Strengthening the Rotator Cuff After Fatty Infiltration

When rotator cuff surgery is needed, the surgeon has to take into consideration whether or not fatty infiltration has occurred. Ideally, the surgeon can perform the surgery at an early enough stage–before fatty infiltration becomes an issue.

What is fatty infiltration? Sometimes, when the rotator cuff tendons have significantly pulled away from the bone where they have been attached, fat infiltrates the muscular portions, resulting in weakened muscles. Although the surgeon will take this into account when performing a repair, weakness can remain even after the rotator cuff has been repaired.

Fortunately, with successful surgery, the process of fatty infiltration does not generally progress any further. While the previous changes are irreversible, the addition of physical therapy can be critical to rebuild strength in the muscles. Since there is also no clear understanding of how fatty infiltration prior to surgery may affect the healing and surgical outcomes, it is even more important to start physical therapy soon after surgery.

We can help in a number of ways that go beyond just improving movement after you have experienced fatty infiltration. Your individualized physical therapy program can help to

  • relieve pain and swelling
  • teach techniques you can perform at home
  • prevent pain and injury recurrence
  • develop a progressive strength-training routine

Through personal attention and collaboration, we can provide you with numerous exercises after rotator cuff surgery. Together, we can devise a long-term plan to provide positive postsurgical results. When physical therapy is included after fatty infiltration and rotator cuff repair, long-term outcomes are more likely to be optimistic.

Vary Your Routine and Improve Your Fitness

Cross-training involves engaging in different types of physical activity and brings multiple benefits. It is an excellent way to prevent sports-related injuries, improve your skill in a variety of sports and improve your overall health–all while keeping workout boredom at bay. A good cross-training program improves all three elements of fitness: aerobic endurance, flexibility and strength.

You can cross-train within the same workout (e.g., doing a combination of stretching and a strength-training class) or by alternating activities throughout the week (cycling one day, jogging the next, taking a dance class over the weekend). It’s especially helpful to switch between high-impact workouts (running, tennis, racquetball) and low-impact activities (swimming, recumbent cycling), since combining the two will increase endurance, build muscle and improve cardiovascular health–all while avoiding repetitive strain injuries.

How exactly does cross-training offer sports-related injury prevention? Let’s say you are a competitive runner. You run every day, never allowing your body to rest and recover. You overuse certain muscle groups and ignore others, causing an imbalance in your body that can easily lead to strain. When cross-training, you space your runs out to every other day, and on your “off” days, you alternate yoga, a Pilates class and a short workout on a recumbent bike at your gym. Your sore lower back and tight hamstrings start to abate, as you stretch these key muscles in yoga. Pilates strengthens your core and minimizes the impact to joints and soft tissues. And your stiff knees benefit from the safe strengthening offered by the recumbent bike.

Runners aren’t the only ones who can benefit from cross-training. Professional athletes are fond of this type of training (we’ve all heard stories of football players taking up ballet), but nonathletic types will find it equally beneficial. The beauty of cross-training is that simple, fun activities apply. Taking a hike with your dog one day and attending a swing-dance class the next qualifies as cross-training. The goal is to enjoy 30 minutes of moderate activity a day, and to make sure you tackle strength training, flexibility and exercise.

Talk with us about designing a cross-training program that works for you. After all, the key to a successful fitness program is making it fun and pain-free!

Maintaining Strength While Undergoing Dialysis

A major advance in treating the kidney failure of end-stage kidney disease is the ability to undergo dialysis–the treatment that removes waste and excess fluid from the blood–at home rather than at a hospital or other outside facility. However, a downside to this development is that a home-dialysis patient is less likely to be seen by a rehabilitation specialist who can evaluate whether he or she would benefit from physical therapy.

In virtually all cases, patients benefit from such a program because over time, long periods of immobility lead to loss of strength and function. Physical therapy, especially targeted strengthening and balance activities, can significantly limit those side effects, breaking what might otherwise become a cycle of debilitation or deconditioning, whereby the patient does not feel well, becomes inactive, grows weaker and can do even less, leading to more inactivity.

Physical therapy services can be rendered at home or elsewhere; the location depends on one’s individual situation. If a program involving relatively simple equipment such as elastic resistance bands is all that is required, home sessions can be quite convenient. However, because using the wider variety of equipment at an outside physical therapy facility could hasten progress, rehabilitation at a physical therapy facility might be a better option.

Every dialysis patient should exercise to the degree that he or she can (with the physician’s permission), understanding that setting goals can help greatly in making progress. Each session should include a very light warm-up and cool-down, with the bulk of the exercise–walking, riding a stationary bike, rowing–in between. The central conditioning workout can last only a few minutes, at first, but as the weeks pass, it should become easier to add time until the session lasts about a half-hour, with 5- to 10-minute warm-ups and cool-downs.

Whether you are about to undergo or are undergoing dialysis, we can design a program to help you avoid the side effects inherent in the immobility that often accompanies the procedure. This way, you can break the cycle of debilitation and feel more like yourself once again.

Restoring Range of Motion After Elbow Replacement

Total elbow replacement refers to a surgery that creates an artificial joint. Damage to your elbow can initially occur from badly broken bones, severely torn tissues, a tumor in or around the elbow, rheumatoid arthritis or osteoarthritis, or unsuccessful previous surgery.

Your normal elbow joint is comprised of two bones–the humerus in the upper arm and the ulna in the lower arm. When the joint is significantly damaged, surgery is usually required. The artificial elbow joint has two stems of metal, joined by a metal and plastic hinge to allow movement. While most total elbow replacements are successful, surgery can involve significant bone removal, nerve and blood vessel damage, dislocation of the artificial joint, allergic reaction to the new joint and joint loosening over time.

Although the prognosis of elbow replacement surgery is good, physical therapy can be the missing piece to help you regain strength and full range of motion in your arm. Typically, individuals wearing a splint begin physical therapy a few weeks later than those who do not wear a splint.

Initially, you will perform gentle motion exercises. When appropriate, strength training can begin, targeting muscles in and around the elbow to help you regain normal movement. Exercises and treatments may include

  • light grip strengthening to start
  • active elbow and wrist exercises in the second phase
  • flexibility techniques for wrist, elbow and shoulder
  • strategies to relieve pain, inflammation or swelling

When a physical therapy program is planned early on, mobility can significantly improve–with use of the new elbow–as soon as 12 weeks after surgery. Although full recovery can take up to a year, the process is generally much more effective when physical therapy is a consistent part of therapy.

Dedication is key to successful rehabilitation. We can devise an appropriate exercise program to strengthen your elbow.

Arm Yourself After a Distal Radius Fracture

A distal radius fracture–a break near the wrist in the largest forearm bone–is one of the most common injuries of the forearm. The fracture often occurs when a person falls onto an outstretched hand. Other causes include direct impact or axial forces. Treatment depends on such factors as the exact nature of the fracture, your age and health, and previous activity level.

Both surgical and nonsurgical approaches are used to treat a distal radius fracture. If the alignment is reasonably correct, a cast is typically recommended to be worn for approximately six weeks before you begin physical therapy. Surgery is usually called for when the bones must be repositioned to improve their alignment.

It is standard treatment to receive physical therapy for a distal radius fracture–whether you wear a cast or receive surgery. This is because it is considered critical to

  • gently get your wrist joint moving comfortably again
  • prevent stiffness in your fingers, elbow and shoulder
  • ease you back into normal activities

Most patients regain most of their movement if they follow a physical therapy program and aftercare instructions from their doctor. Permanent pain is unlikely, and you can expect to return to normal recreation and work activities.

Generally, intra-articular fractures, which can result in stiffness, pain and a risk of developing arthritis, are the most limiting. For these cases in particular, physical therapy can provide the most significant improvement in rehabilitation after a distal radius fracture.

While active contact sports should be postponed for approximately four months, we can design an individual program that includes functional activities such as bike riding and swimming. By following a carefully designed physical therapy program, you can expect to recover from a distal radius fracture.

Must Arthritic Knees Be Replaced?

If your doctor says you have arthritis in your knee, does that mean you will need knee replacement surgery? The short answer is not necessarily. Fortunately, your body can compensate for the loss of function caused by arthritic damage to cartilage and bone in a knee joint, even if x-ray evidence seems to indicate that the arthritis is severe.

Strong hip and thigh muscles compensate for the knee’s possible weakness as you walk and move about. Individually tailored exercises strengthen these muscles, as well as improve flexibility and range of motion in the affected knee.

Other strategies, too, will lessen pain and reduce the possibility of surgery. These include

  • losing weight if you are overweight
  • avoiding activities that give you particular trouble
  • taking anti-inflammatory medications (if your physician prescribes)

Supportive devices–ranging from knee braces or sleeves to energy-absorbing shoe inserts to canes–also can play an important role in lessening arthritis’ impact. We can, for instance, evaluate your particular arthritis presentation and recommend one of the two main types of knee-stabilizing braces that is right for you:

  • A support brace helps support the whole knee joint and helps evenly displace the weight, or load, you put on your knee with each step.
  • An unloader brace, especially useful if the arthritis affects one side of the knee more than the other, shifts load toward the healthier side.

We have other ways to reduce knee pain, as well, such as ultrasound to help increase blood flow to the surrounding muscles and heat and cold therapies, alternating, if necessary.

Physical therapy can be a powerful tool that may help you avoid invasive surgery to treat arthritis. An exercise regimen tailored to your needs and abilities can help you achieve your goals.

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.

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