Physical Therapy for Ménière’s Disease

Some people may think that they are just clumsy if they briefly lose their balance or feel as if the world is moving while they are standing still. In fact, these people may have a disorder called Ménière’s disease, a serious, episodic, progressively debilitating inner ear condition.

People with this disorder generally exhibit all four of the following symptoms in one ear: a feeling of pressure or fullness in the ear, ringing in the ear (tinnitus), fluctuating hearing loss or the sensation that the world is spinning (vertigo).

The cause of Ménière’s disease is unclear. Initially, symptoms are episodic, usually occur in only one ear and last just a few minutes, followed by long, symptom-free periods. Early in the disorder, hearing loss may be temporary, but gradually the loss becomes permanent, and periods of vertigo lengthen. Vertigo, contrary to popular usage, is neither dizziness, lightheadedness nor fear of heights but a sensation that the world is spinning while the individual is standing still. In Ménière’s disease, vertigo is often accompanied by nausea, vomiting and abnormal eye movements. Even when active symptoms subside, many individuals feel unsteady and exhibit some degree of impaired balance.

There is no cure for Ménière’s disease; however, sometimes people with the disorder are referred to a physical therapist for vestibular rehabilitation therapy (VRT). VRT teaches individualized exercises to help the brain compensate for the disordered signals it receives from the inner ear. We work with patients to prevent falls, control rapid head movements and improve balance deficits left by acute attacks of symptoms.

Several other inner ear disorders can cause temporary dizziness, discomfort or poor balance. If you experience moments of unsteadiness and feel as if the world is rotating while you are standing still, contact your physician. Then call us. Although Ménière’s disease is not curable, we can design a program that can help make you feel safer, more comfortable and more in control.


Osteotomy: Aligning the Leg to Treat Arthritis

The strongest joint in the body, the knee can bear forces of more than twice your body weight. When the thighbone (femur), knee and shinbone (tibia) are properly aligned, weight is distributed equally over the knee. However, degenerative arthritis, osteoarthritis or tearing and repair of the anterior cruciate ligament can result in an uneven distribution of weight.

When weight bearing is uneven, the side of the knee carrying the most weight wears down faster than the opposite side. You become bow-legged (genu varum) when greater weight is shifted to the inside of the knee or knock-kneed (genu valgum) when weight is shifted to the outside compartment.

The problem is self-perpetuating. Misalignment produces uneven weight distribution, which causes uneven wear that creates even greater misalignment, until eventually the knee becomes disablingly painful. At this point, you have two choices: total knee replacement or osteotomy, a surgical procedure to realign the leg. In an osteotomy, the surgeon removes or inserts a wedge of bone from either the tibia or femur so that the realigned leg equalizes weight bearing in the knee.

Knee osteotomy is not for everyone. It is most successful in patients who are:

  • younger than 60 years of age
  • physically active
  • have arthritis only on one side of the knee
  • have healthy bones

Osteotomy can reduce or eliminate pain and restore function, but it usually is not a permanent fix. About 20% of people who undergo osteotomy need total knee replacement after five years, and 50% need total knee replacement after
10 years.

Recovery from osteotomy generally takes three to six months and requires extensive physical therapy, beginning with range-of-motion exercises and progressing to strengthening exercises and gait training. We will work with you and your physician following surgery to devise a rehabilitation program to restore full joint function and relieve pain.

Returning to Action After Biceps Tenodesis

The biceps tendon runs from the biceps muscle through the rotator cuff and into the shoulder joint, where it then attaches to the socket. If the biceps tendon becomes inflamed or irritated, a condition called bicep tendinopathy, you may need to undergo surgery called biceps tenodesis to relieve the discomfort.

Overuse of the tendon from sports, some occupations or other activities is the most common cause of bicep tendinopathy. Although it can develop slowly over time from wear and tear, tendinopathy may also result from a direct injury. Causes of bicep tendon inflammation include

  • shoulder instability
  • rotator cuff tears
  • shoulder impingement syndrome

The surgeon cuts the biceps tendon where it meets the shoulder socket and then reattaches it to the arm bone. This helps relieve the pressure from the cartilage rim of the shoulder socket by shifting the biceps tendon to a position where it does not impede the movement of the shoulder joint.

Physical therapy is vital to successful recovery. Your program will help you

  • increase muscle strength and range of motion
  • protect the integrity of the repair
  • regain proper function

Physical therapy is also important to help avoid a “frozen shoulder” that has poor movement and functioning. Although your initial range of motion will be limited, we will slowly ease you into exercises that enhance recovery and get you back to your normal self.

Most people can begin a physical therapy regimen approximately three to four days following surgery. We will work with your physician to make your recovery comfortable and effective.

Exercise Away Your Back Pain

How common is back pain? The majority of people in the United States will suffer from lower back pain at least once in their lifetimes. But treating the pain can be complex and is usually best done with advice from a physical therapist.

Some people may require surgery to treat their back pain. However, surgery comes with significant risks. After back surgery, you should follow a program of structured exercise for at least six to eight weeks. Such a regimen can help




  • relieve pain and inflammation
  • enhance mobility
  • improve overall fitness
  • encourage proper body mechanics


But surgery may not be inevitable. Working with you and your physician, we can design an individualized program that can reduce back pain. Your program might include targeted abdominal and back muscle exercises, low-impact aerobics that do not harm your back and exercises to gently improve flexibility.

We can also provide advice on how to improve your posture and perform basic movements. These simple changes can help you prevent injury by teaching you how to stand correctly, lift without strain and sit properly.

Exercises to treat back pain are less invasive than surgery and do not require the downtime or intensive rehabilitation that often comes with a surgical procedure. In most instances, you will experience a major improvement that can help you avoid the need for back surgery. After six to eight weeks, your physician can assess your progress to determine a future course of treatment. To ensure that you get the pain relief you need, talk with us about the best exercise program for alleviating your back pain.

Hit the Links in Better Shape

Whether scratch golfers or weekend duffers, most players want to improve their game and lower their score. But maximizing your golf game means more than just practicing regularly. By increasing your fitness, you can play with confidence and success.

Your golf game depends on balance and stabilization, endurance, strength and power, and flexibility and coordination. To ensure that you are in the best possible physical and mental shape to sharpen your game, we can develop a personalized exercise regimen that focuses on improving each of these factors. A personalized exercise program can help in the following areas:



  • Smooth your swing, increase your club head speed and extend your driving distance by conditioning and strengthening your muscles.
  • Enhance your range of motion through flexibility exercises.
  • Improve your agility and balance by toning your body.


Maintaining fitness also helps to prevent golfing injuries. Lower back injuries are more prevalent in men. That means their injury-prevention program should focus on strengthening the trunk and core muscles. Women are more susceptible to elbow injuries. That means their injury-prevention program should focus on improving flexibility and encouraging a stronger elbow and improved swing.

In golf, as in all other sports, practice alone does not make perfect. To improve your game, your approach should include a fitness program that helps you achieve the body you need to withstand the rigors of practice and reap the benefits of your efforts.

Discuss with us your goals for improving your golf game and increasing the enjoyment of your time on the course. Together, we can find a realistic fitness program to make your game more comfortable and maybe shave some strokes off your score.

Strengthening Your Heart Following Angioplasty

People who have undergone angioplasty followed by stent placement generally have better blood supply to the heart muscle than do other people. That increased blood supply means that you should be able to participate in more physical activity than you did before the procedure. Not only is exercise safer than it was before your angioplasty but most doctors recommend it because of the benefits you can enjoy.

Exercise helps prevent the recurrence of the condition that led to the angioplasty in the first place. In addition, regular exercise helps you sleep better at night and keeps your blood pressure, cholesterol and weight at healthy levels.

Your doctor will give you specific instructions concerning when you can resume activity after angioplasty. Usually, you should wait at least two days after your procedure before standing or walking for any length of time. After that, you can begin low-impact exercise–for example, walking for short distances. You should find that you have more energy than before the procedure, because your cardiovascular function is better. Avoid vigorous exercise for 30 days.

Set goals. By the six-week mark, you could be walking two, three or even five miles at a time, depending on how fit you were before your angioplasty. Increase your time and distance slowly. Do not exercise so hard that you feel exhausted, experience chest pain or are unable to speak. Ideally, as you work out, your heart rate will rise gradually–then decrease as you cool down–and you will feel just slightly out of breath.

Besides the moderate fitness routines you already enjoy–walking, swimming, low-impact aerobic dance–we can suggest other exercises tailored to your specific needs. Anything from heel raises to arm lifts can help you build strength and stamina as you work into a healthier, fitter lifestyle.

Getting Into the Swing for Tennis Season

Anyone for tennis? If winter has you longing for court time, you can pump up your enthusiasm–and reduce your chances of injury–by starting a fitness program before you touch a racquet. And it is not just about your swing.
Effective preseason preparation includes a foundation of aerobic conditioning, strength training and skill drills. By increasing the intensity of your workouts over time, you will progress to higher-impact conditioning gradually while avoiding serious injury.

One approach, called “periodization,” involves a three-phase, four-week program of gradual training:

  • Preparation phase (weeks 1 and 2): low-impact aerobics and light weight training
  • Precompetitive phase (week 3): more intense conditioning and interval training, including more emphasis on tennis-specific skills
  • Peak phase (week 4): actual play and skill drills, with continuing low-intensity strength training focused on tennis-specific areas of the body such as rotator cuffs, forearms and body core

Training just your upper body is not enough. Your strength training should include the trunk and legs as well as the shoulders. Tennis gives your whole body a good workout, so be sure that all your large muscle groups are fit before you start playing competitively.

After a long winter layoff, even four weeks of training may not be enough to get you up to full speed every day. After building up gradually, consider easing into the season with one or two days of play every week for the first few weeks.
Then you can begin to increase your frequency. Be sure to balance exertion
with adequate rest, both passive (sleep and inactivity) and active (nontennis activities). Ask us for suggestions about specific training activities and strategies that will help you prepare for a successful tennis season.

Bracing for a New Arthritis Treatment

Knee pain from osteoarthritis is no walk in the park. In fact, the pain probably keeps you from walks in the park. Could wearing a knee brace help you overcome this discomfort?

Often, arthritis affects only one compartment of the knee. This can result in your lower leg angling awkwardly and appearing “bow legged” (varus) or “knock kneed” (valgus). Special braces, called unloader braces, shift the workload from the arthritic compartment to the healthier compartment of the knee, pushing the knee toward a more normal position in the process. According to several published studies, these braces can increase the distance a patient can walk comfortably. Even better, for patients who cannot tolerate pain medications, braces can offer drug-free relief.

But unloader braces tend to be bulky and uncomfortable. Unless you invest in an expensive, custom-made brace, you may find yourself with bruised thighs and additional discomfort caused by poor fit. Nor are unloader braces suitable for all forms of osteoarthritis. Some rehabilitation specialists warn that extended or improper use of a brace can even hinder physical therapy, because it may decrease movement and circulation to the knee. Despite these caveats, the American Academy of Orthopaedic Surgeons stated in 2003 that unloader braces “may provide significant reduction in pain when properly fitted in selected patients with osteoarthritis of the knee.”

Rather than thinking of a knee brace as a cure, consider it another tool in your arsenal against arthritis–a crutch that can help you while we work toward building strength and flexibility in the knee. Talk with us about an exercise program that will strengthen the quadriceps muscles in your knee to improve the functionality of your brace. In time, you may even eliminate the need for your brace entirely.

Pedaling Your Way to Health

You probably remember learning how to ride a bike. But most likely, your six-year-old self had no clue just how beneficial this newly acquired skill could be to your overall health and wellness.

One of the most popular and enjoyable fitness activities, cycling was recently celebrated in the medical community for enhancing cardiac health, thanks to a 2009 study published by the Scandinavian Journal of Medicine and Science in Sports. Physical therapists had embraced the bike long before this, however, for its role in post-surgical, post-injury rehabilitation.

Bike riding has specific advantages for people who suffer from back and knee problems. Cycling builds the large muscles in the hip, back and thigh. It specifically helps strengthen the muscles responsible for stabilizing individual vertebrae and nourishes discs as they heal.

Lower down the body, where a breakdown of cartilage is often responsible for knee pain, the action of pedaling a bike encourages nourishment of cartilage in
a low-stress manner. Plus, the overall health benefits of cycling–enhanced cardiac health, improved circulation and better all-around strength and flexibility–can enhance any rehabilitation program.

Cycling is not without risk, however. To avoid stress injuries, you need to follow a few simple procedures. Here are a few tips to get you started:

  • Find a seat that allows for an upright, balanced position. Many seats encourage a “forward bent,” which places stress on your back, neck, elbows and wrists. Sitting totally erect is the most ergonomically healthy way to ride.
  • Employ a precycling workout that improves strength and flexibility in hamstrings and quadriceps.
  • Take frequent breaks to stretch your neck, arms and shoulders when riding for long periods of time or at high intensity.

We can design an appropriate stretching and strengthening routine to ensure that your body is ready to ride, whether on the racetrack, in the mountains or on an indoor recumbent bike in the comfort of your living room. Soon, you will be riding your way to better overall health and physical well-being.


Getting a Grip on Extensor Tendon Repair

Extensor tendons allow you to extend your wrist and open your hand. They run along the forearm to the wrist and then along the back of the hand. Because these tendons have little protection, they are quite vulnerable to injury. You could injure your extensor tendons in several ways:

  • lacerations (for example, if your hand goes through a glass window)
  • blunt trauma or crush injuries
  • deep burns
  • animal bites
  • disease


In people with rheumatoid arthritis, these tendons can erode and rupture at the wrist. And someone with ruptured extensor tendons will lose movement in the fingers.

Most extensor tendon ruptures must be surgically repaired, but surgery alone will not restore the hand to the fullest function possible. To regain dexterity, it is essential that surgery be followed by several months of physical therapy. Because the wrist and hand are complex structures, each extensor tendon repair requires a slightly different approach to rehabilitation, depending on where the rupture occurred, how many tendons were injured and whether there are other surrounding injuries such as broken bones.

Physical therapy can prevent scar tissue from forming between the tendon and the bone so that the gliding motion of the tendon is restored. This allows the hand to open and close smoothly through its complete range of motion (ROM). But care must be taken to balance exercises that increase ROM against putting too much tension on the repair site before it is fully healed.

Only properly guided rehabilitation can return full use of your hand following extensor tendon surgery. We can work with your doctor to develop a physical therapy and home exercise program appropriate to your injury.

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