Foot pain is a very common complaint seen in the clinic, with plantar fasciitis being one of most common pathologies seen. Shoe inserts and custom orthotics are the most valid interventions for foot pain, especially plantar fasciitis. Research shows that shoe inserts alone may improve foot pain, but when combined with a stretching and strengthening regimen outcomes further improve. Store-bought inserts are an inexpensive intervention that may yield great results. If you are having foot pain, try a store-bought shoe insert to see if that relieves your foot symptoms, but if the pain persists consider setting up an appointment with your physical therapist at Island PT for further evaluation at one of our 5 locations.
Jon Holleman, PT, DPT
Rotator cuff injuries and tears are a common shoulder problem encountered by people. Most common in the 5th and 6th decades of life, many rotator cuff tears require surgery. After the patient has surgery, they are usually sent for physical therapy. Therapy is often a long and slow process, as care must be taken during the early phase to allow healing, to prevent stress and strain on the surgical repair, and prevent re-tears. Depending on the amount of repair performed by the surgeon, full recovery can easily span 6-9 months, possibly up to a year. Leaning on your PT to guide you through this process is critical to recovering function and quality of life.
David Ravnikar, PT, DPT, OCS
Plantar Fasciitis (PF) is a condition causing foot and heel pain. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear. The condition develops normally when repeated weight-bearing activities put a strain on the plantar fascia. Many persons with PF report that symptoms can be the worse when first getting up in the morning and weight bearing. Physical Therapy can help treat PF by instructing in specific stretching of the involved tissues, and with education on proper footwear and orthotics.
Mark DeGarmo, PT, DPT
When injured it is hard not to protect your injury and avoid motion. The real question is, is that the best practice for all injuries? It has been shown that early mobilization is the best method to avoid joint contracture and its harmful consequences on articular cartilage. Early mobilization also serves to maintain joint proprioception, which may help prevent reinjury and hasten recovery to full fitness. Another major positive for early mobilization is to prevent immobilization atrophy. To sum it up, the superiority of early controlled mobilization is apparent in terms of producing quicker recovery and return to full activity, without jeopardizing the long-term rehabilitative outcome.
Kannus, Pekka. “Immobilization or Early Mobilization After an Acute Soft-Tissue Injury?” The Physician and Sportsmedicine 28, no. 3 (2000): 55–63. https://doi.org/10.3810/psm. 2000.03.775.
Jon Holleman, PT, DPT
Tennis elbow or lateral epicondylitis is a painful condition of the lateral elbow often associated with overuse. Treatment and management of this condition varies enormously in part because the pathology is not always understood.
Historically this condition has been labeled as “tendonitis,” which means inflammation of the tendon. Tendon inflammation is rarely the cause of tendon pain. “Tendinosis” refers to micro-tears in the tendon and is associated with overuse of the tendon. In the majority of cases, lateral epicondylitis is better described as tendinosis and needs to be treated as an “overuse” condition rather than simply inflammation.
Overuse: Typically related to repetitive activity either with sport (think tennis, weightlifting or golf) or with occupation (referring to activities like keyboard entry, painting, plumbing, carpentry or cooking).
Age: Most common between ages 30-50, but if related to poor technique can come on at any stage of life.
Change In Activity: Frequently symptoms start after a change in type or frequency of activity; either sport, recreational or work-related. Typically, people may develop this condition if beginning a new activity with which they are unfamiliar or is new to them.
Symptoms: Normally begin slowly and gradually worsen over weeks or months. Pain or burning over the lateral elbow, sometimes extending down the forearm to the wrist. Loss of grip strength. The pain increased by forearm activities-such as shaking hands, holding a racquet, using a tool and gripping of objects.
Conservative treatment will be successful in greater than 90% of cases. Better outcomes are achieved when treatment is initiated earlier. Anti-inflammatory medication and/or a local steroid injection are useful in conjunction with physical therapy to assist in allowing a more progressive exercise program.
Relative Rest: A short period of rest from aggravating activities may be needed to initiate healing. Successful physical therapy involves re-introducing activity gradually once the patient is responding to the eccentric exercise program.
Ice: Patient education in the use of ice is important. Ice should be applied immediately after aggravating activities (sport, work, etc).
Manual Therapy: Soft-tissue release techniques are applied to prevent adhesions at the tendon attachment and to release tightness in the opposing muscle group (the flexors). Joint mobilization to the elbow has been found to improve grip strength, decrease pain and improve function. Physical therapists are trained in manual therapy to assist with the healing of tennis elbow.
Mark DeGarmo, PT, DPT
We’ve all had one, a palpable “knot” in your neck muscles that hurts when you press on it, but “hurts so good” to have it massaged. Physical therapists call them myofascial trigger points, but what are they, how do they form, and how do you treat them?
In general, these trigger points are due to muscle overload over time, when muscle demand exceeds the capacity for the muscle to recover. This can happen from repetitive low-level chronic overload, like bad posture, or come from a quick maximal force that exceeds the muscle’s strength, like a whiplash injury.
When this overload happens, a group of muscle fibers gets stuck in a contracted position restricting blood flow to the muscle and causing painful inflammatory chemicals to build up inside the trigger point. This pain is both localized at the knot, but can also refer pain to other places. For instance, trigger points in the sub occipital region (base of the back of the skull) frequently refer pain up and around to the front of the head, causing tension headaches that are commonly mistaken for migraine headaches. This can happen all over the body, from the glutes and legs to the back and shoulders.
There are various ways to treat trigger points. Dry needling goes directly into the trigger point to cause a twitch response and release the knot. Massage and soft tissue mobilization can bring blood flow to the area and help “reset” the muscle. Exercise causes a rhythmic contraction and relaxation of the muscle to aid in restoring normal blood flow. Stretching and heat can also help promote healing.
Treatment strategies like this can take care of some of the symptoms of myofascial pain, but what about the underlying cause? Physical therapists are musculoskeletal experts who are specifically trained to find and treat trigger points, but treating the symptoms alone is insufficient to prevent them from returning. Often times patients suffering from myofascial pain also need to strengthen and stretch specific muscles to correct any imbalance that caused the trigger point to form in the first place. If you are unsure what may be causing myofascial pain in your life, make an appointment with one of our therapists and we will do a thorough examination to find the source of your symptoms and educate you on ways to reduce your pain and prevent the recurrence of chronic pain.
What is Dry Needling (DN)?
Dry needling is a treatment used by a trained Physical Therapist to help treat trigger points. The term “dry” refers to no medication or solution being used in conjunction with the “needling”, hence it is not an injection. So what are trigger points? They are tight bands or “knots” in your muscles that can limit movement as well as cause pain and dysfunction. It targets these trigger points using small monofilament needles similar to those used in acupuncture. The small needle is used to deactivate the trigger points to decrease pain and restore mobility and function. This targeting of muscle tension is what differentiates dry needling from acupuncture. It can be used for a variety of ailments including neck pain, shoulder pain, back pain and more. Our outcomes with dry needling are amazing!
We offer this treatment as a stand-alone service or within a treatment plan. Make an appointment or stop by to see if dry needling could help.
By maintaining a good posture one can benefit by:
Keeping bones and joints in the correct alignment so that muscles are being used properly;
Decreasing the abnormal wearing of joint surfaces;
Decreasing the stress on the ligaments holding the joints of the spine together;
Preventing the spine from becoming fixed in abnormal positions;
Preventing fatigue because muscles are being used more efficiently, allowing the body to use less energy;
Preventing backache and muscular pain;
Contributing to a good appearance.
Mark DeGarmo, PT, DPT
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