Training in Planes

Many trendy buzzwords and catch phrases are often used in fitness circles, with the phrase “training in planes” heard quite frequently. The concept, which has nothing to do with aviation, sounds interesting, but what does it really mean?

Simply put, every move we make involves one of the following three planes of motion in the body: the sagittal plane, which involves a flexion or extension, such as squatting, walking or pressing a weight overhead; the frontal plane, which is an abduction or side flexion, such as a lateral arm raise or a side bend; and the transverse plane, which involves a rotation, such as a golf swing, a swing of a baseball bat or a throw.

The aim of training in planes is to prepare the body for any movement during activities, whatever they may be. Training in planes

  • exercises the body in a balanced manner
  • builds functional strength in virtually every major muscle group
  • keeps all movement in proper proportion
  • helps the body move more effectively because it emphasizes movement in three dimensions

Another important benefit is that training in planes usually benefits the core muscle group, also known as the midsection, which provides the basis for a person’s ability to move. This aids virtually everything we do, giving us strength, agility, balance and body control.

We will be happy to meet with you to develop an exercise program that involves all three planes and benefits your core muscle group while meeting your individual needs. Your body will thank you as it moves through its daily activities with increased agility, stability, endurance, strength and general fitness.

Physical Therapy for Skier’s Thumb

Thumb injuries are quite common, especially among skiers. During a fall, a skier’s thumb can easily catch against the ski pole, resulting in a tear of the ligament that stabilizes the thumb. This ligament, known as the ulnar collateral ligament, normally keeps the thumb from pointing too far away from the hand. When it is injured, typical symptoms include pain, bruising, swelling over the torn ligament and weakness when grasping objects.

Treatment depends on the extent of the tear. To repair a partial tear, wearing a cast or modified splint for four to six weeks might be sufficient. For a full tear, especially where a person experiences significant instability, surgery may be needed to reattach the torn ends of the ligament.

Usually, surgery performed within the first few weeks following the tear offers the best outcome. A cast afterwards provides protection while the torn ligament heals. This is an ideal time to see us to design a rehabilitative program. After your cast is removed, gentle motion can usually start. Suggested exercises typically focus on helping you to

  • normalize strength
  • regain flexibility
  • enhance coordination
  • improve range of motion

By following the program, you can expect to return to skiing or playing sports approximately three to four months after surgery. It is crucial that you avoid stressful postures or any direct forces during the rehabilitation phase to give the ligament enough time to properly heal.

Once you add physical therapy exercises to your treatment regimen, you can expect to get back into skiing and other sports soon. We can address your particular needs and help you attain your goals.

Elbow Excellence Through Tommy John Surgery

One of the major advancements in sports medicine in the last 35 years, surgical repair of the ulnar collateral ligament (UCL) is named for Los Angeles Dodgers pitcher Tommy John, the first person to successfully undergo the procedure in 1974. John returned to the mound two years later.

This procedure, invented and pioneered by Dr. Frank Jobe, reconstructs a torn UCL by using a tendon from somewhere else in the body, such as the forearm or hamstring. The UCL, along with the lateral collateral ligament, gives the elbow stability. Before this operation, pitching careers usually ended when the UCL was damaged. The surgery is now common among collegiate and professional athletes in several sports, most notably baseball.

Tommy John surgery is necessitated when these two ligaments, which connect the humerus (the bone of the upper arm) to the ulna (the larger forearm bone), are

  • torn by injury or dislocation
  • damaged or overstretched from improper healing of an injury
  • stressfully overused, as would be typical of a college-level or professional pitcher

As important as the surgery itself is the rehabilitation period, which–to return to the previous level of expertise–can last approximately a year for pitchers and about six months for other baseball players and athletes. After a week to 10 days during which the elbow is immobilized, rehabilitation includes working back to a full range of motion, followed by gradual strength training at about four months postsurgery. Also crucial during this period are exercises to improve flexibility and coordination, as well as aerobic conditioning to improve overall fitness.

Contact us before surgery and then when you are ready to begin the physical therapy phase of your recovery. We can devise a course of exercises that will get you back on the athletic field, physically fit and ready to pitch strikes to retire the opposing team in short order–perhaps, winning the game!

Navigating Recovery After a “Ship” Fracture

A scaphoid fracture refers to a fracture of the wrist–specifically the bone shaped like a boat, which is why it is often called a “ship” fracture. A fracture of this bone can result from falling on an outstretched arm, sustaining a direct blow to the wrist or receiving a severe twist of the wrist.

A scaphoid fracture is commonly missed, which can lead to long-term weakness and a poor hand grip. For this reason, it is important to receive early diagnosis, treatment and physical therapy.

If you initially suspect a broken wrist, see a physician immediately for an x-ray to assess whether your scaphoid bone is involved. Treatment depends on the location, fracture type and fracture location in the bone. Because the scaphoid bone has an unusual shape, blood supply can be obstructed, thus slowing down the healing process. For those patients who suffer from delayed or poor healing, surgical intervention may be needed to ensure bone fusion.

If you undergo surgery, your wrist will be placed in a cast and then in a splint for several weeks afterwards to hold the bones in place as they heal. Once your cast has been removed, it is important that regular physical therapy be performed on a gradual basis, to enable you to slowly return to previous physical activities. For some people, this process may take one month while for others it may last longer.

Physical therapy facilitates recovery from a scaphoid fracture through exercises that promote stability, along with stretching and strengthening. These exercises will help to

  • improve your range of motion
  • reduce stiffness from immobilization after surgery
  • build strength
  • increase coordination

With our support, most patients can expect a positive outcome after treatment for a “ship” fracture. Since so many daily activities require use of the hand, we can design a program specially suited to your rate of recovery and your individual requirements.

The Case of the Wandering Kneecap

Kneecap dislocation occurs when the patella, or kneecap, slides to the outside of the joint, thus stretching and possibly tearing the ligaments that hold it in place. The patella is probably the most commonly dislocated bone in the body, with kneecap dislocation occurring most often in teenage athletes and adult women.

Kneecap dislocations fall into two categories. Those involving an accident, such as a blow to or a twisting of the knee, are called traumatic dislocations. Atraumatic dislocations occur when the person is “loose-jointed” or the kneecap is misaligned (tilted or shifted), thus making the joint less stable.



Symptoms of a dislocated kneecap include

  • bleeding under the patella
  • bruising around the patella
  • swelling of the kneecap
  • tenderness along the edge of the patella
  • pain and clicking when the patella pops out of its groove and then moves back into place
  • actual dislocation of the patella when it moves out of the groove and gets stuck out there

Surgery is required when significant damage, such as muscle rupture, bone fracture or detachment of the ligaments, occurs or when kneecap injuries become recurrent. When recurrent injuries or serious damage are not involved, however, the patient usually engages in protective rehabilitation for three to five weeks to prevent the kneecap from moving laterally and relieve pain.

The second phase of kneecap rehabilitation, which should take anywhere from two to four months, involves rebuilding and strengthening the quadriceps muscle to prevent dislocation from happening again. We will be glad to design an individual rehabilitation program that will address your particular needs and get this complex joint functioning smoothly and strongly once more.


Straightening the Curves of Scoliosis

Scoliosis is a condition in which the spine is curved toward either the right or left side. Thus, the upper back seems to be rounded, the lower back appears to curve inward (swayback), and one shoulder and/or hip looks higher than the other.

About 80% of scoliosis cases occur in people 10 to 18 years of age, and the condition is far more common in girls. While most cases among both genders are mild and require no treatment, girls are more likely to progress significantly without treatment.

For a diagnosis of scoliosis to be made, a curve must measure 11º or more; a curve less than that is labeled spinal asymmetry and is unlikely to get much worse, although a pediatrician or an orthopedic surgeon can monitor it with visual inspections and x-rays to be sure it does not move in that direction.

The following procedures are commonly used to treat scoliosis:

  • A brace is the most common treatment for children who have scoliosis spine curvatures of 25º to 40º and who have not finished growing. The brace will not correct the curvature, but it will keep it from worsening.
  • Surgery is an option for more severe cases, in which the curves are 40º to 50º or more.
  • Spinal fusion, which joins vertebrae permanently, is effective but is not used for children whose bones are not fully grown because growth will no longer be possible in the fused area. Thus, fusion is often performed for older adolescents.
  • Metal implants and bone grafts are utilized to straighten the curve, although a zero-degree curvature is not possible.

Scoliosis does not usually cause back pain, but in severe, uncorrected cases, it can compromise overall health because there is less room in the chest cavity for the heart and lungs to function properly.

While physical therapy alone cannot cure scoliosis, exercise helps maintain good muscle tone and a healthier heart and lungs, and it may reduce discomfort. We will be glad to work with your physician to design an exercise program to augment the benefits of a brace or surgery in the treatment of this condition.

Why You Need Crutches After Meniscus Surgery

If only surgical treatment worked so perfectly that the patient would hop off the operating table, cured, with no painful recovery required. For knee surgery, that is not the case.

Today, most surgical procedures on the crescent-shaped, fibrous knee joint cartilage called the meniscus are performed with tiny incisions, cameras and instruments. Thus, the recovery timeframe is much shorter than for the once more common open-knee surgeries.

The meniscus, the knee’s shock absorber, is composed of rings of spongy cartilage located between the thigh bone (femur) and shin bone (tibia). When the meniscus is torn by injury and surgery is recommended, postsurgical measures frequently include the use of crutches. How long you use them will depend on several factors, including whether the meniscus tear was actually repaired or if, more simply, a piece of it was just removed (partial meniscectomy).

With a partial meniscectomy, crutches may be needed until you can walk without limping (usually five to seven days). With a proper rehabilitation program, you can usually expect to resume sports within four to six weeks after the surgery.

Following a repair, you will typically use crutches for at least three weeks to allow the repaired tissue to become attached and to avoid retearing the meniscus. Maximal weight training is not allowed for two to three months, and a return to running and agility sports is permitted after three to four months if strength and motion have returned and there is no pain in the joint. Of course, your pre- and postoperative condition and the progress of your overall recovery will influence that timeframe.

In addition to using crutches, you may also engage in physical therapy to

  • strengthen your leg muscles
  • strengthen and regain full motion in your knee
  • return to a normal activity level

We will be happy to work with you and your surgeon to customize a physical therapy plan that will meet your goal of returning to work, home responsibilities and sports as quickly, comfortably and safely as possible.

Stroke: Every Second Counts

Strokes, or cerebral vascular accidents, exist in varying degrees of severity, depending upon which part of the brain is affected, how much of the brain is affected and the level of exercise the person performs. Other factors that affect stroke severity include advanced age, high blood pressure, diabetes, smoking, minimal variety in the types of food consumed, high cholesterol and migraine headaches.

There are two main types of stroke: a hemorrhagic stroke, which occurs when a blood vessel bursts, and an ischemic stroke, the result of a clogged blood vessel. A transient ischemic attack is referred to as a “mini-stroke” because the blood flow to the brain is briefly interrupted.

Because the care a stroke victim receives in the first few hours can significantly affect recovery, rapid recognition and transport to medical evaluation and treatment is vital. By recognizing the following signs and symptoms of a stroke, you can help clinicians give you the most effective treatment possible, as soon as possible.

  • sudden numbness or weakness of the face, arm or leg
  • sudden confusion, trouble speaking or understanding what has been said
  • difficulty seeing out of one or both eyes
  • trouble walking
  • dizziness
  • loss of balance or coordination
  • severe headache without a known cause

During the stroke recovery period, we can work with your physician to assess your unique presentation–that is, how much recovery you can achieve–and design a rehabilitation program tailored to your particular physical requirements. We can devise a recovery program to help improve your physical skills and suggest various lifestyle changes you can make to reduce the future risk of stroke.

Move Your Hips After Hip Arthroscopy

Arthroscopy, a procedure using a small fiber-optic camera device, has revolutionized hip joint surgery. Often recommended for athletes or those with degenerative arthritis, it is used to remove damaged tissue or splintered-off cartilage floating around the hip joint or to reattach structures within the hip.

A surgeon uses a small incision to insert a tiny camera into the hip, so that the damage around the joint is visible and whatever is causing pain and dysfunction in the patient can be fixed. In the past, an invasive procedure (and much larger incision) would have been necessary to treat many hip problems, but arthroscopy can achieve the same results with easier recovery time and less chance of complications.

Hip arthroscopy is an outpatient procedure, meaning that you will be sent home within hours after the surgery. Your physician may recommend using crutches, resting and applying ice packs for a short time to relieve pain and inflammation. Within a few weeks, you will feel well enough to incorporate some gentle movement of the hip into your recuperative routine. It is important to start a rehabilitation program as soon as possible, because research suggests that early movement speeds healing while lack of movement can lead to lasting problems. The rehabilitation sequence will be dictated by the specific tissues affected by the surgery.

Working with us, you can take advantage of what some experts have dubbed the “window of opportunity” after hip arthroscopy, when physical therapy makes the muscles around the joint stronger and before your body re-creates the corrosive fluids that caused your hip problems in the first place. Because your surgeon has just removed inflamed tissues and extra fluid that have affected the hip joint, you may find yourself pain-free for the first time in years. This is a perfect time to increase flexibility and function in the hip and strengthen the surrounding muscles, especially in the case of degenerative arthritis, whose symptoms may reappear in time.

On average, the rehabilitation process takes around six weeks, but the length and intensity of your postoperative rehabilitation will depend upon exactly what was accomplished–and why–through your surgery. Regardless, we can assist you to achieve your best chance of a full recovery after this revolutionary and effective type of joint surgery.

Shake Hands with Dupuytren’s Contracture

What did Ronald Reagan, Margaret Thatcher and Samuel Beckett have in common? The answer is Dupuytren’s contracture, a progressive, slow-moving condition that affects the connective fibrous tissue in the hand. Thatcher was the odd person in this group, since the condition normally strikes men of Northern European descent over the age of 50 and is more common in people who smoke heavily or use alcohol.

People suffering from Dupuytren’s contracture usually become aware of the condition when the skin on the palm of their hands starts to thicken; they may notice lumps, puckering or dimpling of the skin before any pain or discomfort develops. As the condition progresses and more tissue is affected, forming tight “bands” that can force fingers (typically the fourth and fifth fingers) to curl, patients may find that shaking hands or grasping objects becomes more difficult.

Although Dupuytren’s contracture is typically painless, treatment may help relieve discomfort and preserve the hand’s range of motion. Treatment depends on the severity of the condition and the rate of progression. Surgery can remove fibrous tissue in extreme cases, but the hand will require extensive physical therapy as part of the healing process. Common nonsurgical interventions include

  • corticosteroid (anti-inflammatory) injections to soften or flatten the thickened tissue on the palm of the hand
  • a procedure whereby needles puncture and break up the thick cords of tissue that cause fingers to contract
  • njections of an enzyme called collagenase to soften the thick cords of tissue, allowing the physician to gently manipulate the hand and stretch the fingers back into normal position

For mild cases or to support other treatments, physical therapy is a safe, effective way to alleviate symptoms of Dupuytren’s contracture. We can design a program that utilizes massage, stretching and tissue mobilization to treat the condition. We will also show you ways to use therapeutic tools, splinting or alternative movements to more easily handle such everyday tasks as writing, placing your hands in your pockets, putting on gloves or shaking hands, despite the deformities caused by Dupuytren’s contracture.

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