Human Performance and Rehabilitation Centers, Inc.

ACL tears in athletes

“I heard it go ‘pop,’” an athlete says with dread.

That sickening sound and a sudden pain in the knee point to the culprit: an ACL tear. Sports that demand sudden stops and quick lateral movements like football, soccer and basketball are hotbeds for ACL tears. Here’s what an athlete needs to know about recovering from this common sports injury.

About the injury

The anterior cruciate ligament (ACL) is one of four main ligaments in the knee that connect the femur above the knee to the tibia below. Injuries to the ACL can happen to anyone, but they are common among competitive athletes in their late teens to mid- to late twenties. As more young people are participating in sports with higher levels of athleticism, the injury is on the rise. According to the American Academy of Orthopaedic Surgeons, the annual incident rate of ACL injury is about 200,000 with 100,000 ACL reconstructions performed a year.

How it happens       

ACL injuries often occur when an athlete makes a quick stop, plants his or her foot and then changes direction. The abrupt change of speed combined with an abrupt change in direction stresses the ACL, which can tear and make a popping sound. Pain and swelling sets in quickly. Athletes will generally opt for reconstructive surgery of the ligament to maximize their ability to resume competition.

The road to recovery

Orthopedic surgeons thread in a new tendon to replace the torn ACL that is taken from the patient’s hamstring or from a cadaver. A patient will usually be on crutches for the first couple of weeks after surgery. The rehabilitation plan is dependent on the extent of injuries sustained during an ACL tear; it’s not uncommon to also experience damage to the meniscus. Therapy starts with very limited weight-bearing exercises that will slowly increase over time.

Strengthening the quadriceps is the primary goal of first 6 weeks of therapy. This helps provide stability to knee. The physical therapist will then move to short arc exercises, straight leg raises, hip strengthening and some balance exercises.

During the first 6 weeks, the goal is to increase range of motion — helping a patient go from zero to 135 degrees of flexion.

At the 8 to 12-week mark, the healing process is well underway with the reconstructed tendon tightening down as it should. Balance and biomechanics become key therapy priorities. Patients also progress into plyometric training, working their way up to light jogging and mild ladder drills at about the 10-week juncture. After 12-16 weeks, patients get into heavier plyometrics with the intention of soon getting back into their chosen sport. The therapist observes movement and watches for any signs of instability or imbalance.

Listen to your PT

Throughout therapy, it’s critical that a patient stick to the prescribed home exercise program to supplement therapy sessions. It’s also important a patient understand that the adage “no pain, no gain” does not apply to ACL recovery.  Take it slow and allow the ligament to fully heal in place. Patience goes a long way in preventing future injury.

Ankle Sprain: Here’s how to treat this common injury

Ankle sprains can happen to anyone. Sure, athletes who spend a lot of time running and jumping are vulnerable, but everyday individuals can experience ankle sprains while carrying out routine activities. Stepping off a curb incorrectly, stumbling while doing yard work, or other occasions when you unexpectedly meet uneven terrain can result in an ankle sprain. The good news is that this injury rarely requires surgery. Patients can recover quickly with the right treatment.

What usually happens when you sprain your ankle is that the ankle rolls inward, tearing the anterior talofibular ligament. Physical therapists classify ankle sprains in one of three categories depending on the level of trauma the ligament sustains.

A Grade 1 sprain is a mild sprain that will heal on its own. You can walk it off, and it exhibits little to no swelling. Ice and rest are recommended to ensure a full recovery, which tends to occur within a week.

A Grade 2 sprain usually exhibits bruising as well as swelling immediately after the injury takes place. A Grade 3 sprain presents a higher degree of swelling and bruising and results in difficulty walking. A physical therapist can determine the extent of the injury through a routine examination of the ankle.

The treatment for a Grade 2 or 3 ankle sprain is first to decrease the swelling through what we call “PRICE,” an acronym that stands for Protect, Rest, Ice, Compression and Elevation. Once the swelling subsides, we focus on restoring movement to the ankle through manual therapy to the ankle joint. We also have patients perform specific isolated exercises that build flexibility. A common exercise is to have patients “draw” the alphabet with the big toe of the affected foot while sitting in a resting position.

As we see improvement in the movement of the ankle, we focus on restoring strength to the area by exercising the surrounding musculature. We also work to restore balance – a very important function of the ankle. Think about it. Your ankles are constantly working to help your body adjust to uneven surfaces as you move throughout the day. We work to restore this sense of balance by having patients perform proprioceptive exercises, or exercises that help the body understand where it is in relation to its environment.

Generally, patients can make a full recovery from an ankle sprain within two to four weeks.

Sit Up Straight: How Workplace Posture Impacts Health

For a growing number of professionals, the cumulative effects of working behind a desk can take their toll. Years of pecking away at a computer and talking on the phone can lead to a variety of issues, including headaches, stiffness, and pain in the shoulders, middle back and neck. There’s hope, though. These issues can be effectively addressed through physical therapy and by making adjustments to your everyday posture.

We see patients routinely who experience pain that we can link directly to the way they sit at work. The modern world has created all sorts of demands that don’t square with our bodies’ natural movements. We are not designed to perch in uncomfortable chairs six to eight hours a day, and as the years go by, our body rebels by expressing pain. Physical therapists address these issues by using interventions that can effectively remove stiffness. We also help patients strengthen muscles in the upper back to provide additional support to the neck and shoulders. And, we make specific recommendations for postural adjustments so that pain does not return.

Improving the way you sit at a desk goes a long way. Here are some recommendations:

  • Your feet should touch the floor completely. For people under 5’5”, this can be a challenge as most desks are made for taller people. Use a box or stool if needed.
  • You should be able to place your forearm on your desk or your elbows on arm rests while typing at a keyboard.
  • Your knees should be at a 90-degree angle when you sit, making sure your knees are in line with your hips.
  • Don’t crane your neck to talk on the phone. Use a headset.
  • Ideally, your computer screen should be at eye level.

One of the most important issues to remember is that the body doesn’t like being stagnant. Set a timer and take a “micro-break” every 20 minutes. I can hear the work-a-haulics groaning, but this doesn’t have to take long – a mere 10-15 seconds is all that’s required to stand up and stretch. It’s a simple strategy that goes a long way in protecting your health and warding off pain.

Treating Achilles Tendonitis

Overview of Achilles tendonitis

Achilles tendonitis is a condition in which the Achilles tendon becomes painful or inflamed because of overuse. It’s often experienced by runners who make an abrupt change in their routine, such as an increase in mileage, hills or speed work without building up adequately. Weekend athletes who are sedentary during the week can also experience the condition. It’s easy to assume that Achilles tendonitis will improve on its own, but that’s usually not the case. Untreated, it almost always gets worse.

How to recognize Achilles tendonitis

Achilles tendonitis comes on slowly. Overuse causes the tendon to become tight and inflamed. Pain and swelling can occur anywhere along the Achilles tendon, which spans from the heel bone to the calf. When the condition first appears, the patient might notice some discomfort above the heel when running, walking, getting out of bed or standing for long periods. The pain and stiffness will usually worsen over time.

How physical therapy can help

Reducing inflammation in the Achilles tendon is the main goal of therapy. Depending on the patient’s level of mobility, treatment can include modalities like therapeutic ultrasound, dry needling and Astym. These modalities reduce inflammation and decrease the chances of the tendonitis from returning.

  • Therapeutic ultrasound is a highly effective treatment for Achilles tendonitis. It is used in conjunction with an anti-inflammatory gel applied to the surface of the skin. The ultrasonic waves help the gel to penetrate the tissue faster and bring relief to the inflamed area.
  • Dry needling is a form of manual therapy in which small needles are inserted into “knots” or trigger points. In Achilles tendonitis patients, it is used to address the referred pain that a patient can experience in the calf muscles. Dry needles are applied in a relatively painless manner and coax the muscle to release tension and “reset.”
  • Astym is a soft tissue therapy in which a clinician performs certain protocols of manual therapy using a small hard plastic instrument. This is an effective strategy for breaking down scar tissue and stimulating the growth of healthy soft tissue.

Patients with Achilles tendonitis usually see good results between 8-12 weeks.