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1 Step Up to Therapy After a Meniscus Tear Signs of a possible torn meniscus include swelling joint pain the knee catching and locking The menisci, two semicircular pieces of knee cartilage located where the femur (thigh bone) and tibia (shin bone) meet, help diffuse the forces on the knee and act as shock absorbers. Meniscal tears are common. Young athletes often tear a meniscus when twisting with the knee flexed and the foot firmly planted. Older adults may develop degenerative wear and tear meniscal injuries. In young adults, the surgeon may be able to repair the meniscus by reconnecting the torn ends. But most often, meniscal tears are treated with surgery called a partial meniscectomy performed as an outpatient procedure. The surgeon makes two small slits in the knee and removes the damaged portion of the meniscus and any loose fragments that can cause the knee to catch or lock. After partial meniscectomy, you may have restricted range of motion in the knee, along with some pain and possible swelling. This is where visits to our office and a home exercise program can help you return to normal functioning more quickly. We can design a program to extend your range of motion and increase the flexibility of the knee. As your condition improves, we can add exercises to strengthen your quadriceps and hamstrings. Keeping these muscles strong helps stabilize the knee and reduce the risk of future injury. Most people do not require prolonged physical therapy after partial meniscectomy if they diligently perform their exercise program at home. Young adults who have a torn meniscus reconnected may require more extensive physical therapy. Individuals whose goal is a rapid return to athletics may also need an intensive program of thigh muscle strengthening to protect against reinjury. If you have undergone surgery to repair a torn meniscus, please see us. We can develop an individualized exercise regimen that will enable you to return to your sports and everyday activities while avoiding reinjury to this very important structure.

2 Early Exercise = Speedy Healing Following Disc Surgery If you have had a microdiscectomy surgery to alleviate sciatica, or sciatic nerve pain caused by a herniated disc a postoperative regimen that includes exercise can help speed your return to a normal, active life. In the past, patients were advised to limit their movements for up to six weeks after microdiscectomy surgery to avoid reinjury. However, the thinking on this has changed in recent years. Experts now suggest that introducing an appropriate early exercise program that includes stretching, strengthening and conditioning may help patients heal sooner and minimize formation of scar tissue. Generally, patients are advised to exercise for a total of one hour each day, usually in shorter segments of time rather than all at once. A therapeutic exercise program often includes walking, usually beginning within the first two to four days after returning home. Most patients start by walking a short distance each day, gradually increasing to about three miles daily. Let pain be our guide. You should expect to feel some discomfort after an exercise session, especially in the leg or buttocks. This can be relieved with over-the-counter analgesics and an ice pack. However, if the pain is strong, we will reduce the intensity of exercise until you can handle it better. You can probably resume most of your day-to-day activities, but avoid the common causes of disc herniation: heavy lifting repetitive bending or twisting prolonged sitting We can provide you with guidance for a long-term spine health program that includes good posture and proper body mechanics (how to bend, lift, etc.). A program that includes stretching, strengthening and aerobic exercises can help get and keep your back in good health.

3 Dive Back in After Swimmer s Shoulder Are you an avid swimmer now sidelined by swimmer s shoulder? You have plenty of company. Swimmer s shoulder can develop from overuse, a change in your stroke or an increase in the intensity or duration of your swimming activity. Swimmers tend to have above-average flexibility and range of motion in the shoulder that s great for swimming. But that extra flexibility and range of motion can predispose your shoulder to laxity and injury. The most common swimmer s shoulder complaint is tendinitis of the rotator cuff, the four muscles that help stabilize and move the shoulder. Injury to any of the muscles or their tendons can cause pain and limit range of motion. Rotator cuff pain is usually felt deep within the shoulder. If there is also a popping sound or the swimmer experiences a catch in the joint, a ligament or joint lip (labrum) may be torn. An evaluation by a physician is necessary to determine the extent of the injury and the best course of treatment. Resting the shoulder is important, so you should stop or significantly reduce swimming during treatment. Anti-inflammatory medications (if your physician approves) and ice packs applied to the injured area can minimize the pain. A well-designed rehabilitation program, usually a supervised exercise regimen using light weights, will gradually strengthen your rotator cuff. Working with us, you will modify everyday activities to reduce stress on the shoulder joint. Other therapies, such as ultrasound or electrical stimulation, may be used as needed to reduce pain and inflammation. We will also help you return to the pool sooner by using proper stroking technique. If pain persists after about six months of therapy, surgery may be recommended. However, most cases of swimmer s shoulder can be resolved with rest and an individualized physical therapy program.

4 The Hot and Cold of Physical Therapy Heat applied before exercise or treatment and ice applied afterward are standard physical therapy interventions. Why? Because heat maximizes the benefits while cold minimizes any microdamage from physical therapy. Heat expands the blood vessels in the area to which it is applied. As the blood vessels expand, more blood flows into the area, bringing with it additional oxygen and nutrients. This increases the metabolism of the tissue, allowing it to work harder. Heat works on tissues in other ways, too. It relaxes muscles, ligaments and tendons, making them more flexible and elastic. That allows for increased range of motion and decreased pain in joints. Although it does not replace a gradual, structured warm-up, pretreatment of an injured area with heat allows you to get more out of your physical therapy session. During exercise, especially exercise that pushes the boundaries of your strength and flexibility, tissues can suffer microtears. The application of cold helps reduce the impact of those tiny tears. Cold constricts blood vessels and decreases blood flow. That decreases the oxygen in the area, helping to inhibit tissue response to the chemicals that cause inflammation. Cold also makes blood vessels less porous. Although we often picture blood vessels as solid tubes, they actually are permeable and allow fluid to flow out into the surrounding tissue in response to injury. That can cause swelling; the application of cold can mitigate this response. Another benefit: Cold also reduces muscle spasms and increases pain thresholds. To sum up, the application of heat before physical activity loosens up tissue and prepares the body for exercise while the application of cold after physical activity reduces the body s response to injury, whether it is microtears from a healthy workout or serious injury to overstressed tissues. At home, use heat and a gradual warm-up before a workout, and apply cold after any strenuous activity. If you are injured, apply ice, 20 minutes on and 20 minutes off, for the first 24 to 48 hours to minimize tissue damage. If symptoms persist or you feel unusually stiff, one-on-one treatment with your physical therapist may be the best solution.

5 Brace Yourself for More Ankle Bracing Questions Ankle sprains are the most common sports-related injury, so athletes and coaches have a high degree of interest in preventing them. In addition, almost three-quarters of athletes with ankle sprains reinjure their ankle. Multiple recurring sprains can lead to chronic ankle instability and end an athletic career. If you are an athlete, should you wear an ankle brace when you compete? Can an ankle brace prevent sprains? Does an ankle brace make an athlete feel more confident and improve performance? The research on this issue appears inconclusive even before we get to the question of whether a lace-up or semi-rigid ankle brace is better and how ankle braces compare to taping. The confusion arises because ankle bracing has been studied in different sports, using different style braces and on different levels of athletes, some of whom have previously experienced ankle sprains and others who have not. This makes drawing conclusions complicated. Here are the results of some recent studies: A study of more than 2,000 high school football players showed that the use of lace-up ankle braces reduced ankle injuries by 61%, but braces did not reduce the severity of sprains in those who were injured. A study of almost 1,500 male and female high school basketball players showed that the use of lace-up ankle braces reduced the incidence of ankle injuries by 68% regardless of whether or not the player had a previous history of ankle injury, but braces did not reduce the severity of sprains in those who were injured. A study of 1,000 male and female high school volleyball players showed that neither lace-up nor semi-rigid ankle braces reduced ankle injuries, but semi-rigid braces prevented ankle sprains in a subgroup of athletes who had never had a sprain. Three small studies showed that ankle bracing and taping increased athletes confidence but did not improve their performance. One area of agreement, however, is that bracing and taping cannot substitute for aggressive ankle rehabilitation after an injury. We will be happy to discuss the pros and cons of bracing and different styles of braces appropriate to your sport and level of play. We can design a program to return strength and flexibility to your ankle and help prevent reinjury.

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