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Juvenile Disc Disorder Prognosis

Juvenile disc disorder occurs when the parts of the vertebrae called end plates are too weak to withstand the pressures inside the disc spaces. The end plates are the very top and bottom portions of the vertebrae that attach to the cartilaginous disc between each vertebra.

 

 

Most of the time, chronic back pain or long term back problems are associated with elderly or middle-aged people.  But Juvenile Disc Disorder can also affect people as young as 20 years of age. It means that if you are an adolescent, even then you cannot save yourself from this deformity. The fact is; some patients may inherit a prematurely ageing spine.

What do we understand about Juvenile Disc Disorder ?

Juvenile Disc Disorder is a condition where end-plates of disc spaces are not that strong to bear the pressures generated within the disc spaces. Such a condition leads to disc herniations into the vertebral bodies and triggers back pain at quite an early age.

The condition is very much similar to that of degenerative disc disease but with a difference that in this condition, degeneration starts at a much earlier age and generally, most of the discs of lumbar spine are involved as opposed to that of degenerative disc disorder, where only one or two discs are typically involved.

What are the causes of Juvenile Disc Disorder ?

Following factors can lead to Juvenile Disc Disorder:

  • Injury to back.

  • Weakening of discs due to wear and tear.

  • Strain and stress you put on your backs.

  • Changes in your discs and other spine structures.

  • Decreasing of water in the discs.

  • Discs become less spongy and much thinner.

  • Space between the vertebrae above and below the disc gets smaller.

  • Hypermobility of facet joints.

  • Your genes; you may be predisposed to excessive wear and tear of joints.

What are the potential signs and symptoms of Juvenile Disc Disorder?

Any part of your spine can get affected due to Juvenile Disc Disorder but the low back or neck are the most commonly affected parts. Other signs and symptoms of the disease include:

  • Chronic back and neck pain.

  • Pain at the site of the damaged disc.

  • Pain radiating to another body part.

  • More pain while sitting for a long time.

  • Feeling of pain while bending, lifting or twisting.

  • Feeling less pain while walking, running or if you change positions frequently.

  • Pain subsides with rest.

What are the treatment options suggested by the Physical Therapists to treat Juvenile Disc Disorder?

Physical Therapy treatment to treat Juvenile Disc Disorder is much similar to that of Degenerative Disc Disorder. Most of the patients respond well to the physical therapy techniques and recovery is possible in about five-six weeks. Physicals therapists may suggest the following techniques to treat Juvenile Disc Disorder:

  • Physical Therapists may suggest rest or restricted activity but for a few days only. Extended rest is not recommended and mild activity is suggested for better healing.

  • A daily hamstring stretching and aerobic conditioning may be suggested for the better healing

  • Deep tissue massage is recommended to release the tension in soft tissues like; ligaments, tendons or muscles

  • Heat therapy is suggested to remove the waste by-products caused due to spasms.

  • Cold therapy is used to lessen the pain and inflammation.

  • Spinal traction is administered to eliminate the pain caused due to the muscle tightness or compressed nerves.

  • Various exercises to improve the flexibility, strength, core stability and range of motion are practised.

  • An individualised treatment program, taking into account your health and history is formulated

  • Your physical therapists will make you learn about various body mechanics to limit pain. Positions causing pain will also be made familiar to you.

  • Proper work ergonomics and posture corrections are taught to help you to take better care of your back.

  • Strengthening exercises to strengthen abdominal and back muscles are also recommended.

Juvenile Disc Disorder can wreak havoc on the back of an adolescent, so the parents should watch out for the early signs of the disease and if you find any warning signs, should go for immediate diagnosis and treatment. Contact Active Physical Therapy for the state-of-art treatment of any of your musculoskeletal disease. Our treatment modules are planned and coordinated according to the needs, requirements and urgencies of our patients. The treatment modules co-ordinated by us will not only cure your current ailment but also pose a check on the further ones.

Tips for Safe and Healthy Spring Cleaning

Spring is always a welcome change after cold and lethargic winters. The blue skies and warm temperatures also bring open windows, fresh air, blossoming flowers and above all the spring cleaning.  Spring cleaning can be as hard and difficult as full-body workout as it involves good dusting, mowing of lawns; clearing gutters and many more. But the statistics show that great many numbers of people injure themselves during this annual cleaning. Active Physical Therapy suggests you to be cautious and observe the following measures to avoid any harm or injury to your body:

  • Do not perform similar motions repeatedly as this can result into sprains, strains or low back pain.
  • Keep your spine in line i.e. maintain a good posture and keep a wide base of support.
  • Avoid too much twisting or bending while lifting objects. Lift the objects properly by getting closer to them i.e. use your legs instead of your back.
  • Use long-handled tools, kneeling pad and stools while doing yard work and gardening as well.
  • Keep your properly hydrated throughout the cleaning session.
  • Wear skid resistant shoes to ensure proper footing on uneven surfaces.
  • Take regular breaks, in order to relax your tense muscles.
  • Use correct height ladder to minimize the risk of falls during cleaning your windows. Also make sure that ladder is placed on a levelled surface.
  • Move your feet and body while vacuuming, instead of reaching forward and sideways with your arms and trunk.
  • Use extension cords carefully. Do not drape them across the spans of crossing walkways to avoid tripping or falling.
  • Avoid twisting while bending, raking or thatching; instead use your legs to shift your weight from side to side.
  • To avoid slips and falls, always work in the yard wherever it is dry. Do not overfill bags or tarps as it can put pressure on your spine.
  • Do not over-exert yourself. Listen to your body and if you notice any symptoms like light-headedness, shortness of breath, sudden or severe headache, excess sweating, chest or stomach pain after or during cleaning, Contact Your Doctor immediately.

Prevention is always better than cure. Poor Physical posture, lack of exercise or warm-up, poor Physical condition can lead to injury or pain. So always do your best and follow good practices to save yourself form all such hazards.

Active Physical Therapy will be glad to help you with more spring cleaning tips or with any injuries or pain you experience during cleaning. Our diligent and expert physical therapists use state of art techniques to treat any of your musculoskeletal pains or injuries.

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Treatment of Hand Joint Pain:

Volar Barton (Palmar rim dislocation) is a palmar rim fracture of distal radius. The most common cause of this type of fracture is a drop on an outstretched hand.

Mechanism

It is due to palmar tensile stress and dorsal shear stress and is usually combined with Radial styloid fracture.

Clinical Features

  • Pain

  • Swelling

  • Tenderness

  • Loss of wrist movements

  • Palmar flexion is grossly restricted and painful

Radiograph

Palmar rim of distal radial articular surface is displaced dorsally. Proximally and posteriorly and may be associated with dorsal subluxation of the wrist.

Treatment

Conservative

Reduction is simple, but retention is difficult. Long arm cast is used.

Surgery

If reduction does not remain satisfactorily with the wrist in neutral or slight palmar flexion, fixation with K-wire, external fixators and buttress plate, etc. may be done. Ellis T-’shaped buttress plate fixation is the preferred method of treatment.

Active Physical Therapy provides state of the art physical therapy throughout the state of Maryland.  Active’s friendly staff looks forward to assisting you in making your appointment in any of our clinics. Contact Us

http://www.active-physicaltherapy.com

 

Elbow Pain: Causes, Symptoms And Treatment

Elbow Pain: Causes, Symptoms And Treatment

Use of the upper limb in sport demands a well functioning elbow. In addition, injuries in this region may interfere with the patient’s everyday activities. The clinical approach to elbow pain is considered under the following headings:

  • Lateral Elbow Pain, with a particular focus on
  • Extensor Tendinopathy
  • Medial Elbow Pain
  • Posterior Elbow Pain
  • Acute Elbow Injuries
  • Forearm Pain
  • Upper Arm Pain.

Lateral Elbow Pain

Lateral elbow pain is an extremely common presentation among sportspeople and manual workers. The most common cause is an overuse syndrome related to excessive wrist extension. This condition has traditionally been known as ‘tennis elbow’. This is an unsatisfactory term as it gives little indication of the pathological processes involved. In fact, the condition is more common in non-tennis players than in tennis players. It has also been referred to as ‘lateral epicondylitis’. This is also inappropriate as the site of the abnormality is usually just below the lateral epicondyle and the primary pathology is due to collagen disarray rather than inflammation.

The primary pathological process involved in this condition is tendinosis of the extensor carpiradials brevis (ECRB) tendon, usually within 1-2 cm of its attachment to the common extensor origin at the lateral epicondyle. This condition will be referred to as extensor tendinopathy.

Other conditions that may cause lateral elbow pain include synovitis of the radio humeral joint, radiohumeralbursitis and entrapment of the posterior interosseous branch of the radial nerve (radial tunnel syndrome). These conditions may exist by themselves or in conjunction with extensor tendinopathy.

There is often a contribution to lateral elbow pain from the cervical and upper thoracic spines and neural structures. This may be a relatively minor contribution or, in some cases, the main cause of the patients elbow pain. A full assessment of the cervical spine and neural structures is essential in examination of the patient with lateral elbow pain.

History

The characteristics of the patients lateral elbow pain should be elicited. The diffuse pain of extensor tendinopathy typically radiates from the lateral epicondyle into the proximal forearm extensor muscle mass. Occasionally the pain may be more localized. The onset of pain may be either acute or insidious. There may have been recent changes in training or technique, note-taking or equipment used in sport or work.

The severity of pain ranges from relatively trivial pain to an almost incapacitating pain that may keep the patient awake at night. It is important to note whether the pain is aggravated by relatively minor everyday activities, such as picking up a cup, or whether it requires repeated activity, such as playing tennis or bricklaying, to become painful.

Pain may radiate into the lateral aspect of the forearm. This may be consistent with posterior interosseous nerve entrapment or irritation of other neural structures. If pain is closely related to the activity level, it is more likely to be of a mechanical origin. If pain is persistent, unpredictable or related to posture, referred pain should be considered.

Certain movements, usually those involving wrist extension or gripping, will aggravate mechanical pain. Referred pain is affected by prolonged posture, such as lengthy periods seated at a desk or in a car. Associated sensory symptoms, such as pins and needles, may indicate a neural component. Presence of neck, upper thoracic or shoulder pain should also be noted.

Often by the time the patient presents to the sports medicine clinician, he or she will already have undergone a variety of treatments. It is important to note the response to each of these treatments.

An activity history should also be taken, noting any recent change in the level of activity. In tennis players, note any change in racquet size, grip size or string tension and whether or not any comment has been made regarding his or her technique.

Examination

Examination involves:

1. Observation from the front

2. Active movements

  • elbow flexion/extension
  • supination/pronation
  • wrist flexion (forearm pronated)
  • wrist extension

3. Passive movements

  • as above

4. Resisted movements

  • wrist extension
  • extension at the third metacarpophalangaI-joint
  • grip test

5. Palpation

  • lateral epicondyle
  • extensor muscles

6. Special tests

  • neural tension
  • cervical spine examination
  • thoracic spine examination
  • periscapular soft tissues

Investigations

Investigations are usually not performed in the straightforward case of lateral elbow pain. However, in longstanding cases, plain X-ray (AP and lateral views) of the elbow may show osteochondritis dissecans, degenerative joint changes or evidence of heterotopic calcification.

Ultrasound examination may prove to be a useful diagnostic tool in the investigation of patients with lateral elbow pain. Ultrasound may demonstrate the degree of tendon damage as well as the presence of a bursa.

Extensor tendinopathy

For this major sports medicine condition, we review the pathology, outline the clinical presentation, and then discuss evidence based and clinically founded treatment.

Clinical Features

Extensor tendinopathy occurs in association with any activity involving repeated wrist extension against resistance. This includes sporting activities, such as tennis ,squash and badminton, as well as occupational and leisure activities, such as carpentry, bricklaying, sewing and knitting. Computer use has been shown to be associated with the development of this condition. The peak incidence is between the ages of 40 and 50 years but this condition may affect any age group.

There are two distinct clinical presentations of this condition. The most common is an insidious onset of pain, which occurs 24-72 hours after unaccustomed activity involving repeated wrist extension. This occurs typically after a person spends the weekend laying bricks or using a screwdriver. It is also seen after prolonged sewing or knitting .In the tennis player, it may occur after the use of a new racquet, playing with wet, heavy balls or over hitting, especially hitting into the wind. It also occurs when the player is hitting ‘late’(getting the position slowly), so that body weight is not transferred correctly and the player relies on the forearm muscles exclusively for power.

Treatment

No single treatment has proven to be totally effective in the treatment of this condition. A combination of the different treatments mentioned below will result in resolution of the symptoms in nearly all cases.

The basic principles of treatment of soft tissues injuries apply. There must be control of pain, encouragement of the healing process, restoration of flexibility and strength, treatment of associated factors (e.g. increased neural tension, referred pain),gradual return to activity with added support and correction of the predisposing factors.

Control of Pain

It remains unclear as to how much pain is ideal in the treatment of tendinopathies. Clinical experience suggests that a low level of pain, which does not worsen with training, is likely to not be harmful for tendon healing. However, some patients require relative rest, application of ice and analgesia for comfort.

Active Physical Therapy Treatments for Degenerative Disc Disease

Physical Therapy for Degenerative Disc Disease

Physical therapy includes both passive and active treatments. Passive treatments help to relax you and your body. They’re called passive because you don’t have to actively participate. If you’re experiencing acute pain, you’ll most likely start with passive treatments as your body heals and/or adjusts to the pain. But the goal of physical therapy is to get into active treatments. These are therapeutic exercises that strengthen your body so that your spine has better support.

Passive Physical Therapy Treatments for Degenerative Disc Disease

Your physical therapist may give you one of the passive treatments below.

Deep tissue massage: This technique targets spasms and chronic muscle tension that perhaps builds up through daily life stress. You could also have spasms or muscle tension because of strains or sprains. The therapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles).

Hot and cold therapies: Your physical therapist will alternate between hot and cold therapies. By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. Blood is also needed to remove waste byproducts created by muscle spasms, and it also helps healing.

Cold therapy, also called cryotherapy, slows circulation, helping to reduce inflammation, muscle spasms, and pain. You may have a cold pack placed upon the target area, or even be given an ice massage. Another cryotherapy option is a spray called fluoromethane that cools the tissues. After cold therapy, your therapist may work with you to stretch the affected muscles.

Spinal traction: By stretching the back, spinal traction works to alleviate pain caused by muscle tightness or compressed nerves. The therapist can do that manually (by using his or her own body) or mechanically (with special machines). Especially if your nerve is being pinched by the foramen—the area where the nerve exits the spinal canal—your therapist may try traction. It’s thought to widen the foramen by stretching the spine to readjust the vertebrae.

Active Physical Therapy Treatments for Degenerative Disc Disease

In the active part of physical therapy, your therapist will teach you various exercises to improve your flexibility, strength, core stability, and range of motion (how easily your joints move). Your physical therapy program is individualized, taking into consideration your health and history. Your exercises may not be suitable for another person with DDD.

Degenerative disc disease won’t ever entirely “go away”—once your discs start to degenerate, you can’t reverse that process—and because of that, your physical therapist will help you learn how to work around it and how to limit the pain. You’ll learn about body mechanics and how to avoid positions that cause pain.

If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities.

If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities. This is all part of the “self-care” or “self-treatment” aspect of physical therapy: Through physical therapy, you learn good habits and principles that enable you to take better care of your body.

Your physical therapist may also suggest a personalized exercise program for you. The goals may include: strengthening abdominal and back muscles, increasing muscle endurance (so that your stronger muscles can work harder longer), and getting your body to carry your weight more efficiently. An exercise program comes with another bonus—it may help you lose weight. Extra weight can exacerbate pain from DDD, so if you need to lose weight, your physical therapist can work with you to set goals and then follow through.

 

Elbow Pain and Problems

The elbow is a hinge joint between the lower end of the humerus bone in the upper arm and the upper end of the radius and ulnar bones in the lower arm. The arm is bent and rotated at the elbow by the biceps muscles in the upper arm. Ligaments located at the front, back, and sides of the elbow help stabilize the joint.

Elbow pain can be caused by many problems. A common cause in adults is tendinitis. This is inflammation and injury to the tendons, which are soft tissues that attach muscle to bone.

Lateral Elbow Pain: Causes, Symptoms And Treatment

Use of the upper limb in sport demands a well functioning elbow. In addition, injuries in this region may interfere with the patient’s everyday activities. The clinical approach to elbow pain is considered under the following headings:

  • Lateral Elbow Pain, with a particular focus on
  • Extensor Tendinopathy
  • Medial Elbow Pain
  • Posterior Elbow Pain
  • Acute Elbow Injuries
  • Forearm Pain
  • Upper Arm Pain.

Lateral Elbow Pain

Lateral elbow pain is an extremely common presentation among sportspeople and manual workers. The most common cause is an overuse syndrome related to excessive wrist extension. This condition has traditionally been known as ‘tennis elbow’. This is an unsatisfactory term as it gives little indication of the pathological processes involved. In fact, the condition is more common in non-tennis players than in tennis players. It has also been referred to as ‘lateral epicondylitis’. This is also inappropriate as the site of the abnormality is usually just below the lateral epicondyle and the primary pathology is due to collagen disarray rather than inflammation.

The primary pathological process involved in this condition is tendinosis of the extensor carpiradials brevis (ECRB) tendon, usually within 1-2 cm of its attachment to the common extensor origin at the lateral epicondyle. This condition will be referred to as extensor tendinopathy.

Other conditions that may cause lateral elbow pain include synovitis of the radio humeral joint, radiohumeral bursitis and entrapment of the posterior interosseous branch of the radial nerve (radial tunnel syndrome). These conditions may exist by themselves or in conjunction with extensor tendinopathy.

There is often a contribution to lateral elbow pain from the cervical and upper thoracic spines and neural structures. This may be a relatively minor contribution or, in some cases, the main cause of the patients elbow pain. A full assessment of the cervical spine and neural structures is essential in examination of the patient with lateral elbow pain.

History

The characteristics of the patients lateral elbow pain should be elicited. The diffuse pain of extensor tendinopathy typically radiates from the lateral epicondyle into the proximal forearm extensor muscle mass. Occasionally the pain may be more localized. The onset of pain may be either acute or insidious. There may have been recent changes in training or technique, note-taking or equipment used in sport or work.

The severity of pain ranges from relatively trivial pain to an almost incapacitating pain that may keep the patient awake at night. It is important to note whether the pain is aggravated by relatively minor everyday activities, such as picking up a cup, or whether it requires repeated activity, such as playing tennis or bricklaying, to become painful.

Pain may radiate into the lateral aspect of the forearm. This may be consistent with posterior interosseous nerve entrapment or irritation of other neural structures. If pain is closely related to the activity level, it is more likely to be of a mechanical origin. If pain is persistent, unpredictable or related to posture, referred pain should be considered.

Certain movements, usually those involving wrist extension or gripping, will aggravate mechanical pain. Referred pain is affected by prolonged posture, such as lengthy periods seated at a desk or in a car. Associated sensory symptoms, such as pins and needles, may indicate a neural component. Presence of neck, upper thoracic or shoulder pain should also be noted.

Often by the time the patient presents to the sports medicine clinician, he or she will already have undergone a variety of treatments. It is important to note the response to each of these treatments.

An activity history should also be taken, noting any recent change in the level of activity. In tennis players, note any change in racquet size, grip size or string tension and whether or not any comment has been made regarding his or her technique.

Extensor tendinopathy

For this major sports medicine condition, we review the pathology, outline the clinical presentation, and then discuss evidence based and clinically founded treatment.

Clinical Features

Extensor tendinopathy occurs in association with any activity involving repeated wrist extension against resistance. This includes sporting activities, such as tennis ,squash and badminton, as well as occupational and leisure activities, such as carpentry, bricklaying, sewing and knitting. Computer use has been shown to be associated with the development of this condition. The peak incidence is between the ages of 40 and 50 years but this condition may affect any age group.

There are two distinct clinical presentations of this condition. The most common is an insidious onset of pain, which occurs 24-72 hours after unaccustomed activity involving repeated wrist extension. This occurs typically after a person spends the weekend laying bricks or using a screwdriver. It is also seen after prolonged sewing or knitting .In the tennis player, it may occur after the use of a new racquet, playing with wet, heavy balls or over hitting, especially hitting into the wind. It also occurs when the player is hitting ‘late’(getting the position slowly), so that body weight is not transferred correctly and the player relies on the forearm muscles exclusively for power.

Treatment

No single treatment has proven to be totally effective in the treatment of this condition. A combination of the different treatments mentioned below will result in resolution of the symptoms in nearly all cases.

The basic principles of treatment of soft tissues injuries apply. There must be control of pain, encouragement of the healing process, restoration of flexibility and strength, treatment of associated factors (e.g. increased neural tension, referred pain),gradual return to activity with added support and correction of the predisposing factors.

Control of Pain

It remains unclear as to how much pain is ideal in the treatment of tendinopathies. Clinical experience suggests that a low level of pain, which does not worsen with training, is likely to not be harmful for tendon healing. However, some patients require relative rest, application of ice and analgesia for comfort.

Acute Spinal Cord Injury

Your spine is made of many bones called vertebrae. Your spinal cord runs downward through a canal in the center of these bones. Acute spinal cord injury (SCI) is due to a traumatic injury that bruises, partially tears, or completely tears the spinal cord.