Human Performance and Rehabilitation Centers, Inc.

Student Blog

Upon entering the HPRC main office, I was bombarded with joy, excitement, and warmth, mostly my own, but I knew that I was in good hands. This is my first long-term rotation, building relationships with patients, seeing their growth, and facing their challenges. I have been nothing but thankful to my patients, my Clinical Instructor, and the organization for the experiences I’ve had thus far and those that are yet to come.

The training and education that I’ve received has proven to be valuable every day. I have been trained to view each person differently, evaluating their symptoms and impairments, and using the findings to reach their personal goals. Even after such a short period of time in clinic, I’ve grown to love this profession even more (which is reassuring after dedicating so many resources to my education).

So what makes a PT’s education and training unique? Physical therapy school is a professional program that focuses on human anatomy and ultimately how the body moves. We consider ourselves the experts in human movement, recognizing abnormalities that are either contributing to an injury or inhibiting a person’s function. This includes three years of continuous learning divided between the classroom and clinic. There, we are subjected to a combination of written and practical exams testing our knowledge and competency in skills. You grow to rely on your PT family, a group of adults gathered with the same passion of bettering people’s lives by utilizing our extensive knowledge of human anatomy, kinesiology, and proper motion.

It should also be known that all physical therapy students graduate with a DPT, or a doctorate of physical therapy degree. The emphasis on higher education has come to light by including differential diagnosis (acknowledging other causes with similar symptoms), pharmacology, among other courses. This is all in preparation of treating patients directly, without the gate of a physician. Every state has some form of direct access of offering services to patients. This assists in cost savings through the elimination of an extra co-payment.   In addition, direct access allows patients the opportunity to have an individualized exercise plan, addressing muscle imbalances, and to provide relief from injury.

While we like to think we are ready to practice right at the start of school, we need guidance and practice to develop our skills, exercise progressions, and patient handling skills. If you ever have the pleasure to work with a student, make sure to maintain open communication. If something is uncomfortable, doesn’t seem to be improving your overall function, or you have a question about your condition or therapy, express your concern. You will improve your therapy as well as future experiences for other patients who are too timid to express their concerns.

Just remember, you are helping to mold the newest member of the healthcare team. Every therapist has memories from their clinical experiences that will affect how they treat and in what specialty they will dedicate their time. Be patient and open. But, most importantly, be an advocate for yourself. This will lead to better overall care for our future patients.

 

Frozen Shoulder

I just found out that I have a frozen shoulder. My friend said that therapy for this is very painful. Is that true?brycegaunt

Frozen shoulder is a painful condition in which the shoulder loses the ability to move normally.  Often, patients’ shoulders can be painful at night and also hurt when reaching overhead, behind their back, or in other extremes of motion such as putting on a jacket.  Some therapists do take a “no pain, no gain approach”. However, at the St. Francis Rehabilitation Center, in helping patients with this condition, we prefer the slogan “you don’t get a sore thumb better by hitting it with a hammer”.  While you will need to do exercises that gently move the shoulder, we carefully choose exercises that are friendly to your shoulder and teach you to perform them in a very comfortable manner that is NOT painful.  This gradually improves the movement in your shoulder while decreasing pain and inflammation.  Frozen shoulder can typically get better with exercises done primarily at home – only a few visits to see a therapist are usually necessary.  This approach is supported by multiple studies published in medical journals demonstrating that home based comfortable stretching guided by skilled therapists provides superior results compared to highly painful stretching.

Balance

I’ve been sent to Physical Therapy to receive help with my balance. What do I need to know?JulieKing

Many times, doctors will send a patient to physical therapy if he/she has experienced a fall, been ill, or just felt unsteady while walking. There are several different components to increasing and maintaining balance and mobility.

When you arrive for your appointment, there will be paperwork to complete, most importantly a past medical history form, including a list of your medications. This information is needed to see if you have any conditions or take any medication that could contribute to your symptoms.

During the evaluation, the therapist will test the muscle strength in your legs and assess your balance. These tests are done in an effort to determine which system of balance needs to be addressed. There are three primary systems of balance: vestibular, visual, and proprioceptive. The vestibular system is located in your inner ear and is sensitive to head movements and can create dizziness if there is a dysfunction. The visual system plays a role in your balance by interpreting what you see and making adjustments to obstacles that are ahead, such as a curb. Proprioception is the feedback that you receive from your feet being in contact with a surface. This is important if you are walking on an unstable surface, such as grass or gravel. These three systems help maintain your balance, and your legs have to be strong enough to help hold you up!

The PT will analyze how you walk and determine if you need an assistive device, such as a cane or walker, for safety. Your balance may be tested by your performing tasks such as balancing on one leg and standing with your eyes closed and by performing tasks that involve putting your feet close together or in front of each other. Some of these tests may seem silly, but they give the therapist information about your ability to perform daily activities safely.

Often, your therapist will want to see you once or twice a week to work on increasing strength and balance. One thing to remember with balance is that repetition helps the body re-learn the correct way to perform daily activities. More than likely, the PT will send you home with exercises to perform on your own. Performing these exercises will help maintain your mobility and strength between PT visits. Working on balance is a time-consuming process; you will need to be patient with yourself as your symptoms improve. Most importantly, therapists want patients to remain safe with their mobility and prevent future falls. By improving strength and balance, you will be on the right track to stay injury free!

Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS)brooketeaster

By Brooke Teaster Schwoebel MHS, OTR/L, CHT

Do you wake up at night finding yourself having to shake out your hand because it falls asleep? Do your fingers go numb while you are typing at work? If you answer yes to either or both of these questions, you may have Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome is a condition in which the median nerve is compressed as it passes through an opening from the wrist to the hand called the carpal tunnel. It is formed by the carpal bones on the bottom of the wrist and a ligament structure on top (transverse carpal ligament) that runs across the wrist. The Median nerve, is just below this ligament, and provides sensory and motor functions to the thumb, index finger, middle finger and ½ of the ring finger.

Carpal Tunnel Syndrome is a repetitive use injury/Cumulative Trauma Disorder and can begin with numbness and tingling that comes and goes in above specific fingers; however, it can become constant, causing an increase in discomfort in the hand and even forearm. This can be caused from poor positioning while sleeping allowing wrist(s) to stay bent for long periods, using tools that vibrate for long periods of time, poor ergonomics while sitting and typing or even while standing at a work bench with repetitive use of hand(s). Other symptoms include weakness with gripping objects, dropping items with affected hand, swollen feeling in fingers, and/or awakening at night due to discomfort in thumb, index and middle fingers.

It’s important for you, with these symptoms, to seek medical attention quickly as compression on the nerve will continue and can eventually lead to nerve damage.

How to treat it?

Treatment will be based on your age, past medical history and the extent of the syndrome. To begin relieving compression on the nerve at the wrist and prevent wrist motion, wrist splints are beneficial to wear during the time the symptoms are more prevalent. Other treatments can include anti-inflammatory medication, phonophoresis/iontophoresis, median nerve glides, ASTYM (Augmented soft tissue mobilization), changing positions of work station (ergonomics), or surgery to relieve the compression of the nerve in the carpal tunnel.

If your symptoms are not improving with conservative treatment above, a nerve study (EMG) can be ordered to determine the location of the compression and its severity. As a result, this will allow the surgeon to determine if surgical intervention is warranted or to continue with conservative treatment to alleviate the symptoms.

If you have surgery, what to expect:

Surgery is a scary thought and there are risks involved; however, this surgery is performed using a scope and a small incision and recovery is pretty quick as long as you follow instructions via the doctor and your therapist. If you are non compliant, the recovery can be long and make you question why you had surgery.

In general, the surgery for CTS is performed under local or regional anesthesia and is an outpatient procedure allowing you to go home the same day after surgery. For endoscopic approach, there is a small incision made at your wrist area, and the tissue that is pressing on the nerve will be cut to decrease the pressure.   After the surgery, a bulky dressing will be used to immobilize your wrist, but your fingers are free allowing you to move them immediately after surgery. You will follow up in therapy 3-5 days after surgery. The bulky dressing will be removed, incision cleaned and your home exercise program will be initiated. A smaller dressing will be reapplied after therapy for ease of daily dressing changes at home. Approximately 10-12 days from surgery, stitches will be removed either by doctor or therapist and will continue to progress your movement and activities, as tolerated. The length of recovery can vary with each person especially if the nerve has been compressed for a long time, return of your sensation may take longer. Typically, four weeks from surgery, strengthening activities will begin under the supervision of a therapist to ensure you are progressing well without pain or discomfort. Weekly progression of resistance’s/weight limits are issued via your therapist and this methodical succession will return you to your prior level of function pre-Carpal Tunnel symptoms. Full recovery of the nerve is said to be approximately 18 months, but most people’s sensation returns well before that time frame.

 

Knee Pain

Suffering from knee pain? Here are some reasons why…

Jo Barker PTjobarker

Knee pain is something nearly every person experiences at one point or another, usually related to a particular injury or provocative activity, such as lots of kneeling for spring planting in the yard or playing the occasional game of basketball. How do you know the difference in a serious injury versus simple overuse? The causes of knee pain typically fall into one of three categories: traumatic, overuse, and degenerative.

Traumatic is self-explanatory; a fall, collision, twist, or awkward landing can create enough force to damage the structures inside the joint. When this type of damage occurs, the person may experience severe and immediate swelling, severe pain, a loss of ability to move the joint, and an inability to bear weight through the limb; a safe bet is when two of the three exist, the person should seek medical attention from a physician and/or physical therapist immediately. Attempting to “walk it off” is not recommended.

An overuse injury can be a little tougher to recognize. Starting a fitness program or a dramatic change in a person’s activity level (more or less) can provoke this type of pain. So can rapid increases in body weight, such as pregnancy. Adolescents who are going through growth spurts will often have pain in the knees because of changes in the way the muscles and joint function together. The pain may show up immediately or gradually, appearing more and more frequently until it is constant. Swelling may appear but it is typically not severe, and disappears overnight. Depending on the structure inside the knee that is taking the abuse, surgery may be needed, but many times this is treated quickly and effectively with a short course of rest, stretching and strengthening.

“Degenerative” describes the normal changes our joints experience with aging, specifically thinning of the articular cartilage and the loss of quality in the soft tissue of the joint. Knee pain from degenerative changes generally does not produce swelling, and is provoked by remaining in one position for a great deal of time.

Besides pain, a problem within the knee (or any joint) will also cause the muscles around the joint to stop working effectively. Over time this will produce a loss of muscle size as well as a loss of control of the joint. The longer the joint remains untreated, the more severe the muscle atrophy and loss in function will become. Other joints may become painful as a result, particularly the areas above and below the injured joint or the opposite side. Medical treatment should begin before the body learns bad movement patterns.

Unless severe structural damage is present, a course of physical therapy will often be successful in getting rid of pain and restoring a person’s usual activity level. Any physician can refer to physical therapy; in most cases, the therapist can make an accurate assessment of the problem and begin treatment immediately. If the problem be severe enough that a specialist should be involved, the therapist can facilitate the referral and also make recommendations for any diagnostic testing.