesis: Back Condition And Treatment[1]
[2]Spondylolisthesis refers to the slipping of part or all of one [3]vertebra forward on another. The term is
derived from the Greek spondylos, meaning vertebra and olisthanein, meaning to slip or slide down a slippery
path.
It is often associated with [4]bilateral pars defects that usually develop in early childhood and have a
denite family predisposition.[5] Pars defects that develop due to [6]athletic activity (stress fractures) rarely
result in spondylolisthesis.
Spondylolisthesis is most commonly seen in children between the ages of 9 and 14, in the vast major-
ity of cases it is the LS vertebra that slips forward on the S1. The [7]spondylolisthesis is graded according to
the degree of slip of the vertebra. A grade I slip denotes that a vertebra has slipped up to 25 % over the
body of the vertebra underlying it; in a grade II slip the displacement is greater than 25 %; in a grade III slip,
greater than 50 %; and in a grade IV slip, greater than 75 %. Lateral X-rays best demonstrate the extent of
[8]vertebral slippage.
Clinical Features
[9]Grade I spondylolisthesis is often asymptomatic and the patients may be unaware of the defect. Pa-
tients with grade II or higher slips may complain of [10]low back pain, with or without leg pain. The back
pain is aggravated by extension activities.
On examination, there may be a palpable dip corresponding to the slip. Associated [11]soft tissue ab-
normalities may be present. In considering the [12]treatment of this condition, it is important to remember
that the patients low [13]back pain is not necessarily being caused by the spondylolisthesis.
Treatment
[14]Treatment of athletes with grade I or grade II symptomatic spondylolisthesis involves:
Rest from aggravating activities combined with abdominal and extensor stabilizing exercises and
[15]hamstring stretching.
Antilordotic bracing, which may also be helpful.
105
Mobilization of [16]sti joints above or below the slip on clinical assessment; gentle rotations may be
helpful in reducing [17]pain; manipulation should not be performed at the level of the slip.
Athletes with grade I or grade II spondylolisthesis may return to [18]sport after [19]treatment when
they are pain free on extension and have good [20]spinal stabilization.
If the symptoms recur, activity must be ceased.
Athletes with grade III or [21]grade IV spondylolisthesis should avoid high speed or contact sports.
[22]Treatment is symptomatic. It is rare for a slip to progress; however, if there is evidence of progression,
[23]spinal fusion should be performed.
If you are being impacted in low back pain again then come instantly at Alliance Rehab & Physical Therapy
Center in VA & DC. Our Reduced Lower back Program uses a consistent, functional and outcomes-oriented
approach to care that concentrates specically on the lower back. Through an active and educational proces-
sion of treatment, our practitioners assist the aected person in returning to normal, activities as soon as
possible. By providing comprehensive education in structure, pathology and proper proper the lower back,
the aected person is motivated to participate in his or her recovery and in the prevention of future injury.
For more information Call Now at: [24]703-205-1919
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How to Prevent Patella Fracture? (2012-12-27 07:46)
Clinical Features and Treatment of Acute Patellar (Kneecap) Trauma: [1]
[2]Acute trauma to the patella (e.g. from a hockey stick or from a fall onto the [3]kneecap) can cause
a range of [4]injuries from fracture of the patella to osteochondral damage of the [5]patellofemoral joint with
persisting patellofemoral joint [6]pain. In some athletes, the pain settles without any long-term sequelae. If
there is suspicion of [7]fracture, X-ray should be obtained. It is important to be able to dierentiate between
a fracture of the [8]patella and a bipartite patella. A skyline view of the patella should be performed in
addition to normal views. If there is no evidence of fracture, the patient can be assumed to be suering acute
patellofemoral [9]inammation. This can be a dicult condition to treat. Treatment consists of NSAIDs,
local electrotherapy (e.g. interferential stimulation, TENS) and avoidance of aggravating activities such as
squatting or walking down stairs. Taping of the patella may alter the mechanics of patellar tracking and
therefore reduce the irritation and [10]pain.
Fracture of the Patella
[11]Patellar fractures can occur either by direct [12]trauma, in which case the surrounding retinaculum
can be intact, or by indirect injury from quadriceps contraction, in which case the [13]retinaculum and
the vastus muscles are usually torn.
Undisplaced fractures of the patella with normal continuity of the extensor mechanism can be managed
conservatively, initially with an extension [14]splint.
Over the next weeks as the fracture unites, the range of exion can be gradually increased and the
quadriceps strengthened in the inner range.
Fractures with signicant displacement, where the extensor mechanism is not intact, require [15]surgical
treatment. This involves reduction of the patella and xation, usually with a tension band wire
technique.
The vastus [16]muscle on both sides also needs to be repaired. The [17]rehabilitation following this
procedure is as for undisplaced fracture.
Patella Dislocation
[18]Patella dislocation occurs when the patella moves out of its groove laterally onto the lateral femoral
[19]condyle.
Acute patella dislocation may be either traumatic with a good history of trauma and development of a
hemarthrosis following [20]injury, or atraumatic, which usually occurs in young girls with associated
107
ligamentous laxity, does not have a good history of trauma, and is accompanied by mild-to-moderate
[21]swelling.
Clinical Features
Patients with traumatic patella dislocation usually complain that, on twisting or jumping, the [22]knee
suddenly gave way with the development of severe pain. Often the patient will describe a feeling of something
popping out. Swelling develops almost immediately. The [23]dislocation usually reduces spontaneously with
knee extension; however, in some cases this may require some assistance or regional anesthesia (e.g. femoral
[24]nerve block). A number of factors predispose to dislocation of the patella:
Femoral anteversion
Shallow femoral groove
Genu valgum
Loose [25]medial retinaculum
Tight lateral retinaculum
Vastus medialis [26]dysplasia
Increased Q angle
Patellar alta
Excessive subtalar pronation
Patellar dysplasia
General [27]hypermobility
The main dierential diagnosis of patella dislocation is an [28]ACL rupture. Both conditions have similar
histories of twisting, an audible pop, a feeling of something going out and subsequent development of
hemarthrosis. On examination, there is usually a gross eusion marked [29]tenderness over the medial border
of the [30]patella and a positive lateral apprehension test when attempts are made to push the patella in
a lateral direction. Any attempt to contract the quadriceps muscle aggravates the pain. X-rays, including
anteroposterior, lateral, skyline, and intercondylar views, should be performed to rule out osteochondral
fracture or a loose body.
Treatment
[31]Treatment of traumatic patella dislocation depends on presentation. Relatively atraumatic disloca-
tions are treated conservatively.
Traumatic rst- or second-time dislocations (hemarthrosis present) are treated with [32]arthroscopic
washout and debridement.
Recurrent dislocation is treated with [33]surgical stabilization.
As a result, the [34]rehabilitation program is lengthy and emphasizes core stability, pelvic positioning,
vastus medialis obliquus strength, and stretching of the lateral structures when tight.
108
The most helpful addition to patellofemoral rehabilitation in the recent past is increased emphasis on
core stability.
Similar to [35]ACL intervention exercises, rotational control of the limb under the pelvis is critical to
knee and kneecap stability.
Patella Fracture is common among athletes. It is an injury to kneecap. Major symptom of Patella Fracture is
knee swelling. Alliance Rehab & Physical Therapy is the best Rehab & Physical Therapy center in Virginia.
We provide 24/7 access to online appointments, with most of the requests scheduled in less than 48 hours.
Contact Us at: [36]703-751-1008
[37]http://www.alliancephysicaltherapyva.com
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How to treat Longstanding Groin Pain? (2012-12-31 10:57)
Treatment of Adductor-Related Longstanding Groin Pain: [1]
Longstanding adductor-related [2]groin pain is localized medially in the groin and may radiate down along
the [3]adductor muscles. The key examination features that distinguish this clinical entity from others are
maximal [4]tenderness at the adductor [5]tendon insertion and pain with resisted adduction. Weakness of the
adductor muscles is common and palpation of the adductors reveals generally increased muscle tone with
trigger points along the [6]adductor longus. The pubic symphysis is frequently tender but this does not help
to dierentiate the four clinical entities.
Occasionally there may be an obvious adductor [7]tendinopathy or enthesopathy with localized tender-
ness, [8]pain, and weakness on contraction, especially eccentric contraction, and a typical appearance of
tendinopathy on ultrasound or MRI examination. More frequently there is no specic tendinopathy present.
Signs and Symptoms of Groin Pain
Unfortunately most patients with adductor-related [9]groin pain continue to train and play until pain
prevents them from running. When the condition has reached that stage, a lengthy period of rest and
[10]rehabilitation is usually required. However, if early warning signs are heeded, appropriate measures may
prevent the development of the full blown [11]syndrome. These early clinical warning signs are (from most
common to least):
Tightness/[12]stiness during or after activity with nil (or temporary only) relief from stretching
Loss of acceleration
Loss of maximal sprinting speed
Loss of distance with long kick on run
Vague [13]discomfort with deceleration.
110
Treatment of Groin Pain
Traditional [14]treatment for most types of groin pain was rest but this most often resulted in a return of
symptoms on resumption of activity. Compared with rest and passive [15]electrotherapy, active rehabilitation
provides more than 10 times the likelihood of pain-free successful return to [16]sport. Thus, we outline a
treatment protocol that combines experience and evidence from leading clinical centers. Five basic principles
underpin a treatment regimen:
Ensure that exercise is performed without [17]pain.
Identify and reduce the sources of increased load on the pelvis.
Improve lumbopelvic stability.
Strengthen local musculature using proven protocols.
Progress the patients level of activity on the basis of regular clinical assessment.
These are outlined below.
1. Ensure that exercise is performed without pain
The rst and most important step is for the patient to cease training and playing in pain. Pain-free
exercise is absolutely crucial for this [18]rehabilitation program. If pain is experienced during any of the
rehabilitation activities, or after them, that activity should be reduced or ceased altogether. Experienced
clinicians use absence of pain on the key provocation tests (e.g. squeeze test and Thomas test) as a guide to
progress the rehabilitation program and minimize the mechanical [19]stress on injured [20]tissues.
2. Identify and reduce the sources of increased load on the pelvis
As discussed previously, it is essential to identify and reduce the sources of increased load on the pu-
bic bones. This may involve:
Reducing adductor muscle tone and guarding with [21]soft tissue treatment and/or dry needling
Correcting [22]iliopsoas muscle shortening with local soft tissue treatment, neural stretching and
mobilization of upper [23]lumbar intervertebral [24]joints
Reducing glutens medius muscle tone and myofascial shortening with soft tissue [25]treatment and/or
dry needling
Identifying and correcting any [26]hip joint abnormality
Mobilizing sti intervertebral segments
Improving core stability, especially activation of transversus abdominis and anterior pelvic oor [27]mus-
cles.
3. Improve lumbopelvic stability
Research has demonstrated a delayed onset of action of transversus abdominis activity in patients with
111
longstanding groin pain, suggesting that impaired core or [28]lumbopelvic stability plays a role in the devel-
opment of this condition.
4. Strengthen local musculature using proven protocols
Once pain has settled and muscle shortening has been corrected in the [29]adductor, iliopsoas and [30]gluteal
muscles, then a graduated pain-free muscle strengthening program can be commenced. A similar pre-season
adductor muscle strengthening program reduced the incidence of adductor [31]muscle strains in ice hockey
players who were identied as at risk.
5. Progress the patients level of activity on the basis of regular clinical assessment
The aim of the graded exercise program is to gradually increase the load on the pubic [32]bones and
surrounding [33]tissues. Once the patient is pain-free, pain-free walking can begin and be gradually increased
in speed and distance. The criteria for when the patient may return to running are when:
Brisk walking is pain-free
Resisted [34]hip exion in the Thomas position is pain-free
There is no crossover sign
There is minimal adductor guarding.
Other non-surgical treatments
Compression shorts have been advocated for those with mild pain who insist on continuing to train
and play, and for those returning to sport after [35]rehabilitation.
The shorts substantially reduced pain when worn during exercise.
The mechanism of action of compression shorts remains unclear, but Dutch researchers have reported
that [36]groin pain on resisted adduction (the squeeze test) was signicantly reduced by the application
of a [37]pelvic belt.
They speculated that relative pelvic instability may contribute to the groin pain typically attributed to
[38]tendinopathy.
Groin Pain is very common among athletes. A signicant cause of long-standing issues is adductor-related
groin discomfort. Alliance Rehab and Physical Therapy provide 24/7 access to online appointments. If you
are suering from Groin Pain then Contact us at our [39]website or Call us at: [40]703-750-1204
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Chapter 3
2013
3.1 January
How to Care for Muscle Injury Pain? (2013-01-03 12:14)
Types, Causes, Symptoms And Treatment of Muscle Injuries (Strain):[1]
Denition of Muscle Injury:
[2]Injury to the muscle and tendons is called [3]strain.
Reasons
Sudden unaccustomed or abrupt action or movements may tear the muscles.
Direct [4]trauma can also injure the muscles and[5] tendons.
Overstretching of muscles due to indirect trauma, especially in [6]sports persons.
Types
Acute Strain: This is due to sudden violent force or direct trauma.
Chronic Strain: This is due to injury existing since a long period leading to [7]muscle ischemia and
brosis.
115
Path physiology
Injury to the muscles leads to [8]pain. As a result, the muscle goes into spasm to limit the movements and
reduce pain. Nevertheless, paradoxically, this protective [9]muscle spasm causes pain due to stimulation of
pain bers and thus a vicious cycle sets. The painful stimuli cause muscle spasm through the [10]peripheral
nociceptive stimuli.
Severity of Strain
First Degree [11]Strain (Mild Con Tusion)
This is due to blunt injury and is due to direct trauma of lose intensity.
Pathology: Few muscle bers torn. Bleeding is minimal and the [12]fascia remains intact.
Clinical Features
Localized pain and tenderness.
[13]Pain and spasm prevents muscle stretching.
Function is not impaired largely.
Tenderness over the aected [14]muscles.
Management:
First aid is by [15]Cryotherapy (by application of ice) for a period of 20 minutes.
Gentle active muscle stretch may be permitted after 20 to 60 minutes.
Compression bandaging with optimum pressure.
Low dose and low power ultrasound helps.
Gentle massaging of the surrounding area helps.
If [16]pain is minimal, the patient can be allowed to do the light work the next day.
Second Degree Strain
Cause: Here the [17]trauma is more serious.
Pathology
Greater number of muscle bers is torn.
There is bleeding.
The fascia is still intact.
116
[18]Hematoma is still localized.
Symptoms: Here are the symptoms.
Pain is more severe.
Tenderness is severe.
[19]Severe muscle spasm.
The patient is unable to move the [20]limb.
Third Degree Strain
Cause: Undoubtedly, these injuries are due to trauma of a greater magnitude.
Pathology: Larger area and greater number of muscle bers are involved. More than one muscle group may
be involved. The [21]fascia is partially torn.
Bleeding is widespread and more. There could be both [22]intramuscular and inter muscular bleeding.
The patient experiences severe pain and loss of function.
Symptoms: Here all the above symptoms are of greater intensity.
Treatment in Grade II and III Strains
For rst 24 hours
Immediate application of ice.
Compression bandage.
Limb elevation.
[23]Limb immobilized in splints.
Isometrics to the muscles, which are immobilized.
Active exercises to the unaected [24]joints.
Pulsed electromagnetic eld [25]therapy (PEMF) is known to help.
No active movements to the aected muscles.
During the Next 24 to 48 Hours
The pressure bandage is removed and active [26]muscle exercises are begun.
Stretching within the limits of pain is commenced.
Thermotherapy: Ultrasound, short wave diathermy and TENS help to relieve pain.
117
Slow rhythmic massaging helps relieve the [27]muscle
Non weight bearing on crutches is slowly started
Rest of the measures is the same as above.
Between 48 and 72 hours
Apart from all the measures mentioned so far, the additional measures during this phase include:
More vigorous active movements are encouraged.
Deep transverse friction [28]massage is added.
Partial weight bearing can be permitted.
After 72 hours
All the above measures are pursued in a more vigorous manner.
Pressure bandage is totally removed.
Progressive resisted exercises using the Fowler technique by taking out 10 to 12 repetition maximum
(RM), is practiced.
Full weight bearing should be permitted in injuries of the [29]lower limbs.
After full movement is regained, the patient is allowed to walk and jog.
Full functional activity should be regained by 4 to 6 weeks.
The various drugs used in the [30]treatment of muscle strain to relieve pain and [31]muscle stiness is
depicted.
Grade Four Strain
Cause: This is usually caused by [32]severe trauma.
Pathology
Complete tear of the muscle.
The fascia is tom.
Considerable bleeding which is intramuscular and diuse.
Gross [33]swelling is present.
Clinical Features
118
Excruciating pain.
Severe tenderness is present.
A snapping sound may be heard by the patient.
Palpable gap between the [34]muscles felt.
Severe loss of function.
Active movements produced by the agonist are absent.
Active muscle contraction is absent.
[35]Joint function is not lost.
Muscle spasm is very severe.
Treatment
[36]Surgery is advised. This involves opening the ruptured site, evacuating the hematoma and suturing the
[37]fascia sheath. Direct muscle repair is avoided.
Compression bandage is applied and the [38]limb is immobilized for 2 to 3 weeks.
Active exercises to the unaected joints.
Slow rhythmic [39]isometric exercises to the aected muscles.
Non-weight bearing after 48 hours.
The use of low frequency current (faradism) to obtain passive contraction is very useful.
Deep heating modalities like ultrasound, etc. help.
Rest of the measures is same as for [40]Grade II / III injuries.
If you suer a muscle injury(Strains) which fails to respond after a few days or continues to niggle, please
contact Alliance Rehab & Physical Therapy for more specic advice. For more detailed Information Call
Now at: [41]703-205-1919
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How we treat Fracture of Femur? (2013-01-10 11:26)
Classication And Treatment in Supracondylar Fracture of Femur:[1]
[2]Supracondylar region extends from the [3]femoral condyles to the junction of metaphysis with femoral
shaft .The distal fragment is displaced and angulated posteriorly due to the pull of gastrocnemius [4]muscle.
Mechanism of Injury
It is due to severe [5]valgus or varus forces with axial loading and rotation due to RTA, fall, etc.
Classication
1. Nearss Classication
Undisplaced Fracture
[6]Displaced Fracture
Medial Displacement
Lateral Displacement
Comminuted Fracture
1. Mullers AO Classication
Type A: Extra-articular Fractures.
Type B: Unicondylar Fractures.
Type C: [7]Bicondylar Fractures.
Each is further subdivided into 1-3 depending on the severity of comminution.
1. OTA Classication of Supracondylar Fractures of Femur
121
Supracondylar Fractures of Femur
Type A: [8]Extra-articular.
Type B: Partial articular (Unicondylar).
Type C: Total articular (Bicondylar).
1. Further Subdivisions
Type A
Simple
Metaphyseal Wedge
[9]Metaphyseal Comminution
Type B
Fracture lateral condyle.
Fracture medial condyle.
[10]Frontal fracture.
Type C
Articular and metaphyseal simple.
Articular simple and metaphyseal comminution.
Total comminution.
Clinical Features
It consists of the usual features of [11]fractures, but what is specic to this fracture is the [12]exion
deformity caused by the pull of gastrocnemius. Hemarthrosis is commonly seen, especially with fractures
extending into the [13]joint.
Radiographs
Radiograph helps to study the fracture pattern more accurately. Routine AP, lateral and oblique (45degree)
views are required.
Arteriography: This should be performed in suspected [14]vascular damage or in associated dislocation of
the [15]knee joint.
Treatment
The [16]treatment usually consists of conservative methods, traction and operative methods.
122
Conservative Methods: This has a limited role and is usually useful in impacted and undisplaced
fractures. In the former, a long [17]leg or Spica cast is sucient and in the latter, a long above [18]knee
cast after an initial period of skin or skeletal traction is all that is required.
Traction Methods: The choice is mainly skeletal traction and two methods are described.
Upper Tibial Traction: Here the skeletal traction is applied through the upper end of [19]tibia.
Initial weight used is around 15-20 lbs and is subsequently reduced. The traction is given for a period
of 8-12 weeks and the patient is put on cast braces. To prevent the [20]knee stiness from developing,
the patient is encouraged to carry out the knee movements during the traction itself.
Two-Pin Traction Method: In this method, traction is added through the [21]distal femur apart
from the traction given through the upper end of tibia. This helps in accurate reduction of the fracture
and maintains the reduction so obtained. The disadvantage of this technique is that it is cumbersome
and may cause [22]neurovascular compressions in and around the knee.
Operative Methods: This consists of DRIP and is preferred as the closed reduction is associated with
troublesome complications like limited knee motion, residual varus and internal rotation deformities.
The advantages of open reduction are [23]early mobilization of the knee joint and an accurate reduction
and rigid xation.
Fixation Methods: The choice is between [24]medullary xation and blade plate xation.
Intramedullary Fixations: Rush pins, Enders nail, medullary nails, split nails, static locking nails,
etc. are some of the commonly used medullary xation methods. They oer biological xation but the
xation oered is less stable.
Trigen (Third generation) Knee Nail: Inserted in a retrograde fashion. It is a titanium nail and
has two holes for oblique screws and one for transverse screw at the insertion end. At the opposite
locking end two holes are present in the [25]anteroposterior plane and 2 holes in the lateral plane. The
results are encouraging.
Complications
The complications commonly encountered in [26]supracondylar fractures are delayed union, mal union,
nonunion, [27]injury to the popliteal vessels and common peroneal [28]nerves, knee stiness, deep vein throm-
bosis, infection, implant failure, etc.
If you are being aected bone fracture of femur and come instantly our clinic Alliance Rehab & Physi-
cal Therapy. Our highly skilled hand therapists are procient in the treatment of hand and upper extremity
pathologies, from the acute to the chronic. Under the direction of the referring physician, our team designs
each treatment based on the physicians diagnosis and the specic needs of the patient. Conditions treated
include, but are not limited to arthritis, fractures, tendon injuries, peripheral nerve injuries, carpal tunnel
syndrome, crush injuries and repetitive motion disorder. For more detailed information our clinic Call Now
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How to get comfort from Thoracic Outlet Syndrome (Neck Tingling)? (2013-01-22 10:36)
Clinical Features and Treatment of Thoracic Outlet Syndrome:
[1]
The space at the [2]thoracic outlet or inlet when it is less than adequate, subjects the [3]neurovascular
structures seeking to gain entry into the [4]upper limbs via this space, to undue pressure. The blame for the
neurovascular complaints should be placed at the doorstep of the decreased space and not at the structures
producing the problems.
This [5]syndrome results from the compression of neurovascular bundle comprising of [6]subclavian artery
and [7]vein, [8]axillary artery and vein and [9]brachial plexus at the thoracic outlet. Thoracic outlet is a space
124
between the rst rib, clavicle, and the [10]scalene muscles.
Sites of Compression
The sites of compression could be either Supraclavicular, Subclavicular or Infraclavicular.
Supraclavicular: Interscalene triangle between the anterior scalene muscles.
Subclavicular: Interval between the second [11]thoracic rib, clavicle, and subclavius.
Infraclavicular: Beneath an enclosure formed by the coracoid process, [12]pectoralis minor, and
costocoracoid membrane.
Rare Cause
Scissor-like encirclement of axillary artery by the median [13]nerve.
Contributing Factors
Dynamic Factors
[14]Arm when in full abduction pulls up the artery by 180 degree causing compression in the short [15]retro-
clavicular space.
Static Factors
Vigorous occupation: Increases the [16]muscle bulk and thereby decreases the space.
Inactive occupation: Decreases the muscle bulk and thereby increases the space.
Congenital: [17]Cervical rib decreases the interscalene space and thereby decreases the retroclavicular
space.
Traumatic: Malunion or nonunion of [18]fracture clavicle.
Anomalies of the rst thoracic rib.
Miscellaneous
[19]Tumor arising from the upper lobe of the lung.
[20]Cervicothoracic scoliosis.
Abnormal variations of the [21]scalene muscles.
125
Clinical Features
Obviously, this syndrome poses two major problems. The rst one relates to the compression of the
major [22]vessels and secondly to the compression of the nerves.
1. Vascular Problems
Here the compression could be [23]arterial or venous. During the arterial compression, which is mild
in the early stages the patient complains of numbness of the whole arm with rapid fatigue during overhead
exercises. If the compression is signicant, the patient will complain of [24]cold, cyanosis, [25]pallor, and
Raynauds phenomenon. Venous compression leaves the [26]limb swollen and discolored after exercises, which
disappears slowly with rest.
2. Neurogenic Problems
Patients complain of par esthesia along the medial aspect of the arm, [27]hand, little and ring ngers.
There is weakness of the hand also.
Complications
Subclavian [28]artery compression
Results in poststenotic dilatation
Stasis favors [29]thrombosis
The thrombi break and migrate distally causing embolization
Investigations
X-ray Neck: To rule out intrinsic causes like [30]cervical spondylosis, cervical rib, etc.
Nerve Conduction Studies: Dicult to determine the nerve conduction velocity through the thoracic
outlet, but its biggest value is to rule-out problems like entrapment, e.g. ulnar nerve at [31]elbow,
[32]wrist, etc.
Treatment
Conservative treatment: Consists of rest, [33]physiotherapy, exercises like shoulder shrugging, etc.
Surgical [34]treatment
Thoracic Outlet problem is a number of conditions that happen when the veins or anxiety in the thoracic
store the area between your collarbone and your rst rib become compacted. This can cause discomfort
in shoulder area and throat and pins and needles in your ngertips. Call now for best Physical Therapy:
[35]703-205-1919
126
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Alliance Rehab and Physical Therapy (2013-04-20 10:57:35)
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3.2 February
How Foot and Ankle Discomfort is treated? (2013-02-04 06:17)
Causes and Treatment of Hallux Valgus: [1]
[2]Hallux Valgus is dened as a static [3]subluxation of the rst [4]metatarsophalangeal joint. It is charac-
terized by valgus (lateral) deviation of the great [5]toe and varus (medial) deviation of the rst metatarsal.
[6]Bony exostoses develop around the rst metatarsophalangeal joint, often with an overlying [7]bursitis.
In severe cases, exostoses limit rst metatarsophalangeal joint range of motion and cause [8]pain with the
pressure of footwear.
Causes
The development of hallux valgus appears to occur secondary to a combination of [9]intrinsic and [10]extrinsic
causes. Recognized causative factors include:
Constricting footwear (e.g. high heels)
Excessive pronation-increased pressure on the medial border of the [11]hallux, resulting in deformation
of the medial capsular structures.
Others-cystic degeneration of the medial capsule, [12]Achilles tendon contracture, neuro-muscular
[13]disorders, collagen decient diseases.
Clinical Features
In the early phases [14]hallux valgus is often asymptomatic, however, as the deformity develops, pain
over the medial eminence occurs.
The pain is typicaIly relieved by removing the shoes or by wearing soft, exible, wide-toed shoes.
Blistering of the skin or development of an [15]inamed bursa over the medial eminence may occur.
In severe deformity, [16]lateral metatarsalgia may occur due to the diminished weight-bearing capacity
of the rst ray.
128
Examination reveals the hallux valgus deformity often with a tender [17]swelling overlying the medial
eminence.
Investigation
Plain X-rays should be performed to assess both the severity of the deformity and the degree of rst
[18]metatarsophalangeal joint degeneration.
Treatment
Initial [19]treatment involves appropriate padding and footwear to reduce friction over the [20]medial
eminence.
Correction of foot function with [21]orthoses is essential.
In more severe cases surgery may be required to reconstruct the rst metatarsophalangeal joint and
remove the bony exostoses.
[22]Orthoses are often required after surgery.
Hallux valgus is a situation that impacts the combined at the platform of the big toe. This condition is
commonly known as [23]bunion. The big toe of the feet is known as the hallux. If the big toe begins to vary
inward towards the child toe the situation is known as hallux valgus. [24]Alliance Rehab & Physical Therapy
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129
How to cure Ankle Tibial Nerve? (2013-02-22 10:13)
Clinical Features, Investigation and Treatment of Tibial Nerve:
[1] [2]Stress fracture of the [3]medial malleolus is an unusual [4]injury
but should be considered in the runner presenting with persistent medial [5]ankle pain aggravated by activity.
Although the [6]fracture line is frequently vertical from the junction of the tibial plafond and the medial
malleolus, it may arch obliquely from the junction to the [7]distal tibial metaphysis.
Clinical Features
Athletes classically present with medial ankle pain that progressively increases with running and jumping
activities.
Often they experience an acute episode, which leads to their seeking medical attention.
Examination reveals [8]tenderness overlying the medial malleolus frequently in conjunction with an
[9]ankle eusion.
Investigations
In the early stages, X-rays may be normal, but with time a linear area of [10]hyperlucency may be
apparent, progressing to a lytic area and fracture line.
If the X-ray is normal, a radioisotopic [11]bone scan, CT or MRI will be required to demonstrate the
fracture.
Treatment
130
If no fracture or an undisplaced fracture is evident on X-ray, [12]treatment requires weight-bearing rest
with an air-cast brace until local [13]tenderness resolves, a period of approximately six weeks.
If, however, a displaced fracture or a fracture that has progressed to non-union is present, surgery with
internal xation is required.
Following [14]fracture healing, the practitioner should assess [15]biomechanics and footwear. A graduated
return to activity is required.
Stress bone injuries of the inside malleolus generally happen over time with extreme standing and walking
action such as running. Physical rehabilitation treatment is essential for all suerers with a stress crack of the
inside malleolus to speed up treatment, avoid repeat and make sure an maximum result. At Alliance Rehab
& Physical Therapy we provide 24/7 access to online appointments, with most of the requests scheduled in
less than 48 hours. For Best Rehabilitation and Physical Therapy Call now at: [16]703-750-1204
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How do you heal OLECRANON BURSITIS? (2013-02-27 07:19)
[1] This is a [2]chronic inamma-
tion of the [3]olecranon bursa. It may be the result of repetitive minor [4]injuries or irritation, microcrystalline
deposition. [5]Infection occurs due to chronic friction as in students who tend to keep their [6]elbows repeat-
edly over the table, bench, etc. over long periods during writing, reading, etc.
Clinical Features:
It usually manifests as a swelling over the tip of the olecranon. There may be [7]pain, if there is inammation.
Inspection or palpation usually easily detects it.
Investigations:
Aspiration and culture of the [8]bursal uid are necessary in order to exclude the possibility of an infectious
etiology.
Treatment:
[9]Treatment is essentially conservative and consists of NSAIDs, local steroids, etc. Surgical excision is done
in chronic cases. Microcrystalline-induced bursitis has a good prognosis and the symptoms usually resolve
after a few days, whether treated or not. However, bursitis due to repeated minor irritation is more dicult
to treat.
Do not worry about Olercranon Bursitis now. We are here to [10]diagnose you. [11]Alliance Rehab &
Physical Therapy is best Rehab & Physical Therapy center in Virginia. Call now for quick Appointment:
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3.3 March
How to get relief from Wrist Joint Pain? (2013-03-13 04:43)
Clinical Features and Treatment of Wrist Joint Injury:
[1] [2]Wrist Joint is a common [3]carpal dislocation and can lead
to severe disability of the [4]wrist function.
Mechanism of injury
This is due usually due to fall on the out-stretched [5]hands. It can cause late carpal instability and
[6]arthritis. Hence, prompt and correct [7]treatment is mandatory.
Clinical Features
Patient presents with [8]pain
[9]Swelling
Tenderness
133
Loss of wrist movements.
Radiograph
In radiograph of the lateral view, normally [10]lunate forms a half-moon shape, which is lost in this
dislocation.
Moreover, in the anteroposterior view the normal rectangular prole is lost.
Treatment
Problems
This may cause compression of the median [11]nerve.
If left untreated it may cause permanent palsy, hence, reduction should be carried out as an emergency
procedure.
Methods
If seen early, reduction is easy and immobilization for 3 weeks with wrist in slight [12]exion usually
gives good results.
If seen after 3 weeks, open reduction is done.
If lunate cannot be reduced by open reduction, resection of the proximal [13]carpal bones or arthrodesis
of the [14]wrist may be necessary.
Alliance Hand Therapy is currently providing care throughout Northern Virginia from our clinics located in
Alexandria, Fairfax, Springeld and Woodbridge. Call today at: [15]703-205-1919
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134
How to prevent Foot Bone Injury? (2013-03-26 05:31)
Clinical Features and Investigation of Foot Bone Injury:
[1] [2]Foot injuries are rare [3]injuries and are usually due to indi-
rect forces. More commonly, they are associated with injuries to the [4]tarsometatarsal joints.
Clinical Features
[5]Pain
[6]Swelling
Tenderness
Limp and [7]pain on weight bearing
Investigations
Plain X-ray (AP, lateral, oblique views) with CT scan of the [8]foot.
Classication
Group A: Extra-articular
Group B: Partly intra-articular (involves other navicular [9]cuneiform or [10]metatarsal [11]cuneiform joints).
Group C: Involves both [12]articular surfaces.
Treatment
Non-operative: Short leg cast for 6 to 8 weeks for undisplaced fractures.
Operative: For displaced fractures, open reduction and internal xation with pins or screws.
[13]Alliance Rehab & Physical Therapy provide 24/7 access to [14]online appointments, with most of
the requests scheduled in less than 48 hours. If you are suering from Foot Bone Injury then visit
[15]http://www.alliancephysicaltherapyva.com/ or contact us at: [16]703-670-9935.
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What are the classications of Capitellum (Elbow) Fracture? (2013-03-30 06:17)
Classications and Treatment of Capitellum Fracture (Elbow Injury):
[1] [2]Capitellum is the anterior portion of the lateral [3]humeral
condyle. This fracture is unique in being intra-articular always.
Mechanism of injury
Fall on an outstretched hand, with [4]exion or extension of the [5]elbow and the resulting shear forces
through the radial head slices the capitellum.
Classications
Based on the size of the articulating fragment, it is classied into three types:
Type I (Hahn-Steinthal variety): This involves a large portion of the [6]capitellum and a small chunk of
trochlea with less of [7]subchondral portion.
Type II (Kocher-Lorenz variety): Here only a large portion of the capitellum is involved with a huge
chunk of subchondral bone.
Type III: Comminuted [8]fracture.
136
Clinical Features
The patient complains of [9]pain and [10]swelling over the lateral aspect of the elbow.
[11]Elbow and forearm movements are also restricted.
Radiographs
A true lateral view of the elbow is mandatory to accurately [12]diagnose this fracture. The character-
istic nding of this fracture is the presence of double arc sign described by McKay over the X-ray.
Treatment
Undisplaced fractures can be managed conservatively by an above [13]elbow plaster cast or slab for 3
to 4 weeks.
Displaced fractures need open reduction and internal xation with minifragment screws.
[14]Alliance Hand Therapy is currently providing care throughout Northern Virginia from our clinics located
in Alexandria, Fairfax, Springeld and Woodbridge. Our Hand therapy Program is a [15]specialized treatment
program focusing primarily on conditions aecting the hand and upper extremities. Our Certied Hand
Therapists have a high degree of specialization that requires several thousands of hours continuing education
and advanced certication. Call today for best Hand Therapy: [16]703-726-9352
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3.4 April
How to cure Wrist Bone Fracture? (2013-04-19 10:40)
Classication and Treatment of Wrist Bone Fracture:
[1] [2]Trapezium bone accidents are unusual carpal bone accidents. They
can either happen in solitude or along with other [3]carpal bony injury. This accounts for 1 to 5 percent of
[4]wrist fractures. It could be isolated fracture or dislocations.
Mechanism of Injury
Fall on an outstretched [5]hand.
Direct blow over the dorsum of the hand.
Classications
Trapezium fractures are divided into:
Body fractures
Ridge fractures (Palmar)
Dislocations: This could be dorsal, palmar or [6]radial and may be associated with [7]fracture of the
scaphoid and trapezium.
Clinical Features
The patient complains of:
138
[8]Pain
[9]Swelling
Tenderness over the [10]wrist
Resisted exion produces pain
Investigations
Plain X-rays though useful are not reliable. CT scan is a better option.
Treatment
Undisplaced fracture: [11]Thumb spica for 4 to 6 weeks.
Displaced fracture: Open reduction and rigid internal xation is advised.
Dislocation is [12]treated by open reduction and K-wire xation.
[13]Alliance Hand Therapy is currently providing care throughout Northern Virginia from [14]our clinics
located in [15]Alexandria, Fairfax, Springeld and Woodbridge. Our [16]Hand therapy Program is a specialized
[17]treatment program focusing primarily on conditions aecting the hand and upper extremities. Call now
at: [18]703-750-1204 or Visit: [19]http://www.alliancephysicaltherapyva.com
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Physical Therapy treatment for Back Pain (2013-04-25 10:32)
Treatment for Back Pain:
[1] [2]Back pain and [3]injuries can be treated and managed extremely well
using a range of physical therapies in combination with controlled exercise programmes. Often this is com-
bined with medication to provide patients with a good outcome and relief of their [4]pain and symptoms.
The aim of this approach is to:
Decrease pain and [5]stiness
Improve daily quality of life
Improve and maintain tness, strength and posture
Increase exibility and endurance
Several avenues and professionals people are available to help with this conservative [6]treatment.
Exercise
People who are physically t usually suer less [7]back pain, and recover from injuries more quickly.
The muscular supports of the spine are crucial to maintaining good function and stability of the back.
With ageing, [8]injury or underlying spinal problems, the back muscles can easily become weakened,
lose tone and are quickly tired.
Its known that poor muscle condition can in itself be a cause of disability and pain.
Bed rest for more than one or two days can delay recovery and slow progress, as it results in joint
mobility loss and deterioration in physical tness.
A programme should include specic exercises to help your condition as well as to strengthen your back,
[9]leg and abdominal [10]muscles.
140
If you have [11]pain during the exercise, it may mean youre not doing it correctly or that its not
suitable for you. Talk to your doctor or [12]physiotherapist.
Walking, swimming and riding an exercise bike are good ways to improve tness, but always seek
professional advice, as some may aggravate back problem (for example, some swimming strokes).
Physical Therapy
Using a variety of techniques and equipment (including Pilates), and working closely with the patient,
a [13]physiotherapist is professionally trained to:
Assess and [14]treat your back pain with medical consultation and in partnership with your spinal
surgeon
Help you restore normal back and spinal function
Help you learn how to prevent further injury
Provide specic exercises for your back condition
Our [15]Lower Back Program uses a standardized, functional and outcomes-oriented approach to care that
focuses specically on the lower back. Through an active and educational continuum of treatment, our thera-
pists assist the patient in returning to normal, daily activities as soon as possible. By providing comprehensive
education in anatomy, pathology and care of the lower back, the patient is empowered to participate in his or
her recovery and in the prevention of future injury. Call now for Best Physical Therapy: [16]703-704-5771
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141
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Mechanisms of Spinal Cord Injury (2013-04-27 07:18)
Causes and Syndromes of Spinal Cord Injury:
[1] [2]Injuries to the [3]cervical spine constitute uncommon but nonethe-
less devastating occurrences to those participating in athletic events. These injuries happen primarily to
athletes involved in the contact sports of football, wrestling, and ice hockey, with football injuries constituting
the largest number of cases. The important work of Schneider in the mid 1960s, focusing on football-related
head and [4]neck injuries, resulted in a signicant reduction in the incidence of these accidents owing to
improvements in equipment, education in proper techniques, oseason conditioning, and rule changes.
Causes and Mechanisms of Spinal Cord Injury
The mechanism of [5]spinal cord injury can be sport related, but it is more commonly independent of
the sport.
The major mechanism of serious cervical injury is an axial load, or a large compressive force applied to
the top of the head.
This mechanism is more dangerous when the neck is slightly exed, because the [6]spine is brought out
of its normal lordotic alignment, which does not allow for proper distribution of force to the thorax.
Flexion puts the cervical spine in a straight line; thus, the musculature cannot assist in absorbing the
force.
Torget al indicated that [7]injury occurs to the cervical spine when it is compressed between the body
and the rapidly decelerating head.
When a fracture results, if the bone fragments or herniated disc materials encroach on the spinal cord,
neurologic damage will occur.
142
This mechanism is the primary cause of cervical [8]fracture, dislocation, and quadriplegia.
Syndromes of Spinal Cord Injury
[9]Spinal trauma may result in a variety of clinical syndromes, according to the type and severity of the
impact and bony displacement as well as the subsequent secondary insults such as:
Hemorrhage
[10]Ischemia
Edema
Complete spinal cord injury is a transverse myelopathy with total loss of spinal function below the level of
the lesion. This insult is caused by either anatomic disruption of the [11]spinal cord or, more commonly,
hemorrhagic or ischemic damage at the site of injury. Although the spinal cord usually remains in continuity,
a physiologic block to impulse transmission results in the complete injury. Complete injury patterns are
rarely reversible, although with long-term follow-up, improvement of 1 spinal level may be seen when the
initial segmental traumatic [12]spinal cord swelling resolves.
Several patterns of incomplete spinal cord injury are common, usually produced on a vascular basis.
The central cord syndrome causes incomplete loss of motor function with a disproportionate weakness
of the upper extremities as compared with the lower extremities.
This condition is thought to be the result of hemorrhagic and ischemic injury to the corticospinal tracts
because of their somatotopic arrangement.
Fibers of cervical nerves that innervate the [13]upper extremities are arranged more medially than those
subserving function to the lower extremities. The originally described central cord syndrome also includes
nonspecic sensory loss and bladder and sexual dysfunction. This injury pattern is also often seen in older
patients with vertebral osteophytes and in those with hyper-extension injuries.
[14]Alliance Rehab & Physical Therapy provide a comprehensive, multi-disciplinary approach to [15]neurolog-
ical rehabilitation that includes muscle and sensory re-education, coordination activities, range of motion
and speech therapy to those patients who have experienced a neurological disorder such as a [16]stroke or
spinal cord injury. Call now for Quick Appointment: [17]703-205-1919
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3.5 May
How to get Relaxation from Neck Pain? (2013-05-07 10:34)
Causes of Neck Pain:
[1] [2]Neck pain can be caused by irregularities in the [3]soft tissues
areas, namely in the [4]muscles, ligaments, and [5]nerves. The irregularities can also occur in the bones and
joints of the spine. The most common causes of neck pain in the soft-tissue regions are due to [6]injuries,
degeneration, or prolonged wear and tear on the muscles and ligaments. In rare cases, infections or tumors
may be the cause of neck pain. For some people, neck problems may be the source of [7]pain in the upper
back, [8]shoulders, or arms.
Other causes of neck pain can be caused by:
INFLAMMATORY DISEASES - [9]Rheumatoid arthritis can cause destruction of the joints of the
neck. Rheumatoid arthritis typically occurs in the upper neck area.
CERVICAL DISK DEGENERATION - The [10]cervical discs act as a shock absorber between the
bones in the [11]neck. In cervical disk degeneration, which typically occurs in people age 40 years and older,
the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the
disc space becomes narrow, additional stress is placed on the joints of the [12]spine.
INJURY - Because the neck has so much exibility and it must constantly support the head, it is ex-
tremely susceptible to [13]injury. Motor vehicle or diving accidents, participation in contact sports, traumatic
injuries, or falls may result in neck injuries. The regular use of safety belts in motor vehicles can help to
144
minimize or prevent [14]neck injury.
OTHER CAUSES - Tumors, Infections, or Congenital abnormalities of the vertebrae may also cause
neck pain and range of motion limitations.
Risks and Prevention of Neck Pain
You may be most shocked to learn that you do much of your standing, sitting, [15]exercise and other
activities with a forward head. Test yourself and see if you have a tendency to tilt forward:
Stand with your back to a wall, but not touching the wall.
Back yourself up to the wall until something on your body makes contact.
Start paying attention to how other people sit while eating or how they tend to carry a large purse or
backpack. Does their neck tilt forward against the load or are they using muscles to hold the spine in a
healthy position? The average person will overstretch their [16]neck and upper body unequally so often, it is
a mystery that they dont have more pain.
[17]
Stand with your whole body (heels, hips, upper back, and the back of your head) against a wall.
Bring the back of your head against the wall without raising or dropping your chin, or arching your
back.
If you cannot keep your heels, hips, upper back, and the back of your head against the wall in a
comfortable position or you crane your neck, you are too tight to stand up straight.
Many people are susceptible to neck and shoulder pain because of repetitive [18]work-related issues, poor
posture, and overall bad habits. The things listed below will help you assess your situation and your likely
cause of neck and shoulder pain.
Be aware of your Posture
If you are sitting in the same position for long amounts of time you are a prime canditate for [19]neck
stiness and pain.
145
Identify the risks associated with your job and your daily work routine. If you are required to lift heavy
objects or are at risk of injury due to a fall or other trauma, you may eventually sustain a more serious
injury which causes neck pain. Be certain you take the necessary precautions and safety measures while
working.
Make an [20]appointment with your [21]doctor for a full check-up annually, especially if you are at
increased risk of osteoporosis or congenital problems.
Examine your lifestyle for habits that may lead to [22]pain. Pay attention to how you fall asleep, or
when you are resting on the couch. Pillows that are very soft or lled with feather or down are likely to
cause bad posture during sleep. You should investigate pillows that support the natural curve of your
back and neck. Make sure you have suitable furniture in your home. A desk chair that is not supportive
or a pillow that doesnt oer enough neck support will lead to bad posture and result in neck pain.
Use relaxation techniques when you are under mental and emotional stress. Stress is a major culprit
in bad cases of [23]neck pain. Incorporate the following daily exercises and activities into your day to
keep muscles exible and healthy. Exercising regularly will also reduce tension and stress hormones in
your body.
[24]Aquatic therapy or pool therapy consists of an exercise program that is executed in the water. It is a
valuable form of therapy that is useful for a range of medical conditions. Aquatic therapy utilizes the physical
properties of water to aid in patient healing and exercise performance. Call today at: [25]703-670-9935
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What are the Causes of Achilles Tendonitis (Heel Pain)? (2013-05-24 05:15)
Symptoms and Causes of Achilles Tendonitis:
[1]Achilles Tendonitis is inammation of the Achilles tendon. In most cases, it is a type of overuse [2]injury and
is more common in younger people. Professional and weekend athletes can suer from Achilles tendonitis, but
it is also a common overuse injury in people not involved in sport. [3]Treatment includes rest, non-steroidal
anti-inammatory drugs (NSAIDs), physical therapy and avoiding activities that aggravate the condition.
[4]
Symptoms of Achilles Tendonitis
Symptoms of Achilles Tendonitis include:
[5]Pain in the back of the [6]heel
Diculty walking sometimes the pain makes walking impossible
[7]Swelling, [8]tenderness and warmth of the Achilles tendon
Causes of Achilles Tendonitis
Some of the causes of Achilles tendonitis include:
Overuse injury This occurs when the [9]Achilles tendon is stressed until it develops small tears. Runners
seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are
also at increased risk.
Arthritis Achilles tendonitis can be a part of generalised inammatory [10]arthritis, such as ankylosing
spondylitis or psoriatic arthritis. In these conditions both tendons can be aected.
Foot problems Some people with at feet or hyperpronated feet (feet that turn inward while walking)
are prone to Achilles tendonitis. The attened arch pulls on calf muscles and keeps the Achilles tendon
under tight strain. This constant mechanical stress on the heel and tendon can cause inammation,
pain and swelling of the [11]tendon. Being overweight can make the problem worse.
147
Footwear Wearing shoes with minimal support while walking or running can increase the risk, as can
wearing high heels.
Overweight and obesity Being overweight places more [12]strain on many parts of the body, including
the Achilles tendon.
Diagnosis of Achilles Tendonitis
To conrm the diagnosis and consider what might be causing the problem, its important to see your
doctor or a [13]physiotherapist. Methods used to make a diagnosis may include:
Medical history, including your exercise habits and footwear.
Physical examination, especially examining for thickness and tenderness of the Achilles tendon.
Tests may be required. These may include an x-ray of the foot, ultrasound and occasionally blood tests
(to test for an inammatory condition), and an MRI scan of the tendon.
Treatment for Achilles Tendonitis
The aim of the [14]treatment is to reduce strain on the tendon and reduce inammation. Strain may
be reduced by:
1. Avoiding or severely limiting activities that may aggravate the condition, such as running.
2. Using shoe inserts (orthoses) to take pressure o the tendon as it heals. In cases of at or hyperpronated
feet, your doctor or podiatrist may recommend long-term use of orthoses.
3. Inammation may be reduced by:
Applying icepacks for 20 minutes per hour during the acute stage
Taking non-steroidal anti-inammatory drugs
Other Treatment that may be Recommended
You may also be given specic [15]exercises to gently stretch the calf muscles once the [16]acute stage
of inammation has settled down. Your doctor or [17]physiotherapist will recommend these exercises when
you are on the road to recovery. Recovery is often slow and will depend on the severity of the condition and
how carefully you follow the [18]treatment and care instructions you are given.
[19]Alliance Rehab & Physical Therapy is the Best Physical Therapy Clinic. At Alliance Rehab & Physical
Therapy we provide 24/7 access to online appointments, with most of the requests scheduled in less than 48
hours. Call now for Quick Appointment: [20]703-356-3470
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How to Recover from Knee Injuries? (2013-05-29 10:26)
Prevention of Knee Injuries:
The [1]knee joint allows you to run, walk and play sport. Awkward movements, falls and collisions, sudden
twists, excessive force or overuse can result in a range of injuries to the knee joint and the structures sup-
porting it. Common knee injuries include [2]ligament, tendon and cartilage tears, and [3]patello-femoral pain
syndrome.
[4] First aid for Knee Injuries in the rst 48 to 72 hours
Suggestions for rst aid [5]treatment of an injured [6]knee include:
Stop your activity immediately. Dont work through the [7]pain.
Rest the joint at rst.
Reduce pain, [8]swelling and internal bleeding with icepacks, applied for 15 minutes every couple of
hours.
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Bandage the knee rmly and extend the wrapping down the lower leg.
Elevate the injured leg.
Dont apply heat to the [9]joint.
Avoid alcohol, as this encourages bleeding and swelling.
Dont massage the joint, as this encourages bleeding and swelling.
Prevention tips for Knee Injuries
You can help to prevent injuries if you:
Warm up joints and [10]muscles by gently going through the motions of your [11]sport or activity and
stretching muscles.
Wear appropriate footwear.
Avoid sudden jarring motions.
Try to turn on the balls of your feet when youre changing direction, rather than twisting through your
knees.
Cool down after exercise by performing light, easy and sustained stretches.
Build up an exercise program slowly over time.
Professional help for Knee Injuries
Mild [12]knee injuries may heal by themselves, but all injuries should be checked and diagnosed by a
doctor or [13]physiotherapist. Persistent knee pain needs professional help. Prompt medical attention for any
knee injury increases the chances of a full recovery. [14]Treatment options include:
1. Aspiration If the knee joint is grossly swollen, the doctor may release the pressure by drawing o
some of the uid with a ne needle.
2. Physiotherapy Including ultrasound and electrical muscle stimulation [15]treatment, kneecap taping,
exercises for increased mobility and strength, and associated [16]rehabilitation techniques.
3. Arthroscopic surgery or keyhole surgery Where the knee operation is performed by inserting slender
instruments through small incisions (cuts). [17]Cartilage tears are often treated with arthroscopic
surgery.
4. Open surgery Required when the injuries are more severe and the entire joint needs to be laid open
for repair.
[18]Aquatic therapy or pool therapy consists of an exercise program that is executed in the water. It is
a valuable form of therapy that is useful for a range of medical conditions. [19]Aquatic therapy utilizes
the physical properties of water to aid in patient healing and exercise performance. Call now for Quick
Appointment: [20]703-670-9935
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3.6 July
How to cure Foot Pain? (2013-07-15 09:03)
Causes and Symptoms of Foot Pain:
[1] [2]Foot pain can aect any part of your foot, from your toes to
your [3]Achilles tendon at the back of your [4]heel. Some foot pain is just an annoyance, but foot pain can
also be more serious, especially if its the result of an injury or certain chronic conditions. Minor foot pain
usually responds well to home [5]treatment but more severe foot pain needs medical attention. If not treated,
some types of foot pain can lead to long-term damage or disability.
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Causes of Foot Pain
Most foot pain is due to poorly tting shoes, [6]injury or overuse. But structural defects and medical
conditions, such as arthritis and diabetes, also can lead to foot problems. Foot pain may be caused by many
dierent conditions or injuries. Acute or repeated injury, disease, or a combination is the most common
causes of foot pain. Injury is a result of forces outside the body either directly impacting the body or forcing
the body into a position where a single or combination of forces results in damage to the structures of the
body. Poor biomechanical alignment may lead to foot pain. Wearing shoes that are too tight or high heels
can cause pain at the balls of the feet and the bones in that area. Shoes that are tied too tightly may cause
pain and bruising on the top of the foot.
Injuries such as [7]ligament sprains, bruises, [8]muscle strains and fractures commonly happen suddenly
(acutely).
Sprains, strains, bruises, and fractures may be the result of a single or a combination of stresses to the
foot.
A sprain of the foot or [9]ankle happens when ligaments that hold the bones together are overstretched
and their bers tear.
The looseness of ligaments in the joints of the foot may lead to foot pain.
The muscles bursa and fascia of the foot can be strained by overstretching, overuse, overloading, bruising,
or a cut (such as by stepping on a sharp object). Achilles tendonitis is a common injury to the tendon that
attaches at the back of the heel.
Injury to the bones and joints of the foot can be caused by a single blow or twist to the foot, or also by
repetitive injury that can result in a stress fracture.
A blunt-force injury such as someone stepping on your foot may result not only in a bruise (contusion)
injury but also damage to the [10]muscles and ligaments of the foot.
Direct blows to the foot can cause bruising, breaking of the skin, or even fracturing of bones.
[11]Metarsalgia is the irritation of the joints of the ball of the foot. Turf toe is a common athletic
injury in which the tendon under the joint at the base of the big toe is strained.
Injury to the toenail can cause pooling of blood under the nail and the permanent or temporary loss of
a toenail.
Repetitive injury to the [12]bones, muscles, and ligaments can result in extra bone growth known as
spurs or exostosis.
Symptoms may accompany foot pain
Pain and point tenderness are the rst indications that something is wrong in a specic area. The on-
set of pain, whether suddenly or over time, is an important indicator of the cause of the problem.
Bones of the [13]foot are joined together by ligaments. A [14]sprain happens when the ligaments that
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hold the bones together are overstretched and the bers tear. Point tenderness and looseness of a [15]joint
are indications of a sprain.
Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repeti-
tive injury that can end in a stress fracture. Fractures are indicated by a small point of pain that may be
exquisitely tender on the bone. There may be a noticeable lump or gap at the site of the fracture. A turned
toe or forefoot may also be a sign of a fracture.
Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repeti-
tive injury that can end in a stress fracture. Fractures are indicated by a small point of pain that may be
exquisitely tender on the bone. There may be a noticeable lump or gap at the site of the fracture. A turned
[16]toe or forefoot may also be a sign of a fracture.
Prevention of Foot Pain
To prevent injuries and pain, the following issues should be addressed before starting an [17]exercise
routine.
Are you in good health? A general physical exam by a physician will help to evaluate your cardiovascular
function, the possibility of disease or any other general medical problems that you may have.
Before beginning activities, diseases such as gout, diabetes, certain types of arthritis, and neuropathies
should be treated.
Treatment for Foot Pain
When the pain begins to interfere with your daily living activities or if you cannot perform your cho-
sen activities without pain, you should consider getting medical attention. Indications that you should seek
medical care are:
The area looks deformed, you have loss of function, change of sensation, a large amount of [18]swelling
with pain, prolonged change of skin or toenail color, the aected area becomes warmer than the surrounding
areas, becomes extremely tender to the touch, or is causing you to move dierently.
At [19]Alliance Rehab & Physical Therapy we provide 24/7 access to online [20]appointments, with most of
the requests scheduled in less than 48 hours. Visit here for more information: [21]http://www.alliancephysical-
therapyva.com
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3.7 August
What are the Symptoms of Trigger Finger? (2013-08-28 09:15)
Causes, Symptoms and Treatment of Trigger Finger:
[1]Trigger nger is a condition in which it is dicult to straighten a [2]nger (or ngers) once bent. The
medical term for trigger nger is stenosing [3]tenosynovitis.
[4] Causes of Trigger Finger
Trigger nger results from inammation or [5]swelling of the brous sheath that encloses the [6]tendons. A
tendon is a band of strong brous tissue that connects a [7]muscle to a [8]bone.
The straightening mechanism hesitates for a few moments before the tendon suddenly overcomes the resistance.
The nger then straightens with a sudden jerk or triggering motion.
Symptoms of Trigger Finger
Symptoms include:
1. A snapping sensation (triggering) in the aected nger or [9]ngers
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2. Inability to extend the nger smoothly or at all (it may lock in place while bent)
3. Tenderness to the touch over the tendon, usually at the base of the nger or palm
4. Soreness in the aected nger or ngers
Diagnosis of Trigger Finger
Your [10]health care provider will review your [11]symptoms and examine you.
Treatment of Trigger Finger
Sometimes it is helped by ice and anti-inammatory medicine, such as ibuprofen. If this does not work, your
health care provider may give you an injection of a local anesthetic to keep you from feeling pain in the area
and a corticosteroid to reduce the inammation of the tendon sheath. If necessary, surgery will be done to
remove the part of the tendon sheath that is causing the tendon to get stuck.
Ways to take care of yourself
It is important to follow your health care providers instructions.
In addition, rest and limit the activity of the aected nger or ngers and of the [12]hand and [13]wrist.
Prevention of Trigger Finger
Since the cause of [14]trigger nger is unknown, there is no reliable way to prevent this condition from
developing.
[15]Alliance Hand Therapy is currently providing care throughout [16]Northern Virginia from [17]our clinics
located in Alexandria, Fairfax, Springeld and Woodbridge. Call Us at: [18]703-750-1204
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3.8 September
How to cure Plantar Fasciitis? (2013-09-17 04:20)
Symptoms and Treatment of Plantar Fasciitis:
[1] [2]Heel pain is a common complaint that has many causes. Heel
pain may result from inammation of the [3]tissue on the bottom of the foot. This is called [4]plantar fasciitis.
The plantar ([5]foot) fascia (connective tissue) stretches under the skin across the [6]arch of the foot from
the heel to the base of the toes, when this tissue is tom, overused, or improperly stretched. It can become
inamed (fasciitis) Soreness, [7]tenderness, and palm result. Persons who are overweight, female, or older
than 40 years or who spend long hours on their feet are especially at risk of developing plantar fasciitis
[8]Athletes, especially joggers and runners, may develop plantar fasciitis.
Sometimes [9]plantar fasciitis can be associated with heel spurs. These spurs are outgrowths of bone
on the calcaneus (heel bone). They are sometimes painful and may occasionally require surgical [10]treat-
ment.
Symptoms
Heel Pain, especially in the early morning or after a period of rest
Increasing pain with standing
[11]Pain in the heel after exercising
Treatments
Rest
Arch supports (sometimes called orthotics) to be worn in shoes
Stretching the calf muscles and [12]Achilles tendon
Ice packs
Nonsteroidal anti-inammatory drugs (NSAIDs) such as ibuprofen or naproxen
Reducing excess body weight
Corticosteroid injections may be used in select cases
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Surgery may be helpful if other [13]treatments are not successful
Other causes of Heel Pain
It is important to understand that all heel pain is not from plantar fasciitis. Other medical problems
can cause [14]foot and heel pain. Diabetes and blood vessel disease, both serious medical problems, can cause
heel pain. Arthritis, traumatic injury and bruising, gout, stress fractures (caused by repeated stress on bone),
and other diseases can also cause heel pain. Rarely, tumors (either benign or cancerous) or infections can
cause heel pain. If you develop persisting heel pain, see your [15]doctor for an evaluation.
[16]Plantar fasciitis is common in middle-aged people. It also happens in young individuals who are on their
legs a lot, like sportsmen or military. It can occur in one feet or both legs. For best treatment of Plantar
fasciitis Visit [17]http://www.alliancephysicaltherapyva.com Contact Us at: [18]703-751-1008.
2. http://www.alliancephysicaltherapyoffredericksburg.com/
Physical-Therapy-orthopedic-rehabilitation-programs-in-va.aspx
physical-therapy-treatments-in-fredericksburg-stafford-virginia.aspx
9. http://alliancephysicaltherapy.wordpress.com/2011/08/26/foot-pain/
3.9 October
Physical Therapy Post Knee Replacement (2013-10-09 09:25)
Knee tends to be the most common joint to be replaced in the human body. People are advised Knee
Replacement surgery if, either [1]arthritis, bone diseases and some fracture has deteriorated the joint or if
alignment problems have started hindering daily activities like walking, sitting and standing.
[2]Post Knee Replacement Physical Therapy
[3]Physical Therapy techniques after Knee Replacement Surgery help you to heal and resume your rou-
tine activities faster. [4]Physical Therapist provides you with [5]rehabilitation services during and after
hospitalization.
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While you are in the hospital after surgery, a [6]physical therapist will :
"Educate you about practice walking with help of a walker or crutches
"Guide you regarding getting in and out of a chair or bed safely
"May employ electrical stimulation to decrease pain and swelling
"Administer isometric exercises to prevent blood clotting and to enhance blood circulation.
After you are discharged, your [7]physical therapist will execute a customized treatment plan including various
progressive exercises catering to your specic needs and goals as well :
"Motion Exercises : Pain and swelling can impede the progress of your replaced joint. Physical Thera-
pists, to regain your motion, make you learn[8] exercises that will enhance blood circulation and reduce
swelling and as well prevent blood clotting. Below listed exercises may be performed to heighten the range of
motion:
1.Ankle Pumps
2.Knee Bending
3.Heel Slides
4.Knee Straightening Stretch
"Strengthening Exercises : These exercises strengthen the otherwise weakened muscles of thigh and lower
leg. Physical Therapists administer these exercises to strengthen your muscles and to stabilize[9] knee joint.
Following exercises are performed to revitalize your muscles :
1.Lying Kicks
2.Quadriceps Sets
3.Straight Leg Lifts
4. Exercycling
"Balance Training: Specic balance training exercises are taught and performed to [10]help patients to gain
gait stability. These exercises are administered when you become able to put full weight and pressure on your
replaced knee. These may include :
1.Leg Slides
2.Sitting Unsupported Knee Bends
3.Knee Exercises with Resistance
"Functional Training: [11]Physical Therapists forward this training when you become capable to walk freely
without feeling any pain or strain. This program is executed to heighten your activity level. They may
include following [12]exercises in your schedule :
1.Stair Climbing and Descending
2.Prolonged Knee Stretch
3.Standing Knee Bends
4.Community based actions viz. Crossing a busy street, Getting on and o escalator
[13]Contact [14]Alliance Rehab And Physical Therapy for your successful recovery after Knee Replace-
ment and to get back to your feet as soon as possible. We develop a customized treatment plan after
collaborating with your consulting surgeon and will help you to [15]rehabilitate quickly.
[contact-form][contact-eld label=Name type=name required=1/][contact-eld label=Email type=email
required=1/][contact-eld label=Comment type=textarea required=1/][contact-eld label=Location
type=select options=Alexandria,Alexandria-Mt.Vernon,Fairfax,Fredericksburg,Tyso ns Corner / Vi-
enna,Springeld,Staord
Leesburg / Lansdowne,Woodbridge,Washington DC/][contact-eld label=Phone

Number type=text required=1/][/contact-form]
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3.10 November
Vestibular Rehabilitation Therapy (2013-11-15 06:49)
What Is Vestibular Rehabilitation Therapy?
Vestibular Rehabilitation Therapy (VRT) is a specic exercise based program that is designed and de-
veloped by a [1]professional Physical Therapist to maximize the natural bodily capacities to compensate
for the balance disorders and as well to lessen the dizziness related problems. Through Vestibular Re-
habilitation Therapy [2]physical therapists treat variety of [3]symptoms related to vestibular
disorders viz.
Dizziness [4] Symptoms Related to Vestibular Disorders
Vertigo
Imbalance
Nausea
Anxiety
Fatigue
Trouble concentrating
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Blurred Vision
Muscle or Neck Stiness or pain
Headaches
Which are the tests conducted under Vestibular Rehabilitation Therapy?
Before designing an ecient [5]Vestibular Rehabilitation Therapy plan for a patient, following tests are
conducted to recognize his symptoms and to identify problem areas:
Examination of patients medical history
Identifying and measuring balance, gait and posture
Eye- head Co-ordination tests
Questions are asked in form of Questionnaire to measure the severity of symptoms
What type of exercises is prescribed under Vestibular Rehabilitation Therapy?
The brain of a patient suering from [6]vestibular disorders can not depend upon the information it re-
ceives from vestibular system. As a result of this, his ability to maintain balance gets aected and the
symptoms start getting worse and heightened, day by day. To overcome such conditions,[7] vestibular
exercises including the following are practiced under [8]Vestibular Rehabilitation Therapy to
improvise gait and gaze stability of a patient:
VOR Stimulation Exercises: This include the exercises which help to stabilize gaze and visual focus
as well.During the course, the patient is asked to x his vision on a set target while moving his or her
head.
Ocular Motor Exercises: This include a course of exercises, wherethe patient traces the eld with
the movement of his eyes only, i.e. without stirring his or her head.
Balance Retraining Exercises: This incorporates the set of exercises, which aid to better the
co-ordination of muscular responses and structuring of sensory information as well, which in turn results
in improved balance control.
Canal Re-positioning Maneuvers: These are administered to dislocate the debris with in the
aected canal. This debris consists of small crystals of calcium carbonate that get collected with in the
canal of inner ear.
Aquatic Physiotherapy: It is benecial for the patients suering from the problem of chronic
dizziness. During the course, all of the exercises are administered in a pool.
If the patients [9]suering from vestibular disorders perform their exercises correctly and regularly, in most of
the cases the balance problems are improvised ad more over symptoms like muscle tension, dizziness, vertigo,
headaches, fatigue begin to diminish or disappear completely with time.
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[10]Alliance[11] Rehab and Physical Therapy oers a wide range of [12]support services to
the patients. Our trained and [13]qualied physical therapists provide reliable and customized
[14]treatment plans as per requirement and condition of the patients and help them to reha-
bilitate as soon as possible.
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3.11 December
Identifying and Treating Cluster Headaches (2013-12-20 09:50)
What are Cluster Headaches?
[1]Cluster Headaches are one-sided headaches which occur in cyclic patterns or clusters and are marked by
the tearing of the eyes and stuy nose. It is amongst the most agonizing and traumatic types of pain. Such
headaches occur at the same time every year and is much more painful if it strikes you at night as compared
to the day time. Episodes of pain occur constantly for one week to one year.
Who normally get aected by Cluster Headaches?
Men are at higher risk of getting aected by [2]Cluster Headaches than women. These headaches can
strike at any age but are more likely to occur at adolescent or middle age. These are commonly inherent and
are transmitted through genes.
What triggers Cluster Headaches?
The exact causes of Cluster Headaches are still not known to the physicians, but the following are con-
sidered as the potential [3]causes of Cluster Headaches:
Sudden release of Histamine or Serotonin
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In taking alcohol or Smoking cigarettes
Bright Lights
Exertion
Heat
Nitrites rich food
Cocaine
Stress and Anxiety
Season(common in spring or autumn)
What are the symptoms associated with Cluster Headaches?
These [4]headaches arise frequently and without any warning signals but the pain most commonly at-
tacks 2 or 3 hrs. after you fall asleep. Following can be enlisted as the signs and symptoms of Cluster
Headaches:
Excessive or throbbing pain; commonly concentrated around or in one eye
One sided pain; from neck to temples
Uneasiness
Excessive Tearing
Redness in the aected side eye
One sided runny nose
Sweating
Swelling around the aected side eye
Drooping eyelids
What are the [5]treatments available for Cluster Headaches?
Physicians adopt two types of techniques to treat Cluster Headaches viz.
Abortive Medications: These medications are prescribed to treat pain when it strikes. Imitrex or
some other triptans are prescribed to subside pain when it occurs. At times, oxygen therapy is also
administered, where you have to inhale oxygen through face mask.
Preventive Medications : These medicines are prescribed by your doctor to minimize the time
duration of[6] cluster headaches and to reduce the severity of pain during[7] cluster headaches.
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How [8]Physical Therapists can help to treat Cluster Headaches?
[9]Physical Therapists can assist you in getting rid of your Cluster Headaches beyond medications. Practicing
exercises under the surveillance of an expert and trained [10]Physical Therapist can enable you to relax
muscle tension and as well to relieve stress. [11]Physical Therapists prescribe following exercises to treat
Cluster Headaches :
Physical Therapists administer various relaxation techniques to help you to relax the muscles of your
neck, jaw and shoulders. Progressive Relaxation techniques are also administered and practiced to relax
each and every muscle of your body.
Cluster Headaches occur due to stress. Your breathing patterns get disturbed, when you are stressed.
So to alter these disrupted breathing patterns, [12]Physical Therapists practice dierent breathing
exercises and make you relieved. These exercises are really advantageous when you are suering from
pain.
Exercises that help to alleviate stress are followed. These help to reduce the occurrence ands severity of
headaches. These also heighten the level of beta- endorphins which are your natural stress relievers.
[13]Contact Alliance Rehab And Physical Therapy for the ecient management of any type
of pain. Timely [14]diagnosis and treatment can save you from further pain and suering and
as well help you to lead a healthy and quality life.
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Chapter 4
2014
4.1 January
Skiers Thumb: Causes, Symptoms and Treatments (2014-01-20 09:37)
What do we mean by Skiers Thumb?
Skiers Thumb is described as an [1]injury caused to Ulnar Collateral Ligament (UCL) of thumb joint.
The twisting and tearing away of UCL results this condition. Any [2]injury to UCL weakens thumbs gripping
strength and as well causes loss of function. In other words, it unstables or loosens the thumb joint.
As this injury recurrently happens during skiing accidents, therefore it is referred to as
[3]Skiers Thumb. But it does not imply that this injury occurs to skiers only. It can aect any-
body who falls on an [4]outstretched hand with sucient force applied to thumb that extends it away from
the index nger.
[5] Skiers Thumb Treatment & Management
What are the causes of Skiers Thumb?
Following conditions can be cited as the common causes of Skiers Thumb:
A straight away or direct [6]injury to your thumb
Extending away of thumb from the palm of your hand
Falling on your open hand with tucked in thumb
Repetitive and gradual traumas to your thumb
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Slipping on the ski-slopes while holding or hands strapped to ski pole
What are the signs and symptoms of Skiers Thumb?
[7]Pain, tenderness and swelling at the inner base of your thumb
Bruising
Diculty in holding objects and moving your thumb
Diculty in applying force using your thumb
Ability to pinch and grasp things with thumb and index nger gets impaired
Diculty in throwing objects
Unstable Thumb
A lump in your thumb
Deformed thumb
What are the treatment options available for Skiers Thumb?
The [8]treatment for Skiers Thumb depends upon the extent of injury, patients condition and his spe-
cic needs and requirements. Following treatment options are followed to [9]treat Skiers Thumb:
To ease pain and swelling, ice pack may be placed on your thumb for 2 or 3 days after injury
To immobilize or reduce the movement of thumb, support devices like; splint, brace or thumb cast may
be used.
The splints or thumb casts are worn for 4 to 6 weeks and thereafter, a[10] physical therapy
regime is followed and adopted to mobilize the thumb again. It includes:
Ultra sound therapy; where sound waves are used to treat injury to soft tissues.
Massage Therapy is administered to repair the aected ligament.
Mobilization[11] exercises are performed to restore thumb functioning and movement.
[12]Physical Therapists make use of [13]Hand Therapy balls and Therapeutic Putty to restore thumb
strength and dexterity.
Strengthening exercises are performed to strengthen the otherwise loosened thumb.
[14]Contact Alliance Rehab and Physical Therapy for ecient [15]treatment of any of your
musculoskeletal problems. Our patients well being and care are our top most priorities. Our
brigade of exuberant, determined and acknowledged [16]physical therapists strives to provide
nest [17]clinical treatments to our patients in friendly and caring environment.
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4.2 March
Anterior Knee Pain (2014-03-31 10:32)
Chondromalacia Patellae: Causes, Symptoms and Treatment
[1] Chondromalacia Patellae
[2]Chondromalacia Patellae, also known as runners knee is the most common cause of [3]chronic knee
pain. It often aects the young athletics, but may also happen to-older people with arthritis and females as
well, as they have less muscle mass than males.
What do we mean by Chondromalacia Patellae?
[4]Chondromalacia Patellae is a condition, where the cartilage under your patella or knee cap softens
and wears away or deteriorates. Poor alignment or overuse of [5]knee cap or patella wears down the cartilage
and as a result, knee cap begins to rub against the thigh bone which further leads to grinding sensations and
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chronic pain in the front of the knee.
What are factors leading to Chondromalacia Patellae?
When you bend your knee; the backside of your knee cap slides over the femur (thigh bone). But when
the knee cap does not move properly it begins to rub with the thigh bone leading to swelling and pain.
Many factors including the following lead to the improper movement of knee cap which ultimately results in
[6]Chondromalacia Patellae:
Weak hamstrings and quadriceps (back and front thigh muscles)
Imbalance between the adductors and abductors (the muscles on the outside and inside of your thigh)
Improper tracking of knee cap
Trauma to knee cap like; Dislocation or Fracture
Repetitive stress on knee joint due to activities like; running, jumping, twisting, skiing and playing
soccer
Over-weight
[7]Knock-knees or Flat foot
Unusual or improper shaped patella under surface
[8]Arthritis
What are the signs and symptoms associated with Chondromalacia Patellae?
[9]Chondromalacia Patellae generally leads to a vague discomfort in the front of the knee, generally
known as patellofemoral pain. This pain worsens with the activities like; sitting, bending, standing for
longer periods and exercising
Feeling of tightness in the knee area
Reduction in thigh muscle mass
Minor swelling in the knee area
Loss of thigh muscle strength
Grinding or cracking sensation when knee is extended
Pain increases with kneeling down and squatting
You may feel trouble moving your knee joint past a certain point
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What are the treatment options available to treat Chondromalacia Patellae?
Non-surgical treatment techniques are generally adopted to treat Chondromalacia Patellae. The most
eective treatment technique is to adhere to a well-organised [10]Physical Therapy treatment program. A
[11]Physical Therapy treatment program comprises of a complete rehabilitation program improving your
muscle function and exibility while relieving you from pain and swelling. Following treatment techniques
are adopted under a complete [12]Physical Therapy Rehabilitation Program:
Initially for the management of pain and swelling, physical therapists may recommend:
Resting your knee
Avoiding activities that irritate your knee cap
Icing your knee
Knee braces or arch supports to protect your knee joint and to improve the alignment as well
Special shoes inserts and support devices (orthotics) for at feet
Once the pain and swelling subsides below mentioned treatment techniques are employed by the Physical
Therapists to help the patients to regain pain-free functioning and activity:
Selective strengthening exercises are recommended to strengthen the inner portion of thigh muscles
Stationary bicycling, pool running or swimming are advised to maintain cardiovascular conditioning
Isometric exercises involving the tightening and releasing of muscles are recommended to maintain
muscle mass
Taping of knee is recommended to reduce pain and as well to enhance the exercising ability
Specic exercises to correct the misalignment and muscle imbalance are recommended
[13]Contact Alliance Rehab and Physical Therapy
Contact [14]Alliance Rehab and Physical Therapy for the ecient and state-of-art treatment and quick
relieve from any of your musculoskeletal pains. Our compassionate [15]physical therapists make use of
minimum invasive diagnostic and [16]treatment techniques to save you from further pain and suering and
assist you to lead an active and healthy life.
1. http://alliancephysicaltherapy.files.wordpress.com/2014/03/knee-pain.jpg
3. http://www.alliancephysicaltherapyva.com/treatments-backpain-neckpain.aspx
6. http://www.alliancephysicaltherapyva.com/programs-physical-therapy-orthopedic-neurological-hand-therapy.
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13. http://www.alliancephysicaltherapyva.com/contact-alliance-rehab-physical-therapy.aspx
Hey Thanks Alot Dear.
knee pain (2014-04-10 08:06:48)
Thank you very much. I agree with your article, this really helped me. I appreciate your help. Thanks a lot. Good
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4.3 April
Becker Muscular Dystrophy (2014-04-09 11:33)
[1] What do we mean by Becker Muscular Dystrophy?
[2]Muscular Dystrophy belongs to that group of genetic degenerative disorders which involve progressive
weakness and wasting of voluntary muscles of the body. This condition is named after the German doctor
Peter Emil Becker who rst described the disorder.
[3]Becker Muscular Dystrophy (BMD) is among those common nine kinds of dystrophies; which are
characterized by the slow weakness and wasting of skeletal muscles that are used for movement and heart
muscles as well. Such dystrophies are common among the men than women. Being a genetic disorder; your
family history of disease increases your risk of getting aected.
Despite of being more common in men than women; males usually inherit it from their mothers,
i.e. females are the carriers of this disease but they usually do not exhibit any symptoms.
How is the Becker Muscular Dystrophy an inherited disease?
When a particular awed gene or mutation of a particular gene on the X-chromosome makes its as-
sociated protein (named as dystrophin) partially functional, this results in the [4]Becker Muscular Dystrophy.
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That is the reason that [5]Becker Muscular Disease is also known as X-linked recessive genetic defect i.e. it
is inherited due to a defective gene on the X-chromosome.
Males manifest the symptoms of this disease because they have only one X- chromosome. While
the females have two X- chromosomes, so they usually do not show any signs or symptoms as the healthier
X- chromosome compensate for the defective one.
What are the signs and symptoms of Becker Muscular Disease?
The symptoms usually begin to appear during the childhood and are diagnosed by the age of 11
years. But the severity of the disease varies from person to person. The symptoms may include:
" Gradual but progressive muscle weakness
" Muscles cramps on exercising
" Inability to walk independently by the age of 16
" Loss of walking by the age of 40 -60 and at times, 20-30
" Severe upper extremity and trunk muscle weakness
" Toe-Walking and frequent falls
" Diculty in breathing and Heart disease; particularly, Dilated Cardiomyopathy
" Skeletal and Muscular Deformities
" Fatigue
" Diculty in getting up from the oor and Climbing stairs
" Loss of balance, co-ordination and muscle mass
What are the treatment options suggested to treat Becker Muscular Dystrophy?
The treatment is generally focused at treating the symptoms and enhancing the patients quality of
life. Treatment options suggested are generally supportive and include the following:
" Physical therapy is suggested to encourage the activity as the inactivity (like bed rest) can further worsen
the condition. Muscle strengthening exercises are suggested to maintain muscle strength.
" Massage, Compression treatment and night Splints may be advised to treat muscle cramps.
" Use of assistive devices like; knee, leg or back braces are suggested to keep the muscles exible.
" Occupational Therapy is advised; where patients are helped and taught to use orthopedic appliances like;
wheel chairs and other assistive devices as well to improve movement and training for doing the daily tasks
in new ways is also provided.
[6]Contact Alliance Rehab and Physical Therapy for the adequate and enhanced treatment of any
of your neuromuscular disorder. Our [7]certied therapists develop customized treatment plans according to
your needs and preferences and utilize patient proven treatment techniques to heighten the quality of your
life.
1. http://alliancephysicaltherapy.files.wordpress.com/2014/04/becker-muscular-dystrophy-treatment.png
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Knobby Knees (2014-04-19 12:11)
Osgood Schlatter Disease
Osgood Schlatter Disease (OSD) or [1]Knobby Knees is a common cause of [2]knee-pain among the teenagers.
This pain mostly aects the boys between 13 to 14 years of age and the girls between 11 to 12 years. This
problem mostly occurs during the growth spurt.
What do we understand by Osgood Schlatter Disease?
[3]Osgood Schlatter Disease is an overuse [4]injury of the knee resulting in pain and swelling below the
knee cap over the shin bone. This disease is marked by the inammation of the bone cartilage and /or tendon
at the top of the shin bone, where the tendon from the knee cap attaches. It commonly aects the teens who
are engaged in vigorous sports activities which involve lots of running, jumping and swift direction changes,
as in; basket ball, gymnastics, soccer, gure skating, ballet and volley ball.
What are the potential signs and symptoms of Osgood Schlatter Disease?
Osgood Schlatter Disease usually harms one knee at a time but it may aect the both knees. It lasts
for months and recurs until the child stops growing. Following signs and symptoms may be observed in the
teens with OSD:
Pain below the knee cap
Severe [5]pain during and after the activity
A tiny and soft bony bump under the knee cap
The swelled area becomes tender to pressure
Limping after the physical activity
Pain Easing with Rest
Tightness in the muscles surrounding the knee.
What are the factors leading to the Osgood Schlatter Disease?
At times, Osgood Schlatter Disease develops for no apparent reason. But the below mentioned factors
may lead to the condition:
Repeated small [6]injuries to knee before the growth spurt is over
Overuse of thigh muscles resulting in swelling
Repeated strain on the attachment of the patellar ligament
Formation of callus (healing bone) resulting into hard bony bump
What are the treatment options suggested to heal Osgood Schlatter Disease?
Osgood Schlatter Disease usually heals itself after the childs bones stop growing. Till then, a customized
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physical therapy treatment program targeted at relieving pain and swelling are practiced, following techniques
are employed to treat the symptoms:
Activity modication and in more severe cases, activity elimination is advised
R.I.C.E. Therapy (Rest, Ice, Compression and Elevation) is suggested to relieve pain
Stretching exercises; concentrated on the stretching of thigh muscles, are recommended
Strengthening exercises may be advised to stabilize the knee joint
To shield the sensitive area, the physical therapists may recommend to wear knee pads during the sport
Bracing, strapping and wrapping of knee area may be recommended for support
Contact Alliance Rehab and Physical Therapy
[7]Contact Alliance Rehab and Physical Therapy to prociently manage and relieve any type of muscu-
loskeletal pain. Our diversied team of [8]trained and certied therapists will develop a customized treatment
plan for you while taking due care of your needs and urgencies and will help you to regain health and proper
functioning.
Check Our Latest Videos:
[9]Alliance Rehab & Physical Therapy
[10] Alliance Rehab & Physical Therapy in DC
[11]Alliance Rehab & Physical Therapy Springeld VA
[12]Alliance Rehab & Physical Therapy Woodbridge
aspx
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9. http://www.youtube.com/watch?v=tZEbYQ91qw8&feature=youtu.be
10. https://www.youtube.com/watch?v=koEap-Yb5ww&feature=youtu.be
11. https://www.youtube.com/watch?v=rcqt_omDGL4&feature=youtu.be
12. https://www.youtube.com/watch?v=okSGYdqrW8g&feature=youtu.be
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4.4 May
Alliance Rehab & Physical Therapy Clinics oer Treatments for Auto- Accident Injuries
(2014-05-22 11:05)
[1]
[2]Auto-Accidents are said to happen every 5 seconds in the United States and these gures continue
to rise. Victims of auto-accidents usually suer from [3]skeletal, muscular, neurological and [4]soft-tissue
injuries which are not detectable initially as they do not cause much pain. So the victims ignore them and do
not seek professional [5]treatment. This causes the biggest blunder. With [6]auto-accident injuries, immediate
and specialized treatment is needed to avoid developing long term discomfort and chronic pain. A pro-active
[7]Physical Therapy treatment and Rehabilitation plan can save the victims from surgical interventions and
long term reliance on medications as well.
[8]Physical Therapy modalities while conditioning your muscles and bones also help to alleviate pain and
relieve the debilitating eects of [9]auto-accident injuries. Vehicular injuries often develop the symptoms like;
back pain, whiplash, fatigue, headache, muscle-spasms, nausea, neck pain, tendinitis, shoulder pain, problems
with vision, dizziness etc. [10]Physical Therapists are experts at diagnosing, evaluating and treating these
injuries. They re-align your vertebrae and help to restore your lost structural balance and treat soft tissue
injuries with customized[11] rehabilitation program.
Various structural evaluation techniques including; X-rays, Spinal Joint Movement Evaluation, Gait and
Postural Analysis, Joint Range-of Motion Testing, Strength and Reex Evaluation, CAT or CT scan and
MRI are conducted and adopted to detect and correct various musculoskeletal injuries. [12]Physical Therapy
is mainly directed towards maximizing the motion of spine, curing spinal disc, alleviating muscle spasm and
improvising the muscular strength. Following Physical Therapy modalities are used to [13]treat auto-accident
injuries:
Hands-On Therapy and therapeutic equipments are used for the vestibulo-ocular rehabilitation of the
victims.
Corrective exercises are used to stretch and strengthen the damaged muscles.
Range-of Motion exercises are prescribed to improvise function and mobility
[14]Spinal Decompression therapy is employed to relieve [15]back pain due to herniated disc or Sciatica
Therapeutic exercises targeting and strengthening the joints are suggested.
So if you have been a victim of vehicular accident and sustained a musculoskeletal injury and want to get
relief without pain-killers and surgical interventions, then Physical Therapy is the most inuential treatment
available.
[16]Contact Alliance Rehab & Physical Therapy for the skilled and prompt treatment of[17] auto-accident
injuries. Our board certied therapists are specialized in diagnosing, treating and managing auto-accident
whiplash injuries and have helped numerous patients to recover successfully from whiplash.
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15. http://www.alliancephysicaltherapyva.com/treatments-backpain-neckpain.aspxhttp:
//www.alliancephysicaltherapyva.com/treatments-backpain-neckpain.aspx
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Edited: June 7, 2014

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