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Patient Education

Ankle and Foot Pain

Common Conditions include:

» Ankle sprains – One of the most common of all ankle injuries is an ankle sprain, which occurs due to a stretching or tearing of the ankle ligaments surrounding the ankle joint. A tear may be either a complete tear of the ligament or a partial tear of only some of the strands of the ligament. This tearing creates an inflammatory response that produces pain and swelling.

» Plantar fasciitis / Heel pain - The plantar fascia a dense strip of tissue that runs along the bottom of the foot from the front of the heel bone to the ball of the foot. It is subjected to a tremendous amount of force daily. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. Small tears can result, which lead to pain and inflammation.  Usually, a sharp pain is felt at the heel when weight bearing on it, as well as, at the arch of the foot during the first steps in the morning or after sitting for a long time. Wearing shoes with poor arch support or cushioning can trigger off the pain.

» Achilles Tendonitis - The Achilles tendon attaches the calf muscle to your heel bone. Tight and/or weak calf muscles, leg length discrepancies or a too rapid increase in the frequency or intensity of athletic activity typically cause Achilles tendonitis. The pain is characterized by a sharp or burning pain above the heel bone of the foot and can radiate into the calf muscle.

» Heel spurs - This is when there is an abnormal growth of the bone on the bottom of the heel where the muscles and other soft tissue attach. Most commonly, the plantar fascia becomes inflamed and causes pain on the bottom of the foot, as well.

» Shin Splints - This condition is, also, an overuse syndrome. Repeated movements of the foot can damage the anterior or posterior tibialis tendons and muscles. In some cases, the covering of the bone where these tendons attach may become inflamed. Anterior shin splints most commonly occur in people who take up a new activity, such as jogging, sprinting or playing sports

that require quick starts and stops. Posterior shin splints tend to occur in people with imbalances in the leg and foot, such as tight calf muscles and over pronation (flat arches).

» Arthritis - According to the Centers for Disease Control, arthritis is the leading cause of disability in the U.S. In fact, an estimated 46 million people (1 in 5 adults) report being doctor-diagnosed with arthritis, and nearly 19 million report activity limitations as a result of the disease. Two main forms of arthritis include:

   1) Osteoarthritis - a chronic condition characterized by the breakdown of the joint’s cartilage.

The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint.

   2) Rheumatoid arthritis - a chronic disease, mainly characterized by inflammation of the lining, or synovium, of the joints. It can lead to long-term joint damage, resulting in chronic pain, loss of function and disability. Physical Therapy can help by developing a customized program that is designed to relieve pain and inflammation, reduce joint stiffness, increase mobility and muscle strength, while helping you reach your activity goals.

» Back Pain - Studies have shown that back pain affects close to 80% of Americans at some point in time in their lives.

» Symptoms include:

» Generalized lower back pain

» Back stiffness with reduced range of motion

» Pain radiating into the buttocks and/or legs

» Sensory changes (numbness, prickling or tingling) in the legs, feet or toes.

The most common cause of back pain is due to muscular strains.

Others include: Disc Herniations - Intervetebral discs fit between each vertebra and provide a space between the spine bones. The discs act like a shock absorbers. A herniated disc occurs when the nucleus (the spongy center) of the disc juts out through the tough outer ring of cartilage and presses on a nerve, which can cause lower back pain and/or radiating pain down one or both legs. One form of this radiating pain is often called sciatica.

»Degenerative Disc Disease - The discs between each vertebrae become stiff, weaker and thinner over time and, as a result, they cannot absorb forces as well. Routine stress and strain begin to take a toll on the structures of the spine and results in pain.

»Spinal Stenosis - The spinal canal usually has ample room for the spinal nerves. This space shrinks with age, as well as, by disc herniations or degenerating discs, bone spurs or thickened ligaments. Symptoms from stenosis rarely develop quickly and occur more commonly in people over age 50. Patients with stenosis don’t always feel back pain. Often they have pain and weakness or “a heaviness” in their legs that develops after standing too long or after walking a short distance. Most patients get relief from their symptoms when they sit down.

»Piriformis Syndrome - The piriformis muscle lies under the large buttock muscles and helps to turn your leg outward. Problems with this muscle can cause compression of the sciatic nerve because the sciatic nerve runs under (and sometimes through) the piriformis muscle. This compression causes pain in the buttock area and usually radiates down the back of the leg, similar to that of sciatica.

» Balance - Balance related issues can result from a problem with the vestibular system (consisting of the parts of the inner ear and nervous system that control equilibrium, balance and orientation), failing vision, nerve damage in the legs (peripheral neuropathy) or weakness of the muscles in the back and/or legs. Many people assume that feeling “unsteady” is an inevitable part of aging. Balance related issues, therefore, often go unnoticed until a serious fall or injury occurs. Studies have shown that each year, 1 in 3 people over the age of 60 experience a fall. Equally tragic is that the fear of falling itself may be causing you to give up the activities and independence that are so essential to enjoying a normal, healthy life.

     Our experienced physical therapists can perform a comprehensive neuromuscular evaluation in order to assess the extent of your balance issue. The results are used to design a customized rehabilitation program to help restore your balance, as well as, your confidence, reduce your risk of falls and improve your functional independence.

»Elbow, wrist and Hand Pain - Physical therapists typically deal with two types of elbow, wrist and hand injuries:

   1) Traumatic injuries - including fractures, lacerations, amputations, etc. and always require

immediate medical attention

   2) Repetitive motion ailments - including Trigger Fingers (a form of tendinitis), Tennis Elbow, Golfers Elbow, DeQuervain's Syndrome, Carpal Tunnel Syndrome, etc. and can often be effectively treated with the proper type of physical therapy and prevention plans.

»Lateral Epicondylitis (Tennis Elbow): This problem is not limited to tennis players. Many other types of repetitive activities can lead to this problem, such as using hand tools, lifting heavy weights, painting with a brush and even simply using one’s computer. These types of activities can create small tears in the forearm tendon. The tears try to heal, but constant strain and over-use keep re-injuring the tendon.

»Medial Epicondylitis (Golfers Elbow): This problem is not limited to golfers. Many other types of repetitive activities can lead to this problem, such as shoveling, gardening, lifting heavy weights and hammering nails. These types of activities can create small tears in the forearm tendon. The tears try to heal, but constant strain and over-use keep re-injuring the tendon.

Sprains: Occur when a ligament is stretched beyond its normal limits. These often occur as a result of sports injuries. Sprains can take weeks or months to heal properly.

»Carpal Tunnel Syndrome: This is probably the best known of the repetitive stress injuries. It is caused by a swelling of the tendons in the carpal tunnel region of the wrist (a narrow channel running through the palmer surface of the wrist). Swelling causes pressure on the median nerve, which can result in symptoms of weakness, numbness, tingling and burning in the hands/fingers. One major part of treating such an injury is by the physical therapist teaching their patient the proper preventative measures, which can drastically reduce their chances of experiencing carpal tunnel syndrome again.

» Hip Disorders -  Common conditions include:

»Hip Tendonitis: Inflammation or irritation of a tendon, a chord-like structure that connects muscles to bones. Tendonitis causes pain due to inflammation and swelling. In some cases a loss of motion in the joint will occur due to excessive inflammation. Tendonitis is often caused by repetitive overuse that causes irritation and inflammation of the tendons.

»Hip sprain/strain: involves the injury to soft tissues of the hip area. Sprains involve injury to the ligaments within the joint and strains refer to the injuries of the muscles and tendons. Most hip sprains or stains happen from an accident or trauma such as a fall or direct/forceful contact. Other instances of hip sprain/strain are from overuse or over stretching of the muscles or ligaments in

the hip.

»Trochanteric Bursitis: The greater trochanter is the large bump on the outside of the upper end of the thigh bone. You can feel it on the outside of your hip. Where friction occurs between the muscles tendons and bones, there is usually a structure called a bursa, which is a thin sac of tissue that helps reduce this friction. Sometimes, this bursa becomes inflamed because of too much friction or because of an injury to it. Most cases of trochanteric bursitis appear gradually. The pain can be very sharp and is localized primarily to the outside of the hip. The pain may radiate down the outside of the thigh.

»Hip Osteoarthritis: This condition is a common problem for many middle aged people. It is caused by the wearing away of the cartilage that is on the end of each bone. As the cartilage wears away the two bones rub together, which produces pain and inflammation. Bone spurs may develop which can, also, limit how far the hip can move. The pain is mostly felt in the groin region and stiffness at the hip joint is usually worse in the morning or after prolonged walking or immobility.

» Knee Disorders - Knee pain and knee injuries are fairly common and can affect nearly anyone, whether you are highly active or fairly sedentary. There are many potential causes for knee pain, and physical therapy may be the best treatment option for you.

Some of the most common conditions include:

»Knee osteoarthritis: This condition is a common problem for many elderly and middle-aged people. Knee OA occurs when the cartilage on the end of each bone wears away. As the cartilage deteriorates, the bones rub together, causing pain and inflammation. Bone spurs may develop which can also limit how far the knee can move. The pain and stiffness are usually worse in the morning and after prolonged standing or walking.

»Patellafemoral Problems: The patella (knee cap) is the moveable bone on the front of the knee that is covered with cartilage on the underlying surface. Problems develop when the patella doesn’t track properly and suffers wear and tear or when the underlying cartilage begins to deteriorate due to aging or a weakness or imbalance of the quadriceps muscles.

»Illiotibial Band Syndrome: The ITB is a long tendon that runs down the side of the thigh and connects to the outside of the knee. The ITB glides back and forth over the knee as it bends and straightens. Sometimes this tendon can become inflamed as a result of too much activity or by not stretching enough. The pain is localized to the outside of the knee and occasionally radiates up the side of the thigh or down the outside of the shin. People with weak hip muscles and over pronation of the foot are more likely to develop this condition.

Meniscal Tears: There are two menisci between your shin (tibia) and thigh bone (femur). These two menisci act as shock absorbers in the knee. They help spread out the forces that are transmitted across the joint. ITears usually occur in younger people as a result of a forceful twisting injury. The menisci weakens with age and many older people can suffer from a tear as a result of normal activity, such as the up-and-down motion of squatting. The pain is localized to either side of the knee depending on which meniscus is torn.

Anterior Cruciate Ligament (ACL) tear: This is one of the most common knee injuries, and is nearly always associated with a traumatic event. Treatment often requires surgical intervention followed by physical therapy to ensure proper rehabilitation and a return to normal activities.

Patellar Tendinitis: Patellar tendinitis is an overuse injury that affects the tendon connecting your kneecap (patella) to your shinbone (tibia). The patellar tendon plays a pivotal role in the way you use your legs. It helps your muscles extend your lower leg so you can kick a ball, climb stairs, run, push the pedals on your bicycle and jump up in the air. Patellar tendinitis occurs when you place repeated stress on your patellar tendon, often when you suddenly increase the intensity or frequency of your workouts. Stress causes tiny tears in the tendon, which your body attempts to repair. But as the tears in the tendon become more numerous, your body can't keep up, causing the inflammation in your tendon to worsen. Pain may be infrequent at first, but with continued stress and damage to the patellar tendon, the pain of patellar tendinitis can become a constant ache.

Osgood Schlatter’s Disease (OSD): This condition is one of the most common causes of knee pain in adolescents. The good news is that this is not really a disease, but an overuse injury. It is an inflammation of the bone, cartilage, and/or tendon at the top of the shinbone (tibia), where the tendon from the kneecap (patella) attaches. Most often, only one knee is affected. OSD usually strikes active adolescents around the beginning of their growth spurts, the approximately 2-year period during which they grow most rapidly. Growth spurts can begin any time between the ages of 8 and 13 for girls, or 10 and 15 for boys. Teens increase their risk for OSD if they play sports involving running, twisting, and jumping, such as basketball, football, volleyball, soccer, tennis, figure skating, and gymnastics due to an increase in stress being placed at this area on the bone.

» Neck Pain - Neck pain is a common complaint among individuals. Symptoms can vary in location and intensity. Localized neck pain is usually caused by wear and tear of the cervical spine, including the muscles, ligaments, joints and intervertebral discs. Neck muscles can be strained from poor posture, whether it is leaning into your computer, sitting with a slouched posture or hunching over your desk.

Neck pain can reveal itself as:

» Generalized pain in the neck

» Neck stiffness with reduced range of motion

» Headaches

» Muscle weakness in the shoulders, arms or hands

» Pain radiating into the upper back, jaw or down the arms

» Sensory changes, such as numbness, prickling or tingling, into the arms, hands or fingers

Mechanical Neck Pain: This condition is caused by wear and tear on the parts of the cervical spine that move, including the discs, facet joints, ligaments and muscles. The pain may spread from the neck into the upper traps, upper back or into the shoulder region and can result in difficulty with neck movements. Mechanical pain does not cause weakness or numbness in the arm or hand because the problem is not from pressure on the spinal nerves.

Cervical Radiculopathy: This is caused by pressure or irritation of the nerves in the cervical spine. The symptoms include tingling or numbness, weakness in the muscles and/or pain along the path of the nerve. The pressure or irritation can be caused by herniated or bulging discs, degenerative discs or narrowing of the space in the spinal canal.

Cervical Stenosis: The spinal canal usually has ample room for the spinal nerves. This space shrinks with age, as well as, by disc herniations or degenerating discs, bone spurs or thickened ligaments. Symptoms from stenosis rarely develop quickly and occur more commonly in people over age 50.

» Post Surgical Therapy - We have a wealth of experience in rehabilitation for most orthopedic procedures including:

» Spine: Discectomy, Spinal Fusion and Laminectomy.

» Shoulder: SLAP Repairs, Rotator Cuff Repairs, Decompression, Shoulder Replacement and Fractures.

» Elbow: Fractures, Tendon Debridement and Tendon Release.

» Wrist: Carpel Tunnel Release and Fractures.

» Hand/Fingers: Fractures.

» Hip: Hip Replacements and Fractures.

» Knee: Knee Replacements, ACL/PCL Reconstruction Collateral Ligament Repair, Meniscectomies, Quadriceps Tendon/Patella Tendon Repair, Fractures.

» Ankle/Foot: Achilles Tendon Repair, Posterior Tibialis Tendon Repair, Plantar Fasciitis Release, Heel Spur Repair, Fractures.

» Shoulder Pain

Common conditions include:

Tendinitis: Stiffness and soreness in the tendons of the shoulder is generally caused by over use. If proper care is not provided, tendinitis can degenerate into actual tearing of the muscle tissue as we age.

Bursitis: Inflammation of the bursa sacs, which reduces free space in the joint and restricts movement. Bursitis usually goes hand-in-hand with tendinitis and is treated much the same.

Rotator Cuff Injuries: Tears in the rotator cuff (the group of muscles encircling the shoulder joint that help with the proper alignment of movement at the shoulder) can be caused by the progressive worsening of tendinitis, repetitive strain through overuse or trauma.

Osteoarthritis: A condition in which the joint cartilage deteriorates and the joint becomes rough. The AC joint in the shoulder is particularly susceptible because it degenerates faster than any other joint in the body.

Impingement Syndrome: This occurs when the rotator cuff tendons and bursa (a sac between the tendons and the bony roof of the shoulder joint) become irritated with repeated rubbing. Impingement syndrome is commonly caused by continuously working the arms overhead, repeated throwing activities or other repetitive actions such as weight lifting and swimming.

Adhesive Capsulitis (Frozen Shoulder): The causes of frozen shoulder are largely unknown. One common way that people develop this condition is by not moving at the shoulder joint properly for a long time because of the pain that they are experiencing with that movement. Another theory is that it is caused by an autoimmune reaction, which can cause an intense inflammatory reaction in the ligament tissue of the shoulder joint. This inflammation leads to pain and rapid loss of range of motion. This pain and tightness in the shoulder can make it difficult to perform essential daily activities, such as getting dressed.

Shoulder Instability: For some people, the shoulder joint is too loose and moves around too much within the socket. In some cases, the unstable shoulder slips out of the socket and becomes subluxed (comes out a little bit) or dislocated (comes out all the way). If not treated properly, shoulder instability can lead to arthritis due to the abnormal rubbing or wear and tear that occurs over time in the joint. The primary cause of an unstable shoulder is a previous injury that caused a dislocation. The ligaments that hold the shoulder in the socket may have become stretched or torn. An unstable shoulder can, also, result from less severe shoulder injuries.

» Sports Injuries:  Sports injuries are equally frustrating for all athletes, whether you are a professional athlete, a student, a “weekend warrior” or an active senior. In fact, the almost universal question that injured athletes ask is: “When can I get back to playing again?”

  Our physical therapists have years of experience and do more than just get you back in the game. We commit 100% of our expertise and energy to restoring you to the level of fitness you enjoyed before your injury.

Sports Performance for Children

Avi Kleinman,MSPT

I am approached by many parents asking what are the best exercises to make my child a better basketball player. My reply usually focuses more on "what they should not do" more than what they should. A few basic ABCs about youth sports performance training.

A. Always stretch! Before... during... after. Stressing the muscles and tendons requires those said muscles and tendons are at maximal tension at all times.

B. Never perform an activity that requires landing on one leg. If you are performing any one leg exercise - power jump, lateral jump ... land on both feet. The only exception would be quick hopping forward.

C. Keep the routine to no more than 2-3 times a week. And Ice up after each workout.

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