As we explained in our last post, there are several steps you can take and training habits you can change that will reduce your odds for suffering an injury in your sport. But even if an athlete closely follows all these steps and takes every preventive measure imaginable, injuries can still happen. Sports are simply too unpredictable, and there are countless variables out of each athlete’s control that may contribute to an injury.

If an injury does occur, the smartest and safest decision you can make is to see a physical therapist right away. Physical therapists are movement experts with a thorough understanding of the biomechanics involved in all sports. With this knowledge, physical therapists can help athletes prepare for the demands of their respective sport to prevent injury, and in the event of an injury, can guide patients through a comprehensive rehabilitation program. All programs are personalized to the unique demands of each patient’s sport, as well as their physical abilities, goals, and tolerance to various interventions.

To provide you with a better idea of how physical therapists treat sports–related injury, we’ve answered some of the most frequently asked questions that we get at our practice.

Q: What should I expect from my first session with a physical therapist?

A: During the first session, your physical therapist will perform a thorough interview and physical examination to identify the source of your pain and establish a diagnosis. Next, he or she will assess your strength, flexibility, agility, and endurance to develop a better sense of your current fitness level. Part of this process will also involve you answering specific questions about the sport you participate in, your level of involvement, and your goals from physical therapy. Based on the information gathered, your therapist will design an individualized treatment program intended to target your limitations, reduce your pain levels, and improve your physical function.

Q: Will I need to have additional tests done, like an MRI?

A: Diagnostic tests like MRIs and CT scans are vital tools that can help medical professionals reach or confirm a diagnosis, but they are not always needed. Most mild–to–moderate sports injuries—and even some severe injuries—can be diagnosed through a thorough physical examination alone. Therefore, physical therapists try to only order diagnostic tests when it is deemed to be necessary. This usually means that the injury is severe and/or the diagnosis is uncertain after the initial examination. Instead, therapists aim to start patients on a treatment program right away.

Q: What types of treatments will I be doing during therapy?

A: Since treatment plans are personalized for each patient, the specific components will vary from one person to the next, but there are certain interventions that physical therapists frequently use in rehabilitation programs for athletes in every sport. These include the following:

• Strengthening exercises: a fundamental component of every program is to help you regain the strength that you’ve lost and reinforce the structures around the damage to prevent future injuries
• Stretching exercises: impaired flexibility is one of the major factors that leads to injury, so it’s essential to gradually improve your range of motion through targeted exercises
• Manual therapy: this therapeutic approach involves the therapist performing various manipulations and mobilizations of injured joints and muscles to alleviate pain and increase flexibility
• Pain–relieving modalities: ice, heat, electrical stimulation, and ultrasound are often used, as they can often reduce pain levels immediately
• Sport–specific training: many of the exercises you perform will be based on the specific movements and motions involved in your sport

Q: Will physical therapy hurt?

A: Physical therapy usually focuses on healing damaged tissues. Therefore, depending on the stage of your recovery, some pain may be involved, especially if tightened tissues are stretched or weak muscles are strengthened. But physical therapists work closely to ensure your pain from treatment is never more than you can handle. During your first visit, a physical therapist will aim to get an idea what causes pain and how much is too much. Throughout the entire treatment process, your physical therapist will also ask if your pain is sharp or throbbing, if it occurs at the end of a motion or if it continues after the exercise. These are signs that something else may be wrong and that a change is needed. At every step of the way, your physical therapist will monitor your pain and adjust the treatment program whenever necessary.

Q: How will I know when I can safely return to my sport?

A: Physical therapists pride take every measure to ensure that no athlete returns to the field or court until they have completed their rehabilitation and can do so with a minimal risk for injury. This is accomplished by structuring the timeline of programs based on the average time needed to recover, closely evaluating athlete’s progress along the way, and then assessing the athlete towards to end to ensure they fulfill a return–to–play protocol. Only then will therapists provide the go–ahead that you can safely return to your sport.

In our next post, we’ll take a closer look at how physical therapists treat some common sports–related injuries.

Regardless of an athlete’s age, sport, fitness level, or years of experience, some risk for injury will always exist. In general, the more contact and cutting movements that are involved in the sport, the higher the risk for acute—or traumatic—injuries. This explains why some of the highest rates of injury are found in basketball and football, since both elements are prevalent in both sports. But overtraining and failing to take adequate time to recover can also lead to injury in practically every sport.

Sports injuries often have both short– and long–term consequences that are important to understand. Immediately after an injury, an athlete will usually be sidelined for days or weeks, which temporarily prevents him or her from reaping the benefits of physical activity during that time. But when an athlete is unable to participate in a sport for several months or longer, it can lead to reduced fitness levels and weight gain if the athlete doesn’t find other ways to get active. In worst–case scenarios, athletes with severe injuries and those who return to their sport without completing rehabilitation may experience long–term impairments that prevent them regaining their pre–injury capabilities.

No athlete wants to get injured, and most should therefore be interested in finding the best ways to keep their risk for injury to a minimum. While there is unfortunately no silver bullet solution that can eliminate the risk for all injuries in all sports, there are several universal strategies that can significantly reduce it.

All athletes should participate in an injury–prevention program specific for their sport

One of the most effective ways to reduce the risk for injury is by participating in a training program specifically designed for this purpose. There are numerous sport–specific prevention programs that have been designed to improve athletes’ strength, flexibility, and conditioning by focusing on the dynamic movements involved in their sport. Research has continuously shown that these injury–prevention programs are effective for lowering the risk of injury in a variety of sports, including the two key studies summarized below:

• One study reviewed all the available research on exercise–based programs to reduce injury risk in tackle collision sports like American football, Australian football, and rugby. Nine studies were identified, and of these, seven supported the prevention programs as an effective method for lowering the incidence of injuries in these sports.
• Another study reviewed eight high–powered studies called meta–analyses on prevention programs for anterior cruciate ligament (ACL) tears. Results showed that the prevention programs led to a 50% reduction in the risk for all ACL injuries in all athletes and a 67% reduction for non–contact ACL injuries in females.

General guidelines and other tips to lower the risk for sports injuries

In addition to sport–specific injury–prevention programs, athletes of all sports should adhere to some general guidelines regarding how they train, how often they should rest, and the use of proper equipment. While some of these tips may seem like common sense, they can all go a long way in reducing injury risk:

• Warm up: always warm up before every practice and game/match; warm–ups should last at least 5–10 minutes and include low–level cardiovascular activities, stretching exercises, and movements that mimic those involved in your sport
• Ease into it: when returning to a sport or activity after an extended absence, start off gently and slowly, and gradually work your way up to more aggressive play or training
• Avoid overtraining: take enough time to rest and let your body recover in order to avoid overuse injuries, especially if you play one sport; a good rule of thumb is to take at least one day off per week and one month off per year from training in a single sport and switch over to other sports or activities during that time
• Use proper equipment: make sure that all of your gear—including pads, helmets, and other protective devices—is in good, working shape and fits properly; also be sure to wear the appropriate shoes for the appropriate sport, and replace old or worn–out shoes
• Improve your form or technique: whatever your spot, it’s essential that you’re using a form or technique that is helping you excel rather that adding to your injury risk; if you have a coach, they will be able to help you work on this; for others, see a physical therapist for guidance on improving your form
• Don’t play overly fatigued: if you feel too tired during a game or practice, don’t push yourself and sit out to recover; many injuries occur in athletes that are overly fatigued and incapable of performing at their optimal level, which is why it’s crucial to know where this line is drawn and how to respond if it’s crossed

In our next post, we’ll discuss the crucial role that physical therapy should play in helping athletes recover from sports–related injuries.

Sports have the power to bring athletes—and their fans—to the highest of highs, as well as the lowest of lows. The highs usually include achieving an optimal fitness level, performing well on a consistent basis, and winning lots of games, matches, or races. The lows can include just about anything that prevents an athlete or their team from reaching their goals, and easily the biggest culprit that can derail this course is injury.

Participating in a sport is one of the best choices you can make for your health, as regular physical activity is associated with a bounty of both physical and mental benefits. But along with all the good that sports can bring about, there is also an inherent risk for injury that unfortunately cannot be avoided. All sports are associated with some risk for injury risk due to their physical toll on the body through contact, collisions, and excessive exertion, regardless of its intensity. While many injuries are minor and only sideline athletes for a short period, others can have serious long–term repercussions.

According to recent statistics, about 8.6 million injuries related to sports and recreational activities occur each year. Injuries can occur in any sport and at any age, but younger athletes report more injuries than older athletes, as approximately 65% of injuries occur in athletes between the ages of 5–24 years. The incidence of injuries is also slightly higher in male athletes (61%) than female athletes (39%), and general exercise—like running and other aerobic activity—and basketball are the most common physical activities associated with injury.

The 5 most common injuries across all sports

The degree of injury risk and the type of injuries that are most likely to occur vary drastically from sport to sport, with higher levels of intensity and physical exertion generally associated with greater odds for injury. But some injuries deserve special attention because they are seen frequently across nearly all sports, often sidelining athletes in the process. Below, we present our selection of the 5 most common sports–related injuries:

1. Sprains and strains
   • Sprains and strains together represent the two most common injuries overall in sports (we’re grouping them together because their mechanisms and occurrence rates are very similar); sprains occur when a ligament—the tough tissue that connects bones together in a joint—is suddenly stretched beyond its limits and damaged in the process; strains are injuries to muscle fibers or tendons—which anchor muscles to bones—and often occur from over–stretching or overusing a muscle
   • Ankle sprains are the single most common injury sustained in sports, accounting for up to 40% of sports–related injuries; these sprains usually occur when the foot turns inwards too aggressively, which tears the ligaments on the outside of the ankle; they are seen in many sports, including basketball, football, soccer, and volleyball
2. Knee injuries
   • Nearly half of all sports–related injuries involve the lower extremity (legs, ankles, and feet), and the knee is the most frequently injured joint in the body due to its large size, complex anatomy, and frequent use; traumatic sports injuries involving the knee typically result from falls onto the knee, extreme cutting movements, or landing from a jump incorrectly, any of which can push certain structures of the knee too far and cause them to sprain or tear; overuse knee injuries can also occur from too much repetition without sufficient rest
   • Two of the most common knee injuries are anterior cruciate ligament (ACL) tears and patellofemoral pain syndrome
   • The ACL is one of the four main ligaments of the knee that provides stability and prevents the knee from sliding out of place; it can be damaged or torn when an athlete suddenly cuts or changes direction, and tears are most often seen in football, basketball, and soccer; about 1 in 60 athletes will suffer an ACL tear at some point in their career
   • Patellofemoral pain syndrome, or runner’s knee, accounts for up to 25% of all running injuries and involves the kneecap rubbing against the groove of the upper leg bone (femur), which causes a dull pain behind or around the patella; this pain is often aggravated from running, squatting, climbing stairs, or sitting, and may also be accompanied by swelling or a “popping” of the patella when bending the knee
3. Shoulder injuries
   • The shoulder is the most flexible and mobile joint in the body, but it is also one of the weakest, and it’s subject to a great deal of force in sports; this makes it one of the most common locations for sports injuries, as shoulder pain affects up to 26% of adults at some point; shoulder injuries are most likely to occur in sports that involve overhead motions, particularly baseball, softball, tennis, and quarterbacks in football
   • About 85% of shoulder injuries involve the rotator cuff, an important group of four muscles that surround the bones of the shoulder; rotator cuff tendinitis, shoulder impingement syndrome, and rotator cuff tears are all related injuries that are frequently seen in the overhead sports mentioned above
4. Foot and ankle injuries
   • The feet and ankles are another hotspot for injury because of the heavy loads they withstand from the rest of the body during sports and physical activities, since many sports involve running and/or jumping; there are several structures and mechanisms in place that increase the durability of the feet and ankles, but they have a breaking point; over time, repetitive abuse can push these structures past this point and can lead to damage and lead to a wide range of potential injuries.
   • While ankle sprains are the most prevalent sports–related injury, plantar fasciitis is generally considered to be the most common cause of heel pain in adults, usually from sports; in the majority of cases, plantar fasciitis occurs in runners or athletes that run frequently, and this can overstrain the plantar fascia and lead to a stabbing pain near the heel
5. Golfer’s elbow and tennis elbow
   • Golfer’s elbow and tennis elbow are two common sports–related injuries that occur most frequently in the sports that bear their nicknames:
   • Medical epicondylitis, or golfer’s elbow, results from repeated bending of the wrist, which damages the muscles and tendons of a structure called the medial epicondyle and leads to inflammation; it is particularly common in golfers because gripping or swinging clubs incorrectly or with too much force can take a toll on these structures over time
   • Lateral epicondylitis, or tennis elbow, is a similar overuse injury in which the tendons that attach to the lateral epicondyle become inflamed due to repeated use of the arm and elbow; this explains why the injury is so common in tennis and other racquet sports, since these activities involve repetitive and vigorous use of the forearm muscles

In our next post, we’ll look at some of the most effective ways to prevent sports–related injuries.

October is a special month for our profession, as it marks the annual National Physical Therapy Month campaign. All month long, physical therapists and physical therapist assistants around the country work to boost public awareness about physical therapy by explaining what the profession entails and how it can significantly improve patients’ lives. To this end, we’ve been offering a detailed review of the numerous conditions that physical therapists can treat in different regions of the body.

In this, our last post of the month, we’re going to look at a few other injuries, conditions, and situations that physical therapists also treat, but which don’t easily fit into any of the other categories we’ve described so far:

• Post–surgical rehabilitation: physical therapy is strongly recommended as a first–line treatment for most musculoskeletal injuries and conditions, as it will often lead to successful outcomes and can often help patients avoid surgery; however, certain patients are candidates for surgery, particularly those who don’t improve with physical therapy, those with severe injuries, and athletes who are on a tight timetable and looking to return to play as soon as possible; when a patient decides to have surgery, a course of physical therapy will always advised to help these individuals regain their abilities during the recovery period with a progressive rehabilitation program
• Balance–related disorders: physical therapists can also address issues related to balance impairments; for example, many physical therapists offer vestibular therapy, which is a specific approach designed to address problems involving the body’s vestibular (balance) system, such as vertigo; in addition, physical therapists can provide fall–prevention programs for older adults that primarily aim to improve balance—as well as strength and flexibility—and thus reduce the risk for falls in the process
• Concussions: a concussion is a traumatic brain injury caused by the brain rapidly moving back and forth or banging against the side of the skull, which can lead to headache, dizziness, nausea/vomiting, and fatigue, among other symptoms; although rest is the most important treatment for concussions, physical therapists can help individuals recover more quickly by providing vestibular therapy and utilizing other techniques that address the wide range of concussion symptoms
• Temporomandibular joint disorders: the temporomandibular joint (TMJ) is a hinge joint that connects the part of the skull directly in front of the ears (temporal bone) to the lower jaw (mandible); temporomandibular disorder (TMD) is a general term that describes any condition that involves this joint, and the result is usually pain or tenderness in the face, jaw, neck, or shoulders; physical therapists frequently see patients with TMDs and manage these patients with massage and other interventions that target the jaw

Research backs physical therapy for these conditions, too

Physical therapy programs for these conditions differ more widely than for the other regions of the body we’ve reviewed so far due to their variety, but many of the same principles and techniques that are fundamental to the practice will still be incorporated into each individualized treatment program. For example, treatment for concussions and balance–related disorders typically includes specific exercises and other interventions that aim to improve patients’ balance, while post–surgical rehabilitation programs progress gradually to help patients regain their strength and flexibility to pre–injury levels.

Research supports the use of physical therapy for these conditions, as it does for the other regions of the body we’ve reviewed so far. In one study, exercise therapy was found to reduce pain and significantly increase range of motion for patients with TMDs. Other research from one systematic review showed that vestibular therapy is effective for older adults with vertigo, dizziness, and balance disorders, while another systematic review found that exercise programs may reduce risk factors associated with falls and the incidence of falls in older adults.

We hope you’ve learned something about physical therapy this month for National Physical Therapy Month. By now, you should have a firm grasp of the multitude of conditions that we can treat and the many types of benefits you can expect if complete treatment with a physical therapist. So if you’re dealing with pain, movement–related issues, or any other deficits, we strongly encourage you to contact us to learn more or schedule an appointment today.

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.

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.

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.

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.

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.

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.

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.