Align Your Spine

By Nancy Simpkins

What single thing can improve your appearance, reduce your risk of suffering chronic back pain and headaches, improve your circulation and digestion, and reduce your stress levels? No, it’s not a miracle drug. It’s good posture.

Good posture keeps your bones properly aligned, reducing the strain on your muscles and joints. When your posture is correct, your spine will curve slightly forward at the neck, slightly backward in the upper back, and slightly forward in the lower back. These are the cervical, thoracic and lumbar curves. Strong and flexible muscles in the abdomen, hips and legs make it easier to maintain good posture.

Poor posture can cause misalignment of the joints, resulting in excessive wear and tear that leads to arthritis. Muscles become imbalanced, with some growing stronger and tighter, while others grow weaker and overstretched. Imbalances can put pressure on nerves, causing pain. For example, studies have shown that the shoulder position of a person who slumps while sitting may cause damage to the median nerve, which runs from the shoulder to the hand. Excessive pressure on the sciatic nerve causes pain in the back and legs, and misalignment of the cervical spine can lead to headaches.

When a slumped sitting posture compresses the abdomen, stomach contents may back up into the esophagus and cause gastroesophageal reflux. Poor posture can also compress blood vessels, interfering with normal circulation.

Causes of bad posture include weak muscles, poor flexibility, improper sitting and standing habits, obesity, pregnancy, and wearing high-heeled shoes. Physical therapists can evaluate and treat problems with posture. Treatment will usually include exercises to strengthen weak muscles and stretch tight ones, so that the body can achieve proper alignment.

Total Knee Replacement

When arthritis in the knee causes severe pain or disability that is not improved by conservative treatments, surgery to replace the joint may be recommended. In total knee replacement surgery, damaged cartilage is removed, and a metal or plastic joint is attached to the femur (thigh bone), tibia (shin) and patella (knee cap).

A small number of orthopedic surgeons do quadriceps-sparing minimally invasive total knee replacement, which requires a smaller incision that in traditional surgery, and eliminates the need to cut the quadriceps tendon and muscles, and to dislocate the kneecap. Patients benefit from a shorter hospital stay, shorter recovery time and a smaller scar.

After knee replacement surgery, patients receive physical therapy to learn exercises that strengthen the muscles in the knee and increase the range of motion in the joint. Physical therapy can also help reduce pain and swelling. Some patients may need to relearn good standing and walking techniques. Many patients with knee pain develop a habit of using the hips to stand up from a chair, which increases the risk of falling and could lead to future knee osteoarthritis. After knee replacement surgery eliminates the pain, a physical therapist can train these patients to use their quadriceps muscles instead.

In addition to improving function in the knee, exercise can help control weight, which is important since excess weight can reduce the life of the new joint. When knee replacement began in the 1970’s, the life of the replacement joint was estimated at 10 years. Current replacement joints are expected to last closer to 20 years.

Stress Fractures

stress fractureBy Nancy Simpkins

A stress fracture is a small crack in a bone, occurring most often in the lower leg or foot. These fractures are usually caused by overuse, particularly among participants in sports such as tennis, running, gymnastics and basketball.

Bones break down and repair themselves in response to stress, and the muscles also act as shock absorbers to protect the bones. When the muscles become fatigued, extra force may be transmitted to the bones. If an athlete increases the amount or intensity of activity more quickly than the bones can rebuild themselves, a stress fracture will develop.

Poor nutrition that diminishes bone health can increase the risk of stress fractures, and having leg-length discrepancies, flat feet or high arches increases the risk as well. People with osteoporosis can experience stress fractures from activities of daily living.

The symptoms of a stress fracture are pain and swelling that increases with activity. Treatment includes rest, ice and pain relievers. Some experts recommend acetaminophen because non-steroidal anti-inflammatory medicines may interfere with bone healing. For severe stress fractures in the foot, a splint, cast, walking boot or crutches may be necessary, or a surgeon may need to insert a pin to hold the bone together. Patients recovering from stress fractures can benefit from physical therapy to learn exercises that improve strength and stability.

ACL Tears

By Nancy Simpkins

What do quarterback Carson Palmer, outfielder Milton Bradley, point guard Lindsey Harding and Olympic soccer player Heather Mitts have in common? They have all torn an anterior cruciate ligament (ACL).

The ACL connects the tibia (shin bone) to the femur (thigh bone). A tear in this ligament can make the knee joint unstable or prone to giving way. Sudden, pivoting movements become difficult, and arthritis is more likely to develop.

Many ACL tears happen after landing from a jump or changing direction rapidly, after a blow to the knee, or while planting and cutting. ACL tears are common in basketball, football, soccer and skiing.

Women are more susceptible to ACL tears than men are, which may be due to anatomical differences and the effects of hormones on ligaments. Another factor is that women tend to use a more upright posture than men. Athletes who use a crouching posture are less likely to suffer ACL injuries. The ACL also weakens with age and is more likely to tear in athletes over 40.

Symptoms of an ACL tear include a popping sound, sudden instability of the knee, pain and swelling. Initial treatment includes ice, and it’s important to keep weight off the knee to prevent further damage. If an athlete wants to continue in a high-impact sport, an ACL tear usually requires surgery, followed by physical therapy to strengthen the muscles surrounding the knee. For the knee to function in normal daily activities, physical therapy alone may be sufficient.

Hamstring Injuries

HamstringBy Nancy Simpkins

A dancer’s arabesque, a baseball player’s sprint for first base, and a football player’s place kick are all activities that depend on healthy hamstrings. The hamstrings are three muscles at the back of the thigh: the semitendinosus, semimembranosus, and biceps femoris. They start at the ischial tuberosity, (also called the sitz bone) at the back of the pelvis, and are connected to the lower leg by the hamstring tendons.

The term “hamstrung” acquired the meaning of “powerless” or “crippled” from the historical practice of cutting domestic servants’ hamstring tendons so they couldn’t escape. Now, hamstring injuries are most prevalent among athletes, particularly those who run, jump or kick.

The hamstrings help bend the knee and extend the hip, and they work in opposition to the quadriceps, the muscles on the front of the thigh. The quadriceps are normally stronger than the hamstrings, but if they become too much stronger, the resulting muscular imbalance puts the hamstrings at risk of injury. Tight hamstrings are also prone to injury.

Hamstring strains can range from a partial tear of the muscle to a complete rupture. Symptoms range from tightness and pain in the back of the thigh to inability to walk or straighten the knee. There may be bruising in the back of the thigh, swelling, or muscle spasms. Sudden movement of the knee can cause the hamstring tendon to rupture. Symptoms include sudden pain at the back of the knee followed by swelling, and pain when bending the knee against resistance.

Treatment of hamstring injuries usually starts with rest, ice, compression and elevation. Physical therapy may be recommended, and will include range of motion and strengthening exercises. Some doctors try to stimulate faster healing by injecting platelets of the patient’s own blood into the site of the injury, a technique called platelet rich plasma therapy (PRP). Severe hamstring injuries may require surgery.

To avoid hamstring injuries, it is important to warm up and stretch before exercise, and to do strengthening exercises as well. Athletes who have suffered one hamstring injury are at increased risk for another one. A physical therapist can teach you how to keep your hamstrings flexible and strong.

Resistance Isn’t Futile: The Benefits of Swimming

SwimmerBy Nancy Simpkins

For people with joint problems, exercise can be agonizing. Swimming provides them with a painless way to improve cardiovascular fitness and build muscle strength. “I had a patient who was headed for a knee replacement. She weighed close to 300 pounds, she could barely walk, and she had severe osteoarthritis,” recalled Hector Mayo, clinical director at Grand Central Physical Therapy and Hand Therapy. “I told her that losing weight would help, but she had reached the point where she couldn’t support her own weight, and most exercises were too painful.” Mayo recommended that the woman take up swimming, and she lost weight and avoided the need for surgery.

A swimmer’s body weighs about 90 percent less in the water than it does on land. This is due to the force of buoyancy, which causes the water to push up as the body’s weight pushes down. With less weight on the joints, swimming has one of the lowest injury rates of any sport. In a 2005 study of young athletes published in Archives of Disease in Childhood, researchers found that more than five times as many soccer players had suffered two or more injuries than a comparable group of swimmers had. Mayo estimates that in his career as a physical therapist, he has treated a handful of injuries caused by swimming, compared with hundreds of injuries sustained by golfers, and thousands of injuries due to running.

The low impact of swimming makes the sport an excellent exercise for people with arthritis, joint injuries, or back pain, as well as for pregnant women and anyone who is overweight. Arthritis sufferers can reduce symptoms by swimming in warm water. Exercising in warm water raises body temperature, which dilates the blood vessels and increases circulation. This usually decreases joint stiffness and swelling, with a corresponding reduction in pain. The Arthritis Foundation recommends pool temperatures between 83 and 88 degrees Fahrenheit.

Swimming is one of the few exercises that use all the major muscle groups, and because water is much denser than air, swimming provides resistance that strengthens muscles in the same way that weight training does. As an aerobic activity, swimming provides benefits to the cardiovascular system, including strengthening the heart and lowering blood pressure.

Even if you never learned to swim, or you just don’t want to get your hair wet, you can still benefit from water exercise. Chest-deep water supports about two-thirds of the body’s weight, so water aerobics provides the benefits of exercise with minimal stress on the joints.

Although swimming injuries are rare, they do occur in competitive swimmers or those who train intensely. The repetitive motions used in swimming strokes can cause overuse injuries such as swimmer’s shoulder or breaststroke knee.

Swimmer’s shoulder is most often associated with the overhead arm motions of the freestyle and butterfly strokes, although the backstroke can also increase the risk of this condition. Poor swimming technique and overtraining cause the muscles to become fatigued, which results in the swimmer using more strokes to cover the same distance. The tendons in the rotator cuff become inflamed, causing pain that can be constant or brought on by certain motions.

Breaststroke knee usually refers either to an irritation of the bursa in the knee, or to a sprain of the medial collateral ligament of the knee. Both can be caused by improper kicking technique.

Treatments for both swimmer’s shoulder and breaststroke knee include rest, ice, and nonsteroidal anti-inflammatory medications such as ibuprofen. Patients with severe cases sometimes receive corticosteroid injections. For patients with swimmer’s shoulder, physical therapy usually helps to improve rotator cuff flexibility and strengthen shoulder muscles. For those with breaststroke knee, physical therapy can strengthen the muscles surrounding the knee and increase the knee’s range of motion. If your bursa is swollen, your doctor may remove fluid with a needle.

Simple precautions such as warming up and stretching can reduce the risk of swimming injuries. With proper preparation, almost anyone can benefit from this very safe sport.