Geaux to Physical Therapy℠

Physical Therapy Over Opioids

MoniqueSerpasPT — Sat, 23 Jan 2016 17:01:52 +0000

Opioid abuse and resulting drug addiction have become such an issue that presidential candidates are talking about it. It is becoming much more prevalent and has even hit close to home last year with the bust of a heroin ring on the Northshore of Lake Pontchartrain. A discussion about it this week on NPR’s On Point described this kind of addiction as a disease in itself. A young man called in, Tom, stating he was a recovering heroin abuser, currently receiving regular methadone doses at a clinic. He said it started when he injured his back at work. He went on to describe the progression from injury to addiction, “From there you got to have them everyday to function at work and it gets to a point where actually you don’t even care about the high anymore, you just don’t want to get sick. Then the time comes and somebody offers you heroin.” The show talked about how the market for heroin has increased because of people that have become addicted to opioid pain killers, like hydrocodone, Vicodin, and Percocet. Fortunately for Tom, he was able to recognize his problem and receive treatment. Others are not so fortunate and waste their lives away before dying.

Picture 1: Drug Poisoning Deaths Involving Opioid Analgesics

Where does the drug addiction start? It starts with prescribing the medication and many times it is prescribed for a musculoskeletal pain, like Tom’s. Want a solution to this rampant problem? The answer is physical therapy. Physical therapy is an effective treatment for a host of pains, including back pain, for which these medications are commonly prescribed. Physical therapy as a treatment is not prescribed nearly as much or as quickly as it should be. Physical therapy is effective in treating back pain, especially within two weeks of onset. Research has shown earlier PT can decrease the prescription of opioid medications by 78%. Other benefits include decreased surgery by 45%, decreased advanced imaging by 34%, and decreased injections by 42%. The earlier, the better, when it comes to starting therapy.

The costs of opioid addiction are high and devastating.

As a physical therapist, it is frustrating to hear stories like Tom’s, even from my own patients who were not prescribed physical therapy first. For people with pain, get physical therapy first. Let’s get this message out to more people so they know to ask for effective, non-pharmacologic treatments. It’s the way it should be.

References

Fritz, Julie M., et al. “Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.” Spine37.25 (2012): 2114-2121.
Choi, B. (2011). Exercises for prevention of recurrences of low-back pain. Cochrane Database of Systematic Reviews. [serial online]. January 18,2011;(2) Available from Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed July 7, 2014.
“Policy Impact: Prescription Painkiller Overdoses, What’s the Issue” (2013). Centers for Disease Control. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/
Health, United States, 2013 (2013). Centers for Disease Control, Natl Center for Health Statistics. http://www.cdc.gov/nchs/hus.htm

Author information

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

Follow @MoniqueSerpasPT

My name is Monique Serpas, PT, DPT, OCS. I am a physical therapist and board-certified Orthopaedic Clinical Specialist practicing at the Southeast Louisiana Healthcare System in New Orleans, LA. I realize how difficult it can be to overcome an injury or manage a chronic condition and am focused on helping my clients achieve wellness through a physically active lifestyle. I treat orthopaedic, balance, and vestibular disorders and practice using a combination of hands-on manual therapy, therapeutic exercise, and education. This enables my patients to assist in their own recovery and injury prevention. I also have developed fall prevention and golf-related rehab programs in the past. I hold a Doctor of Physical Therapy from Concordia University Wisconsin (2008) and a Bachelor of Science in Kinesiology from Louisiana State University (2004). I am a member of the American Physical Therapy Association (APTA), Louisiana Physical Therapy Association (LPTA), and the Orthopaedic and Neurology sections of the APTA.

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

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Giving Shoulder Impingement Up for Lent

MoniqueSerpasPT — Sun, 22 Feb 2015 13:09:48 +0000

Drew Brees as King Bacchus- He knows a thing or two about shoulder rehab. By Rian Castillo (originally posted to Flickr as king bacchus) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

The denial is over and the hangover is real. The overindulgences of Mardi Gras can be felt for most of us in our waistline, which causes many to make the painful forty-day commitment to spurn all things fried or sweet. But some of us may have come out of the carnival season with not just a painful fullness in the gut, but a real pain in the shoulder and this is no joke. If you felt a pain when reaching up to throw or catch a bead, you may have a condition called shoulder impingement.

Shoulder impingement results when the rotator cuff muscles and fibrous capsule of the shoulder joint get pinched around the shoulder joint. Symptoms include difficulty reaching above shoulder height and pain felt on the outside of the shoulder. Over time, shoulder impingement can lead to rotator cuff tears. Many times shoulder impingement is due to joint stiffness, muscle imbalances, and weakness, all of which can be addressed in physical therapy.

If this sounds like you, challenge yourself this lent to give up the time it takes to exercise for your shoulder’s health. A physical therapist can design a program that addresses your specific needs so that your shoulder is ready to hold an umbrella for Jazz Fest. I promise it’s not as painful as giving up fried or sweet foods.

Author information

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

The post Giving Shoulder Impingement Up for Lent appeared first on Geaux to Physical Therapy℠.

There is a Season for Everything

MoniqueSerpasPT — Sun, 01 Feb 2015 02:10:51 +0000

If you’ve wondered where I’ve been for the past few months… I’ve been focusing my efforts on my growing family and work. My husband and I had our second son last fall and with two children in diapers, efforts have focused on keeping our family in a relative state of sanity. In reality, we are enjoying our current season of parenting.

I haven’t devoted much time to writing for Geaux to Physical Therapy, but I’ve been promoting physical therapy in other ways. I spoke at Touro Infirmary, where I work, about back pain last Fall and was recently featured on WLAE’s Doctors New Orleans show. I am also excited to be writing for Touro’s newly updated blog. I’ll be contributing pieces there throughout the year. You can catch my first post here.

To everything there is a season and the season of promoting physical therapy is year round for me. I hope to see you here more this year! Move well. Geaux to physical therapy.

Author information

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

The post There is a Season for Everything appeared first on Geaux to Physical Therapy℠.

That Pain in Your Arm Could Be a Real Pain in the Neck

MoniqueSerpasPT — Tue, 01 Apr 2014 21:07:33 +0000

Tug Of War – 2008 Retie – 10 (Photo credit: Alex De Mey)

A recent patient came to me with pain in her shoulder. She said it started with just pain in the shoulder that would come and go, then it became more constant and interfered with her ability to use her arm. After evaluating the patient, I explained that I thought most of the problem was originating from her neck. “But the pain is in my shoulder.” I explained, one thing can lead to another. That pain in your arm is really a pain in the neck.

//www.youtube.com/watch?v=JHYIGy1dyd8

Nerves are like strings and when tugged at one end can create symptoms anywhere along the course of the string. Nerves originate from the spine, specifically in the neck or cervical spine for the arm. Pain caused by conditions such as tennis elbow, carpal tunnel syndrome, cubital tunnel syndrome, tendinitis, and bursitis in the arm could actually be originating from an undiagnosed condition of the neck called cervical radiculopathy. Cervical radiculopathy is a condition in which a nerve is injured at the site of the cervical nerve root, where it exits the spine. Some people call it a “pinched nerve.” Symptoms of cervical radiculopathy include pain, numbness and tingling or “funny feelings” in the arm, and weakness in the arm or hand. These symptoms can mimic other conditions of the arm and hand such as carpal tunnel syndrome or tennis elbow. I have even known some patients that had surgeries for carpal tunnel syndrome, only to find out afterwards that cervical radiculopathy was contributing to their original symptoms. Don’t let this happen to you or someone you know! Be sure to have your neck evaluated if you are having pain, numbness, tingling, or weakness in your arm or hand. It could be a real pain in the neck!

Want to read more about what physical therapy can do for this condition?

Go to JOSPT’s website. for the article “Neck and Arm Pain: Mechanical Traction and Exercises Prove an Effective Treatment.”

References

De-La-Llave-Rincon, et al. (2011). Women With Carpal Tunnel Syndrome Show Restricted Cervical Range of Motion. JOSPT, 41(5): 305-310.

Fritz et al, titled “Exercise Only, Exercise With Mechanical Traction, or Exercise With Over-Door Traction for Patients With Cervical Radiculopathy, With or Without Consideration of Status on a Previously Described Subgrouping Rule: A Randomized Clinical Trial,” J Orthop Sports Phys Ther 2014;44(2):45–57.

“Neck and Arm Pain: Mechanical Traction and Exercises Prove an Effective Treatment.” J Orthop Sports Phys Ther 2014;44(2):58.

Author information

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

The post That Pain in Your Arm Could Be a Real Pain in the Neck appeared first on Geaux to Physical Therapy℠.

Bringing Up Mama: Postpartum Recovery with PT

MoniqueSerpasPT — Fri, 10 May 2013 15:23:27 +0000

Cover of Baby Care (101 Essential Tips)

Childbirth is a physically-demanding process. Though they try, no amount of birthing class instruction or self-help books can fully prepare an expectant mother for the demands of childbirth. Even though I did all I could do to prepare, the feeling of childbirth came as a surprise. Likewise, postpartum has its own demands and surprises. Moms, though they know life will be an adjustment when a baby arrives, they may not recognize the adjustments their own bodies will go through. With all the rocking, diaper changes, and time spent hypnotized by the cuteness of a new baby, a new mom may find it hard to focus on her own postpartum recovery. Supporting this is our culture of expecting moms to be superhuman. Women can raise babies, work full-time, cook, clean, and organize the household’s activities… all on a good solid 3 hours of sleep.

Most women expect recovery from childbirth to include weight loss. I read the book “Bringing up Bebe” and in it author, Pamela Druckerman, talks about how French women are expected to get their figure back and usually by the third month postpartum! Tres bien! The new mom, however, may not expect some of the other potential postpartum difficulties including the following:

low endurance
uterine contractions
depression
overstretched abdominals (diastasis recti)
back, hip, pelvic, and/or neck pain
incontinence

As I’ve talked with other women, I’ve found that there is a wide disparity in postpartum education and recovery. In the U.S., there seems to be a lack of formal programs and guidelines for the recovering mom, but in some other countries, women are automatically enrolled in a 6 week postpartum class. These “What to expect when you’re done expecting” classes teach women about their bodies and exercises to help them get back in shape and feeling like themselves again.

If you are a new mom, you should not expect the above problems to linger. This is NOT normal. Ask for help. Specifically, ask for a physical therapist. I’m always surprised to find moms in therapy that have had ongoing problems following childbirth, and it took years for them to get into physical therapy to finally start addressing them properly. If your hip still hurts, your back started hurting and never stopped, or you lose a little urine when you jump or run, someone can help you… and that someone is a physical therapist. Seek out a PT that specializes in women’s health and orthopaedics. A PT can teach you how to manage these conditions and give excellent consultation on exercises that are most appropriate for postpartum recovery. We give so much attention to bringing up bebe that we have forgotten that we’re bringing up mama too. Let’s not forget to give moms the attention they deserve and not just on Mother’s Day! Now that I’ve been through it, I know I won’t forget!

Author information

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

The post Bringing Up Mama: Postpartum Recovery with PT appeared first on Geaux to Physical Therapy℠.

Prevent Fractures with PT

MoniqueSerpasPT — Tue, 12 Mar 2013 18:00:55 +0000

Benjamin Franklin (Photo credit: elycefeliz)

The United States Preventive Services Task Force (USPSTF- now say that five times fast) recently issued new recommendations in regard to vitamin D and calcium supplement prescription to prevent fractures. The recommendations guide health professionals to practice utilizing current research evidence. The task force concluded, “the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men.” It was also inconclusive as to, “daily supplementation with greater than 400 IU of vitamin D₃ and greater than 1,000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women.” It also recommended, “against daily supplementation with 400 IU or less of vitamin D₃ and 1,000 mg or less of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women.”

Fractures happen when bone fails and breaks. An unexpected fall could result in a fracture. According to the CDC, most fractures in older adults are a result of a traumatic fall. Over 95% of hip fractures are due to a fall. For those with osteoporosis, a fracture can result from seemingly harmless activities, like getting out of bed. For those trying to be more physically active, fractures can result from training errors.

A physical therapist can help prevent fractures. PTs can help improve strength and balance in order to reduce the risk of falling. They make home visits to identify unsafe conditions in the home and make recommendations to make the environment safer. They can instruct patients who have osteoporosis in safe exercise to maintain good bone health and activities to avoid to reduce the risk of fracture. They can also advise active individuals in safe training that will not result in overuse injuries such as stress fractures.

Broken bones can result from trauma and accidents and these can be hard to prevent, but as you see in certain conditions, physical therapy is the ounce of prevention needed to prevent fracture.

Need a physical therapist? Find me at New Orleans’ Touro. Or go to the APTA’s Move Forward website to find one in your area.

References

Falls in Older Adults: An Overview. (2012). Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. Accessed on 03-11-13 at http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;(9):CD007146.

Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011, (7): CD000333.

Vitamin D and Calcium Supplementation to Prevent Fractures, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsvitd.htm

Author information

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

The post Prevent Fractures with PT appeared first on Geaux to Physical Therapy℠.

Cortisone Injection or Physical Therapy?

MoniqueSerpasPT — Tue, 05 Feb 2013 12:44:19 +0000

English: A scene in the Atchafalaya Basin in Louisiana, USA. (Photo credit: Wikipedia)

It was recently suggested that I provide another blog on cortisone injections. I wrote one of my earlier blogs to address the topic of cortisone injections because of the number of questions I get about them from my patients. I answered questions about how they work, my opinion on their use, and the side effects you would expect in my earlier blog. Now, I’d like to talk about potential reasons for having cortisone injections, how physical therapy can help, and research in regard to the effects of cortisone injections.

As a physical therapist that practices in an outpatient setting, my patients with orthopedic problems such as arthritis, bursitis, and tendinopathies tend to have questions about these injections. Cortisone injections are powerful anti-inflammatory treatments administered by Medical Doctors that can be used for a wide variety of problems. One thing I stress to my patients is that if they have questions about cortisone injections, they should share them with their doctor. It’s important to discuss the reasons for having a cortisone injection and the potential side effects. Some of the known side effects can be serious and include such problems as infection, tendon rupture, and osteoporosis to name a few. The doctor may be using the injection to make a diagnosis, to determine a course of treatment, or to provide pain relief, and it is important for you to understand why he or she is recommending it so you, the patient, know what to expect. In making a diagnosis, cortisone injections may differentiate one condition from another, thus making further treatments more likely to succeed.1 2 For instance, sometimes relief from cortisone injection can be used to help predict the success of a possible surgery.3 4

Many people want cortisone injections to alleviate pain. For pain relief, the success of cortisone injections varies and can be affected by the presence of other contributing factors including other medical conditions.5 6 If you have a medical condition that impairs healing or a compromised immune system, the risk of side effects may be increased and the success rate may be decreased.7 8 Be sure your physician is aware of your preexisting conditions since there are many factors that could impact cortisone injection effectiveness.

But before I continue, let’s talk about why you’re here on my blog reading about cortisone injections. Are you in pain? Are you having trouble moving and going about your normal day due to pain and stiffness? Do you have arthritis, bursitis, tendinitis/tendinosis/tendinopathy, plantar fasciitis, rotator cuff problems, labral tears, degenerative joint disease, a bad back, or other painful orthopedic condition? Are you having trouble moving or being in certain positions? Because if you are, step one of treatment should be physical therapy. If your doctor hasn’t suggested physical therapy as an option for you and your condition, you should ask him or her why not. Physical therapy is beneficial to all of the conditions I just mentioned and more, plus there are several added bonuses.9 10 11

Taking a more natural approach, avoiding the side effects of injections and medication
Learning how to take control of your own situation through a plan that you can do at home
Physical therapy helps you find and treat the problems that are contributing to your condition. Physical therapy is not a temporary bandage. PT supports long-term healing, reduces strain and stress, and can slow down degenerative conditions while improving your freedom of movement.12 13

Cortisone injections are helpful for some conditions and you should discuss with your doctor whether your condition is one in which cortisone is shown to be effective. Most of the research I have found shows cortisone injections are most effective in the short-term and this mimics what I have seen in the clinic with my clients.14 15 16 The injection can be helpful to the therapy process when the pain is unbearable and exercise is not tolerable. Where I have seen them to be especially helpful is with knee arthritis and with persistent hip bursitis.

There is research since that first blog in regard to cortisone injections that is worth mentioning. For shoulder impingement and rotator cuff tendinitis, it is unclear whether injections are beneficial.17 18 For some other conditions, specifically tendinopathies, research either shows injection ineffectiveness or that it may actually worsen the condition.19 20 21 Recent research into tendinopathies has shown that many times inflammation is not even present and the painful condition is due more to degeneration of a tendon and improper healing.22 23 Cortisone works by decreasing inflammation and if this is not present, there should be no reason for it to work. Due to the side effect cortisone has on weakening connective tissue, it seems this should not benefit the natural course of the disease in the already weakened tendon. There is not much research on the long-term effects of cortisone injections for the most common conditions I mentioned at the start of the post, though for tennis elbow, or lateral epicondylitis (which is a tendinopathy), there is research showing that those who had cortisone injections actually do worse at 3 and 12 month long term follow up compared to those who did not have the injections.24 25

Are you debating whether to have a cortisone injection or physical therapy? My biased opinion is to try physical therapy first. Cortisone injections have side effects that shouldn’t be taken lightly. The success of cortisone injections varies by condition and for certain tendinopathies, there are studies that show it can actually make the condition worse. You should always discuss treatments with your healthcare providers and weigh the risks and benefits. A physical therapist is going to look at how you are moving, educate you about your body’s characteristics that are contributing to your problem, and develop a plan to improve your body in order to reduce stress and strain to an area and promote healing. I’ve helped people with the conditions I mentioned above reduce their pain, improve their strength and flexibility, and return to their usual activities. Need a physical therapist? Find one here.

And to end on a personal note… it has been a while since I’ve written… but there are good reasons. #1 A move from Wisconsin back to Louisiana to be closer to my family and #2 (the driver for #1), my first baby, a son Lucas.

Additional References (Open)

Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006; 333: 939.

Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2009; 1: CD004016.

Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; published online Oct 22. DOI:10.1016/S0140-6736(10)61160-9.

Fedorczyk, Jane M. Tendinopathies of the Elbow, Wrist, and Hand: Histopathology and Clinical Considerations. Journal of Hand Therapy 25. 2 (Apr-Jun 2012): 191-200.

Grumet, Robert and Rubin, Benjamin. Injection Therapies in the Management of Shoulder Injuries. Oper Tech Sports Med 20:114-123.

Habib, George S; Saliba, Walid; Nashashibi, Munir. Local effects of intra-articular corticosteroids. Clinical Rheumatology 29. 4 (Apr 2010): 347-56.

Hadwen, Georgy. Shoulder Pain: Corticosteroid Injections. Evidence Summaries – Joanna Briggs Institute. (May 14, 2011).

Koester, Michael; Dunn, Warren; Kuhn, John; Spindler, Kurt. J Am Acad Orthop Surg, January 2007 vol. 15 no. 1 3-11.

Johansson, Kajsa; Bergstromb, Anna; Schroderb, Karin and Foldevi, Mats. Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care–a randomized clinical trial. Fam Pract August 2011 ; 28:355-365.

Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med 2009; 43: 247-52.

Kon, Elizaveta; Filardo, Giuseppe; Drobnic, Matej; Madry, Henning; Jelic, Mislav; van Dijk, Niek; Della Villa, Stefano. Non-surgical management of early knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy 20. 3 (Mar 2012): 436-49.

Mayo Clinic Staff. Cortisone Injections. http://www.mayoclinic.com/health/cortisone-shots/MY00268

Mcgarry, James G; Daruwalla, Zubin J. The efficacy, accuracy and complications of corticosteroid injections of the knee joint. Knee Surgery, Sports Traumatology, Arthroscopy 19. 10 (Oct 2011): 1649-54.

Peterson, Cynthia; Hodler, Juerg. Adverse events from diagnostic and therapeutic joint injections: a literature review. Skeletal Radiology 40. 1 (Jan 2011): 5-12.

Roh, Young Hak; Yi, Seung Rim; Noh, Jung Ho; Lee, Sung Yup; Oh, Joo Han; Gong, Hyun Sik; Baek, Goo Hyun. Intra-articular corticosteroid injection in diabetic patients with adhesive capsulitis: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy 20. 10 (Oct 2012): 1943-8.

Scott, Alexander; Khan, Karim M. Corticosteroids: short-term gain for long-term pain? The Lancet 376. 9754 (Nov 20-Nov 26, 2010): 1714-5.

Van Thiel, Geoffrey S.; Chahal, Jaskarndip; Mall, Nathan; Heard, Wendell; Jordan, Mark A.; Nho, Shane J. Hip and Pelvic Injections. Operative Techniques in Sports Medicine 20. 2 (2012): 142-153.

Wysocki, Robert W.; Biswas, Debdut; Bayne, Christopher O. Injection Therapy in the Management of Musculoskeletal Injuries: Hand and Wrist. Operative Techniques in Sports Medicine 20. 2 (2012): 132-141.

Grumet, Robert and Rubin, Benjamin. Injection Therapies in the Management of Shoulder Injuries. Oper Tech Sports Med 20:114-123.
Wysocki, Robert W.; Biswas, Debdut; Bayne, Christopher O. Injection Therapy in the Management of Musculoskeletal Injuries: Hand and Wrist. Operative Techniques in Sports Medicine 20. 2 (2012): 132-141.
Grumet, Robert and Rubin, Benjamin. Injection Therapies in the Management of Shoulder Injuries. Oper Tech Sports Med 20:114-123.
Wysocki, Robert W.; Biswas, Debdut; Bayne, Christopher O. Injection Therapy in the Management of Musculoskeletal Injuries: Hand and Wrist. Operative Techniques in Sports Medicine 20. 2 (2012): 132-141.
Grumet, Robert and Rubin, Benjamin. Injection Therapies in the Management of Shoulder Injuries. Oper Tech Sports Med 20:114-123.
Wysocki, Robert W.; Biswas, Debdut; Bayne, Christopher O. Injection Therapy in the Management of Musculoskeletal Injuries: Hand and Wrist. Operative Techniques in Sports Medicine 20. 2 (2012): 132-141.
Grumet, Robert and Rubin, Benjamin. Injection Therapies in the Management of Shoulder Injuries. Oper Tech Sports Med 20:114-123.
Wysocki, Robert W.; Biswas, Debdut; Bayne, Christopher O. Injection Therapy in the Management of Musculoskeletal Injuries: Hand and Wrist. Operative Techniques in Sports Medicine 20. 2 (2012): 132-141.
Fedorczyk, Jane M. Tendinopathies of the Elbow, Wrist, and Hand: Histopathology and Clinical Considerations. Journal of Hand Therapy 25. 2 (Apr-Jun 2012): 191-200.
Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med 2009; 43: 247-52.
Kon, Elizaveta; Filardo, Giuseppe; Drobnic, Matej; Madry, Henning; Jelic, Mislav; van Dijk, Niek; Della Villa, Stefano. Non-surgical management of early knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy 20. 3 (Mar 2012): 436-49.
Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med 2009; 43: 247-52.
Kon, Elizaveta; Filardo, Giuseppe; Drobnic, Matej; Madry, Henning; Jelic, Mislav; van Dijk, Niek; Della Villa, Stefano. Non-surgical management of early knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy 20. 3 (Mar 2012): 436-49.
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; published online Oct 22. DOI:10.1016/S0140-6736(10)61160-9.
Roh, Young Hak; Yi, Seung Rim; Noh, Jung Ho; Lee, Sung Yup; Oh, Joo Han; Gong, Hyun Sik; Baek, Goo Hyun. Intra-articular corticosteroid injection in diabetic patients with adhesive capsulitis: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy 20. 10 (Oct 2012): 1943-8.
Mcgarry, James G; Daruwalla, Zubin J. The efficacy, accuracy and complications of corticosteroid injections of the knee joint. Knee Surgery, Sports Traumatology, Arthroscopy 19. 10 (Oct 2011): 1649-54.
Johansson, Kajsa; Bergstromb, Anna; Schroderb, Karin and Foldevi, Mats. Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care–a randomized clinical trial. Fam Pract August 2011 ; 28:355-365.
Koester, Michael; Dunn, Warren; Kuhn, John; Spindler, Kurt. J Am Acad Orthop Surg, January 2007 vol. 15 no. 1 3-11.
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; published online Oct 22. DOI:10.1016/S0140-6736(10)61160-9.
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006; 333: 939.
Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2009; 1: CD004016.
Fedorczyk, Jane M. Tendinopathies of the Elbow, Wrist, and Hand: Histopathology and Clinical Considerations. Journal of Hand Therapy 25. 2 (Apr-Jun 2012): 191-200.
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006; 333: 939.
Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; published online Oct 22. DOI:10.1016/S0140-6736(10)61160-9.
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006; 333: 939.

Author information

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

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Exercise Solutions for Your Pregnancy Problems

MoniqueSerpasPT — Fri, 07 Sep 2012 12:00:38 +0000

I’ve officially crossed the threshold into the third trimester of pregnancy. I tried to prepare myself as much as possible prior to getting pregnant and based on stories and conjecture I had a few preconceptions (pun intended) about what this experience would be like.

Monique’s Preconceptions on Pregnancy (circa early 2012)

9 months of tired, bloated, nauseous torture. joy.
I wonder what it’s like to feel like a cow…
How will I be lifted every time I need to get out of a chair?
I have seen the future of pregnancy-related pain and it is not pretty.
Goodbye fun, active lifestyle
Will need new shoes to accommodate the hobbit feet. At least I’ll get to buy new shoes- that’s fun.

Maybe it’s the fuzzy feel-good hormones talking, but the experience actually has NOT felt like a 9-month sentence to Guantanamo Bay. I’m glad I was wrong, and I think I might actually get out of this without feeling too terrible. One big reason I think I’m feeling more like a magical unicorn than a cow is exercise. There are a lot of pregnancy-related woes that can be helped by this simple, regular activity, not to mention the benefits to your baby’s health.

Exercise during Pregnancy can Help the Following:

Fatigue: some people just get this in the first trimester like I did, some people have it their entire pregnancy, and others don’t get it at all (and those of you in this category need to stop bragging). If you have fatigue, regular exercise can help to keep your energy levels up. The biggest battle is getting out there and doing something, but once you have you’ll feel much more energized. It doesn’t have to require any special equipment, you can feel better with simple things like taking a walk. A walk makes me feel much more refreshed than a nap.
Cankles: Exercise improves your circulation and the pumping action of the muscles in your legs can help to prevent or minimize the development of swelling which leads to the dreaded cankle.
Waddling Duck Gait: Your pelvis will be looser due to the hormonal changes your body goes through and this can result in a waddling gait, but some of this waddling is due to weakness in the hips which are not supporting the pelvis well. Do your best to prevent waddling by strengthening your glutes. This will also help to improve your ability to squat and get up from chairs or the floor.
Loss of Bladder Control when sneezing or giggling: Performing exercises to strengthen the pelvic floor muscles can help to prevent this embarassing problem, but it also helps to prepare you for the rigors of labor. One exercise that can help to engage and strengthen your pelvic floor is the kegel, where you contract and relax the muscles of the pelvic floor.
Body Image and Confidence: You will get the preggy belly and larger breasts which will encourage your posture to unattractively slump. Work on good preggie posture by strengthening muscles in your back and core, stand tall, and feel more confident about your body.
Back Pain: I could write a separate post about this topic. Strengthening exercises and exercises to promote an improved posture will help to prevent and manage back pain. Most pregnant women do experience some form of back pain, but if it gets bothersome, don’t suffer, see a physical therapist. I’ve seen women, usually in the third trimester, with back pain and the therapy has helped to make them much more comfortable and in control of this problem.

Exercise can also help to reduce your stress, manage your blood glucose levels, manage your blood pressure, and help to prevent blood clots, all leading to a more healthy you, pregnancy, and baby. Exercise is still my drug of choice, even when pregnant. Talk to your doctor to be sure exercise is safe for you during your pregnancy as there are some conditions in which it is not safe to exercise. If all systems are go, get into the routine of continuing exercise while you’re pregnant and squash the preconceptions.

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MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

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Anatomy of the Rotator Cuff

MoniqueSerpasPT — Mon, 11 Jun 2012 14:23:50 +0000

An injury to the rotator cuff can be very painful, not to mention make simple tasks like putting on a shirt or picking up a gallon of milk very difficult. When I see a patient who has a torn rotator cuff, rotator cuff tendinitis, or rotator cuff “impingement,” I spend a good amount of time showing them what the rotator cuff is and describing how it works.

The Human Shoulder Joint - via Wikimedia Commons

The rotator cuff is a group of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. The muscles form a cuff around the humerus (long bone of the arm) to keep the ball of your shoulder joint seated properly in the socket. The muscles attach the shoulder blade to the humerus and act to elevate the arm and rotate it back and forth.

The rotator cuff maintains shoulder stability. The main joint of the shoulder is shaped like a ball and socket. The socket (glenoid) is relatively small and shallow when compared with the ball end (humerus). A good analogy is to picture how a golf ball (humerus) sits on a tee (glenoid). The deltoid is a large and powerful muscle that pulls the arm up when you reach up above your head. It pulls on the top of the “golf ball” in an upward direction. The rotator cuff muscles help to counteract the upward pull of the deltoid, by producing a force that pulls in the opposite direction. The rotator cuff pulls on the “golf ball” on the side resting on the tee. This force keeps the ball (humerus) in the socket (glenoid), or the “golf ball” from rolling up and off the “tee.” When the arm is raised and these forces are balanced, the golf ball rotates on the tee. When the deltoid pull is not balanced out by the pull of the rotator cuff, it rolls off the tee and can result in painful conditions. It can cause impingement, rotator cuff disorders, and early shoulder joint degeneration.

Now that you know a little more about where these muscles are located and how they function, you can appreciate how important they are in rehabilitating a painful shoulder. If you are having shoulder pain, find a physical therapist. You can find me here.

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MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

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Preventing Painful Shin Splints

MoniqueSerpasPT — Mon, 30 Apr 2012 15:05:18 +0000

As the weather gets warmer in Wisconsin, more people get outside to start their spring training. Warmer weather may inspire you to be more active, which is always a good thing. However, too much activity, too soon into your training can bring on painful shin splints. If you’ve ever had them before you know how painful they can be and how they can put a damper on any hopeful spring training goals. “Shin splints” is a term that describes pain along the bone below the knee, the tibia. This type of pain is most commonly termed by medical professionals as “medial tibial stress syndrome” and is very treatable. I’ll give you a few tips to help prevent what can be a really annoying condition.

Risk factors associated with shin splints include:

Improper shoewear
Training errors
Overpronation
Excessively high arch types
Muscular weakness
Inflexibility

Some Tips for Prevention

Increase your distance by no more than 10% per week to minimize the risk of injury.
Running surfaces that are harder, uneven, or a curved track could also contribute to shin splints. Switching to a softer surface, such as grass, may be helpful to your prevention.
Running shoes should be replaced every 300-350 miles to ensure they are providing the adequate support and shock absorption.
If your shoes are new and you’re finding you have shin splints, you may want to try shock absorbing insoles as research has shown these to be effective in minimizing this pain.
Your conditioning program should include cross-training with activities that are lower-impact such as cycling and swimming.
Regular stretching of the gastrocnemius and particularly the soleus (calf muscles) is also important to reduce traction stress to the tibia. Additionally, strength training, particularly in the core and legs can help your body better absorb shock.

If you have unfortunately developed shin splints, the first thing to try is PRICE. If they aren’t going away, or are becoming a recurring problem, be sure to consult with your physician. Shin splints are most commonly medial tibial stress syndrome, however there are more serious conditions that can cause shin splints such as stress fractures and compartment syndrome. Once you visit with your doctor, and have ruled out these serious conditions, be sure to see a physical therapist. A PT can evaluate your risk factors, biomechanics, strength, and flexibility to determine a customized program for returning you safely to the activities you love.

References

1. Craig, Debbie I, PhD,L.A.T., A.T.C. Medial tibial stress syndrome: Evidence-based prevention. Journal of Athletic Training. 2008;43(3):316-8.

2. Newlin D, Smith DS. Shin splints 101: Explaining shin splints to young runners. Strategies. 2011;24(3):10-13.

3. Richter, Randy R,PhD., P.T., Austin, Tricia M, PhD,P.T., A.T.C., Reinking, Mark F, PhD, PT,A.T.C., S.C.S. Foot orthoses in lower limb overuse conditions: A systematic review and meta-analysis – critical appraisal and commentary. Journal of Athletic Training. 2011;46(1):103-6.

4. Tolbert, Timothy A,PhD., A.T.C., Binkley, Helen M, PhD, ATC,C.S.C.S.D., N.S.C.A.-C.P.T.D. Treatment and prevention of shin splints. Strength and Conditioning Journal. 2009;31(5):69-72.

Author information

MoniqueSerpasPT

Physical Therapy Orthopaedic Specialist at Southeast Louisiana Veterans Health Care System

If you want to connect beyond the blog, m...@geaux2pt.com or click on the following social network icons:

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