Agility Physical Therapy of Tucson News

Agility Physical Therapy News

Adrienne Parry Physical Therapy is joining the Agility Spine & Sports Physical Therapy Family

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Adrienne Parry Physical Therapy is joining the Agility Family

Agility Spine & Sports Physical Therapy in Tucson is excited to announce that Adrienne Parry Physical Therapy is joining the Agility Family and the team of the best Physical Therapists in Tucson ! We would like to welcome all of the patients and employees! Adrienne Physical Therapy, on Orange Grove Road, has been a fixture in the Tucson Physical Therapy community, for many years. The excellent care and outstanding customer service the staff of Adrienne Parry Physical Therapy provides coincides with the values of Agility. This new location is a proof of our commitment to quality care, first rate customer service and to the community with four Physical Therapy locations in Tucson.We are looking forward to a fantastic collaboration! Welcome!

Protect the head: how to avoid, identify and deal with concussions

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Protect the head: how to avoid, identify and deal with concussions

Your brain is your body’s command center. Its soft, sensitive tissues float in a cushioning fluid within the hard and sturdy skull. But a swift blow to the head or violent shaking can override these protections and lead to a mild type of brain injury known as a concussion.

More than 1 million mild traumatic brain injuries occur nationwide each year. These injuries can be caused by falls, car crashes or recreational activities like bike riding, skateboarding, skiing or even playing at the playground. More than half of concussions occur in children-often when playing organized sports such as football and soccer.

Though concussions might be categorized as mild brain injuries, they can have long-term effects and should be taken seriously. A single concussion is also known to raise your risk for having another concussion-and a second concussion may be more severe. It’s important to learn to recognize the causes and symptoms of concussion so you can take steps to prevent or treat these head injuries.

Concussions usually come about as a result of the brain moving rapidly back and forth or from banging against the side of the skull. While the skull may be designed to prevent most traumas to the brain, it’s not built to sustain significant moving that occurs within the skull. This sudden movement can stretch and damage brain tissue and trigger a chain of harmful changes within the brain that interfere with normal brain activities.

More serious brain injuries that involve skull fracture, bleeding in the brain or swelling of the brain can be detected with X-rays or other imaging methods. Unfortunately, concussions can be more difficult to identify because they’re not visible from the outside with standard imaging tools like MRI and CAT scans. Instead, concussions are usually suspected when certain signs and symptoms are evident. Common symptoms include nausea, headache, confusion, dizziness and memory problems. Loss of consciousness occurs in about 1 in 10 concussions, and a person with a concussion might also have trouble answering basic questions and move in an awkward, clumsy way.

For about 9 in 10 people with concussions, symptoms disappear within 7 to 10 days. Scientists have been working to learn more about those who take longer to recover. In one recent study, 8- to 15-year-olds treated in an emergency room for mild traumatic brain injuries were observed. While most kids recovered quickly, a small group of about 10-20% of the group developed more intense symptoms following the concussion that lasted for as long as one year for certain individuals.

Body-related symptoms, such as headache and dizziness, tended to fade fairly quickly, the researchers found. But thinking-related symptoms, including problems with memory and paying attention, tended to linger in some kids throughout the year-long study. Children who had lost consciousness or had some additional abnormality that showed up on MRI scans after the injury had an increased risk for lasting problems such as a reduced overall quality of life and even academic problems.

Based on these shocking findings, researchers continue to explore ways to predict a person’s response to a concussion, as much remains unknown about the underlying biology and outcomes of mild head injuries. Some studies are looking at how injury and recovery processes differ in immature and adult brains, while other scientists are examining the problems that can arise from repeated injuries to the brain.

Researchers know that immediately after a concussion, the brain is especially vulnerable to having a second, more serious injury, but it’s not clear why-or how long that vulnerable period lasts. One study found that a single mild injury reduces the brain’s use of the sugar glucose as a fuel, at least in rats. A second mild injury 24 hours later leads to an even steeper drop in glucose use and memory problems that last longer. But when the brain has several days to recover, and the use of glucose returns to normal, a second mild brain injury seems to be no worse than the first.

Studies have found that the risk for a second injury is greatest in the 10 days following an initial concussion. If you suspect that someone has a concussion, make sure they stop whatever activity they’re doing, especially if they’re involved in a sport. Their brain dysfunction might not only cloud their thinking, and can also slow reaction times and affect their balance so they become more likely to have another injury.

You should also take the following steps to avoid concussions. Wear helmets when appropriate, such as when bicycling, skateboarding or riding a horse. Athletes can decrease their risk of concussion by wearing proper headgear and following the rules of good sportsmanship. Make living areas safer for seniors by removing tripping hazards such as throw rugs and clutter in walkways, and install handrails on both sides of stairways.

This is an ongoing process that requires a conscious effort to better understand, prevent and treat concussions. While this research continues, do what you can to prevent concussions. Learn to recognize the symptoms, and make sure that people with signs of concussion stop their activities and seek medical attention.

For any other sports injuries, be sure to see your physical therapist fast and first, since the best outcomes usually result from a program that starts as early as possible.

 

Biomechanics – get to know your body’s movements and avoid injury

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Biomechanics – get to know your body’s movements and avoid injury

Think about all the movements you do every day: walking, climbing stairs, typing, turning doorknobs and lifting. Your bones, muscles and joints all work together to make your body an amazingly movable machine.

Like any machine, your body can suffer some wear and tear. It needs regular care and maintenance to keep moving with ease. Scientists are currently studying the mechanical movements of our bodies to help us be as strong, flexible and mobile as possible throughout our lives. This type of research is called biomechanics. These studies are finding that the way you move-including walking, standing and bending-can affect your future mobility and overall health.

Body movements involve a number of factors, including force, balance, gravity and motion. The main moving parts of your body include the solid bones, the joint tissues that link bones together, and the muscles that attach to your bones. Your body has about 200 bones and more than 600 muscles. These parts all work together to help you move throughout the day. Some studies of biomechanics have already led to better ways to prevent muscle and joint injuries in kids during sports and play, and to help older people stay more mobile and independent. Some researchers are working to develop better artificial joints, while others have devised improved treatments for movement disorders such as cerebral palsy and Parkinson’s disease.

Joints are one of the most common sources of problems and pain. Certain joints such as the shoulder can move in many directions, but others, like the knee joint, can only bend one way. Any movements outside a joint’s natural range might cause injury. One important structure that usually garners much attention is the ACL (anterior cruciate ligament), which connects the thigh bone to the shin bone. When it stretches or tears, some people hear or feel a “pop.” Athletes who need to make sudden stops or quickly change direction-as in basketball, tennis and soccer-are at a particularly high risk for damaging their ACL.

Biomechanics researchers use “motion capture” tools to study how people move. Reflective markers-each about the size of a coin-are attached to the skin or clothing over people’s joints and muscles to make it easy to visualize their movements on a computer screen. A series of cameras can then track how people run, jump, walk and twist. Feeding these data into computers allows scientists to create 3-D animations of full-body motions.

Using this technology, researchers have identified certain movements that make some people more likely to injure their ACL. For instance, athletes who allow their knees to collapse inward when landing from a jump are at an elevated risk for ACL tears. Once at-risk people are identified, coaches and physical therapists can develop exercises to help them strengthen certain muscles and learn to land and pivot in healthier, safer ways. Motion-tracking tools are also being used to understand how older people might avoid injury from falls by modifying their movements to adapt to unexpected environments, such as a slippery floor. Falls can be serious at any age, but are especially a concern for older adults, who are more likely to break a bone in the process. Each year, more than 1.6 million older Americans go to emergency rooms for fall-related injuries.

Exercises that improve your balance and strengthen your muscles can help to prevent falls. It’s also possible for people to be trained to avoid falls if they practice walking over unstable-but safe-surfaces in a laboratory. With some practice, they can adapt their gait and remember how to keep body posture upright in response to disturbances in a new environment.

Biomechanics can also be used to guide treatments for movement problems. In some tests, computer models look at how hip joints are stressed when someone walks or travels up and down stairs, which can help in analyzing body movements that might be a risk for future conditions. Eventually, these computer models might help doctors choose appropriate treatments and figure out which patients could benefit from surgery.

Finally, people with cerebral palsy, Parkinson’s disease and multiple sclerosis could also benefit from biomechanical analysis by looking at how well each patient walks to help determine how to best address their issues. From there, physical therapists can help patients strengthen muscles and improve balance and coordination as deficits are identified by the analysis. Brain activation also plays a part, as identifying which parts of the brain are active during movement can lead to a better understanding of what’s leading to the problem.

Muscle strengthening and proper joint alignment are important for just about anyone who wants to stay flexible and mobile. With technology like this, physical therapists and other health-care professionals can better help ensure more people are moving properly and with a movement that reduces their risk of any type of future injury or condition.

If you’re interested in these types of services or if you’d like more information on biomechanics, see your local physical therapist. Also remember that your physical therapist can help you with any aches or pains in your muscles or joints, and your best option is to always see them first if any problems come up.

Make eating properly and staying active a family affair

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Make eating properly and staying active a family affair

Many things can influence a child, including friends, teachers and the things they see when they sit in front of the TV or computer. If you’re a parent, know that your everyday behavior plays a big part in shaping your child’s behavior, too. With your help, kids can learn to develop healthy eating and physical activity habits that last throughout their lives.

Healthy eating and physical activity are essential for children of any age, as proper nutrition and sufficient physical activity are important for building strong bones and muscles. Getting active and eating right may also prevent excess weight and childhood obesity, a growing concern in this country. Today, nearly 1 in 3 children in the U.S. is overweight or obese, and their weight problems put excess stress on joints, muscles and bones, as well as an increase of risk for certain diseases.

Although most of us know that it’s a good idea to eat healthy food and move more, it isn’t always easy to do. Children aren’t likely to change their diet and activity habits on their own without anyone influencing them. It’s up to the parents to make it easier for their family to make healthy choices since they are the ones bringing food into the house and controlling how much time children are allowed to watch TV or play on the computer, among many other decisions.

In one recent study, a team assigned obese children, ages 8-12, to different types of weight-loss programs. All the groups were taught about healthy diet, behaviors and exercise. For some groups, positive feedback and encouragement for weight loss and behavior changes were given only to the child. Other groups focused on both the child and an obese parent. Comparison groups received little feedback.

The researchers found that when obese parents and children worked together, both were more successful at losing weight and making healthy changes. This suggests that the involvement of the entire family can lead to major benefits for the child, which can establish habits that should last for a long time.

Over time, most parents gradually began to regain their lost weight, the researchers found. But after 10 years, more than 40% of the kids who worked with their parents had maintained a weight reduction of at least 20%. While it’s never too late to start making healthy changes in your family, research suggests that the earlier your kids learn healthy behaviors, the better.

Preschool is considered an ideal time to start exposing your children to a variety of healthy foods, such as fruits and vegetables, so they develop an early liking for them. Getting young ones to accept fruits and vegetables can be a challenge, but some parents give up too quickly if a child rejects a new food. Research suggests that the more times you offer a food, the more likely a child will be to warm up to it. If your child doesn’t like a new food right away, stay positive and keep trying over time. Encouraging kids to take just one bite of a new food can help, but avoid creating conflicts and stress over it.

Children under the age of 3 tend to stop eating on their own when they’re full. But after that, they tend to eat whatever is put on their plate. Therefore it’s important to give your kids child-size portions and to teach them about their feelings when it comes to how much they’ve eaten.

Several studies show that parents can effectively influence healthy behaviors by talking in a positive way or avoiding certain situations altogether. One example is to simply keep cookies and other unhealthy foods out of the house entirely rather than deal with the denying them those foods when they ask for them.

Experts recommend that most kids get at least an hour of moderate to vigorous physical activity each day. Parents can help by limiting TV and computer time to no more than 1 or 2 hours per day. Small changes in the home environment can also have a huge effect on physical activity. You can make sports equipment like balls and jump ropes more accessible by putting them next to the door. Walking fast, bicycling, jumping rope, and playing basketball, soccer or hopscotch are all good ways for kids to be active.

When it comes to food and physical activity, what you say and do around your children can have a lasting effect. Work together as a family to make healthy habits easy and fun.

The responsibility of getting children to have healthy diets and stay physically active lies in the hands of their parents. Healthy habits can start early and will lead to an array of benefits in kids’ future, and can be accomplished with some minor changes and serious dedication. Keep this in mind in all the decisions you make regarding your children, and always remember to see a physical therapist immediately if you or your child suffers from an injury or experiences any persisting pain in your muscles or joints.

Are supplements really necessary for good health?

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Are supplements really necessary for good health?

When you reach for that bottle of vitamin C or fish oil pills, you might wonder how well they’ll work and if they’re safe. Before that, the first thing you should be asking yourself is whether you actually need them in the first place.

More than half of all Americans take one or more dietary supplements daily or on occasion. Supplements are available without a prescription and usually come in pill, powder or liquid form. Common supplements include vitamins, minerals and herbal products, also known as botanicals. People take these supplements to make sure they get enough essential nutrients and to maintain or improve their health, but not everyone needs to take supplements.

For most people, it’s feasible to get all the essential nutrients needed for a good diet by eating a variety of healthy foods on a regular basis, but supplements do serve the purpose of filling in gaps that some might find in their diet.

Unfortunately, some supplements may have side effects, especially if taken before surgery or with other medicines. Supplements can also cause problems for those with certain health conditions, and the effects of many supplements haven’t been tested in children, pregnant women and other groups. For these reasons, it’s important to talk with your health-care provider if you’re thinking about taking dietary supplements.

The U.S. Food and Drug Administration (FDA) regulate dietary supplements as foods, not as drugs. What this means is that the label may claim certain health benefits, but unlike medicines, supplements can’t claim to cure, treat or prevent a disease. Though there’s minimal evidence that any supplements can reverse the course of chronic diseases, evidence does suggest that some supplements can enhance health in different ways. The most popular nutrient supplements are multivitamins, calcium and vitamins B, C and D. Calcium supports bone health, and vitamin D helps the body absorb calcium, while vitamins C and E are antioxidants-molecules that prevent cell damage and help to maintain health.

Women need iron during pregnancy, and breastfed infants need vitamin D. Folic acid-400 micrograms daily, whether from supplements or fortified food-is important for all women of childbearing age. Vitamin B12, which comes primarily from meat, fish and dairy, keeps nerve and blood cells healthy. Research also suggests that fish oil can promote heart health. Of the supplements not derived from vitamins and minerals, fish oil has been supported by scientific evidence more than any other supplements.

The health effects of some other common supplements need more study. These include glucosamine (for joint pain) and herbal supplements such as Echinacea (immune health) and flaxseed oil (digestion). Many other supplements have mild effects but with few risks, so they should be used with caution. Vitamin K, for example, will reduce the ability of blood thinners to work, while Ginkgo biloba can increase blood thinning. The herb St. John’s wort is sometimes used to ease depression, anxiety or nerve pain, but it can also speed the breakdown of many drugs-such as antidepressants and birth control pills-and make them less effective.

Something else to keep in mind is the fact that just because a supplement is promoted as “natural” doesn’t necessarily mean it’s safe. The herbs comfrey and kava, for example, can seriously damage the liver. For vitamins and minerals, check the % Daily Value (DV) for each nutrient to make sure you’re not getting too much.

Scientists still have much to learn even about common vitamins. One recent study found unexpected evidence about vitamin E. Earlier research suggested that men who took vitamin E supplements might have a lower risk of developing prostate cancer, but a recent large-scale study found that vitamin E actually increased risk for the disease instead of reducing it. That’s why it’s important to conduct clinical studies of supplements to confirm their effects.

Because supplements are regulated as foods, not as drugs, the FDA doesn’t evaluate the quality of supplements or assess their effects on the body. If a product is found to be unsafe after it reaches the market, the FDA can restrict or ban its use. Manufacturers are also responsible for the product’s purity, and they must accurately list ingredients and their amounts, but there’s no regulatory agency that makes sure that labels match what’s in the bottles. As a result, you risk getting less, or sometimes more, of the listed ingredients. Sometimes all of the ingredients may not even be listed.

A few independent organizations conduct quality tests of supplements and offer seals of approval. This doesn’t guarantee the product works or is safe, but it does assure that the product was properly made and contains the listed ingredients.

Avoid any potential risks and play it safe by doing your research and consulting your health-care professional about any supplements you’re taking now or thinking about taking before doing so. Remember that while certain supplements might claim to improve your body in one way or another, most times they should be taken with a grain of salt before solid evidence is found to support them.

Also keep in mind that the safest alternative to supplements for any bodily pain you might be experiencing is to see a physical therapist, who can create a personal program to help you improve upon any physical issues and live a more enjoyable life.

Don’t sell yourself short when it comes to sleep

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We often post information about exercise and nutrition as keys to health and longevity. One other important factor, that isn’t discussed enough is sleep.

We have so many demands on our time-jobs, family, errands-not to mention finding some time to relax. To fit everything in, we often sacrifice sleep. But sleep affects both mental and physical health, and it’s extremely vital to your wellbeing.

Of course, sleep helps you feel rested each day, but while you’re sleeping, your brain and body don’t just shut down. Internal organs and processes are still hard at work throughout the night, as sleep continues to service all aspects of our body like energy balance and intellectual function while we’re in slumber.

When you’re tired, you can’t function at your best. Sleep helps you think more clearly, have quicker reflexes and focus better, and better-rested people therefore operate on a more efficient level than those who don’t get sufficient sleep. Tired people tend to be less productive at work, and they’re at a much higher risk for traffic accidents. Lack of sleep also influences your mood, which can affect how you interact with others. A sleep deficit over time can even put you at greater risk for developing depression.

But sleep isn’t just essential for the brain. In actuality, it affects nearly every tissue in our bodies, including growth and stress hormones, our immune system, appetite, breathing, blood pressure and cardiovascular health.

Research shows that lack of sleep increases the risk for obesity, heart disease and infections. Throughout the night, your heart rate, breathing rate and blood pressure rise and fall, a process that may be important for cardiovascular health. Your body releases hormones during sleep that help repair cells and control the body’s use of energy. These hormone changes can affect your body weight.

Recent studies also reveal that sleep can affect the efficiency of vaccinations, with one showing that well-rested people who received the flu vaccine developed stronger protection against the illness.

A good night’s sleep consists of 4 to 5 sleep cycles. Each cycle includes periods of deep sleep and rapid eye movement (REM) sleep, when we dream. Although personal needs vary, on average, adults need 7 to 8 hours of sleep per night. Babies typically sleep about 16 hours a day, young children need at least 10 hours of sleep, while teenagers should get at least 9 hours. To attain the maximum restorative benefits of sleep, getting a full night of quality sleep is important.

Sleep can be disrupted by a number of factors. Stimulants such as caffeine or certain medications can keep you up, and distractions such as electronics-especially the light from TVs, cell phones, tablets and e-readers-can also prevent you from falling asleep.

As people get older, they may not get enough sleep because of illness, medications or sleep disorders. By some estimates, about 70 million Americans of all ages suffer from chronic sleep problems. The two most common sleep disorders are insomnia and sleep apnea.

People with insomnia have trouble falling or staying asleep. Anxiety about falling asleep often makes the condition worse. Most of us have occasional insomnia, but chronic insomnia-lasting at least 3 nights per week for more than a month-can trigger serious daytime problems such as exhaustion, irritability and difficulty concentrating.

Common therapies include relaxation and deep-breathing techniques. Medicine may also be prescribed, but you should consult a doctor before trying even over-the-counter sleep pills, as they may leave you feeling unrefreshed in the morning.

People with sleep apnea have a loud, uneven snore (although not everyone who snores has apnea). Breathing repeatedly stops or becomes shallow. If you have apnea, you’re not getting enough oxygen, and your brain disturbs your sleep to open your windpipe.

Apnea is dangerous, as there is little air exchange for 10 seconds or more at a time. The oxygen goes down and the body’s fight or flight response is activated. Blood pressure spikes, your heart rate fluctuates and the brain wakes you up partially to start your breathing again. This creates stress. Apnea can leave you feeling tired and moody, and you may have trouble thinking clearly.

If you have mild sleep apnea, you might try sleeping on your side, exercising or losing weight to reduce symptoms. A CPAP machine, which pumps air into your throat to keep your airway open, can also help. Another treatment is a bite plate that moves the lower jaw forward. In some cases, however, people with sleep apnea need surgery.

Several studies are being performed to gain deeper insights into sleep apnea and other aspects of sleep. One five-year study of 10,000 pregnant women is designed to gauge the effects of apnea on the mother’s and baby’s health, which will shed more light on apnea and the importance of treatment.

Good sleep is critical to your health. To make each day a safe, productive one, take steps to make sure you regularly get a good night’s sleep. Keep this in mind every night before going to sleep. If your life and your sleep is interrupted by a muscle strain, ligament sprain, joint problem or movement disorder, always remember to see a physical therapist first and fast if you happen to experience any aches or pains in your joints or muscles during the day.

Listening to music lowers the level of pain experienced during PT

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Listening to music lowers the level of pain experienced during PT

Distraction could be the key to overcoming painful components of therapy

Physical therapy (PT) is a proven effective treatment for many muscle and joint conditions, but as any patient can attest to, the process can also be painful. Pain is an essential part of PT treatment and improvement in most cases is not possible without it. Still, some patients may be turned off by this detail and dread PT as a result. While extensive research is conducted on analgesia (pain-reducing treatments) for severe problems, little is done to investigate the reduction of pain in more minor situations like PT. Some studies show that distraction in the form of virtual reality or music may actually be helpful in overcoming pain and stress, but it has not been tested on PT. Therefore, a small study evaluated if music can be used as distraction and reduce the level of pain experienced during PT treatment.

Treatment with and without music from iPod is alternated

Twenty-five patients between 18-65 years who were seeing a physical therapist were used in the study. Patients were trained on how to use an iPod, which had three different music compilations on it, and then assigned to one of two groups. Both groups consisted of four therapy sessions and alternated between a session with music followed by one without music. The only difference was one group started with a music session and the other group started with a no-music session. At the end of each PT session, patients filled out a short questionnaire that included questions about pain, stress and satisfaction based on the treatment they received.

Pain is found to be significantly lower when music is used

Results from the questionnaires showed that pain was significantly lower during PT sessions in which the iPod was used compared those when it was not. The scores on the other items of the questionnaire did not show any noteworthy differences, which means the music used in this study had a very specific effect on pain. This gives the results even greater strength, because it shows that patients were most likely honest in their answers, since they were blinded to the specific nature of the study. Based on these findings, it appears that listening to music while undergoing PT can reduce the level of pain and make the therapy more enjoyable for patients. Since it is important for therapists to make sure patients can tolerate the exercises they perform, this can be a helpful tool in easing the treatment process. Therefore, an iPod can be an inexpensive and effective addition to a PT practice that may alleviate pain for patients.

-As reported in the December ’13 edition of Pain Management NursingĀ 

Exercise program reduces occurrence of neck pain for office worker

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Exercise program reduces occurrence of neck pain for office worker

Sitting for most of the day contributes to high rate of neck pain in the office

For people who work in an office setting, much of the time in any given day is spent sitting in a chair. All this time sitting is believed to possibly strain the neck, and office workers report a particularly high rate of neck pain: about 42-69% experience pain every year, according to one study. Neck pain is often a recurring problem and can even lead to an employee missing work in extreme cases. Therefore, it is a major concern in the workplace that must be addressed. One possible way to deal with this issue is to offer a prevention program to office workers that consists of stretching exercises and endurance training, which have been shown to be effective for neck pain. To test out this approach, a study was conducted to evaluate the effect of a 12-month exercise program on the neck pain of office workers.

Workers with impaired neck abilities divided into two groups

A total of 567 office workers between the ages of 18-55 who had lower-than normal neck flexion movement (bending of the neck to the side) or neck muscle endurance were used in the study. These subjects were then divided into two groups: one followed the exercise program intervention, the other was the control group (no intervention). The exercise program consisted of muscle stretching, which was designed to stretch the short neck muscles, and endurance training, which was designed to increase the endurance of the long neck muscles. Participants in the intervention group were instructed to perform the stretching exercises twice a day and endurance training twice a week. All subjects were asked to keep their level of physical activity unchanged and avoid regular exercise.

Incidence of neck pain is significantly reduced

At the 12-month follow-up of the study, 12.1% of subjects in the intervention group and 26.7% of those in the control group reported an incident of neck pain. Neither group experienced any harm or unintended effects from the protocol. Further analysis showed that this type of exercise program could reduce the annual incidence of neck pain by 55%. These results are therefore supportive of the use of a neck stretching and endurance training program to reduce the likelihood of neck pain in office workers. Since a program like this can easily be taught to office workers in a short period of time, it should considered an attractive option for any executive looking for a simple and cost-effective way to keep the necks of their employees pain-free.

-As reported in the January ’14 edition of Occupational and Environmental Medicine

Prehabilitation improves physical function for hip and knee arthritis

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Prehabilitation improves physical function for hip and knee arthritis

For some osteoarthritis patients, waiting too long for surgery may make matters worse.

Osteoarthritis (OA) is the wearing away of cartilage in joints that leads to pain and reduced function. It is the most common type of arthritis and it currently affects more than 20 million Americans. Unfortunately, the cause of OA is not known and there is no definitive cure for the disorder, but strategies to treat it focus on reducing pain and improving function. When this type of treatment is unsuccessful over time, total joint arthroplasty (TJA), or replacement of the affected joint, is usually recommended. Sadly, many patients in this predicament experience long wait times before surgery can be performed, and during this time the function of their hip or knee OA can get even worse. One possible strategy to prevent this from occurring is to give these patients prehabilitation, which is a program of exercise and education to help maintain function. To evaluate this type of program, a study was performed on patients with severe OA waiting for TJA.

Patients are assessed and placed in three different categories

A group of 650 patients with severe OA were evaluated by a physical therapist and assigned to one of three categories: Stream 1 (minimal need for surgical preparation), Stream 2 (moderate need) or Stream 3 (maximal need). From here, 28 patients with the greatest disability were selected from Streams 2 & 3 to participate in the supervised prehabilitation program. Each program was specifically designed by a physical therapist based on the individual needs of each patient, but the overall goal of each program was to improve the function of the affected joint through stretching, strengthening and range of motion exercises. Most programs lasted about nine weeks, and all patients were instructed to also exercise independently at least once a day on their own and to continue taking any medications prescribed for their OA.

Significant improvements observed in most measures taken

Patients were assessed once again after the conclusion of the prehabilitation intervention. Results from these assessments were positive, as they showed that the program led to significant improvements in physical function for patients in the program. This was seen in both self-reported function and in physical performance measures, both of which showed statistically significant improvements after the intervention. These outcomes therefore support the use of prehabilitation for patients with severe OA waiting for surgery that may otherwise lose function of their affected joint. This may be due to the fact that these programs were each tailored specifically to each patient with their needs and abilities in mind. Furthermore, other evidence shows that the better the physical function of a patient is before going into surgery, the better their chances recovering successfully. For these reasons, prehabilitation is recommended as an effective strategy to improve function and reduce pain for patients with severe hip or knee OA while awaiting TJA, and may lead to a better outcome after surgery.

-Summarized by Greg Gargiulo -As reported in the Fall ’13 edition of Physiotherapy Canada

Guidelines for management and prevention of athletic ankle sprains

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Most common injury in sports must be dealt with accordingly

Ankle sprains are the most common injuries in sports. It’s estimated that they account for nearly 45% of all athletic injuries, and that about 28,000 ankle injuries occur in the country every day. The highest rates of ankle sprains are seen in field hockey, followed by volleyball, football, basketball, cheerleading, ice hockey, lacrosse and soccer. Once experienced, ankle sprains will sideline athletes and may lead to long-term problems, and treatment for these injuries is extremely expensive in the health care industry. For these reasons, the National Athletic Trainers’ Association (NATA) compiled a list of guidelines for certified athletic trainers and other allied health care professionals on the conservative management and prevention of ankle sprains in athletes.

Diagnosis should assess patient’s abilities and factor in their history

If an ankle injury is experienced, a clinician should first evaluate the patient before any further action is taken. The patient’s history is extremely important, as a previous ankle sprain is the most common predisposing factor for a recurrent ankle sprain. From there, the clinician should observe the foot, ankle and lower leg on the injured side of the athlete, and ask questions regarding any problems with their abilities. A number of other tests should also be performed, including an assessment of range of motion (ROM) and another special test to determine if there is a high ankle sprain. Radiographs such as magnetic resonance imaging (MRI) may be used in certain situations; however, in most cases, they are not necessary, and the physical examination and evaluation as described above is sufficient to make a clear diagnosis.

Management: RICE, NSAIDs and functional rehabilitation

The acute phase of an ankle sprain is defined as the period of time from the injury until the signs of inflammation (pain, heat, swelling, redness) peak and then start to fade. During this time, management that uses rest, ice, compression and elevation (RICE) is recommended. RICE is almost universally accepted as the best practice by athletic trainers and other health care professionals immediately after acute ankle sprains. Strong evidence also supports the use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and improve function during this phase, and they are therefore recommended in small doses. To actually treat ankle sprains, functional rehabilitation is highly recommended. This should consist of ankle stabilization through bracing or taping, along with progressive weight-bearing exercise. These exercises are designed to increase strength and improve balance and ROM.

Patient self-reports should help determine returning to play

Determining when a player is ready to return to playing their sport is a very difficult process, and each case is different. Two of the most important measures to assist this process are patient self-reports and functional performance tests. No gold standard has been established for the numerous patient self-report questionnaires, such as the Foot and Ankle Disability Index, and any of these can provide important information on a patient’s readiness to return. A combination of functional performance tests can also contribute objective measures on the patient’s status, and should be used during rehab and when making return-to-play decisions. Finally, taping and bracing are highly recommended for athletes with ankle sprains while they make the return to sports.

Prevention of ankle sprains is possible through balance programs

While ankle sprains are so prevalent, they are also preventable. Injury prevention programs that focus on improving balance and increasing strength have been shown to reduce the rate of ankle sprains by as much as 36%, and can easily be given to athletes in high-risk sports. Special care should also be given to athletes with a history of ankle sprains as they return to sports to prevent additional injuries. Of particular concern are athletes who experience high ankle sprains or develop a condition known as chronic ankle instability, in which the athlete has pain/weakness in the ankle and may suffer more injuries in the future. Trainers should work individually with these athletes to restore their function and ensure they’re doing everything possible to prevent another injury.

Combination of strategies can help reduce the likelihood of ankle sprains

Ankle sprains are impossible to eradicate entirely, but the rate of their occurrence can be dramatically lowered. Taken together, these guidelines should help to prevent ankle sprains from occurring in the first place, and manage them properly when they do occur to keep the athlete from experiencing an additional injury down the line. Most importantly, each case and every individual is different, and their treatment plan should be administered based on the needs and abilities of each athlete.

-As reported in the August ’13 edition of Journal of Athletic Training