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Common Neck and Back pain problems:

Neck and back pain can be caused by a variety of problems. Some people may have certain genetic conditions, such as scoliosis or arthritis, that contribute to the pain. Other patients may develop conditions such as Facet syndrome, myofascial pain, disc degeneration, degenerative disc disease, headache, SI joint disease, or muscle or joint strains. Additionally, some back and neck pain can also be caused by surgery or pregnancy.

Treatment: Physical therapy is often used to reduce pain and swelling, restore flexibility and range of motion, and strengthen the muscles of the back and neck. In many cases, it can ease the symptoms and also help in a quick recovery of the back or neck.

One way to accomplish this is through manual therapy. This is a technique in which the physical therapist manually adjusts and massages your back and neck, applying pressure to the soft tissues and bones. Cervical and lumbar exercise therapy is also another way doctors recommend certain exercises to strengthen and stabilize your back. Certain modalities, such as heart, ice, and electrical stimulation, may also be used to reduce symptoms and help your muscles relax during your exercise.

Prevention: One of the best ways to prevent back and neck pain is to educate yourself on proper posture, ergonomic principles, stretching and strengthening. For example, it is very important to always keep your chest out, chin in, and stomach tight in order to use your postural muscles to support your spine. Use neutral positions when sleeping, drive with your head against the headrest, avoid reading in bed, and use a screen at eye level when using a computer. Whenever you have to bend over, always use a half kneeling position to avoid putting too much pressure on your back.

If you notice the onset of back or neck pain, always see a physical therapist right away so they can treat the problem before it gets worse.

Neck and back pain can limit your life and prevent you from doing what you love. By choosing Active Physical Therapy to rehabilitate your neck and back, our experts, certified therapists and team can relieve patients’ suffering and help them return to full mobility. Active Physical Therapy provides over 26 physical therapy locations throughout the Maryland, Baltimore, Washington DC, Anne Arundel County, Carroll County. 

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Exercises for Strong Bones

According to the Medical Researchers people with low bone density are at the higher risk of developing Osteoporosis. National Institutes of Health National Resource Center states that bone mass peaks during the third decade of life and after that we begin to lose bone. But this bone loss can be prevented with regular exercise. If you continue to exercise into middle age and beyond; risk of developing osteoporosis decreases undoubtedly. You can start a bone-healthy exercise program even if you are diagnosed with osteoporosis.

National Osteoporosis Foundation (NOF) suggests that as the people age, they should take the charge of their bone health. Along with diet and regular check-ups, a healthy and regular exercise regimen can help to slow down the aging effects while allowing you to maintain quality of life through activity and independence. A customized and regular exercise program may help to prevent falls and fall related fractures which quite so often result into disability and pre-mature death.

Which exercises can benefit bone health?

Exercises which can be beneficial for bone health and as well strengthen bones and muscles and improvise balance, co-ordination and flexibility can be categorized as follow :-

  • High-Impact Weight-bearing Exercises: Activities like dancing, hiking, jogging, stair climbing, tennis which make you move against gravity are grouped under this exercise regime.
  • Low-Impact Weight-bearing Exercises: Such activities help you to make bones strong while being a safer alternative to high-impact exercises. These include activities like; using elliptical training machine, using stair-step machines or moving fast on a treadmill or outside.
  • Posture Exercises: Such exercises help to improve posture and reduce risk of developing ‘sloped’ shoulders and bone fracture as well.
  • Hip and Back Strengthening Exercises: These include activities which are helpful in strengthening the muscles in the back and hips.
  • Balance Exercises: These exercises strengthen your legs and as well evaluate or test your balance while reducing the risk of falling.
  • Functional Exercises: These include activities for elder adults and specifically for those with limited movements. Such exercises improve how will you move and reduce the chances of falling and breaking a bone.

But it is to be kept in mind that before beginning any exercise regime, you should undergo a through medical examination in order to determine a safer exercise regime. Based on medical evaluation of the following factors a customized exercise regime is set up:

  • Fracture Risk
  • Balanced and Gait
  • Muscle Strength
  • Range of Motion
  • Physical Activity Level
  • Fitness

Your physical therapist would also consider your chronic medical conditions like; obesity, high blood pressure and heart disease. And thereafter, a customized program is designed based on the movement, limitation, personalized goal and health consideration of the clients.

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 coordinated by us will not only cure your current ailment but also pose a check on the further ones.

Injuries Around Shoulder Joint

3d render of a male figure with close up of shoulder joint Free Photo

Physical Therapy for Shoulder injury

The mechanism of injury can be interpreted by asking about the mode of injury such as fall by asking about the mode of injury ,such as fall from height, road traffic accident, position of the limb or body at the time of injury, any rotational force acting on the body and the type of activity done by the time of  injury.

The mechanism of injury, site of injury, pain and disabilities should be interpreted from the history.

Examination

Inspection: The patient should be examined in sitting position with his upper torso and upper limbs exposed upto the waist.

Attitude: The position of the limb on inspection should be noted. In fractures of clavicle and anterior dislocation of shoulder, the patient often supports the injured limbs with the other hand. The arm segment may appear short or long depending on in fracture neck of scapula, there will be lengthing of the arm.

Swelling or deformity: In anterior dislocation of shoulder, the anterior axillary fold may be abnormally prominent due to the presence of head of humerus. A swelling along the line of clavicle, diffuse swelling surrounding the proximal humerus may be seen in fractures of the underlying bones. The lateral end of clavicle may appear to be prominent in acromioclavicular joint injuries. The medial end of clavicle may be seen prominently in sternoclavicular injuries.

Shoulder contour: Normally, the shoulder has a round contour due to prominence of the greater tuberosity beneath the deltoid muscle. The greater tuberosity projects beyond the edge of acromion process giving the normal contour. In dislocation of the shoulder joint, due to loss of projection of greater tuberosity, the normal contour will be lost. This is a valuable sign of dislocation. In deltoid paralysis due to axillary nerve injuries, there may be wasting of the muscle causing apparent loss of contour of the shoulder. The shoulder contour may be masked by diffuse swelling associated with fractures of the proximal humerus.

Bony arch: The bony arch is formed by the clavicle, acromion process and spine of scapula. Any deformity in the bony arch should be noted for.

Palpation

The bony points to be palpated are: clavicle, proximal humerus, acromion process, spine and borders of scapula for signs of fracture.

Clavicle: By standing behind the sitting patient, the examiner places both his hands on the medial end of clavicle and runs his fingers along the shaft of both the clavicles. Any irregularity, gap or crepitus should be looked for. In acromioclavicular joint dislocation, the lateral end of clavicle may be displaced upward. On pressing the lateral end of clavicle, it depresses and bounces back like a piano key.

Proximal humerus: By standing on the side of the patient, the elbow is flexed and the proximal humerus is palpated bimanually by keeping one hand and the medial surface of arm and other on the outer surface of the arm. By standing behind the patient, the examiner slides his fingers down from the acromion process to the arm to palpate the greater tuberosity and proximal humerus. If the head of humerus is in normal position, then there will be a bony resistance to palpation. In dislocations, there will be an empty feeling in the shoulder region. The head may be palpable in either of axillary folds. Diffuse tenderness may be present in fractures of proximal humerus. In an intact humerus, the medial epicondyle will be in the same direction as that of the head of humerus.

Scapula: The acromion process and spine of scapula are palpated for irregularity, bony tenderness and crepitus. The axillary and vertebral borders are palpated for signs of fracture. The coracoids process is situated half an inch below the clavicle at its junction with medial two third and lateral one third. Fracture neck of scapula is diagnosed by axial pressure applied through the arm with the elbow flexed.

Movements

Both active and passive movements of the shoulder should be tested. In anterior dislocation of the shoulder, the patient will not be able to touch the opposite shoulder with his hand of affected extremity. This is called Dugas test.

Tests for detecting anterior dislocation of shoulder:

Hamilton ruler’s test: In normal persons, a straight ruler cannot be placed between the acromion process and lateral epicondyle because of the presence of greater tuberosity in its normal position. In dislocation of the shoulder, a ruler can be placed.

Callaway’s test: The vertical circumference of the axillary is increased in dislocation of shoulder due to the presence of head in the anterior axillary fold.

Measurements

The length of the arm is measured from the angle of acromion process to the lateral epicondyle.

Neurological examination: In fracture of the clavicle, brachial plexus may be injured. In fractures and dislocations of humorous, axillary nerve may get damaged. Axillary nerve damage may manifest as paralysis of deltoid muscle and anesthesia in skin over the lower part of deltoid muscle.

Active physical Therapy providing state-of-the-art physical therapy throughout the state of Maryland having multiple locations located in (Aspen Hill/ Layhill Road, Clinton, Clinton WHC, College Park/ Berwyn Heights, Columbia/ Elkridge, Columbia Aquatic, Gaithersburg/ Germantown, Hyattsville/ Langley Park, Landover, Laurel, Oxon Hill/ Temple Hills, Rockville), Washington, D.C (Washington D.C. N.W./ Near GWU , Washington D.C. N.E./ Brookland CUA, Washington D.C. S.E./ Capitol Hill), Western Maryland (Frederick, Hagerstown), Southern Maryland (California/ Lexington Park, Fort Washington La Plata, Prince Frederick, Waldorf), and Baltimore Metro area (Baltimore/ Mt. Vernon, Dundalk, Glen Burnie, Rosedale/ Near Franklin Sq. Med. Ctr.). We specialize in evaluation and treatment of acute and chronic conditions of the Upper Extremity. Experienced, Qualified and Skilled Certified therapists and our dynamic clinical staff focus on providing personalized attention, individual care, and a positive friendly environment during your treatment session. You can also make your appointment online to start your treatment within 24 to 48 hours at Active Physical Therapy, For more information just visit our Website:-http://active-physicaltherapy.com/

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.

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Damage can be due to various causes

People can receive damage to the spinal cord due to an accident, for example a:

  • Motor accident
  • Diving mishap
  • Fall
  • Sporting accident
  • Household accident

Loss of function usually relates to site of Injury

The amount of function lost tends to correspond to the level in the spinal cord where the damage takes place. A break near the top of the neck can mean that even breathing is difficult and that people must use a respirator. People with an injury in the lower neck, however, usually have arm movement but perhaps not finger movement. However they can often drive, work, write etc with the help of specialized equipment.

People with damage to the upper part of the spinal cord are called quadriplegics. People with damage below this level are called paraplegic.

People with injuries in the lower back can have sensation and movement right to the hips. They can usually live totally independently with a minimum of help, as long as they can use a wheelchair and have the necessary alterations to their home, their bathroom and car.

There are many degrees of injury and function loss, which don’t always correspond to the level of the injury on the spine. Sometimes a quadriplegic only sustains partial damage to the spinal cord and can actually walk, though they may have lost other functions. At all levels, there is usually some loss of function in the bowel and bladder.

Some common Health problems

Other problems which can arise for people with spinal cord injuries are:

Frequent urinary tract infections
Kidney stones
Muscle spasm
Pressure sores from sitting in one position for too long without a correct pressure cushion
Wide and rapid fluctuations in body temperature
Some common causes of Spinal Cord Injury

Most spinal cord injuries are caused by accidents.
Loss of function tends to correspond to the level in the spinal cord where damage occurred.
People with spinal cord injuries can lead productive lives.
Lower back pain occurs due to several causes such as muscle strain, incorrect posture, over-use and spinal injuries, etc.