November 20, 2017

Which side should you use your cane?

How should I use my cane?

Should I use my cane on my weaker side?

A big mistake that most people make is holding their cane in their dominant hand because it feels more natural and comfortable.  However, the cane should be used in the hand opposite of the weaker leg or affected limb.  For example, if you have had a right knee replacement, you should hold your cane in your left hand. This helps to provide a wider base of support while stepping with the affected limb.  Your base of support is the area between your feet.  For example, if you stand with your feet together it is a narrower base of support versus feet shoulder width apart, which is wider and more stable.  Adding a cane with ambulation makes your base of support in a triangle shape from the tip of the cane to both of your feet.  During ambulation, there are times where you are on one foot while you are swinging the other leg forwards for advancement.  As in the example above with a right knee replacement, cane placement in the left hand allows for a wider base of support and more stability while bearing weight on the right leg and advancing the left leg forwards.  If you draw a line between the tip of the cane to your right leg and comparatively do the same thing if holding the cane in the right hand it is easily demonstrated that the distance between the two points is much wider, make it more stable with cane placement on the opposite side of the affected limb.  During ambulation, the cane should be advanced forward at the same time as the affected limb.  Normal ambulation is demonstrated with reciprocal arm swing and that remains the same when using a cane.   Your physical therapist can assist you in proper gait training utilizing your cane to ensure safety and correct use.    

~H White

Common causes of golf injuries

Are injuries common in golf?

What type of injuries are common in golf?

Why does my back hurt after golf?

Why does my shoulder hurt after golf?

Why does my elbow hurt after golf?

How do I prevent golf injuries?

As the snow and ice melts and temperatures begin to warm, there will be between 55-57 million golfers worldwide starting to make their way to the driving ranges and golf courses. Although golf is considered by many to be a recreational non-contact sport, injuries are fairly common.  Golf is considered a “moderate injury risk” sport with a prevalence rate between 25-60% for amateur players.  Approximately 40% of amateur golfers will sustain a golf related injury every year, while injury rates vary between 1.2-1.3 per year.

The golf swing is a highly complex series of integrated motions which involve most of the major muscle groups and joints of the body which transfers power from the upper extremities (arms), through the core (trunk), to the lower extremities (legs) which are firmly planted on the ground.  A proficient golf swing requires a high level of execution, coordination, and power.  The club head speed generates high velocities during a brief time (1.5 sec for amateurs, 1.2 for professionals) which contribute to high biomechanical stress on the body.  Studies have shown that significant compressive and shearing forces are produced that are highly ballistic and explosive, which are not intended for the human body. 

Lower back injuries are most common in golf, accounting for 15-34% of all injuries for amateur players.  The golf swing comprises high forces to the lumbar spinal segments, above levels of biomechanical tolerance of the supporting structures (i.e. ligaments, tendons, intervertebral disc).  Among amateur men, low back pain (LBP) accounts for 36% of all injuries; in women, LBP accounts for only 12%.  In amateur players, the lumbar spine is under greater peak compressive loads shown to be 8 times the body weight.  LBP is correlational to decreased static trunk strength, delayed trunk/core muscle recruitment and diminished trunk/core endurance which contributes to injury.

Elbow/forearm injuries (i.e. Golfer’s elbow or tennis elbow) are second most common, accounting for 7-27% of all golf related injuries and are more common in amateur players.  85% of elbow injuries involve the outer elbow (lateral epicondyle).  These types of overuse injuries are often produced from gripping the club too tightly and having inconsistent technique.  A sudden deceleration of the club head (i.e. hitting the turf) is a more common mechanism to injure the inner elbow (medial epicondyle).

Shoulder injuries are the third most common, accounting for 4-19% of all golf related injuries.  Common injuries include shoulder impingement, rotator cuff tendinitis, and posterior shoulder instability/subluxation.  Overuse injuries to the shoulder occur when relatively weak rotator cuff muscles are fatigued through excessive repetition.  During the golf swing, the shoulder is exposed through a large range of motion.  During the backswing, in a right-handed golfer, the lead shoulder is placed into maximum horizontal adduction (found to produce the significant force across the AC joint), while the trailing shoulder is placed into maximum external rotation.  The opposite occurs during the follow through.  The rotator cuff muscles undergo significant force during the uncoiling phase of the down swing (lead shoulder) while the follow through (trailing shoulder) is at risk of impingement.  The leading shoulder is most affected by injury.

The majority of golf injuries occur during the late down swing (ball impact and follow through phases of the swing).  The follow through accounts for 42% of all injuries while the late down swing and ball impact account for 18%.  Injuries are prominent during these phases because the human body harnesses the highest amount muscular activity than any other phase.  The back swing emphasizes flexibility and coiling the muscular springs to store power, while the downswing generates power that requires muscular strength of your torso, pelvis, and arms. The follow through generates even more torque due to eccentric contraction of the muscles to slow your body’s rotation of the torso and arms.  Studies have shown that younger or more skilled players have more trunk mobility and therefore utilize less muscular activity; while older or less skilled players have up to 50% less trunk rotation which contributes to higher compensatory muscular activation.

There are three main contributing factors that affect golf injuries: overuse, faulty swing mechanics, and poor training habits or fitness level.  Overuse injuries are more common in competitive players and usually involve soft tissue structures such as muscle, tendon, and ligaments.  These types of injuries are caused by short periods of intense play or high number of practice hours.  Repetitive use often produces muscle imbalances which contributes to overuse injuries.  One study found significantly more injuries in golfers who played four rounds a week or who hit at least 200 balls in one week.  Faulty swing mechanics are more typical in the amateur players.  Common flaws include “over-swinging” the club, swinging harder or faster than appropriate, deficiencies in swing technique, improper grip technique, and postural compensation.  Poor training habits or fitness levels are the most common factors to golf injury that can be readily prevented by self-intervention.  Examples of poor training habits/fitness levels include lack of warm-up, reduced mobility and flexibility, lack of strength and stability, and lack of aerobic conditioning.  Many amateur golfers play without warm-up of any kind and are in poor physical condition.  One study found that 81% of amateur golfers did not warm-up for more than 10 minutes prior to playing a round of golf.    Another study found more than 50% of the sample did not perform any warm-up prior to practice or play and fewer than 3% of the golfers were considered to have warmed-up appropriately.  

There are several ways to improve your golf game and lower your risk of injury.  Golf is seasonal in many parts of the country, so rest periods are dependent upon weather/climate.  However, in many parts of the country, golf can be played year round, therefore it is recommended to take 4-6 weeks off after 6 months of play.  Rest is important and is essential for recovery and adaptation.   Golf fitness is important year round and not just during the non-golfing months.  A golf fitness program should be comprised of three components: flexibility, strengthening, and aerobic conditioning.  The benefits of a flexibility program allows for a more fluid swing, improves back swing limits, allows for full follow through, improves muscle coordination, and most importantly reduces injury.  The emphasis of a flexibility program should target the hips/pelvis, torso, shoulder, and forearms. The golf swing uses all major muscle groups in the body, both large and small.  A strengthening program should include exercises to improve power, and should target multiple joint large-muscle groups and single joint small muscle groups.  Focus should also be placed on core musculature of the torso, hips/pelvis, and shoulder girdle.  Aerobic conditioning should also be an emphasis to improve cardiovascular endurance.  The average course is > 3 miles and often a course terrain can challenge your endurance.

Finally, golf preparation should incorporate all aspects of practice.  This would include putting, short game, intermediate game, and long game.  Incorporating and practicing all aspects of your game will allow your body rest from certain elements of the game and will protect your body from overuse, minimizing the repeated stress/strain to your muscles and joints. Proper warm up program should start with 10-15 minutes of light aerobic activity to increase blood flow/warm up muscles.  From there, progress to a stretching program for shorter durations 10-15 sec followed by ballistic/functional stretching.  Lastly, a sequential golf club warm up is also advised which should include wedges/short irons, mid irons, woods/driver, and putting.  Nearly 50% of all amateur/recreational golfers do not warm up prior to play or practice.  Only 3% of amateur golfers participate in proper warm-up.  A warm-up program has been shown to reduce the risk of injury by up to 60% risk of injury.  The most neglected part of any fitness program or sports participation is the cool down.   It is important to repeat the stretching program but using longer and sustained holds closer to 30-40 sec.  The muscles and joints will stretch better after being sufficiently warmed up after the sports activity.  Stretching after activity has also been shown to reduce inflammation and minimize post-activity muscle soreness often accompanied with exercise.

In summary, golf injuries are prevalent in both amateur and professional golfers.  Golf injuries occur from overuse, improper training, poor swing technique and commonly affect the lower back, elbow, and shoulder.  Warm up and fitness training are essential to prevent injuries and fitness training should focus on rotational flexibility, dynamic core strength/stabilization, and aerobic conditioning.  Consider a consultation with a physical therapist who has expertise in golf fitness to give you guidance.

Stay healthy and keep it in the fairway!

~Dr. Sean White, DPT, OCS, CMDT

Can steroid injections harm your body?

What’s the difference between anabolic steroids and corticosteroids? What does a cortisone injection actually do?  Will cortisone injections harm my body?

When people hear the word “steroid”, most of us think of the sports enhancement use to gain muscle. However, there is a difference between anabolic, or muscle building steroids, and corticosteroids. Cortisol is produced naturally in the adrenal cortex of the human body. This hormone is produced at higher levels when your body is under significant levels of stress. Cortisol travels through the body’s bloodstream and helps reduce inflammation. Unfortunately, natural cortisol has a short-term effect.  An anabolic steroid is a man-made substance. These steroids can be used by doctors to treat delayed puberty in young males or muscle loss in patients due to disease. However, anabolic steroids are commonly used by athletes and body builders to help enhance their performance and promote unnatural muscle growth.

A cortisone injection is a common treatment for patients suffering from pain due to significant amounts of inflammation. Cortisone is synthetically made to mimic your bodies naturally produced hormone cortisol. Cortisone injections are injected directly to the injured area. Without being administered into the bloodstream, this allows a longer period of pain relief for the patient. Remember, cortisone injections are used for inflammation not pain.  Therefore, it may take a few days for the relief of pain, as the inflammation is subsiding.

By consulting with a doctor, they will be able to inform you about the correct dosages and frequency of injections.  Overtime, cortisone injections can start to weaken tendon matrix and cartilage within a joint; therefore, a general rule for cortisone injections is not to exceed more than one every six weeks.  Most guidelines limit three to four injections per joint within a calendar year.

L. Bolen

What does a torn rotator cuff feel like?

What is the rotator cuff?

What is the most common way to cause injury to the rotator cuff?

What does rotator cuff pain feel like?

How do you know if you have torn the rotator cuff?

How do you manage a rotator cuff tear?

The rotator cuff (RC) consists of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that originate from the scapula (shoulder blade) and attach to the upper most portion of the humerus (upper arm bone).  The RC muscles each have an independent action but also work together as a group to stabilize the shoulder socket in allowing functional motion of the shoulder.  RC injuries can involve any of the four rotator cuff tendons or may involve multiple tendons.  RC injuries can vary from overuse tendonitis to full thickness tendon ruptures.  Chronic degenerative tears, as seen in middle to older age adults, are most common and usually occur as the tendon gradually frays and becomes fibrotic.  The supraspinatus is the most common RC tendon injury primarily due to its location and action.  The supraspinatus tendon lies in a space just beneath the acromion process (outer tip of the shoulder blade) and just above the shoulder socket.  Inherently, this space develops arthritic changes and narrows over time producing an impingement effect.  Over the course of time with normal use of your arms, especially overhead, the supraspinatus tendon degenerates and weakens.

Pain from an inflamed and/or partially torn RC typically presents over the outer portion of the shoulder, often with radiation down the outside of the upper arm.  Pain can vary from a dull ache, in particular at rest or when lying down, to a sharp pain with certain movements such as reaching out away from your body.  In cases of a fully torn RC, it is common to not have any pain as the tendon and nerve endings have been completely severed.  You likely have a partially torn RC tendon if pain is worsened with resisted activities with your arm moving out away from your body or overhead.  You are likely to have a full rupture if you are unable to move your arm away from your body without shrugging your shoulder to compensate.

If you suspect injuring your RC, try to avoid lifting any significant weight with your arms that would force your elbow to leave your side.  Try resting from above shoulder height work activities for a couple of weeks and try taking over the counter anti-inflammatories while trying gentle mobility exercises.  X-rays are not usually beneficial in diagnosing RC injuries and in most cases the RC will heal with the proper rest and exercises.  An MRI is the preferred imaging test to confirm a RC tear but are expensive and usually not necessary unless the condition is not improving after 6-8 weeks of conservative management.  Cortisone injections may be beneficial in acute cases but are usually unsuccessful in relieving pain in more chronic conditions.  If symptoms persist for longer than 10-14 days without any sign of improvement, consult with a physical therapist to help guide you with the most appropriate exercises.  In most cases, rotator cuff injuries can heal without surgical intervention.  Physical therapy, with proper exercise progression, can promote tendon healing and strengthen the uninvolved rotator cuff muscles and surrounding musculature.

~Dr. Sean White, DPT, OCS, Cert MDT

No Pain, No Gain

She strained her shoulder with that workoutShould I hurt after exercise?

Why do I have soreness in my muscles?

What does No Pain No Gain really mean?

 

We’ve all heard the saying, “No pain No gain”. The question is: myth or fact?

To know the true answer, let’s take a look at what is happening from the inside!

Post-exercise muscle soreness is referred to as “DOMS”, delayed onset muscle soreness. DOMS is a feeling of increased stiffness and/or pain following physical activities. So why does this happen and is this benefiting me?

During physical activity, your muscles contract concentrically (shortening) and eccentrically (lengthening). Imagine performing a bicep curl. When you eccentrically stress your bicep with elbow extension, what is allowing your arm to stop this motion against gravity? Your muscles are made up little muscle fibers that glide in and out of each other during muscle contractions. An eccentric muscle contraction requires “braking” in order to stop your arm movement against gravity. This in turn, causes small micro trauma to the muscle. During the healing process, nutrients are used in your body to repair the damaged tissue which results in muscle gains.

What’s important is knowing when to rest! A safe rule to follow is, allow each muscle group 4-5 days to recover before training it again. This gives your body enough time to repair the damage. You will soon notice that over time, your body will start to adapt to your workouts and the DOMS will become less severe (if felt at all). That’s why it is important to progressively overload your muscles without pushing them too hard. A nice consistent challenge will allow muscle growth without injury.

So yes, pain is a common side-effect of exercise. From athletes to weekend warriors to a patient initiating physical therapy, you will all experience this. What’s important is listening to your body and knowing when rest is appropriate. Nobody knows your body better than YOU!

~Lindsey Bolen, BS, PTA

What is the best position to sleep for back pain?

iStock_000025796411Small (640x426)Why does my back hurt in the morning?
Why is sleeping posture important?

Most of us have heard either mothers or grandmothers scold to “sit up straight.” Posture has always been a focus since we were little (despite few of us heeding this advice). We are exposed to ways to correct posture daily at work and home with the various ergonomic tools made to improve work place stations, but how often do we consider sleeping posture?
Mild stiffness in the mornings is a normal occurrence. When we sleep, gravity is no longer compressing the discs in our spine, allowing them to absorb the fluid around them, much like a sponge. Therefore, when we awake, these discs are a bit more swollen than they are the rest of the day, creating a bit of stiffness initially. As we begin to move around, gravity starts to compress these discs again, squeezing out all the excess fluid, giving us more mobility and less stiffness. Generally this resolves within 30-45 min of waking. However, if you are experiencing any stiffness lingering longer through the morning, or with a bit of discomfort associated with it, you may consider what positions you’re sleeping in.
Many people first admonish their mattresses; however this is generally a pretty expensive “fix” that does not make any guarantees. Ergonomic fixes at your work stations are designed to help keep your spine in a neutral position, why should sleeping be different?

Here are some tips to help improve sleeping posture, to set yourself up for a more limber, pain free day:

1. Try to avoid any twisted positioning, i.e. half stomach, half side
2. Consider the firmness of the mattress, is it very firm? Or very soft allowing some sag in your spine?
3. Consider “lumbar support” in laying: roll a towel into a 3-4 inch roll and wrap it around your natural waist; this will either fill in the gaps your waist creates on a more firm surface or helps prevent any additional “sag” on a softer surface.
4. If you notice the towel roll is helpful, more permanent solutions can be made, much like the lumbar pillows you can buy for sitting during the day.

K. Schultz

What to expect after a knee joint replacement

iStock_TKAWhat should I expect after my knee replacement?

How should I prepare for my knee replacement?

Total knee replacements are becoming an increasingly common surgery. Knee replacements are often performed on patients with severe osteoarthritis, which causes pain and/or buckling of the knee resulting in loss of function, such as difficulty walking, squatting or climbing stairs. (Osteoarthritis is caused by the loss of joint cartilage resulting in bone spurring, commonly known as “bone on bone”). During a knee replacement the ends of the thigh and shin bones are replaced with hardware in order to alleviate the pain produced at the arthritic knee joint.
So, what should you expect following your knee replacement? You can be certain that you will have physical therapy. You will likely start your therapy in the hospital, then transition to an outpatient facility after you return home. Your surgeon might even have you perform exercises before surgery in order to maximize your flexibility and strength, thereby making your post-operative recovery faster. Pre-operative exercises are often prescribed either at the physician’s office, or you may be sent to a physical therapy facility for a one-time visit that will include exercise instruction.
You can expect to have a substantial amount of knee pain immediately after surgery and for several weeks thereafter due to the trauma of the surgery itself. However, your pain can be managed with the use of prescription pain medication, a walker or cane when walking, and management of swelling with ice, compression stockings and leg elevation. It is extremely important to keep up with your prescribed regimen of pain medication, icing and elevating for the first several weeks after surgery in order to minimize your knee pain and better tolerate your rehab experience.

After a total knee replacement your physical therapy rehab is equally important to having the surgery itself. You cannot expect to have good outcomes with your new knee if you do not put in the time and effort rehabilitating it post-op. Your physical therapist will instruct you in a variety of exercises that will work on improving your knee range of motion, flexibility, strength, swelling and scarring that will ultimately allow you to return to routine daily activities like walking, squatting and stair climbing without pain or the use of an assistive device.
You will likely attend physical therapy for 6-8 weeks after surgery; this varies on an individual basis. Full recovery often takes 6-9 months, and you may still notice swelling for up to 1 year. Your new knee is meant to enable you to perform everyday activities, but not necessarily aggressive or high impact sports such as running, tennis or skiing. Most knee replacements will last upward of 20 years, and you can help prolong the life of your new knee by managing your weight and staying active without over-stressing the new joint with high impact activities, such as those mentioned above.

K. Collins

Do arthritis supplements really work?

How do arthritis supplements work?Hands of an elderly lady with medication.

What is Glucosamine?

Does Glucosamine help relieve arthritic pain?

What is Chondroitin Sulfate?

Does Chrondroitin Sulfate relieve arthritic pain?

Osteoarthritis (OA) is the most common type of arthritis and is a degenerative disease process that targets the hyaline articular cartilage of several joints throughout the body, most frequently affected are the hands, knees and hips (Madry et al., 2011; Sawitzke, et al., 2008; Yang et al., 2013). OA is characterized by reduced articular function, impaired mobility, joint swelling, and pain (Madry et al., 2011; Yang et al., 2013). OA was once thought to be an inevitable result of the aging process, although current literature recognizes multiple predisposing factors such as genetics, age, sex, obesity, previous joint injury, muscle weakness, and joint hypermobility (2nd Arthritis Study, 2009; Ciccone, 2007; Sawitzke et al., 2008). OA affects more than 20 million Americans and is expected to double over the next decade (Sawitzke et al., 2008, p. 3184). One in three older adults within the U.S. has clinical OA; ambulatory deficits are the most frequent reported functional limitation as a result of OA, more so than any other disease process (Yang, Dube, Eaton, McAlindon, & Lapane, 2013, p. 1691).
There are many pharmacological and non-pharmacological treatment interventions available to individuals suffering from the symptoms of OA. Some of these options may include over-the-counter (OTC) drugs (Tylenol or NSAID’s), prescription medications (NSAID’s- Cox-1, Cox-2; glucocorticoids; DMOAD’s), dietary supplements, nutritional therapy, exercise, weight loss, acupuncture, and physical therapy. Surgical options should be a last resort. Glucosamine and Chondroitin Sulfate are two popular dietary supplements used to help manage the symptoms of OA. An estimated 2.3 billion dollars are spent each year on these supplements worldwide (Glucosamine, 2014; Wandel et al., 2010). Glucosamine is an amino sugar that is the essential building block for glycoaminoglycans, which bind to water and help cushion, protect, and lubricate joint cartilage (Schardt, 2009; Wandel et al., 2010). Chondroitin is a highly hydrophilic, gel-forming polysaccharide that has protective properties to resist compressive forces of joint cartilage (Schardt, 2009; Wandel et al., 2010). Both glucosamine and chondroitin are naturally produced in the body; ingested versions of these sugar macromolecules may be partially absorbed in the intestine. It is highly debatable if any of the absorbed amounts reach the joints.
Wandel et al. (2010) performed a systemic review of 10 quality large scale patient blinded randomized controlled trials showing no statistical significant difference or clinical relevant effect from using chondroitin, glucosamine, or in combination on perceived pain (p.6). Sawitzke et al. (2008) performed a 24 month double-blinded, placebo-controlled study conducted as part of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) which revealed no statistical significant difference between treatment interventions (Glucosamine, Chondroitin, Celecoxib) and joint pain or joint space width (JSW) compared to placebo. (p. 3188). There is recent evidence supporting that regular exercise, including walking, can improve symptoms and functional mobility in people with knee OA compared to supplement users or control group (Joint support, 2014, p. 3). There is little evidence that suggest taking glucosamine and/or chondroitin are harmful for our bodies. Most experts agree if a person suffering from symptoms of OA has less pain and improved mobility from taking these supplements, and they can afford them, there is little harm (Glucosamine, 2014, p.3). Yang et al. (2013) recommend future studies to assess the extent to which these supplements interact with medications and/or assess the potential cause of unintended adverse effects such as hepatotoxicity (p. 1699).
~Sean White, PT, MPT, OCS, CMDT

References:

2nd arthritis study finds glucosamine and chondroitin no better than placebo. (2009). Tufts University Health & Nutrition Letter, 26(11), 1-2.

Ciccone, C.D. (2007). Pharmacology in Rehabilitation (4th ed.). Philadelphia, PA: FA Davis

Glucosamine fails to help arthritic knees. (2014). Tufts University Health & Nutrition Letter, 32(4), 3.
“Joint support” supplements for arthritis. (2014). Harvard Men’s Health Watch, 19(2), 3.

Madry, H., Grün, U. W., & Knutsen, G. (2011). Cartilage repair and joint preservation. Deutsches Aerzteblatt International, 108(40), 669-677. doi:10.3238/arztebl.2011.0669

Sawitzke, A.D., Shi, H., Finco, M.F., Dunlop, D.D., Bingham, C.O., Harris, C.L., & … Clegg, D.O. (2008). The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis. Arthritis & Rheumatism, 58(10), 3183-3191. doi:10.1002/art.23973

Schardt, D. (2009). Do arthritis supplements work? Don’t bet your joints on it. Nutrition Action Health Letter, 36(8), 10-11.

Shibing, Y., Dubé, C. E., Eaton, C. B., McAlindon, T. E., & Lapane, K. L. (2013). Longitudinal use of complementary and alternative medicine among older adults with radiographic knee osteoarthritis. Clinical Therapeutics, 35(11), 1690-1702. doi:10.1016/j.clinthera.2013.09.022

Wandel, S., Jüni, P., Tendal, B., Nüesch, E., Villiger, P. M., Welton, N. J., & … Trelle, S. (2010). Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. British Medical Journal, 341(c4675), 1-9. doi:10.1136/bmj.c4675

What is frozen shoulder?

Senior womanWhat is frozen shoulder?
What is adhesive capsulitis?
What causes adhesive capsulitis?

Frozen shoulder (also referred to as adhesive capsulitis) is a condition characterized by stiffness, pain, and limited range of motion in the shoulder joint. It occurs most often in postmenopausal women, after surgery or an injury, and in people 40-70 years of age. There are two classifications of adhesive capsulitis, primary or secondary. Primary adhesive capsulitis occurs when there is no significant cause for the pain or stiffness. Secondary adhesive capsulitis follows as a result of an injury. It is not known what causes this condition, but it is thought to be a tightening or inflammation of the joint capsule that surrounds the shoulder joint. Due to this tightening, adhesions are formed, limiting the range of motion and function in the patient.
Frozen shoulder typically has a gradual onset, and progresses through three phases. The first phase is referred to as the freezing (or painful) stage. This phase is characterized by a gradual onset of aching in the shoulder that is often widespread, and can be worse at night, making it difficult to lie on the shoulder. The range of motion begins to become limited in the shoulder. This phase can last 2-9 months. The second phase is referred to as the frozen (or stiffening) stage. It is characterized by continued stiffening of the shoulder joint, reduction of pain, continued decrease in range of motion, and difficulty with daily tasks such as dressing. The patient may also notice decreased strength and muscle wasting. This phase can last 4-12 months. The third phase is referred to as the thawing stage. It is characterized by continued reduction in pain as well as increased range of motion and function of the shoulder.
Treatment of this condition often times includes over the counter medication such as ibuprofen for inflammation reduction. Your physician may prescribe anti-inflammatories, pain killers, or steroids to help as well. Physical therapy will focus on range of motion restoration, pain reduction, strength training, and returning the patient to their prior level of function. Majority of individuals respond well to physical therapy and resume normal pain-free activities. Anesthetic manipulation or surgery is a last resort.

H. Tipsord

Why does my hip hurt?

iStock_hip pain (640x426)Why does my hip hurt?

What is hip bursitis?

How do I alleviate hip bursitis pain?

If you’ve been experiencing a pain along the outside or front of your hip it may be due to an inflamed bursa sac, otherwise known as bursitis. Okay, but what is a bursa sac you ask? Well, it’s a sac filled with a jelly-like substance that creates a buffer between your bones and the overlying soft tissues. Bursa sacs are present around most joints and work to reduce frictional rub and irritation when you move; however when these sacs are over-compressed (by the trauma of falling on your hip or repetitive use), they can become a great source of pain. While hip pain can be caused by a number of structures other than the bursa, including the joint, labrum, or nerves for example, bursitis pain typically presents as point tenderness along the outside of the hip.

To help alleviate hip bursitis pain, avoid repetitive activities that seem to produce your pain. Start a stretching routine for the hip muscles. You can stretch the outside of your hip by lying on your non-painful side and dropping your painful leg back behind you over the edge of a bed. You can stretch the front of your hip by lying on your back at the edge of your bed, allowing your painful leg to dangle over the edge of the bed. (Be sure to keep your non-painful leg on the bed with your knee bent for comfort). To stretch the back of the hip, lie on your back and use your hands to pull your knee toward your opposite shoulder. Hold the stretches for 20-30 seconds and repeat each one 3-4 times. It’s also important to strengthen the hip musculature. To do so, perform straight leg lifts on your back (with opposite knee bent and the foot on the bed to protect your low back), your sides (keep toes pointing forward), and on your stomach (being careful not to over-arch your back). Try 10 repetitions, then rest and repeat.

You may also want to consider using a cane to lessen the weight on the painful joint. (Carry the cane in the hand opposite your painful hip). After exercise or activity try icing the painful area to reduce the inflammation and soreness. If your pain persists, contact your physician or local physical therapist for an evaluation to better determine the source of your pain and appropriate treatment for it.

~K. Collins

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