pain

Labrum Issues

December 7, 2020 by Julie

The Labrum

The labrum is a cup-like structure in the shoulder that reinforces the socket portion of the ball-and-socket joint. The joint in the shoulder is rather shallow. This causes it to rely on the labrum as well as the surrounding rotator cuff muscles. It is composed of fibrocartilage which doesn’t easily regenerate on its own.. Damage to the labrum occurs from repetitive stress to the area. An injury to the bicep which attaches to this part of the shoulder, as well as dislocations to the shoulder joint can cause damage as well.

Tears

A labral tear is most commonly seen in overhead athletes. These are athletes such as volleyball or baseball players, or to those who have repetitive dislocations of the shoulder. A SLAP tear happens when you tear the upper part of your labrum from forward to back. This high energy, quick movement can cause this to happen as it puts unwarranted stress on your bicep and labrum. A Bankart tear happens when there are recurrent dislocations of the shoulder joint. This can tear the lower portion of your labrum. This causes shoulder instability over time, which causes the shoulder to dislocate multiple times.

Symptoms

Symptoms of a labral issue include shoulder instability and weakness. You may also experience pain in the shoulder joint. Other symptoms can include grinding, clicking, or catching when you move your shoulder. Depending on the severity of the injury, you may need surgery to help correct it. As mentioned before, there is little to no regeneration of this part on its own. However, physical therapy and cortisone injections will help restore the mobility and strength. If physical therapy fails or if the initial injury is severe enough, surgery may be warranted to correct the torn labrum. This surgery can include arthroscopic cleaning of the joint, removing the torn areas, and/or relocating the bicep to prevent further stress to the area. The surgeon will determine that based on the patient situation and injury severity.

Treatment

Physical therapy is an integral part of rehabilitation of a labrum injury. This is true whether surgery is needed or not. If you have had a sports related injury, multiple shoulder dislocations or any of the symptoms above, please do not hesitate to contact our office for further evaluation.

Written by: Casey Badder PT

Sever’s Disease

November 1, 2020 by Julie

Sever’s Disease

Sever’s disease is a painful condition that can happen to children as they grow. It happens when the tendon that attaches to the back of the heel (your Achilles) pulls on the growth plate of the bone of the heel. The stress over and over again on the growth plate causes pain and inflammation.

It happens most often to physically active children between the ages of 8 and 14. This pain is often made worse by lots of physical activity or when the Achilles tendons are tight. Pain can also be worse during a growth spurt, when the bones grow faster than the tendons. This increases how much the tendon pulls on the heel. While it is painful, Sever’s disease is not a serious condition. It doesn’t cause long term damage or arthritis and often resolves once the growth plates close.

How do I know if my child has it?

The following are some signs that your child may have Sever’s disease:

Heel pain in one or both heels, which often comes and goes
Pain that gets worse when doing activities activities, especially with new or strenuous activities
Pain may cause limping or walking on toes to avoid putting pressure on the heels
Pain that is worsened by running or jumping
Pain with pressing on the back of the heel
Pain is worse upon waking

What helps Treat it?

Ice: Ice their heel for 15 to 20 minutes when the have pain or after activities. Remember not to put the ice directly on skin. Use a towel or other cloth between the ice and their skin.

Rest: Rest from physical activities, especially running and jumping, while having pain. Take rest breaks between activities.

Shoes: Always have your child wear a well-cushioned pair of supportive shoes. Don’t allow them to walk around in bare feet. In some cases, special gel inserts for the shoe called heel cups may help.

Pain Relief: Anti-inflammatory medicines, such as ibuprofen can be used as needed for pain and swelling. Be sure to read the directions on the bottle in order to give the correct dosage for your child’s height and weight.

Stretching: Stretching their calf muscles can help loosen tight Achilles tendons and help decrease the pull of the tendons on the growth plates.

Road to Recovery

In most cases, Sever’s disease goes away on its own. The important thing is to make sure your child gets rest, treatment, and time to heal. Symptoms might get worse if your child tries to play through the pain. Your child can gradually increase the amount of activities they do when they don’t have symptoms. Remember, this is a disease that can come and go. Sever’s disease usually goes away completely when their growth plates close.

Written by Travis Rohner PT

That’s a Stretch

October 8, 2020 by Julie

Stretch Yourself

When life gets crazy, it’s easy to forget to take care of ourselves. Setting aside a few moments to do something to better your health and the way you feel can make a big impact on your day. One quick and simple thing you can do for your health is stretch. There are many effective stretches that target certain muscle groups and issues. Below you’ll find a couple common stretches that you can do daily that target muscles that often get overworked and strained in our day to day lives.

Neck

First on the stretch list is the neck. Let’s face it, you probably do things throughout your day that are not very kind to your neck. Whether it’s hunching over your phone, cleaning up after the kids, or straining over your work computer, your neck puts up with a lot. Give your neck a stretch by tilting one ear towards your shoulder while standing upright. Once you’ve stretched you neck as far as feels comfortable, open your hand on the side you’re tilting away from, turning your palm outward. This allows your neck to stretch a little bit further.

Calf

Next, is a calf. For those of us who spend a lot of time on our feet this stretch can be a lifesaver. Sore feet are caused in part by tight calf muscles. And for those who may suffer from plantar fasciitis this stretch can be especially helpful. You’re going to need one extra item: a towel. Place your heel on a soft but stable surface like a rug or yoga mat. Roll up a towel and place the ball of your foot on it. Step forward with the other foot. Do this with your knee straight instead of bent. Hold it for a good half a minute and then switch to your other foot.

Give yourself a few minutes to stretch. You’ll feel better.

Written by Tom Farnsworth PT

Little League Elbow

September 8, 2020 by Julie

As a state, Arizona is beginning to see a decrease in numbers of people who are diagnosed with the Corona Virus. There are beginning to be less restrictions and people are cautiously returning to activities. One activity my children participate in is youth baseball. They are between the age of 10 and 13, and children in these ages are normally pretty healthy. There have been several instances that have come up with my children’s friends and teammates which can be extremely painful and reduce their ability to participate in athletics. These are problems in the growth plate. I have witnessed this mostly in one body part: the elbow.

What is it?

The issue at the elbow almost exclusively occurs due to the repetitive action of throwing. This is why this is commonly called Little Leaguer’s Elbow. The medical term for this is Medial Epophysitis. This is basically an irritation on the inside of your elbow joint caused by repetitive motions. Excessive throwing causes a lot of stress on the inside part of the elbow which can be sometimes too much for growing bones and muscles. In extreme cases, part of the bone can actually break off. This typically happens in youth athletes between the ages of 8-17, when bone and muscle growth is most likely to occur.

Does my kid have it?

Typically, there is no specific incident that leads to this injury, but there can be. Usually, the young athlete will begin feeling pain on the inside of the throwing elbow where the bump is. This is where several muscles attach. The pain will worsen with the activity and if it gets bad enough, they will not be able to throw anymore. It will be fairly tender to the touch and you may notice swelling. Pain when extending their elbow or wrist flexion is also a common occurrence.

What do we do about it?

If you notice your child has this, there are two things to immediately do.

STOP THROWING!!! With repetitive stress injuries, the very first thing is to stop doing what is causing the pain. In this case, throwing. It is very important to not push through and play with this injury as it can lead to a much more serious condition.
ICE: Ice at the initial stages can reduce swelling and irritation.

With all injuries that deal with soft tissues (muscle, tendon, ligament) there are several stretches and exercises which can be done. Almost always, the muscles on the palm side of your athlete’s forearm will be very stiff, and most times weak. These muscles should be stretched lightly and strengthened. The two stretches which are important are these:

With your elbow extended, gently extend your wrist to where you feel a gentle stretch on the palm side of your forearm. Hold for about 30 seconds and repeat 3 times.

Now, do the exact opposite. Hold for the same amount of time about 3 times.

Strengthening the forearm, wrist, and shoulder muscles of your throwing arm is extremely important. These should be prescribed specifically for the individual athlete.

How long does it take to heal?

The answer to this question really depends on the severity. It can be anywhere from a few weeks, to 1-3 months. Coaches and leagues take special care with pitch counts depending on ages and this is an excellent thing to do, however any position player who throws often can be at risk. If you want to prevent this, a doctor or a physical therapist can identify the most important activities to do in order to prevent.

Weightlifter’s Shoulder

August 15, 2020 by Julie

Weightlifter’s Shoulder is a term that describes painful wear and tear of one end of your collar bone. It’s an injury that happens due to overuse. It causes small fractures that can be quite painful and effect your range of motion. In some instances, something called osteolysis or bone breakdown occurs.

It’s called Weightlifter’s Shoulder because weightlifters are commonly affected due to the repetitive motions and heavy weight put on the shoulder joint when lifting weights. However, they are not the only ones affected. Jackhammer operators, baseball and football players and even soldiers can develop this problem.

Symptoms

The symptoms of this condition include tenderness over the front of the shoulder. You may also have pain while doing bench presses or dips, or you may be unable to do a push up due to the pain. If you’re experiencing these symptoms it is very important that you do not try and push through the pain. This will only lead to further damage and a longer healing process.

(Not being able to do a pushup due to lack of exercise is not a symptom.)

What Causes this Condition?

Repetitive stress from training and lifting can be a cause. For example, when your elbows drop below or behind your body during bench press, excessive traction on the AC (acromioclavicular) joint occurs. As a result, your shoulders extend too far. If the bone does not have a chance to heal prior to your next workout, your shoulder can become painful and suffer from reduced strength and range of motion.

How to Treat It

Treatment for weightlifter’s shoulder usually starts with physical therapy and no surgery. This may include rest and changes in weight-training activities. You have to avoid over-training so that your joint can heal. We can also help with suggesting modifications and design strength training for your condition.

(Rest is very important)

For those who don’t improve with therapy alone, or have a lot of damage to the shoulder joint, an arthroscopic surgery may be recommended. During the surgery, the surgeon removes portions of the damaged end of the collarbone in a procedure known as “distal clavicle excision”. It is usually an outpatient procedure. Most patients are able to return home the same day.

Physical Therapy is often recommended after surgery to improve strength and restore range of motion. Fortunately, most patients suffer no loss of function in the shoulder after surgery and are able to resume normal activities following rehabilitation.

Written by Travis Rohner PT

Complex Regional Pain Syndrome

August 2, 2020 by Julie

Complex Regional Pain Syndrome (CRPS) is a syndrome that affects the nervous system. It has been called by many names including, Reflex Sympathetic Dystrophy (RSD), Sudek’s atrophy and shoulder/hand syndrome. The condition is more prevalent in women, but can be present in all age groups and genders. The exact cause is unknown, although it usually associated with an injury or physical trauma such as a fracture, crush injury or surgery. CRPS also tends to show up in the extremities; but it can happen anywhere. Early treatment may improve the long-term outcome but doesn’t guarantee complete recovery.

CRPS can become functionally limiting both in terms of range of motion and strength. The constant pain associated with the syndrome can make work and activities of daily life very difficult and frustrating.

Signs and Symptoms

CRPS symptom progression has 3 stages. The first stage begins as burning pain, swelling, stiffness, excessive sensitivity, and increased sweating in the area. This stage can last from 1-3 months.

As CRPS progresses into the second stage, which may last for 3-6 months, the pain becomes more intense and the swelling increases and may spread out from the affected area. Hair growth in the area may decrease. In the hands or feet, nails may become brittle and cracked. On X-rays the bone may show loss of density. The muscles begin to atrophy or diminish in size.

Stage 3 begins any time after 6 months. The condition may be permanent and some of the muscle changes may become irreversible. The pain may progress to such intensity that it is incapacitating. Bone density continues to decrease. Range of motion continues to decrease as a result of avoiding motion due to pain.

Treatment

The goals of treatment are to decrease swelling and pain, maintain or improve range of motion, educate about the condition to reduce or eliminate frustration associated with it, and restore function.

Swelling can be decreased with cold compresses, contrast baths, compressive wrapping or massage. Massage, however, may be difficult because of the pain and sensitivity.

Decreasing the pain and sensitivity is done through several methods. Moist heat can sometimes help. Desensitization is another means. Desensitization can include the use of electrotherapy. Gradual acclimation is another way. It begins by touching the area lightly with a soft material such as tissue paper for several minutes at a time throughout the day. As the area of sensitivity decreases, the tissue is switched to a soft cloth with slightly more pressure. As the sensitivity decreases again, the material is changed to a rougher type and the pressure is increased.

Therapeutic exercise can be help to return strength, range of motion and function. Your health professional can show you the specifics of the rehabilitation program. Quite often the exercises involved with CRPS will include weight-bearing activities to help.

It is important to understand the psychological problems associated with this condition so you can cope with any emotional stress. Because of the constant nature of the pain associated with CRPS, counseling may help. Your health professional can refer you to the proper source.

The use of all the treatment methods as stated above may help to break the pain cycle, decrease pain and improve overall function. It is important for you to maintain independence in the activities of the day, both in work and leisure activity.

Written by Clint Bunker PT

Labrum Issues

The Labrum

Tears

Symptoms

Treatment