July 2013 Lengthening Pain Relief for Short-leg Syndrome Do you ever feel unbalanced when you

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1 Lengthening Pain Relief for Short-leg Syndrome Do you ever feel unbalanced when you walk or run? Have you ever noticed that you look tilted to one side in photos? You may have short-leg syndrome, a common condition in which one leg is shorter than the other. Short-leg syndrome can result from either anatomical or functional causes. Anatomical short-leg syndrome can be the result of several factors: congenital deformity; illnesses that affect limb development in childhood; fractures, dislocations or other injuries; and surgery. Functional short-leg syndrome occurs when muscle imbalance in the legs and hips pull one leg up, causing it to function as if it were shorter than the other. Either form of the syndrome can create various bodily discomforts including fatigue; pain in the back, hips, knees or feet; headaches; and even chewing problems, a result of teeth misalignment. To ease discomfort, people with short-leg syndrome may lean toward the shorter leg when walking, or bend or arch the foot of the shorter leg down and out, trying to lengthen the leg, while sometimes they flatten the arch on the other long leg side. These postural compensations can actually aggravate the problem. Whether you have short-leg syndrome can be determined by observation of your walking patterns, a series of tests to measure your leg lengths and an examination of your shoes for signs of uneven wear. The treatment of choice, particularly for anatomical short-leg syndrome, is the use of a custom-made orthotic in the shoe. These medical devices are created from a mold of your foot and can be up to a half inch in height. When inserted into the shoe of the shorter leg, the orthotic adds the amount of height needed to equalize leg lengths. We can help with a treatment plan designed to equalize the leg lengths and maintain postural integrity, particularly if your syndrome is functional. Often, tightness of muscles in the legs causes imbalances that result in one shorter leg. Exercises to strengthen and stretch the tight muscles can help the short leg to function in a more effective and balanced manner. Once we or your physician have determined that you have short-leg syndrome, we can prescribe an orthotic and design an individual exercise program to improve your posture and help relieve the pain and fatigue caused by the condition. Stretching and strengthening those tight leg and hip muscles will not only affect your gait but your entire body, as well.

2 Restoring Arches in Adult-acquired Flatfoot Women older than 40 years of age often experience a condition called adult-acquired flatfoot that results in a fallen arch with the foot pointed outward. Symptoms include leg fatigue, pain and swelling that worsens with activity, and body aches. Causes include injury to the nerves of the foot, obesity, bone fracture, diabetes, high blood pressure, rheumatoid arthritis and tight calf muscles that can force the foot out of alignment. In the early stage, modifying activities that cause discomfort and resting your painful foot is important. Wearing comfort shoes for arch support and walking stability, and inserting over-the-counter or custom orthotics can bring further relief. Individuals with a more severe deformity might need to wear a customized brace temporarily to stabilize the foot and ankle before wearing a foot orthotic. Physical therapy is often advised as a first-line treatment for adult-acquired flatfoot. Heel rises and toe walking exercises strengthen and stretch the tight muscles of your feet, especially the posterior tibial tendon, as do exercises to strengthen hip muscles that control alignment down the lower leg and help lift the arch of the foot. Because excess weight adds to the problem of adult-acquired flatfoot, weight-loss strategies involving nutritional advice and fitness exercises have helped obese patients experience considerable improvement of their symptoms. Resistance bands, stationary bikes and swimming are safe options to use when a painful foot may make exercising difficult. Other physical therapy treatments include stretching exercises to improve alignment of the foot activity modification relevant to your stage of deformity heat, ice and ultrasound for pain relief specific exercises for sports players If surgery is necessary to correct the condition, we can work with you and your surgeon postoperatively to minimize pain and swelling and ensure a safe return to your activities. Adult-acquired flatfoot may be a vexing problem, but the many treatment options available can help get you back on your feet free of pain.

3 Hit the Ground Running After a Long Hiatus In your youth, it may have been possible for you to sporadically run 5k races without any prior training regimen. Young bodies, blessed with the gift of superior metabolism, increased flexibility, and strong muscles and joints, can withstand a lot of abuse. But from our 30s on, our lung and muscle elasticity, bone density, muscle mass and immunity decrease making us far more prone to sports-related injuries and accidents. The desire to start running again in later life is a positive one. Running has been shown to reduce the risk of heart disease, diabetes, depression and cancer, as well as help to keep weight down and energy up. Before you lace up those sneakers, however, it is important to consider the following tips: Get a physical before getting physical. Especially for those older than 50 years of age, it is essential to obtain your physician s go-ahead prior to starting a new exercise routine. Make sure your heart, back and lower extremities are all in good shape so that you do not face any unforeseen and potentially dangerous setbacks when you start your running program. Buy some new footwear. A good running shoe can help you avoid discomfort and injury. The shoes you have had sitting at the back of your closet for a long time are probably not going to do the trick, so go to a specialty shoe store and enlist the help of a knowledgeable salesperson. Alert them to any knee, foot or back problems, as well as your intentions and fitness goals. Make an appointment to see us. We can design a safe and effective program using a slow progression increasing running time no more than 10% per week and incorporating cross-training, which will build strength and flexibility. We can also help you shed some pounds, if necessary, and strengthen your aerobic endurance so that you can increase your running time and speed in the healthiest way possible. An exercise program tailored to your goals and fitness level is essential when running again after a long hiatus. By taking things slowly and exercising smartly, you will be able to quite literally hit the ground running!

4 Getting Rid of Ganglion Cysts Ganglion cysts are a common but generally harmless condition, although they can be uncomfortable and may affect movement. They start out as bumps on the back of the hand and the sides of the wrist. The cyst itself is filled with fluid, which can thicken over time, making the cyst feel firm or spongy. The cause of ganglion cysts is not really known, but there are a couple of theories. These include trauma or stress at the wrist joints caused by repeated wear and tear from activities that stress the hand, leading to cyst formation; previous wrist injuries; and structural problems in the joint tissues, which cause fluid to collect between joints and create a bulge. Although a cyst is not cancerous and may be painless, some individuals find that it is painful with activity. If the cyst presses on a nerve, it might feel tingling or numb. For some people, the cyst will go away by itself, but they may need to wear a splint during certain activities to reduce pain. Another treatment is needle aspiration to drain the fluid. Massage techniques can also help remove fluid from the cyst. When the cyst is painful or if it interferes with functional movement, surgery is often recommended. After surgery, you will wear a splint on your wrist for a few days. Physical therapy is important before and after medical treatment of the cyst. Under our direction, you will learn a range of exercises to mobilize and strengthen joints reduce swelling after surgery improve hand strength and flexibility prevent stiffness maintain coordination Remember that while ganglion cysts are not dangerous, neglecting their impact on your daily activities can lead to further problems. Regular physical therapy will ensure that you gain maximum function and comfort in your wrist and hand.

5 Nursemaid s Elbow: Avoid Swinging Your Child Young children love it when you swing them by the arms. Unfortunately, this act and other seemingly harmless ones can lead to nursemaid s elbow a common injury where the elbow slips out of its joint. Often seen in children aged 1 to 4 years, this injury can also occur in babies. Young children are especially susceptible because the elbow joint is loose enough to separate slightly when the arm is pulled to full length. Other than swinging your child by the arms, the condition can be caused by lifting your child by the hand, pulling your child s arm through a jacket sleeve, grabbing your child s arm to stop him or her from falling, and dragging your child by the arm to hurry up. If your child has nursemaid s elbow, typical symptoms are refusal to move the arm, crying from sudden pain in the arm and holding the arm close to the side. Nursemaid s elbow can be very painful for the child, so physical therapy initially focuses on pain relief. We may use ice, heat, taping and other pain relief techniques to help your child feel better. Once pain is under control, hands-on techniques gently stretch the elbow and mobilize the joint. For young children, simple movements and games improve range of motion with daily activity. Strengthening exercises such as ball tossing will be used for the elbow. Your child s program will also include strategies to improve coordination. Just as important will be avoidance of activities that injure the elbow. We will explain how activities such as lifting a bag should not be performed. To prevent nursemaid s elbow from recurring, follow these tips: Always lift young children from under their arms. Avoid swinging babies or toddlers by the arms or wrists. Avoid lifting your child by the hands or wrists. After just a few rehabilitation treatments, your child should show noticeable improvement. Soon enough after incurring nursemaid s elbow, the child will regain lost range of motion while improving strength and coordination, returning to play blissfully pain-free.