Knee osteoarthritis is an extremely common disorder that involves the cartilage in a knee joint. In a normal knee, the ends of each bone are covered by cartilage, a smooth substance that protects the bones from one another and absorbs shock during impact. In knee osteoarthritis, this cartilage becomes stiff and loses its elasticity, which makes it more vulnerable to damage. As cartilage wears away over time, it loses its ability to absorb shock, thereby reducing the amount of space between bones and increasing the chances that the two bones will contact one another. The most common symptom of knee osteoarthritis is pain that gets worse with activity, while swelling, tenderness, and stiffness may also occur in some patients.

Knee osteoarthritis is particularly common in older adults, as it affects about 45% of individuals and represents the most common cause of pain in this population. Although no treatment can slow or stop this loss of cartilage, physical therapy is strongly recommended as an initial intervention for all patients with knee osteoarthritis. Undergoing a course of physical therapy can help reduce pain levels and preserve knee function through movement–based strategies like stretching and strengthening exercises, hands–on (manual) therapy, bracing, and lifestyle recommendations.

Patients with knee osteoarthritis are also encouraged to increase their physical activity levels to reduce their pain levels and improve functional capacity, but some healthcare providers—and patients—are uncertain how physical activity affects the structural integrity of the knee and if it can be safely performed by patients. Therefore, a study was conducted to examine the safety of physical activity for patients with knee osteoarthritis.

Consistent evidence shows that many common forms of physical activity are safe

Researchers performed a search of the PubMed database for reviews and high–quality studies that evaluated the biological effects of physical activity on the knee in patients with knee osteoarthritis, and the search led to 20 reviews and 12 original studies being included. Upon reviewing these studies, researchers found consistent evidence that many common forms of physical activity—like walking, running, and certain recreational sports—are not associated with structural progression of knee osteoarthritis. Based on their findings, researchers stated that these types of physical activity can be safely recommended for patients with knee osteoarthritis and those at risk for getting it. Evidence was also found that some patients with knee osteoarthritis may benefit from specific recommendations that address other risk factors present, such as weight–loss strategies and treating previous knee injuries.

From here, researchers went on to make the following recommendations for patients with knee osteoarthritis:

• Brisk walking is strongly recommended for all patients; to meet the World Health Organization’s guidelines for ≥150 weekly minutes of moderate–intensity physical activity, patients can consider going on 5 30–minute walks each week
• Patients with knee osteoarthritis who are already runners are encouraged to continue running, as recreational running for up to 25 miles per week was not associated with an increased risk of structural progression of knee osteoarthritis
• Recreational sports are generally encouraged, but patients should speak to their healthcare providers about which sports are safest, since some sports (eg, soccer, weightlifting, wrestling) may increase the risk for knee osteoarthritis progression

If you have knee osteoarthritis and are interested in becoming more physically active, our physical therapists can help by setting you up with a personalized exercise program that carefully considers your physical limitations.

There are few musculoskeletal conditions that can compete with back pain when it comes to sheer numbers. As one of the most common reasons for visiting a doctor, about 25% of Americans have dealt with back pain in just the past three months, and up to 80% of the population will encounter it at least once in their lives. Unfortunately, this means that if you’ve never dealt with back pain, there’s a strong chance that you will at some point in the future.

One of the more common causes of back pain is a herniated disc, which involves the intervertebral discs that lie between each vertebra of the spine. These discs consist of a tough exterior and are filled with a jelly‐like substance, and their purpose it to absorb shock and prevent the bones of the spine (vertebrae) from rubbing against one another. But when the softer jelly‐like substance of the disc pushes out through a crack in the tough exterior ring, it’s called a herniated disc, which can lead to pain, numbness, and weakness.

Herniated discs can develop anywhere in the spine, but they are most likely to occur in the lower back. Although herniated discs are common, they don’t always cause pain, and for patients that have low back pain, the herniated disc may not actually be the cause. In addition, most herniated discs eventually regress—or heal—on their own without surgery. Therefore, patients with low back pain from a herniated disc should be treated with nonsurgical interventions like physical therapy and avoid surgery unless it’s deemed necessary. However, not all patients experience a positive outcome with nonsurgical interventions, and the reasons why are not yet clear.

Study finds that male gender and use of opioids are associated with treatment failure

With this in mind, a study was conducted to compare the characteristics of patients with herniated disc‐related low back pain who were managed successfully with nonsurgical treatments versus those who failed conservative treatment and underwent surgery. To conduct the study, researchers reviewed the records of patients with a herniated disc in the lower back who were treated over a 10‐year period. These patients were divided into two groups: those who were successfully treated with nonsurgical treatments and those that failed nonsurgical treatments and opted to instead have surgery.

A total of 277,941 patients were included from this review. Of these patients, 97% were successfully managed with nonsurgical treatments, which included opioid medications, steroid injections, physical therapy, and occupational therapy. Only 3% of patients failed nonsurgical treatment and underwent surgery. Further analysis revealed that male gender and the general use of opioid medications were both predicting factors associated with higher rates of nonsurgical treatment failure. Patients who failed nonsurgical treatment also billed for nearly twice as much as patients who were successfully managed, and the greatest contributors to these costs were imaging tests, steroid injections, and opioid medications. Finally, patients who failed nonsurgical treatment only attended an average of 1.6 visits with an occupational or physical therapist, which is much lower than a typical treatment plan.

These findings show that the vast majority of patients with low back pain from a herniated disc were successfully treated through conservative interventions like physical therapy. For those that did not experience positive outcomes, other factors may have been at work, such as the use of opioids or not undergoing enough physical or occupational therapy sessions. We therefore continue to encourage patients with low back pain to see a physical therapist first and complete the recommended course of treatment before considering surgery.

With New Year’s Eve just right around the corner, we thought now would be a great time to talk about resolutions. Many people see the new year as a clean slate and a fresh opportunity to start the year off on the right foot—and stay on it—over the proceeding 12 months with one or more resolutions. Setting a new year’s resolution is noble and can absolutely pay off in major ways, but as we all know, setting a resolution isn’t the hard part. It’s keeping the resolution for the whole year.

It should come as no surprise that success rates for keeping a resolution start off high in the first few weeks of the new year, then drop gradually as the year continues. Statistics vary on how many people do stick with their resolution for the entire year, but some studies have found that it can be as low as 9% or as high as 55% of individuals. However, one thing is clear: those who set a resolution are significantly more likely to change their behavior than those who don’t make these yearly goals. Therefore, it’s better to focus on the potential benefits of setting resolutions than the discouraging odds sticking to them. It also helps to have a strategy to help you keep your resolutions for as long as possible, and that’s what we’re here for.

Why don’t most resolutions stick?

New year’s resolutions vary widely across the board, but there are some popular ones that stand out. Among the most common resolutions are exercising more and improving one’s fitness, losing weight, saving money, and improving one’s diet. Some studies have also reported that more than half of people keep the same resolutions as the previous year, suggesting a desire to overcome initial failures with these resolutions.

While there’s no single reason most people don’t stick with their resolutions, one common problem is starting out strong with ambitions that are too high and a regimen that’s too difficult, only to find out that maintaining it in the long term is not feasible. Many individuals also set resolutions that are far too general—like “lose weight” or “eat healthier”—which can be difficult to measure and quantify. In addition, it’s important to note that truly changing one’s habits in the long term is extremely difficult, which is why so many people eventually resort back to their old ways as time passes.

Our top 7 tips to help you beat the odds

If you’re serious about beating the odds and turning your resolution into a long-term habit, here are top 7 tips to help you make it happen:

1. When deciding on one or more new year’s resolutions, try to avoid setting the ones that you’ve failed to stick with in the past—especially from the prior year— at least temporarily
   • For example, if your resolution was to “be more productive” every year for the past 4 years, it may be time to try something else—like picking up a new hobby or eating fewer snacks—this year; you can always come back to that elusive resolution in the future
2. Start by setting a clear and concrete resolution that can be quantified and then create a plan for the year that will get you there
   • For example, lose 10 pounds, run 4 miles per week, or only eat desert on the weekends
3. Don’t expect to make big changes right out of the gates; start with small and manageable changes, then gradually work your way up as you progress
   • For example, if your goal is to run 4 miles per week and it’s your first time running regularly, start by doing a combination of running and walking over shorter distances, then increase your mileage slowly as your fitness and stamina improve
4. Try new types of exercise or different settings if your game plan in the past hasn’t been working
   • For example, if you’re not a “gym person” or find getting to the gym to be a hurdle in your fitness plan, avoid the gym altogether and try working out at home with workout videos and a few pieces of basic equipment
5. If you’re trying to learn a new skill, make it as easy as possible to practice
   • For example, if your resolution is to learn to play the guitar, leave your guitar in a visible location in your home rather than in a closet; this will reduce the amount of time needed to pick it up and start playing
6. Get support people you’re close with
   • For example, tell your friend, spouse, or family member about what resolution(s) you’ve set and ask them to check in on you periodically to see how you’re doing; it helps to have external sources of motivation
7. Reward yourself any time you accomplish something, however small it may be; on the flip side, don’t give up or get down on yourself if you failed to meet a weekly goal or slipped up in some way; change takes time and there will be bumps and roadblocks along the way

If you can make a commitment and adhere to these tips, 2023 may just be the year that you finally conquer your new year’s resolutions, which will leave you feeling awfully proud of yourself when next December rolls around.

If there’s one thing nearly everyone knows about exercise, it’s that we all need it if we want to be healthy. This association is undoubtedly common knowledge by this point, but what some may fail to fully understand is just how far these benefits go. Research continues to amount that shows how maintaining adequate physical activity levels is associated with a plethora of both physical and mental health benefits, and it can extend your expected lifespan, too.

This list is expansive and encompasses numerous fundamental areas of health, but some of the most notable benefits of exercise and physical activity include the following:

• Physical activity reduces the risk for several types of cancer, including liver, lung, breast, kidney, colon, rectal, and bladder cancer
• Regular physical activity and high fitness levels are associated with a reduced risk for premature death from any cause, particularly heart disease, in individuals with no symptoms
• Regular exercise increases strength and flexibility and lowers the risk for musculoskeletal conditions like osteoarthritis, strains and sprains, fractures, and other painful problems; it also increases stability and reduces the risk for falls in older adults
• Regular physical activity reduces the risk for developing type 2 diabetes—especially in individuals who are considered “prediabetic”—and improves outcomes in patients with diabetes

If reading these benefits motivates you to become more active, you may be wondering just how much physical activity you should be striving to get regularly. The American Heart Association, CDC, and guidelines from most other authority sources recommend that all adults aim for the following each week:

• At least 150 minutes of moderate–intensity aerobic physical activity

OR

• At least 75 minutes of vigorous–intensity aerobic physical activity

AND

• At least two sessions of muscle–strengthening exercises

Moderate–intensity aerobic physical activity

Aerobic physical activity, or “cardio,” is any activity that increases your heart rate, and intensity is how hard your body is working during a physical activity. A moderate–intensity aerobic physical activity is one that causes you to work hard enough to raise your heart rate and break a sweat. One of the easiest ways to determine if an activity is moderate intensity is that you’ll be able to talk, but not sing, the words to your favorite song. Here are a few examples of moderate–intensity physical activities:

• Brisk walking
• Water aerobics
• Riding a bike on level ground or with few hills
• Playing doubles tennis
• Mowing your lawn

Vigorous–intensity aerobic physical activity

A vigorous–intensity aerobic physical activity is one that increases your heart rate more noticeably, causing you to breathe harder and faster. The easiest way to tell if the intensity of an activity is vigorous is the talk test: if you’re unable to say more than a few words without pausing for a breath, you’re engaging in a vigorous–intensity activity. Here are a few examples:

• Running or jogging
• Swimming laps
• Riding on a bike fast or on hills
• Playing singles tennis
• Playing basketball

Strengthening exercises

Any exercise or activity that builds strength is classified as a strengthening exercise, and weights are not necessarily required. Strengthening exercises should be done in addition to aerobic activity and work all the major muscle groups of the body: legs, hips, back, chest, abs, shoulders, and arms. These exercises can be performed on the same or different days of the aerobic activity—whichever is easier for you—and should be done to a point where it’s hard for you to do another repetition without help. Try to do at least 1 set of 8–12 repetitions for each exercise, but more is always better. Here are some examples of muscle–strengthening exercises:

• Lifting weights
• Working with resistance bands
• Doing bodyweight exercises (eg, pushups and sit–ups)
• Heavy gardening (eg, digging and shoveling)
• Some forms of yoga

If you’re interested in increasing your physical activity levels but don’t know where to begin, we can help you get started on an exercise program that works for you.

Falls are the leading cause of non–fatal injuries in older adults, and the likelihood of falling increases each year as various health conditions become more common. One in three adults over the age of 65 and one in two adults over 85 will fall at least once each year, and every 11 seconds an older adult is treated in the ER for a fall. About 20–30% of falls cause moderate to severe injuries that have a significant impact on one’s functional mobility and independence, with hip fractures being the most common complication.

These facts may be daunting, but you shouldn’t allow your fear of falling to dominate your life or prevent you from getting around. Instead, you can take control of your situation by making changes in your life that will keep you strong and stable, thereby reducing your risk of falling in the process.

If you have any difficulty with movement, one positive change you can make to your daily life is to start using a walking aid like a cane or walker. Doing so will improve your mobility, balance, and confidence, which will effectively reduce your risk for falling. Walking aids are also extremely helpful for patients dealing with painful conditions like knee or hip osteoarthritis, degenerative movement disorders like Parkinson’s disease or Huntington’s disease, and those recovering a traumatic injury or surgery.

Determining whether a walker or cane is right for you

You should talk to your doctor or physical therapist about whether you need a walking aid and which type is best for you, but it’s helpful to know that walkers are the more supportive walking aid of the two options. Walkers can support up to half your bodyweight and are also helpful for preventing hip and joint pain if it occurs on both sides of the body. A front–wheeled walker, which has two wheels, is most common and best suited for those with poor balance. Three–wheeled walkers are ideal for smaller living quarters but require the user to have more balance, while four–wheeled walkers have better mobility over uneven surfaces and are recommended for those with decent balance and mobility who only need minimal assistance.

Canes are recommended for adults who only need a walking aid on one side of the body and not as much support as a walker. Canes can support up to 25% of one’s bodyweight and are ideal for when older adults first start to notice balance or mobility issues. As with walkers, there are several types of canes to choose from. A quad–based cane provides the most support and stability but is also heavier and slightly more difficult to maneuver. A standard single–base cane provides less stability but is easier to navigate and may therefore be adequate for those with only minor balance issues.

Tips on how to safely use a walker or cane

To ensure that you’re using a walker or cane as safely as possible to reap the full benefits, here are some tips for both walking aids:

Walkers

• The top of your walker should be at the level of your wrist when you’re standing with your arms relaxed at your side
• When using a front–wheeled walker, be sure to keep the front of your body in line with the back two posts of the walker; advance the walker a few inches in front of you first, and make sure all tips and wheels are touching the ground before taking a step
• When you’re ready to take a step, step forward with your bad leg first, followed by your good leg, placing it in front of your lead foot
• Don’t lift the walker off the ground while turning

Canes

• The top of your cane should also be at the level of your wrist when you’re standing with your arms relaxed at your side
• Always hold your cane with the top of the handle at your wrist in the hand opposite of the painful side
• Keep your elbow slightly bent whenever using your cane
• Move the cane forward at the same time as the leg that is painful or weak
• When walking up stairs, your good leg should go up first, followed by the weak leg and cane; when walking down stairs, the weak leg and cane should go first, followed by your good leg
  • One easy way to remember this is the phrase, “Up with the good, down with the bad”

Ensuring that you’re using safe techniques when transferring or walking with an assistive device will significantly improve your mobility and significantly mitigate your risk for falling as you go about your day. Physical therapists can also take this pra step further by training you in the proper use of these devices and designing a personalized fall–prevention program for high–risk patients. Contact us if you’re interested in learning more about walking aids.

When asked about physical therapists and what types of conditions they treat, most people probably think about ankle sprains, back pain, ACL and meniscus tears, rotator cuff issues, broken bones, and possibly sports injuries overall. While these and other musculoskeletal conditions do account for the majority of physical therapists’ patient load, the range of physical therapy goes far beyond them. Some of the less common conditions physical therapists treat include various pulmonary, cardiovascular, and balance issues, but their role can be just as vital in the management of these patients.

Cardiopulmonary rehab: treatment for pulmonary and/or cardiovascular issues

Any condition involving a problem with the lungs that leads to breathing complications is classified as a pulmonary disorder. The most common of these is chronic obstructive pulmonary disease (COPD), which is the 10th most prevalent disease in the world and expected to become the 5th leading cause of death by 2050. COPD causes the airways of the lungs to become less efficient at moving air and it leads to shortness of breath, coughing and wheezing, excessive mucus, and difficulty taking a deep breath. Chronic bronchitis and emphysema are both types of COPD. Other common pulmonary disorders include asthma, lung cancer, pulmonary fibrosis, and sarcoidosis.

Cardiovascular disorders are defined by a dysfunction of the heart and blood vessels. Heart disease, heart failure, coronary artery disease, hypertension (high blood pressure), hypotension (low blood pressure), and cardiac events like a heart attack are all cardiovascular disorders, which often have serious implications for patients. Some disorders, like pulmonary hypertension (high blood pressure in the blood vessels that lead from the heart to the lungs), involve both the cardiovascular system and the lungs.

Since the heart, lungs, and blood vessels are all closely associated with one another, a specialized form of therapy called cardiopulmonary rehabilitation is recommended as an effective treatment many pulmonary and/or cardiovascular disorders. While a primary care physician and possibly a specialist will serve as the leading provider to guide treatment decisions for these conditions, cardiopulmonary rehabilitation provided by a physical therapist can serve as an important adjunct to help patients become more physically active. Each cardiopulmonary rehabilitation plan is unique, but most will include one or more of the following interventions:

• Breathing retraining, including proper breathing techniques to maximize oxygen intake and consumption Education on the early warning signs of distress
• An appropriate exercise program, including endurance and strength training
• Guidance on how to increase daily physical activity levels
• Medication management guidance
• Instructions on disease pathology, infection control, and energy conservation

Vestibular rehab is strongly recommended for balance disorders

Vertigo is the feeling that things are moving, rotating, rocking, or spinning when a person and their environment are completely still. It occurs when there is a problem with the vestibular system that interferes with communication between the brain and other areas of the body. This communication breakdown leads to perceived motion—the primary symptom of vertigo—as well as other symptoms like dizziness, nausea/vomiting, balance disturbance, and headaches.

Millions of Americans experience vertigo and related symptoms each year, with one study reporting that as many as 35% of adults over the age of 40 have dealt with a vestibular dysfunction at some point in their lives. There are several conditions that can cause vertigo, such as inner ear infections, migraines, stroke, surgery, and head injuries, but the two most common issues are vestibular neuritis and benign paroxysmal vertigo disorder (BPPV).

The good news for patients is that BPPV and other causes of vertigo are very treatable. Physical therapy is regarded as one of the most effective vertigo treatments and it has been proven to significantly reduce symptoms. And best of all, many cases of vertigo can be completely resolved in just a few treatment sessions. The specific treatments used depends on what condition is present, but some of the most common interventions include the following:

• Balance retraining exercises: these types of exercises will have the patient shift their body weight in various directions while standing to improve the way information is sent to the brain
• Gaze stabilization exercises: these are designed to keep vision steady while making rapid side–to–side head turns and focusing on an object, which will help the brain adapt to new signaling from the balance system
• Epley maneuver: an extremely effective technique for cases of BPPV involving the posterior canal of the ear that works by allowing the free–floating crystals to be relocated by gravity back to the utricle; has been found to resolve vertigo in approximately 90–95% of patients
• In another simple maneuver, your physical therapist will guide you through a series of 2–4 positions, each of which should be held for up to two minutes; as with the Epley maneuver, these position changes are designed to move the crystals from the semicircular canals back to the appropriate area of the inner ear
• Balance retraining exercises may be needed for some patients that continue to experience balance issues after the vertigo has subsided

As you can see, physical therapy has many applications beyond what most patients might expect, but it can be doubly effective for those who also have a musculoskeletal disorder. For example, if a patient with pulmonary hypertension has been told to exercise more often but is unable to do so because of knee pain, a physical therapist can help address their knee pain and simultaneously provide exercise recommendations that are considerate of their limitations. It’s a win–win for any patient dealing with these issues, and that’s why we strongly advise you to contact us if you’re being hindered by any pulmonary, cardiovascular, or balance issues.

In the final post of our series, we’re focusing on the wrist and 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. 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 are some of the most common elbow and wrist conditions treated by physical therapists:

• 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
• 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 that describes protective cartilage on the ends of bones in the wrist wearing away, 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
• 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 elbow and wrist conditions is backed by research

Physical therapists can effectively treat these and many other painful conditions affecting the 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, one long–term study of women with carpal tunnel syndrome found that there were no significant differences between patients that received manual therapy compared to those who underwent surgery both one and four years later. There were also no significant differences between groups in the rate of surgery over four years, and patient’s self–reported scores on their perceived improvements were similar. Other research has also found manual therapy to be capable of eliciting significant benefits in patients with carpal tunnel syndrome, while additional studies have shown that exercise therapy is effective for both tennis elbow and golfer’s elbow.

We hope this post series has opened your eyes to the wide array of benefits that physical therapy can provide for patients with nearly any musculoskeletal condition. And if you’re currently dealing with pain and have been putting off getting the care that you need, we strongly encourage you to see a physical therapist before your yearly benefits expire, as doing so now will help you get started on the right foot for the new year.

The knee is the next region of the body we’re going to examine, as it ranks up there with the back, neck, and shoulder as a hot spot for musculoskeletal pain. Knee pain is especially common in athletes of sports that involve lots of cutting motions and is the leading cause of disability in older adults. But sports and advanced age are far from the only factors that can increase the risk for knee problems.

The knee is the largest and one of the most complex joints in the body, and its complexity is one of the main reasons it’s so vulnerable to injury. The frequency with which it’s used also plays a significant role. The knee is a hinge joint that’s responsible for bearing weight and allowing the leg to extend and bend back and forth with minimal side–to–side motion. It primarily joins the thighbone (femur) to the shinbone (tibia), but also includes the kneecap (patella) and other lower leg bone (fibula). The patella is a small, triangle–shaped bone that sits in the front of the knee within the quadriceps muscle, and it’s lined with the thickest layer of cartilage in the body because of the massive forces it takes on.

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 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

For knee pain that doesn’t improve with at–home exercises, see a physical therapist

If you find yourself dealing with knee pain, either from a traumatic incident or due to sustained damage over time, one of the first steps you can take is to try managing it on your own at home with some targeted exercises. These include stretching exercises like the quadriceps stretch, hamstring stretch, calf stretch, and knee range of motion exercise, and strengthening exercises like the wall sit, bridge exercise, single–leg heel raise, and partial lunge. If these exercises fail to produce notable improvements, the next step is to see a physical therapist, and preferably sooner rather than later.

Physical therapists frequently see patients with all types of knee–related conditions and are adept at creating personalized treatment plans based on the patient’s condition, abilities, and goals. A typical treatment program for knee pain will include the following:

• Strengthening exercises to build back up the weakened muscles of the leg
• Stretching and range of motion exercises to increase flexibility and regain normal mobility
• Plyometrics, or jump training (especially for patients recovering from ACL tears)
• Recommendations on how to modify activities to minimize the risk for future injuries
• Exercises to improve body awareness, balance, and neuromuscular control, which is the body’s ability to stay strong and stable during all movements
• Activity–specific training for athletes and active individuals

Research has shown that physical therapy can significantly improve patient outcomes and help them avoid knee surgery in certain cases. There is an abundance of evidence on physical therapy for meniscus injuries, including a powerful study called a randomized clinical trial, which found that physical therapy led to similar improvements in physical function when compared to surgery for patients with meniscus tears. Furthermore, a follow–up analysis of this trial showed that physical therapy is more cost–effective than surgery for meniscus tears, while a separate review of 6 studies found that although surgery led to some initial advantages over exercise therapy, there were no differences between groups 12 months later. A systematic review and meta–analysis of 14 studies also found that manual therapy, an important component of most knee treatment programs, is likely to be effective and safe for improving pain, stiffness, and physical function in patients with knee osteoarthritis.

In our next post, we’ll look at the injuries and conditions involving the wrist and elbow.

For the next installment of our post series, we’re focusing on shoulder pain, which can be extremely disabling. Whether or not you realize it, you use your shoulder almost constantly, as it permits practically any movement that involves your arms. This is why any issue that causes pain and prevents your shoulder from moving normally can be a major burden to your daily life.

After the back and neck, the shoulder ranks as the third most common site in the body for musculoskeletal pain, as about 67% of people will deal with it at least once in their lives. The primary reason is that the shoulder is the most flexible and mobile of all joints—and the only joint that can rotate a full 360°—but this extreme flexibility also makes it vulnerable to numerous injuries. Below is a summary of the most common shoulder–related conditions, many of which involve the rotator cuff, a group of four muscles and tendons that form a “cuff” and support the head of the upper arm bone:

• 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 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
• 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

Physical therapists use various interventions to facilitate recovery from shoulder pain

Regardless of what shoulder condition is present, in most cases, the best course of action is a comprehensive course of physical therapy. Physical therapists are movement experts whose goal is to guide patients back to full strength and function with an exercise–based approach. They accomplish this by first identifying the source of pain and any associated impairments and then by designing a personalized treatment program that targets these areas of weakness and teaches patients how to regain their abilities through movement.

Most treatment programs will involve some combination of pain–relieving interventions, stretching and strengthening exercises, manual (hands–on) techniques administered by the physical therapist, and education on how to avoid future shoulder issues. But the specific approach used will vary depending on the condition present, its severity, and the patient’s abilities and goals.

There is no shortage of research supporting physical therapy as effective solution for many shoulder–related disorders. One powerful study 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. Another systematic review published in 2018 identified moderately strong evidence to support exercise therapy for rotator cuff tears, while a long–term study found that surgery was no better than nonsurgical treatment for patients aged 55 and older with a rotator cuff tear up to five years later. Results from yet another systematic review and meta–analysis published in 2022 showed that exercises—both on their own and as part of a program—improved range of motion, function, disability, and pain in patients with frozen shoulder.

In our next post, we’ll look at the injuries and conditions involving the knee.

With the end of the year fast approaching, now is a great time to see a physical therapist it you’re trying to get the most out of your healthcare plan. We suggest you take a few minutes to review your health insurance policy and check on your benefit status as it pertains to your yearly maximums. If you’ve already met your deductible or out–of–pocket maximum for 2022, you will likely have a lower copay or no copay for the rest of the year before your deductible renews on January 1, 2023.

Seeing a physical therapist is perhaps the best decision you can make if you’re currently experiencing pain from any type of musculoskeletal disorder, as doing so is the safest, most effective, and least expensive route to less pain and greater function.

A musculoskeletal disorder is an injury or condition that involves the musculoskeletal system—which includes the bones, muscles, joints, ligaments, and tendons. These disorders are extremely common, with about 30% of Americans being currently affected. Musculoskeletal disorders can develop anywhere in the body, but the spine is by far the most common location, as low back pain and neck pain are among the leading causes of disability in the U.S. Other common musculoskeletal disorders include osteoarthritis, tendinitis, strains, sprains, fractures, and tears of ligaments and tendons.

Surgery vs nonsurgical treatment for musculoskeletal disorders

Patients with musculoskeletal disorders are faced with several potential options when determining how to address their condition, including surgery, which may be attractive to patients who believe it will lead to immediate relief. But the truth is that recovery from surgery requires effort, too, and the overall outcomes are often no better than those following nonsurgical interventions.

In a powerful study called a systematic review and meta–analysis, researchers reviewed the findings of 100 high–quality clinical trials on surgical versus nonsurgical interventions for various musculoskeletal conditions. These trials covered 28 different types of conditions at nine areas of the body, and in all studies that evaluated function, all studies that evaluated quality of life, and nearly all studies (9 of 13 [69.2%]) that evaluated pain, no clinically relevant differences were found between surgical and nonsurgical interventions.

These findings underscore why patients should strongly consider seeing a physical therapist before opting to undergo a surgical procedure. Surgery may have the appeal of being a “quick fix,” but it still requires extensive rehabilitation afterwards and is associated with several risks and extremely high costs. Physical therapy, on the other hand, is a cost–effective treatment option that is generally considered to be safe while providing similar outcomes to surgery in most cases.

To provide further context on the role of physical therapy for treating musculoskeletal conditions, we’re going to focus on the most common conditions in different regions of the body and provide evidence that shows how physical therapy can help.

Back and neck conditions most frequently seen by physical therapists

The spine is one of the most common locations in the body for musculoskeletal pain. 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. Here are some of the most prevalent conditions of the spine:

• 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
• 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

Evidence supporting 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 to levels similar 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. Other research has shown for patients with chronic neck pain, empowering patients with self–management strategies in addition to a comprehensive physical therapy program will lead to even greater overall benefits.

In our next post, we’ll look at the injuries and conditions involving the shoulder.