Human Performance and Rehabilitation Centers, Inc.

Feeling Better As We Age

It’s just the pits. As we age, things just start to ache more. And as they start to ache more, we become less active and our fitness levels can go down as a result.

We spoke with HPRC Therapist Karen Lynn about steps that we can take to increase our physical fitness and about the overall health benefits this can provide.  In addition to increasing your overall physical health, physical fitness can improve cognitive function.  It can help increase alertness, decrease depression and anxiety, improve sleep and slow the progression of dementia and Alzheimer’s.

Starting Out

Before anyone starts a new fitness program, see your doctor to make sure you choose the best program for what your body can execute effectively.  After you start the program, allow about four weeks for the exercise habit to kick in.  We’ve all done the start and stop and gotten so frustrated we want to throw in the towel. STICK WITH IT!

  • Start slowly, cut yourself a break in the beginning. You aren’t going to go from 0 to 60 in three days! Build up to more rigorous exercise as your fitness level starts to increase.
  • Mix it up! Include a variety of exercises that help with cardio, balance, flexibility and strength.
  • Lastly, always listen to your body. If something doesn’t feel right or you start to feel ill, call your doctor immediately.

Tips to Keep the Program Going

Often, exercise is just plain not fun.  Find something that is FUN for you. It’s possible…just think outside of the box a bit!

  • Make it fun – Choose something that you look forward to – even walking along a local trail is a great start. Find a ballroom dancing class to go to or an aquatics class if you love to be in the pool!
  • Make it social – Join a group of friends for a hike, bike ride or walk in addition to going out for dinner and drinks. It’s a lot more fun when you’re in it together!
  • Make it an adventure – Get out of the gym and explore a different environment. For example, instead of plain yoga or jogging try a yoga retreat or a bike ride along a trail.
  • Keep fueling your body with food – Exercise is going to become easier if you are fueling it with nutrient-dense food.

How Can We Encourage Our Parents?

Some of you reading this may have parents you want to encourage to start moving more.

As children, we want to see our parents live as long and as comfortable of a life as possible.   To encourage them to exercise, we can remind them that being strong, flexible and having good balance can help them remain independent at home longer.  Not having consistent physical activity can lead to falls, which can be very serious for the elderly.

Encourage them to use the buddy system and work out with friends.  If you live close by you could even work out with them.  Encourage your parents to state fitness goals such as playing in the yard with grandkids, walking a race with their daughter or being able to climb the stairs at home. We are happy to help you put a plan in place based on those goals.

How Can PT Help

Physical therapists are ‘movement experts’ in the health field.  A PT can offer guidance with increasing mobility, strength and independence through a program designed around a thorough physical exam.  The program will include considerations of health issues and concerns of the client and can safely get them on the road to being more healthy and happy.

As you can see, there are many ways older people can maintain or become physically fit.  They just need to have a plan, have some goals and an understanding of the importance this can have on their quality of life, now and in the future.

Improve Your Running Through Better Mechanics

Do you feel like you aren’t getting the best results from your morning run?  Maybe you are having a little nagging pain afterwards?  This could be due to poor running mechanics.  Not running properly can lead to a variety of overuse and chronic injuries – Achilles tendonitis, plantar fasciitis, stress fractures, hip and low back pain, etc.  It can also slow down your pace and make your run less efficient.

Most often, we see a patient and learn that they have inefficient running mechanics through treatment of an injury.  We will first treat the injury to get them back to running health and then we will evaluate further to get to the root of the problem. We observe a patient running both on and off a treadmill, slow their pace down to observe their running style, look for compensations and to assess joint movement. We also take a look at their footwear to make sure they are in the proper shoe for their foot type and running style.  This process incorporates everything from their head to their feet.

If there is an issue with your running mechanics, it’s important to focus on correcting it while you are running.  Focusing on the adjustment will improve your mechanics more quickly and will lead to less energy expenditure, less overall fatigue and most importantly less pain, resulting in a decreased chance of injury or reinjury.  Quite often, we have to spend time on running education to discuss running surfaces, road camber, speed and distance training plans, as well as establish frequency and intensity guidelines while making adjustments. Usually after a couple of weeks performing specific exercise techniques and focusing on the change in form, patients are able to report a positive difference in how they feel before and after a run.

Keep in mind, poor running mechanics don’t just show up in adults.  You can spot it in your children as well.   If your child complains of pain while running, anywhere in the body, it can be a sign they have poor mechanics, unless of course, they have pushed their limits in a race or speed workout.  Pain caused by running can present in places one might not expect such as the lower back, shoulders, feet and knees.  Observe their shoulders, hips and knees and also look at their feet.  Having high arches or flat feet can lead to injury in a runner, if not in the proper footwear.   If there is something that just looks a little off, it wouldn’t hurt to have a running assessment done to prevent injuries in your child.

All About Parkinson’s

Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in the area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.  The specific group of symptoms that an individual experiences varies from person to person.

Symptoms

Primary motor (movement) signs of Parkinson’s disease include the following:
Tremor of the hands, arms, legs, jaw and face
Bradykinesia or slowness of movement
Rigidity or stiffness of the limbs and trunk
Postural instability or impaired balance and coordination

Each person with Parkinson’s will experience symptoms differently. For example, many people experience tremor as their primary symptom, while others may not have tremors, but may have problems with balance. Also, for some people the disease progresses quickly, and in others it does not. By definition, Parkinson’s is a progressive disease. Although some people with Parkinson’s only have symptoms on one side of the body for many years, eventually the symptoms begin on the other side. Symptoms on the other side of the body often do not become as severe as symptoms on the initial side.

Progression

The progression of Parkinson’s disease varies among different individuals. Parkinson’s is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years, but is not considered a fatal disease. Movement symptoms vary from person to person, and so does the rate at which they progress. Some are more bothersome than others depending on what a person normally does during the day. Some people with Parkinson’s live with mild symptoms for many years, whereas others develop movement difficulties more quickly.

Non-motor symptoms also are very individualized, and they affect most people with Parkinson’s at all stages of disease. Some people with Parkinson’s find that symptoms such as depression or fatigue interfere more with daily life than do problems with movement.

Since Parkinson’s disease (PD) is a chronic condition, it is important to develop and maintain a solid PD management plan. Research has shown that those who take an active role in their care see an improvement in their Parkinson’s symptoms.

Management

Managing your care means not only finding the right doctor, but ensuring you are prepared for your visit and talking to your doctors about the right issues. It means, not just taking your medications, but keeping track of when you need to take them. People with Parkinson’s are best served by a multi-disciplinary approach that provides not only the expertise of a PD specialist, but also the help of a physical therapist, occupational therapist, speech therapist, nutritionist and social worker. Some people also require medical consultants in areas such as psychiatry and neurosurgery. It is important that these healthcare professionals are aware of each other and communicate regularly, and that they all know the full list of treatments and medications that each is prescribing.
Physical and Occupational therapy focus upon restoring the ability to move effectively and safely by instructing and facilitating normal movement patterns and providing safety education and adaptive equipment to facilitate a person’s ability to maximize independence with mobility, self-care and activities of daily living.

Speech therapy focuses upon restoring swallowing, speech and language production and understanding and cognitive (thinking/memory) functions.

National HelpLine:
Ask the experts at PDF your questions
Are you looking for a support group? Call us at (800) 457-6676 or email info@pdf.org to find a group in your area

The toll-free HelpLine/email service – staffed by a team of information specialists – can:
Answer your questions about Parkinson’s disease: symptoms, treatments, complementary and alternative therapies and the latest scientific studies reported by the media.

Identify financial, legal and other resources to help you live well with Parkinson’s.
Provide access to an interpreter for non-English speaking callers.

Knee Pain Explained

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 between 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 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 and in many states no referral is required; in most cases, the therapist can make an accurate assessment of the problem and begin treatment immediately. If the problem is severe enough that a specialist should be involved, the therapist can facilitate the referral and also make recommendations for any diagnostic testing.

Managing Lymphedema

Lymphedema is a condition that has received a lot of attention in recent years. It can result when the lymph nodes are removed or damaged due to cancer treatment. Cancer patients aren’t the only ones who can have lymphedema, which causes swelling in the arms or legs. Individuals suffering from obesity or vascular issues can also experience it. While lymphedema has no cure, it can be managed effectively with physical therapy.

The lymphatic system is a network of organs, nodes and vessels that make and produce fluids necessary to the body’s function. When the lymph nodes are compromised, they fail to remove proteins from the lymphatic fluid, causing an accumulation of fluid and swelling in the limbs. It’s most often an asymmetrical condition, meaning it will only affect one arm or one leg. If the arms or the legs are both affected, one is usually worse than the other.

Many cancer patients will come to us immediately when their lymph nodes have been removed or radiated. But many other patients have suffered from lymphedema for years before they discover exactly what it is and that physical therapy can help.

We use three main techniques for addressing lymphedema: manual lymphatic drainage, multi-layer bandaging and circulation exercises. The duration of therapy will depend on the severity of the case.

  • Manual lymphatic drainage is an incredibly effective technique for pushing fluid out of the areas where it has built up toward the lymph nodes and the center of the body. A therapist should follow specific pathways, or “watersheds,” natural highways that help the fluid reach the lymph nodes and organs where it will be processed and ultimately flushed out of the body as urine.
  • Once manual lymphatic drainage has been performed, multi-layer bandaging helps keep the fluid from returning. Wrapping a leg or arm with bandaging has a compressive effect that helps restrict fluid build-up.
  • Circulation exercises are also an important part of lymphedema management. These are simple movements performed in a sequence that help pump fluid through the lymphatic pathways.

A good therapy program also teaches patients and caregivers to conduct these techniques at home. Once progress is made and independence is gained in therapy, a patient will continue to manage his or her condition, returning to therapy for extra support when the need arises.

Painful Sex… Physical Therapy?

You might find yourself asking why you would see a physical therapist for dyspareunia (pronounced dis-puh-roo-ne-uh) or in layman’s terms, painful sex.  The short answer is because musculoskeletal pain is a significant component of pelvic pain and dyspareunia.  Pelvic Physical Therapy is a specialization in the field of Physical Therapy that treats pelvic pain.

Were you aware that you have muscles in the base of your pelvis that are under your control?  These muscles are aptly called the pelvic floor muscles.  The muscles are attached to the front of the pelvis, connect to the tail bone and sacrum at the back of the pelvis and extend outward to reach the side walls of the bony pelvis.  They are the only load bearing horizontal oriented muscles in your body.  Think of a muscular bowl or hammock in the bottom of your pelvis.  Diane Lee PT, prefers to call these muscles a condominium rather than a floor as this gives a more accurate picture of their complex interactive placement with all the connective tissue, organs and nerves of the pelvis.  These muscles serve three main functions:

  1.  Supporting the organs within the pelvis, hence their load bearing function. They support your bladder, rectum, the female  vagina, uterus  and ovaries, and the male prostate.  So they are” always working “at a postural level
  2.  The muscles are sphincteric, in other words they control the opening and closing of the urethra, vagina, and rectum.
  3.  The muscles assist in the sexual response, by providing tone to the vaginal walls, maintaining erection in the female and male  and production of reflexive contractions of the deep muscle during orgasm.   Poor sexual response has been associated with  weak muscles  and poor awareness of muscle.  These same muscles provide stability to the pelvic joints, assisting the increased  demands on the low  back during strenuous tasks.

So what role does the muscle play in pain?  Superficial dyspareunia involves the first layer musculature, those that assist with vaginal tone and erection.  Deep dyspareunia involves the deeper muscles of the pelvis which support the organs and help the low back w stability.  The organs of the pelvis, the muscles and even the skin communicate messages through spinal cord and to each other through nerve tissue.

Muscular tension can be generated through organic cause and by direct injury.  Connective tissue can become restricted secondary to muscular tension and nerve irritation.  Tense/ tight muscles can compress and or stretch nerve tissue.  A pain cycle ensues moving from pain to muscular tension to nerve compression and connective tissue restriction and back to pain.

Muscular pain can be the source of dyspareunia, sometimes seen in postpartum women after injury to the muscle system during birth, or it can be in response to infection or dermatological changes within the tissue to name a few.   Hip pain, because of the proximity of the hip muscles to the pelvic wall can be a contributing factor in dyspareunia.  Low back pain can affect the pelvic floor musculature.

Dyspareunia can be related to hormonal changes in the postpartum breast feeding female or menopausal female, secondarily affecting muscle tissue.  The pain of endometriosis and interstitial cystitis can include musculoskeletal pain. In dyspareunia muscles are generally over working and need to learn to regain their normal length, their ability to relax and return to normal postural levels.  Assessment of dyspareunia includes an evaluation of the low back and pelvic joints, ability of the muscles to contract and especially relax and lengthen and evaluation of the nerve and connective tissue about the pelvis.

Physical therapists treat muscular pain with pressure, gentle stretching techniques and specific relaxation exercises. Mobilization of the spine, pelvic joints and connective tissue are generally a component of the treatment process.  The goal of treatment is to gain awareness and specifically motor control of the muscle to reduce or eliminate the cycle of pain.  Pelvic physical therapy restores the length-tension relationship of the muscles.

Painful sex can be embarrassing to discuss.  A pelvic floor physical therapist will put you at ease.   A pelvic health PT understands the complexities of the pelvic floor, and will help your muscles to regain their normal function.

Signs of a Receptive, Expressive and/or Social Pragmatic Language Disorder

Receptive, expressive and social/pragmatic language are considered critical milestones in a child’s life, but sometimes they are delayed. It’s important that parents and caregivers pay attention to the signs that a child is slowly progressing, not progressing or even regressing in language skills so he or she can receive the proper therapy. Early intervention is essential.

In the early years of life, children should begin to make basic connections between language and their surroundings. For example, a child should observe his/her parents’ mouths when they speak and begin to perform gestural language (e.g., waving). Children should also begin to understand what their parents’ words mean (following commands), form sounds that will eventually become words and pair their own words to become utterances about objects or events. When children have language disorders, they will lack one or more of these basic skills.

When one of our speech-language pathologists begins to work with a patient, a comprehensive evaluation is conducted, which includes assessing language (understanding and use), speech/resonance, voice, fluency, oral motor and swallowing abilities. A thorough plan of care with long-term goals and short-term objectives is developed and therapy is initiated. A big part of success in therapy is working closely with parents and caregivers because the home is an environment rich in opportunities to reinforce language. Home programs can empower the parents and caregivers to be involved in moving the child’s language skills along through play, interaction and socialization.

At HPRC Pediatric Therapy and Pediatric Rehabilitation, our setting is unique in that it offers comprehensive services, including therapy for gross and fine motor skills. If a child exhibits problems in these areas, we have physical and occupational therapists on site to work and collaborate with speech-language pathologists. Together, as a comprehensive team, we can see a child’s development as a complete picture.

Are young female athletes at greater risk for ACL injuries?

Young female athletes are five times more likely to sustain an ACL tear than their male counterparts. This is especially common in explosive multidirectional sports like soccer or basketball. It’s important for girls to learn how to jump and land properly in order to prevent an ACL injury from occurring.

Female athletes from about 14-18 years of age are at greater risk than boys of injuring the anterior cruciate ligament (ACL). This is largely due hormonal changes. An increase in estrogen during puberty causes relaxation of the ligaments and the natural widening of the hips causes changes in biomechanics. A female athlete is likely not conscious of these new structural changes as she continues to snag rebounds or bolt across the soccer field. She may inadvertently land or stop stiff-kneed or in a locked position, and she might have a greater tendency to internally rotate the knee due to weakness of the developing outer hip.

In addition, a female athlete may be accustomed to using only the quadriceps instead of her developing hamstrings to control movements. All of these factors can put the ACL at risk.

It’s important to teach young women early on how to adjust the way they run and jump in competition in order to prevent an ACL tear. A physical therapist can screen an athlete to evaluate body mechanics, potential weakness and faulty movement patterns. Prevention is key. And it’s time well spent since a young athlete who has suffered an ACL tear is 70% more likely to suffer a re-injury.

Here are some strategies:

  • Young athletes should be in shape for the demands of their chosen sport. This includes both cardiovascular capacity and muscular strength. During fatigue or exhaustion, even a small weakness or poor body mechanics can become a bigger problem.
  • A good strengthening program will encourage better hamstring-to-quad strength ratio, which will help reduce reliance on quads only.
  • Good lateral hip strength and hip abduction control will help maintain proper knee position so that a girl doesn’t experience what we call a valgus collapse, or the extra internal rotation of the femur and the knee falling inward.
  • Proper proprioception is key. When the foot hits the ground, the knee should be properly positioned over it. This allows for strong core-hip stability during lunges, running and multidirectional activities.

Physical therapists don’t just treat patients after an injury. They also work with patients to prevent one from occurring.

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.