Reviewing National Physical Therapy Month: Knee, Ankle, And Foot

This October, we're celebrating National Physical Therapy Month once again. The national campaign, which has been held annually since 1981, is meant to increase public awareness about physical therapy and to highlight the various ways in which the lives of current and prospective patients can improve from treatment. We fully support these efforts and we're doing our part by reviewing the wide range of conditions that physical therapists can effectively manage in each region of the body.

In this post, we're focusing on the knee, ankle, and foot by looking at some of the most common issues that can develop in these areas.

Knee

The knee is one of the largest and most complex joints in the body. It's also incredibly vulnerable to injury, as knee pain ranks behind just back pain as the second most common condition involving the muscles and bones. Knee pain is the leading cause of disability in adults aged 65 years and older—with knee osteoarthritis being responsible in most of these cases—while various tears are more likely to occur in active individuals. Here's a look at some of the most common conditions that physical therapists treat:

  • Knee osteoarthritis: an extremely common disorder in which the cartilage on the ends of bones in the knee gradually wears away, which reduces its ability to absorb shock and increases the chances that bones will contact one another; usually leads to pain, stiffness, and swelling that makes it difficult to walk and move the knees normally
  • ACL tear: the anterior cruciate ligament (ACL), which helps stabilize the upper leg bone to the knee, can be damaged or torn when an athlete suddenly cuts or changes direction; ACL tears are most often seen in football, basketball, and soccer, and will sideline athletes for extended periods of time
  • Meniscus tear: tears of the meniscus, a tough piece of cartilage that absorbs shock and stabilizes the knee, typically occur from twisting or turning too quickly on a bent knee, often when the foot is planted on the ground; degenerative meniscus tears may also occur in older adults; symptoms include pain, swelling, and difficulty extending the knee
  • Patellofemoral pain syndrome: sometimes referred to as "runner's knee," this overuse injury results from repetitive movement of the kneecap against the thighbone, which can damage the tissue under the patella; as the name suggests, runner's knee is most common in runners and other athletes

Ankle and foot

The feet and ankles have the tall task of withstanding the weight of the entire body, and as a result, injuries are also quite prevalent in this region. Foot and ankle issues are particularly common in active individuals who engage in lots of running and/or jumping activities. Below are some of the most common ankle and foot conditions that physical therapists frequently treat:

  • Ankle sprain: ankle sprains are the most common sports–related injury in both children and adults; this injury typically occurs when an individual twists their ankle or lands awkwardly, which can push ligaments beyond their limits; pain, swelling, tenderness, and difficulty bearing weight are all signs of ankle sprain
  • Plantar fasciitis: this condition results from inflammation of the plantar fascia, a thick band of tissue that connects the heel to the toes; when this tissue is overstrained from repeated activity—like running—it becomes inflamed, which leads to a stabbing pain near the heel that's most noticeable upon waking up; plantar fasciitis is the most common cause of heel pain
  • Achilles tendinitis: another overuse injury related to inflammation of the Achilles tendon, which connects the calf muscle to the back of the heel; it's most common in runners who do lots of speed training, uphill running, or who rapidly increase their training intensity or duration, and it leads to heel pain that usually comes on gradually as a mild ache in the back of the leg or above the heel
  • Turf toe: this is a sprain of the ligaments surrounding the big toe when it's bent back too far (hyperextended), which is common in football players; it can occur from a sudden, forceful movement or repeated hyperextensions over time, and leads to pain, swelling, and limited movement of the big toe

Evidence supports the role of physical therapy for lower extremity conditions

Physical therapists regularly see these and many other painful conditions that involve the knees, feet, and ankles. As with other regions of the body, they utilize a variety of tools and techniques in tailor–made treatment programs that are based on the type of injury and the patient's unique abilities, needs, and goals. Most programs will include specific strengthening and stretching exercises, pain–relieving modalities, manual (hands–on) therapy techniques, sport–specific exercises for athletes, education, and guidance on how to modify activities to avoid further damage.

Research has shown that physical therapy can significantly improve patient outcomes and help them avoid surgery in certain cases. One study found that manual therapy led to clear improvements in physical function and reduced pain in patients with plantar fasciitis, while a robust review of studies found that physical therapy led to outcomes similar to surgery for various types of tendinitis, including Achilles and patellar tendinitis. Other research has shown that physical therapy leads to similar improvements in physical function when compared to surgery for patients with meniscus tears, and that physical therapy is also more cost–effective than surgery for these tears.

In our final post, we'll look at how physical therapy can also help manage other miscellaneous conditions throughout the body.

Reviewing National Physical Therapy Month: Shoulder, Elbow, And Wrist

October is National Physical Therapy Month, an annual campaign that’s intended to increase public awareness about physical therapy and highlight the multitude of ways that patients’ lives can improve from treatment. To do our part in spreading the word and working towards these goals, we’re providing a detailed review of the wide range of conditions that physical therapists can treat in each region of the body.

In this post, we’re focusing on the shoulder, elbow, and wrist with brief summaries of the most prevalent injuries and conditions that occur in these regions.

Shoulder

The shoulder is the third most common site for musculoskeletal pain in the body, with up to 67% of the population bound to experience it at some point. The primary reason pain occurs so frequently in this region is that the shoulder is the most flexible and mobile of all the joints, as it can rotate a full 360°. This extreme flexibility, however, makes the shoulder more vulnerable to a variety of sudden and overuse injuries. Among the most common shoulder–related conditions are the following:

  • Note: about 85% of shoulder issues involve the rotator cuff, a group of four muscles and tendons that form a “cuff” and support the head of the upper arm bone
  • Rotator cuff tendinitis (shoulder tendinitis): results from irritation or inflammation of a rotator cuff tendon, leading to pain and swelling in the front of the shoulder and side of the arm; most common cause of shoulder pain
  • Shoulder impingement syndrome: involves any of the rotator tendons or other structures being trapped (or impinged) by two bones, which leads to shoulder pain, weakness, and difficulty reaching up behind the back
  • Rotator cuff tear: results when a rotator cuff tendon detaches from the bone, either partially or completely; can occur either traumatically or gradually, which is usually the case in older patients
  • Shoulder bursitis: inflammation of a fluid–filled sac in the shoulder called the bursa, which occurs from regularly performing too many overhead activities; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
  • Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, which causes the shoulder capsule to thicken and tighten around the shoulder joint; symptoms include pain and stiffness that makes it difficult to move the shoulder

Elbow

The elbow is the link between the upper and lower arm, and it can be subjected to repeated stress from many daily activities. As a result, most elbow–related injuries that physical therapists treat result from repetitive stress, either from one’s occupation or from certain sports. Below are a few of the most common:

  • Golfer’s elbow (medical epicondylitis): this condition results from repeated bending of the wrist, which damages the muscles and tendons in the elbow and eventually leads to inflammation; it’s most common in golfers, but can occur from other sports and activities that strain the elbow, and the clearest indication is pain on the inside of the elbow that’s most noticeable when performing any type of gripping activities
  • Tennis elbow (lateral epicondylitis): a repetitive strain injury caused by repeatedly performing the same movements—in tennis, other racquet sports, or one’s profession—over and over; common symptoms are pain and a burning sensation on the outside of the forearm and elbow that gets worse with activity, as well as weakened grip strength
  • Ulnar collateral ligament injury: the ulnar collateral ligament, which connects the inside of the upper arm bone to the inside of your forearm, is frequently damaged or torn in youth baseball from young pitchers throwing too often without rest; a tear will sideline a player for an extended period

Wrist

The wrist is comprised of 15 bones, which are connected by three primary joints and several other smaller joints, plus numerous muscles, ligaments, and tendons that reinforce these connections. Any of the structures of the wrist can be damaged by extreme movements—like twisting, bending, or a direct impact—that force it beyond its normal range of motion, or from repetitive use. Below is a selection of the most common wrist–related injuries physical therapists manage:

  • Carpal tunnel syndrome: a repetitive strain injury that affects about 5% of the population; results from regularly performing tasks that require repetitive hand motion, awkward hand positions, strong gripping, mechanical stress, or vibration; starts with a burning/tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then up the arm
  • Wrist arthritis: a general term for the wearing away of protective cartilage on the ends of bones in the wrist, usually either from osteoarthritis or rheumatoid arthritis; leads to pain and impaired wrist range of motion
  • Ulnar tunnel syndrome (Guyon’s canal syndrome): similarly to carpal tunnel syndrome, this condition involves compression of the ulnar nerve and leads to a tingling sensation in the ring and little fingers; it’s particularly common in weightlifters and cyclists
  • Wrist tendinitis: a condition in which one or more tendons in the wrist becomes inflamed and irritated, which leads to pain and disability; tendinitis can occur at any age but is more common in adults, especially those over the age of 40
  • Dupuytren’s contracture: an abnormal thickening of tissue between the skin and tendons in the palm, which may limit the use of the fingers or eventually cause them to be pulled in towards the palm in a bent position

The use of physical therapy for these conditions is backed by research

Physical therapists can effectively treat these and many other painful conditions that affect the shoulder, elbow, and wrist. Most treatment programs will involve some combination of education, pain–relieving interventions, flexibility and strengthening exercises, manual (hands–on) techniques, and activity modification recommendations—particularly for repetitive strain injuries—but the specific contents of each plan will vary depending on the type and severity of the condition, and the patient’s abilities and goals.

There is an abundance of research that supports physical therapy as effective solution for many of these conditions. For example, a recent review of studies called a systematic review found that stretching exercises, strengthening exercises, and other physical therapy techniques reduced pain and improved range of motion in patients with frozen shoulder, while a 2018 systematic review identified moderately strong evidence to support exercise therapy for rotator cuff tears. Research has also shown that exercise therapy is effective for both tennis elbow and golfer’s elbow, and that manual therapy can lead to significant benefits in patients with carpal tunnel syndrome.

In our next post, we’ll review conditions affecting the knee, ankle, and foot.

Reviewing Conditions For National Physical Therapy Month: Neck & Back

October is a special time for our profession that we’d like you to be a part of. It is National Physical Therapy Month, which is an annual opportunity for physical therapists and physical therapist assistants around the country to campaign and speak out about our profession. The goal of the month–long campaign is to increase awareness about the important role physical therapy can play in people’s lives by reducing pain, improving mobility, and encouraging a healthy lifestyle.

National Physical Therapy Month was first established in 1981 by the American Physical Therapy Association (APTA), when the organization wanted to show the public how physical therapy can “transform society by optimizing movement to improve the human experience.” In doing our part to work towards these goals, over the next few posts we will be providing an overview of what physical therapists do and the wide range of conditions they treat throughout the entire body.

Understanding the many conditions that involve the neck or back

Physical therapists are experts in how the body moves. When a patient comes to us with an injury or painful condition, we first perform a thorough evaluation to identify the source of the problem and then create a custom–tailored program that targets the patient’s impairments and limitations. While the elements of each program will vary depending on the specific condition and the patient’s unique needs, abilities, and goals, physical therapists always provide a highly personalized approach to care and pay close attention to each patient’s response, regardless of what they’re being treated for or the location of pain.

In our first post of this series, we’re going to explore which conditions of the spine physical therapists most frequently treat.

The spine is one of the most common locations in the body where pain can arise. Up to 50% of adults deal with neck pain each year, and up to 70% will encounter it at least once in their lifetime. The figures on back pain are even higher, as about 80% of Americans will experience an episode of low back pain at some point in their lives, making it the most common site for pain in the body. Many of the ailments that produce pain in the neck can also develop in the back, and vice versa. Let’s take a look at some of the most prevalent spine–related conditions:

  • Sprain: occurs when a ligament in the spine is pushed beyond its limits, which can cause it to be damaged or torn; typically leads to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
  • Strain: involves a tendon or muscle that supports the spine being twisted, pulled, or torn; as with sprains, neck and back pains usually lead to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
    • Both sprains and strains can occur either from a single incident or due to repetitive stress over time, and these injuries are responsible for most cases of neck and back pain, particularly in younger patients

Herniated disc: a condition in which the softer jelly–like substance of a disc in the spine pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact; a herniated disc is most likely to occur in the lower back, but they are also seen in the neck; common symptoms include arm or leg pain, numbness or tingling, and weakness

Spinal stenosis: a condition in which the spinal canal—the space around the spinal cord filled with a fluid that bathes the nerves and nerve roots of the spine—narrows over time, which puts pressure on the spinal cord and spinal nerve roots; spinal stenosis is most common in the lower back and the neck and is typically only seen in older adults since it’s caused by age–related changes

Joint dysfunction: a term used to describe when any of the joints of the spine—including the facet joints or sacroiliac joint—are either moving too much or too little; this can lead to pain and other symptoms in the hips, pelvis, and lower back

Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues; degenerative disc disease is another one of the most common causes of low back and neck pain

Osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints and discs in the spine; osteoarthritis can occur anywhere in the spine, and has been referred to as the most common cause of low back pain in people over the age of 50; patients typically experience pain and stiffness, as well as weakness or numbness in some cases

Spondylosis: a general term used to describe any pain related to age–related changes in the spine; can occur in the neck or back

Evidence supports the effectiveness of physical therapy for neck and back pain

Physical therapists utilize a variety of interventions to address neck and back pain, including stretching and strengthening exercises, manual (hands–on) therapy techniques, pain–relieving modalities, functional training, education, and guidance on how to avoid further aggravation of pain. After adhering to these treatment recommendations, patients will eventually notice a marked reduction in their pain levels while gradually regaining the ability to move and function similarly to before the onset of their pain.

Research has shown that physical therapy can lead to a multitude of benefits for patients with back or neck pain, including less pain and disability, lower overall treatment costs, and a lower chance of needing additional treatments while avoiding both surgery and opioids.

In our next post, we’ll review conditions that affect the shoulder, elbow, and wrist.

Answers To Your Frequently Asked Questions About Preventing Falls

If you still have questions about what you can do to prevent falls, we have you covered. In our final post of the month, we’re going to provide answers to some of the most frequently asked questions about fall risk reduction to help ensure you’re taking all the steps necessary to decrease the likelihood of a fall for yourself and/or a loved one.

Q: What modifications should I make to my home to increase its safety and minimize hazards?

A: First, conduct a walkthrough of your home—both indoors and outdoors—either by yourself or with a friend, family member, or professional if you need assistance. Take note of any obstacles or hazards that could potentially lead to a slip or fall, such as throw rugs, clutter on the floor, poor lighting, lack of handrails or grab rails, and uneven steps. (During the winter, another danger is ice on walkways and stairs). Once these potential hazards are identified, take measures to address them by installing handrails on both sides of all stairways, removing clutter—and keeping it off the floor—removing all throw rugs, improving the lighting in all rooms, and adding nonskid mats, a raised toilet seat, and grab bars as needed in bathrooms. Be sure to ask for assistance from a friend or family member with any tasks you’re not comfortable completing on your own.

Q: How can a physical therapist help?

A: Physical therapists are perfectly positioned to offer guidance on fall risk reduction because the entire practice is predicated on movement–based strategies intended to increase one’s physical function and avoid injury. A physical therapist will first perform a brief screening to determine your baseline fall risk, and if an elevated risk is detected, a more thorough evaluation of balance, strength, walking ability, footwear, medications being taken, medical history, and other parameters will follow. Based on the findings of this evaluation, the therapist will design a personalized treatment plan that’s intended to minimize fall risk. This may include education, balance training, a walking program, strength training, endurance training, and pain management.

Q: What are some exercises I can perform at home to improve my balance?

A: Regular physical activity—like brisk walking, gardening, and doing household chores—is a great start to increase your fitness levels and reduce your fall risk, but performing specific exercises will have an even greater impact. The best types of exercises are those that improve strength, flexibility, balance, and proprioception (sensing your body’s location and position in space), all of which tend to naturally decline in older age. Here are four of our top exercises to address your weaknesses and reduce your risk for falling:

  1. Single–leg stance exercise: improves your balance on each leg, which will in turn help with overall balance
  2. Heel–to–toe walk: helps you better maintain your balance while moving and encountering obstacles
  3. Sit–to–stand exercise: strengthens your leg, core, and back muscles, increases overall mobility, and improves balance
  4. Heel raise: strengthens the calf and thigh muscles to improve balance

Q: Should I ask my doctor if the medications I’m taking could increase my risk for falls?

A: Absolutely! Doctors should always be extremely careful about choosing which medications to prescribe based on the risk for side effects and any potential interactions each drug could have with other medications, but you should also talk with your doctor before starting any new medication or if you notice any changes to your balance from the drugs you’re currently taking.

Q: How often should I get my eyes checked?

A: If you’re over the age of 65, it’s recommended that you have your eyes checked once a year. But if you notice that your vision has become somewhat fuzzy or starts to get progressively worse, don’t wait for your next appointment and have your eyes checked as soon as possible.

Q: What else can I do to reduce my risk for falls?

A: Here are a few additional steps you can take to manage your fall risk:

  • Always wear appropriate footwear (avoid slippers, flip–flops, and other types of footwear that can easily slip off your foot)
  • Try to plan your day around your energy levels: learn your limits and don’t push yourself or overstrain your body at times when you don’t feel up to certain tasks, which can increase your fall risk
  • Follow a healthy diet that includes lots of fruits, vegetables, and whole grains while minimizing your intake of processed foods and those with high sugar content; consider talking to a nutritionist or dietician for additional support
  • If you’re concerned with your fall risk, consider using an assistive device like a cane or walker when getting around

We hope that these posts have been educational, informative, and helpful for you and/or any loved ones that may be at risk for falling. Contact us if you’re interested in learning more about how to prevent falls or would like to begin a fall–prevention program with a physical therapist.

Education Should Also Play A Significant Role in Fall Prevention

It should be clear by now that falls are a major problem in the elderly community. And as we’ve shown, active, exercise–based prevention programs are one of the most beneficial ways to help at–risk adults avoid falls by improving areas like strength, balance, and flexibility. But in addition to exercise, another important part of any plan designed to reduce the risk for falls should be a strong educational component.

Fall prevention education primarily involves providing information to older adults about why falls are dangerous, what types of risk–prevention services are available, where to access these programs, and what these individuals can expect if they take these measures. When executed properly, this education can lead to several important benefits, such as improving fall prevention awareness, increased self–confidence and self–reliance, and possibly a reduction in the number of falls. And when this education is paired with an exercise–based strategy, the positive effects may be even more substantial.

Evaluating the impact of fall prevention education in community–dwelling adults

Researchers conducted a study to develop a better understanding of the effectiveness of fall prevention education in older adults living in a community setting (eg, a nursing homes and long–stay hospitals) who were referred to or were attending physical therapy. Physical therapists screened potential candidates for balance, gait, strength, and coordination and determined that eight of these patients fit the necessary criteria to be included in the study.

Accepted participants first completed a questionnaire that provided a baseline picture of their knowledge regarding fall risk factors, and their educational needs were determined based on the scores of this questionnaire, their independent level of functioning, and other health conditions present. These patients then participated in the first educational session, which summarized the definition of a fall, the prevalence of falls, potential complications of falls, and the most common risk factors associated with falling, with a particular focus on the risk factors that were relevant to each person according to their baseline measurements.

Patients were also given a resource booklet that included information on resources available for fall risk prevention, common myths associated with falls, and a toolkit for preventing falls. Later, a second educational session was administered that highlighted all the fall risks identified for each patient and the appropriate fall–prevention strategies that were to be implemented. Finally, all patients were called 30 and 60 days later to complete a follow–up questionnaire regarding their current knowledge of falls and the incidence of any falls during that period.

Overall, results at the two follow–ups showed that patients’ knowledge of falls and fall risk improved, with a 50% increase in awareness about medications that could contribute to fall risk. In addition, patients identified numerous strategies that they could implement to reduce their fall risk, with 62% of patients stating that they were motivated to implement a home intervention strategy and 54% having made lifestyle changes based on their strategies. All participants believed that they would benefit from and could participate in balance and strengthening exercise programs, and six participants had their eyes examined within the last year.

Lastly, no patients experienced a fall in the 30 days after the last educational session, and only 1 patient suffered from a fall by the 60–day follow–up, which did not lead to any injuries. For comparison, four patients had fallen in the prior two years and two had fallen in the 12 months before the study began.

Although this study was small, its findings demonstrate that simply attending two educational sessions can improve knowledge and awareness on fall risk, lead to the implementation of fall–prevention strategies at home and may reduce the number of falls and fall risk factors for community–dwelling older adults. Thus, at–risk adults are encouraged to participate in these types of educational programs, coupled with personalized exercise–based interventions, which can have a significant impact on fall risk moving in this population.

In our last post, we’ll answer some additional questions about fall prevention strategies.

Exercise-Based Prevention Programs May Reduce The Risk For Falls

As we explained in our last post, falls represent one of the greatest burdens on the population over 65 years, and consequently, the entire healthcare system. While not all falls result in serious injury, those that do can have significant long-term implications that results in reduced mobility and activity, fear of moving, and a greater risk for other adverse health outcomes. Experiencing a fall can also cause some older adults to enter long-term care facilities like nursing homes and long-stay hospitals, where the risk for falls is generally higher because of a more sedentary lifestyle.

This highlights the urgent need for interventions that can reduce the risk and incidence of falls in the aging population. One of the most effective strategies to accomplish this is the use of exercise-based programs intended to improve strength, flexibility, mobility, balance, and proprioception (how a person senses the position and location of their body in space.) Many of these programs have been implemented for older adults in long-term care facilities, which can generally be classified into the following groups:

  • Single interventions: consists only of various exercise
  • Multifactorial interventions: consists of a customized combination of various exercises and other interventions, such as reducing medication use, modifying one’s home environment, and managing low blood pressure
  • Multiple component interventions: consists of a fixed combination of exercises and other interventions that are intended to promote mobility, prevent muscle loss, and improve muscle coordination during physical tasks

Research on the effectiveness of these types of programs for preventing falls in older adults is mixed, with some identifying benefits and others failing to do so. Therefore, a powerful study called a systematic review was conducted to evaluate the current evidence on various exercise-based programs for reducing falls in community-dwelling older adults.

Most studies support the use of exercise-based prevention programs

Researchers performed a comprehensive search of four major medical databases for high-quality studies that assessed the impact of exercise-based programs (single interventions, multifactorial interventions, or multiple component interventions) for preventing falls and fall risk in older adults. This search led to 34 studies fitting the necessary criteria for inclusion in the systematic review.

Twelve of the included studies were themselves systematic reviews that reported outcomes on the reduction of falls, and of these, 11 reviews concluded that exercise-based interventions significantly reduced the incidence of falls. In addition, 10 systematic reviews discussed fall risk factors as outcomes, and eight of these reviews concluded that there was a significant improvement in various risk factors, including balance, muscle strength, functional mobility, heart and lung health, gait speed, or fear of falling. Only six papers evaluated negative outcomes among patients, and most of these cases were minor, suggesting that these programs were generally safe. Further analysis revealed that the most effective exercise programs were those that accounted for the specific needs and risks of each participant with a personalized rather than a one-size-fits-all approach.

Based on these findings, it appears that various types of programs with single interventions, multifactorial interventions, or multiple component interventions that include light to moderate exercise training can reduce fall risk factors and the incidence of falls in older adults living in long-term care facilities. Physical therapists can design and implement prevention programs of this nature at these facilities or in an office setting and provide additional advice and assistance on how to manage fall risk in this population. In our next post, we’ll discuss why education should also be involved in fall prevention.

Falls Can Have Dire Consequences And Major Costs For Older Adults

Although falls in older adults are responsible for nearly one million hospitalizations and tens of billions of dollars in healthcare spending, many people are not properly informed about the scope of the problem or what they can do to address it. This is the impetus behind Fall Prevention Month, which is a campaign put forth every September that’s intended to boost awareness about the many dangers of falling with educational resources and guidance on what can be done to manage this risk.

To do our part towards these efforts, each of our posts this month will focus on a different aspect of falls in seniors and how they can be prevented.

Eye–opening facts about falls in older adults

Falls are alarmingly common in Americans over the age of 65 years. Here are a few facts to help you better understand the extent of the issue:

  • One out of every three adults over the age of 65 and one of every two adults over 85 will fall at least once each year
  • Approximately 2.8 million older adults visit the ER, 800,000 are hospitalized, and 27,000 die each year because of a fall
    • This makes falls the leading cause of fatal injuries, non–fatal injuries, and hospitalizations in the population over 65
  • The death rate associated with falls for seniors increased by 30% from 2007 to 2016
  • Falls are among the 20 most expensive medical conditions in the U.S., with the yearly costs of fall–related injuries estimated to be about $50 billion
  • About 20–30% of falls cause moderate to severe injuries that have a significant impact on one’s functional mobility and independence

Falls can occur for a variety of reasons, but they are often due to a combination of internal and external factors. Although age certainly contributes to fall risk, health status is a far more accurate predictor of one’s individual risk. Health conditions like arthritis, balance problems, lower body weakness, dementia, diabetes, and impaired vision or hearing all become increasingly common in older age and can make falls more likely. Taking numerous medications—some of which can impair balance or have other dangerous side effects—can further elevate the risk for falls.

A person’s external environment, particularly their home, is also a big determining factor in one’s fall risk. Loose rugs, clutter, slippery surfaces, poor lighting, steep or uneven stairs, and a lack of handrails or grab bars can all pose significant dangers for older adults—especially those who also have many internal, health–related risk factors. These hazards are common in many homes if no guidance is provided on how to avoid them, and this is why so many falls (up to 50%) are related to environmental causes. Collectively, the more internal and external risk factors that are present, the greater the likelihood that the individual will experience a fall.

Common consequences of falls

Fractures are by far the most serious consequence of falls, with hip fractures occurring most frequently and posing the biggest threat to older adults. In the senior community, an astonishing 95% of hip fractures are caused by falls, and more than 300,000 adults over the age of 65 are hospitalized for this type of injury every year. Other common fractures include the spine, arm, forearm, leg and ankle, and the risk for these increases even more when osteoporosis—also common in older adults—is present.

Hip fractures are particularly devastating because of their impact on mobility, as many older adults struggle to recover or regain their prior level of function afterwards. Surgery is also needed for many patients, which is associated with additional risks. Sadly, older adults have a 27% chance of dying within one year if they suffer from a hip fracture.

If a fall does occur, many individuals go on to develop an even greater fear of falling, even if they’re not injured. This can cause them to limit their activities, which leads to reduced mobility and loss of physical fitness. Worst of all, this process can develop into a vicious cycle that further raises the risk for falling because of these changes.

In our next post, we’ll talk about the importance of exercise and why it should serve as a key force for preventing falls in older adults.

Most Cases Of Tennis Elbow Will Improve With Physical Therapy

Tennis is a great form of physical activity that works out many parts of the body due to its demanding dynamics, but just like every other sport, it also comes with a risk for injury. The most common injury in the sport is called lateral epicondylitis, which is often referred to as tennis elbow. Tennis elbow is a bothersome injury that can significantly interfere with gameplay, but there are several steps you can take to reduce your risk. And if it does occur, physical therapists have you covered.

The lateral epicondyle is a bony bump on the outside of the elbow that serves as an attachment point for several muscles, tendons, and ligaments of the elbow and forearm. When the arm is overworked, a muscle in this region called the extensor carpi radialis brevis (ECRB) gets weakened, which eventually leads to microscopic tears in its tendon, which attaches to the lateral epicondyle. This results in inflammation of the ECRB tendon, which is called lateral epicondylitis, or tennis elbow.

Tennis elbow is yet another example of a repetitive strain injury (RSI) that’s caused by repeatedly performing the same movements in tennis over a long period. Thus, athletes who play tennis and other racquet sports therefore have a particularly high risk for developing tennis elbow, particularly due to the groundstroke in these sports, which directly puts a strain on the ECRB. But tennis elbow can occur in anyone who performs repeated movements that involve the elbow, such as painters, plumbers, and carpenters, who are especially prone to getting tennis elbow. When tennis elbow occurs, the most common symptoms are pain and a burning sensation in the outer part of the forearm and elbow that gets worse with activity, as well as weakened grip strength.

If you play tennis regularly, following these tips can reduce your risk for tennis elbow:

  • Learn to use your shoulder and upper arm muscles to take the strain off your elbow
  • Stick to the middle of your range of motion during strokes, and avoid bending or straightening your arm all the way
  • Make sure your racquet is the right size for you; lighter weight, larger grips, and softer strings may reduce the strain on your tendons
  • Take intermittent breaks from tennis throughout the year to avoid overuse
  • Try to maintain adequate fitness and flexibility levels with conditioning exercises
  • Avoid repeating any one type of stroke, and practice a range of strokes instead

Physical therapy may be needed for patients with bothersome symptoms

But for those of you who are already dealing tennis elbow symptoms, or if symptoms develop in the future, the good news is that 90% of cases will significantly resolve with nonsurgical treatment alone, such as physical therapy. Physical therapists are movement experts who will first perform a thorough evaluation to identify the source of your pain and determine if any of your movements or activities may be contributing factors. From there, the therapist will design a personalized, evidence–based treatment program designed to alleviate your symptoms and restore your physical function with a variety of interventions. A typical physical therapy program for tennis elbow will consist of the following components:

  • Elbow bracing, which reduces stress on the ECRB and allows it to self–repair; research has shown that using an elbow brace can significantly reduce the frequency and severity of pain in tennis elbow
  • Strengthening exercises that target weakness in the wrist, forearm, and core muscles; eccentric exercises, or negative strengthening exercises, are particularly effective for tennis elbow and are likely to be included
  • Manual therapy to increase the flexibility of joints and muscles of the lower arm and alleviate painful symptoms
  • Activity modification training, in which the therapist will teach you how to modify any movements you perform regularly that could be contributing to your symptoms
    • For tennis players, your therapist may guide you on how to select the right type of racquet, how to modify your stroke to avoid repetitive strain of your, and how frequently you should be taking breaks to avoid overuse

As we’ve shown you over these last four posts, RSIs and occupational overuse syndrome can be the product of a wide range of movements involved in work, sports, or just about anywhere else, and the only real criterion is that the movement is performed repeatedly over a long period. The resulting pain and functional impairments often hold patients back from certain activities and can degrade their quality of life. But on the bright side, physical therapists are ideally suited to identify and treat these injuries with various interventions that both address patients’ symptoms and teach them how to modify their behaviors and prevent future injuries.

Elbow Pain Is Common In Golfers Due To Repetitive Bending & Twisting

So far, we’ve been primarily focusing on repetitive strain injuries (RSIs) that result from performing the same movements regularly in one’s occupation. But sports—both as a profession and a recreational activity—typically require certain motions to be repeated as well, meaning they are yet another potential contributor to RSIs. For golfer’s, one of the most common issues is golfer’s elbow, which leads to a nagging pain on the inside of the elbow that can seriously derail a player’s game.

The medial epicondyle is a piece of bone located on the inside of the elbow that protrudes out from the humerus (upper arm bone). It contains a group of tendons and muscles, all of which allow the forearm, wrist, and hand to bend and move in several directions. When this area becomes irritated or inflamed, the result is medial epicondylitis, or golfer’s elbow.

Golfer’s elbow results from repeated bending of the wrist, which damages the muscles and tendons of the medial epicondyle and eventually leads to inflammation. The condition is especially common in golfer’s because gripping or swinging clubs incorrectly or with too much force can take a toll on these structures over time. But golfer’s elbow can also occur in other sports and from activities that strain the elbow in a similar manner, such as racquet sports, throwing sports, weight training, and even certain occupations that involve lots of bending of the wrist or elbow.

The clearest indication of golfer’s elbow is pain on the inside of the elbow that’s most noticeable when performing any type of gripping activities. Other symptoms include general weakness in the wrist and forearm when gripping, tenderness and swelling on the inside of the forearm, and elbow stiffness or numbness that radiates down from the elbow into the hand. As a result, many basic activities that require gripping or grasping can become challenging.

What a comprehensive physical therapy program can do for your elbow pain

If you start to notice elbow pain or any other signs of golfer’s elbow—especially if you golf or do any of these activities regularly—we strongly recommend visiting a physical therapist as soon as possible. Failing to address this condition early can lead to further complications down the road such as a torn tendon, which is a much more serious problem. A physical therapist will address your condition immediately by evaluating your symptoms and then developing a personalized treatment program based on your abilities, preferences, and goals. A typical treatment program for golfer’s elbow will consist of the following:

  • Pain–relieving modalities ice, heat, and massage to reduce your pain levels
  • Manual therapy: this type of therapy involves the physical therapist performing a series of mobilizations and manipulations to the forearm and wrist to help the muscles in that region regain their full range of motion
  • Stretching exercises: since muscles will generally lose their flexibility from lack of movement, these exercises will target those areas and address any impairments present
  • Strengthening exercises: weakened muscles are another consequence of golfer’s elbow, and these exercises will work to build back strength in the muscles of the forearm, elbow, arm, and hand; eccentric exercises—or negative strengthening exercises—are especially helpful for this condition
  • Sport–specific functional training: for golfers and other athletes, these exercises will work specifically on the movements involved in your sport, so that you can return to the course or field more quickly and confidently

In our final post, we’ll discuss a related condition called tennis elbow, which occurs due to similar mechanisms in tennis athletes and other individuals who overuse the lower arm and elbow.

A Physical Therapy Program Is Best For Nerve-Related Repetitive Strain

Our hands are the main tools that we use to navigate the world around us. Most—if not all—professions require some use of the hands to complete the task, whether that’s grooming dogs, typing at a computer, or trimming trees. Unfortunately, these repetitive motions can irritate and damage certain structures of the hand and wrist, as we explored in our last post. Over time, this can lead to the development of a repetitive strain injury (RSI), which can cause a variety of symptoms in the hand and wrist that will interfere with hand function and make it a challenge to perform tasks normally. Some common RSIs involve irritation of nerves as they pass through the wrist, and we’re going to discuss each of those below.

Carpal tunnel syndrome

The carpal tunnel is a space at the base of the palm that contains several tendons and the median nerve, which provides sensation to most of our fingers. If these tendons and soft tissue thicken or any other swelling occurs in the area, the tunnel narrows, which puts pressure on the median nerve and leads to carpal tunnel syndrome. Symptoms usually start with a burning or tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then radiate up the arm. As carpal tunnel syndrome progresses, symptoms usually get worse when holding certain items, and the weakness and numbness may occur more frequently if pressure on the nerve persists.

Carpal tunnel syndrome affects about 5% of the population, and the greatest risk factor is performing any task that requires repetitive hand motions, awkward hand positions, strong gripping, mechanical stress on the palms, or vibration. Although office work and repetitive typing may be a potential cause, the professions most frequently associated with carpal tunnel syndrome are those that involve sewing, baking, cleaning, or assembly–line work.

Cubital tunnel syndrome

The ulnar nerve is a major nerve that travels from the neck down to the hand, where it provides sensation to the little finger and half of the ring finger. This nerve can become compressed—or squeezed—by nearby structures at any point along the way. But the most common place this compression occurs is behind the inside of the elbow at the cubital tunnel, a narrow passageway for the ulnar nerve.

The result of this ulnar nerve compression is cubital tunnel syndrome, which is the second most common nerve compression syndrome of the arm after carpal tunnel syndrome. Symptoms are also similar, as pain, numbness, tingling, and weakness in the arm and hand—especially in the ring and little fingers—are most common. Cubital tunnel syndrome is also caused by daily habits like leaning on the elbow for long periods of time, sleeping with the arms bent, or from direct trauma to the ulnar nerve, like hitting your “funny bone.”

Guyon canal syndrome

The Guyon canal is another “tunnel” for the ulnar nerve that is formed by two bones in the wrist (the pisiform and hamate). When the ulnar nerve is compressed at this location, the resulting condition is called Guyon canal syndrome—or ulnar tunnel syndrome—which is far less common than carpal tunnel syndrome; however, both conditions will occur at the same time in some cases.

Guyon canal syndrome often develops due to overuse, particularly from activities like heavy gripping, twisting, and other repeated hand and wrist motions. Repetitive work with the hand bent down and outward and repeated pressure on the hand—such as in cyclists, weightlifters, and with regular use of a jackhammer—can also cause pressure or irritation of the ulnar nerve at the Guyon canal. Symptoms include pins and needles in the ring and little fingers, which may progress to a burning pain, decreased sensation, weakness, and difficulty spreading the fingers and pinching.

Physical therapy and nerve mobilization exercises can effectively alleviate symptoms

If you notice symptoms that sound like any of these conditions, your first step should be to evaluate your daily habits and behaviors to detect any repetitive movements that could be contributing factors. The tips we provided in our last post can be used to treat as well as prevent overuse injuries like carpal tunnel syndrome, cubital tunnel syndrome, and Guyon canal syndrome, but they may not provide you with adequate relief on their own.

In these cases, a course of physical therapy may be needed to manage your condition. A typical physical therapy treatment program will include bracing or splinting, modalities like ultrasound and electrical stimulation, and advice on how to make modifications to your lifestyle and posture. But the central component of most programs for these nerve–related conditions is targeted exercises that help to move the affected nerve away from the compression forces. Nerve mobilization exercises are designed to help glide or mobilize the ulnar nerve and encourage normal movement through the cubital tunnel or Guyon canal, which can effectively alleviate pain and other symptoms. A similar approach is also recommended for carpal tunnel syndrome, as specific exercises can decrease swelling and adhesion in the carpal tunnel, thereby mobilizing the median nerve and reducing pain levels in the process. Below are a few examples of nerve mobilization exercises for each of these conditions:

Carpal tunnel syndrome

Cubital tunnel syndrome

Guyon canal syndrome

In our next two posts, we’ll explore how RSIs can also result from overtraining in sports like golf and tennis.