A recent case study from the Annals of Emergency Medicine examines the different types of injuries and dangers involved in the Tough Mudder obstacle course races. If you haven't seen one, the Tough Mudder is a 10 to 12 mile running race that is peppered with military style obstacles. Obstacles range in difficulty from climbing over 6 foot walls to running over mud and water through a maze of electircal wires.
I participated in a Tough Mudder about a year and a half ago, and quite a few of my friends warned that I would likely finish the course with a broken ankle. That didn't happen, but I did get a nasty cut on my finger.
This particular case series focuses on 5 cases of participants who suffered various injuries on the Tough Mudder course. The injuries included burns and cardiac distress from electrical obstables, right sided weakness (later diagnosed as Todd's paralyisis and possible stroke), and a head injury after losing consciousness and falling in the dirt.
There have also been reports of different sprains, fractures, and other orthopedic injuries as a result from participating in Tough Mudder contests. People with these orthopedic conditions may benefit from phyiscal therapy to help get back to normal activity and function.
If you are planning on participating in a Tough Mudder, perhaps a visit to your physical therapist may be in oorder to help you devise an appropriate training strategy.
Whenever I treat patients who have had an anterior cruciate ligament (ACL) sprain, I am often asked how the injury could have been prevented in the first place. Are there ways to prevent an ACL tear or injury?
There are many factors that lead to an ACL tear. Sometimes collisions with other athletes while playing sports may cause excessive stress to the ACL and cause a tear. But what about non-contact ACL tears? Often we hear about ACL injuries that were the result of improper foot and knee position during high velocity or high impact sports.
There are many studies that examine the factors that are involved in preventing non-contact ACL tears. From these, there appear some simple things you can do to avoid the dreaded ACL tear. Here are a few ideas:
- Maintain strong quads, hamstrings, and hips.
- Maintain appropriate calf and hamstring flexibility.
- Work on jumping and landing properly during plyometric drills.
If you have suffered an ACL tear, a visit to your physical therapist can help to improve your knee ROM and strength and get you back on the sports field. A part of your ACL treatment should focus on ways to minimize the likelihood or re-injury to your ACL.
The snow is flying in the northeast United States, and that means ski and snowboard season is revving up. If you have ever read my blog, you may know that I enjoy skiing with my family.
I just got back from a day of skiing, and I am starting to feel my quads qet a little sore. They feel a little tender when I am walking up and down the stairs and when I am trying to sit down and rise from a chair.
I'm not too worried though. Delayed onset muscle soreness (DOMS) is a common problem after exercise. It simply means that you exercised a muscle or group of muscles that hasn't been worked in a while. I guess I should have done my ski and snowbaord prep exercises a little more diligently.
If you have developed DOMS, do not worry. Simply wait a couple days, and the soreness will go away. A little gnetle stretching to the affected muscles also helps a bit.
Do you want stronger wrists? Of course you do! Strong wrists are helpful in preventing injuries in overhead athletes who play baseball, volleyball, tennis, or golf. Plus, strong wrists may help prevent repetitive strain injuries like carpal tunnel syndrome.If you have a dumbbell or a small weight, you can start wrist strengthening right away. Just use this simple step-by-step guide to wrist strengthening to get started. Make sure you check in with your physical therapist before starting an exercise program, just to make sure you are doing things properly.
Do you want to impress your physical therapist when you head into the clinic for your next visit? I mean really impress your physical therapist? Here's what you do:
Show him or her how well you have been doing before he or she asks.
I had a patient this morning who had a lumbar fusion surgery a few months ago. He had developed weakness in his gluteus muscles after the surgery, and we started really working on his strength with some advanced hip and core strengthening exercises.
He came into the clinic today and said, "Test my hip strength." He was so diligent about working on his hips at home that he knew he I'd be impressed with the improvement. He couldn't wait to get into the clinic and have me test his strength to see his progress. That is the sign of a patient who is fully invested in his recovery.
I had another patient last week who had developed a frozen shoulder over the summer, and we had been working for a couple weeks to improve her shoulder range of motion. Initially she was having difficulty reaching behind her back (a common problem with frozen shoulder).
She marched right into my clinic the other day and said, "Look." She placed her hand behind her back and smiled as her hand rested just above her low back area. She was another patient who couldn't wait to show me her accomplishments.
Why is this important? Because it tells me that these patients were taking responsibility for their care. They were fully invested in their program and were working hard at home. In the case of my patient with the frozen shoulder, she had a method of self-assessing her progress, and she couldn't wait to show me how she was doing.
If you are a patient in physical therapy, find something, anything, to show your PT next visit. Even the littlest gain in range of motion or strength is something to be proud of. Show him or her your improved lumbar mobility. Ask your PT to measure your improved strength. It's these little victories that we celebrate with you that make our profession so special.
Can the shoes you wear affect your spine if you have back pain? Are some shoes better than others for your back? Can rocker soled shoes cure back pain, like many advertisements claim?
Many manufacturers of rocker soled shoes make claims in their advertisements about the fitness benefits of the curved bottom of their product. Sometimes, advertisements claim that the shoes can help relieve foot, knee, hip, or low back pain. But are these claims supported by scientific research?
A recent study published in the journal Spine indicates that rocker bottom shoes are no more effective in relieving chronic low back pain than regular sneakers. The researchers studied 115 subjects with chronic low back pain and randomized them to wear one type of shoe. Some people in the study wore rocker bottom shoes manufactured by Masai Barefoot Technology, and some people wore sneakers of a specific brand (Asics Gel 1140).
At the onset of the study, a disability questionnaire was administered. Data points were collected at the onset, at the 6 week mark, 6 month mark, and after one year. The subjects were required to wear their shoes for 2 hours per day while standing and walking. In addition, all subjects attended an exercise and education class once a week for 4 weeks upon starting the study. The shoes were worn during the class.
After one year of wearing the rocker bottom shoes or the regular sneakers, the data was collected and it showed that the rocker sole shoe group did no better than the sneaker group for decreasing low back pain. In fact, the flat soled sneaker group showed a greater reduction in disability on the questionnaire and reported less pain when compared to the rocker soled group (this difference was not statistically significant).
So it looks like if you have chronic low back pain, there is no need to rush out and purchase rocker soled shoes to help lessen the pain. Simply wear your normal, flat soled shoes, exercise, and maintain proper posture when sitting. And if your low back pain is causing significant disability, see your doctor and perhaps a physical therapist who can help assess your situation and help offer the right treatment for your back.
If you have knee pain due to patellofemoral stress syndrome (PFSS), then you know how painful this condition is and how much the pain can limit your ability to walk, run, and climb or descend stairs. Physical therapy can help patients with PFSS decrease symptoms, improve mobility, and return to normal function.
Patellofemoral stress syndrome often occurs for no apparent reason and without a specific injury. It may be caused by many different factors including quadriceps weakness, gluteus medius weakness, or muscular tightness in various groups surround the thigh and knee.
If you have PFSS, your physical therapist may prescribe exercises to increase the strength of your quadriceps. It is theorized that strengthening the quads helps to control the position of your kneecap. This improved control can help keep your kneecap in the correct position during walking, running, or squatting.
But do people who have PFSS have weak quads? Are the quads smaller (atrophied) in those folks with PFSS? A newly published study in the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) seeks to find out.
The researchers conducted a systematic literature review to determine if people with PFSS have atrophy in their quads. They identified studies that measured quadriceps size in people with PFSS and whether quad size differed in limbs with PFSS compared to non-PFSS limbs. Furthermore, the researchers investigated whether quad size was measured with girth measurements or if quad size was measured using advanced imaging.
The researchers found 10 studies that met the specific search criteria. Three studies measured girth of the quads, and showed that no atrophy was found in quads with PFSS when compared with non-PFSS quads. When imaging was used to measure quad size, atrophy was found in the PFSS quad when compared to the non-PFSS leg. Three studies also found that atrophy was present in quads in patients with PFSS when compared to a control comparison group.
One study included in the analysis found that atrophy was present in the vastus medialis and vastus lateralis parts of the quads in people with PFSS. It is theorized that these parts of the quads are especially important in controlling kneecap position.
So what do these findings mean? Well, if you have PFSS, it is reasonable to perform quad strengthening exercises to help improve the strength of this muscle group. Also, girth measurements of quad size may not reveal any atrophy of the quads with as much accuracy as using diagnostic imaging such as MRI or diagnostic ultrasound.
If you have PFSS, a visit to your physical therapist may be a good idea to help you determine the possible causes of your knee pain. He or she will likely prescribe exercises to help improve the strength of your quads to help you control the pain and return to normal activity and function.
I work with an incredible physical therapist who recently had a little quandry. You see, she was working with a patient who had an acute onset of low back pain and neck pain. This particular PT had seen the patient for three sessions, and the everything was going great. Pain was at a minimum, exercises were progressing, and postural correction was keeping everything in check.
When the patient first saw the doctor about her pain, she was referred to physical therapy (a good first step) and an MRI was ordered to check things out. Her imaging studies were scheduled, but the patient felt she didn't really need them since she was doing so well with her self-care exercises in physical therapy. She asked her PT if she should have the MRI of her back and neck done.
So what's the correct answer? Should the patient still have the MRI, even though things were feeling better? How would getting an MRI help at this point in her care?
The physical therapist thought about telling her to just cancel the MRI, but the PT didn't order the MRI, didn't schedule the MRI, and really has nothing to do with the MRI. The PT's job is to evaluate the patient, offer suggestions, exercises, activity modification, and encouragement to help the patient move and feel better.
After the patient asked if she should have the MRI, the physical therapist told her that it was a good question to ask her doctor. After all, the doctor ordered the MRI. The PT also informed the patient that an MRI may show significant problems with her spine, but what matters most is that the patient is able to move better and has a method to control her symptoms with postural correction and exercise.
Have you ever had low back pain? Did you have an MRI, and did your MRI help in your overall course of care? Leave a comment and tell us about it.
I recently had a patient who was referred with low back pain and left leg pain. She had the back pain for quite a while, but when her pain started in her thigh, she visited a chiropractor. Her experience was less than optimal.
Now, before I go on, I want you to know that I think chiropractors are good folks who want to help people. I think that there may be a few here or there who may have some pretty odd techniques that may not be proven to help. (There are also some physical therapists who do some crazy things in the name of medicine.)
When I saw my patient initially she showed me photos of what happened to her at the chiropractor. Apparently, the chiro used some sort of massager to her low back, hip and leg. My patient described the massager as a "jackhammer." The photos were of her thigh and hip, and there were huge purple bruises up and down her thigh. It looked like someone took a jackhammer to her thigh and started going to town.
My patient told me that she went back to the chiropractor after the jackhammer incident and showed him the bruises. She also asked not to have the jackhammer massage again. After that session, she went back to her doctor and was referred to me.
So here's the lesson: do not let someone convince you that massage should hurt. It shouldn't leave bruises. In fact, massage may feel good, but it has limited use in the management of low back pain and hip pain. And if someone wants to use a jackhammer type massager on your thigh, hip or back, you should probably refuse.
Exercise has been proven to be beneficial for low back pain. A good idea is to visit a physical therapist and learn the correct exercises to perform for your specific condition.
As an About.com writer, I go through each month trying to write engaging content that you may want to read. Hopefully the articles and blog posts that I write are enjoyable and help you gain an understanding of physical therapy or of your specific condition.
Sometimes I publish articles that you may have missed. If that is the case, here are some recent articles that I have written. Hopefully you find them helpful.