Keep Your Blood Pressure in Check

To lower the risk of high blood pressure, or hypertension, public health officials have urged Americans to reduce their salt intake. In addition to modifying your diet, however, a sensible exercise program is essential to control hypertension.

Significant evidence reveals that moderate exercise for as little as 30 minutes a day may lower blood pressure more effectively than intense exercise. The best exercises to lower blood pressure are endurance activities, such as jogging, walking, running and cycling. Adding resistance training to the overall exercise regimen can help reduce high blood pressure in adults even more. However, the American Heart Association does not recommend resistance training for people with uncontrolled high blood pressure.

It is also important to use common sense when beginning an exercise program by taking the following precautions:

  • Have a thorough physical examination, and obtain your physician’s approval before beginning an exercise program.
  • Start exercising slowly, and gradually build up frequency and duration.
  • Use circuit training for resistance rather than free weights if you already have hypertension.
  • Take precautions to avoid dehydration, and be aware of the heat when you exercise.

Remember that nutrition and physical fitness go hand in hand. The recommended daily intake of sodium for healthy adults should not exceed 2500 milligrams, the amount contained in a teaspoon of salt. Because the majority of salt in our diet comes from prepared and prepackaged foods, one way to reduce salt intake on your own is to pay close attention to the amount of sodium listed on product labels and purchase products accordingly. When cooking at home, use seasonings other than salt to enhance food flavor and palatability.

To make the most of your efforts to lower your blood pressure, you will need to visit your family physician regularly. We can work with you and your physician to customize an exercise plan to help you achieve your long-term health goals.

Nothing Funny About a Humerus Fracture

Say you have fractured your humerus, the bone in the upper arm that attaches the limb to the shoulder, but your physician does not think that surgical intervention is the best course of action. This decision may depend upon the part of the humerus involved. You might have a distal fracture, occurring near the elbow joint and most common in young children; a proximal fracture, occurring near the shoulder joint; or a midshaft fracture, involving the middle portion of the bone but not affecting the shoulder or elbow joint.

Proximal and distal fractures are more likely to be treated with surgery. However, humerus fractures can be challenging to fix surgically, and because the humerus bone is not very dense, surgeons often use plates, screws or other fixation devices to stabilize the bone while it heals. Furthermore, this procedure is rather invasive and carries a unique set of risks and potential complications.

The good news is that around 85% of proximal humerus fractures and most midshaft fractures can be treated nonsurgically. The usual protocol involves wearing a sling or brace for approximately six weeks and beginning a rehabilitation regimen with us to regain full range of motion in your injured arm, without overly stressing your shoulder.

Gentle “pendulum” exercises can begin as early as five to ten days after the injury. We will then slowly increase the intensity and range of exercises to restore the flexibility and function of your shoulder and elbow joints. To minimize weakness and muscle loss in your arm, a gentle, progressive approach to lifting will be employed, but your participation in this activity will be restricted.

Then, once it is safe to begin strength training, we can help you do this in the safest and most effective way possible. Resistance-based movements will strengthen the shoulder and major arm muscle groups and promote blood circulation around the injury, which is critical to the healing process. After a while, you may engage in more difficult exercises such as chin-ups, thus incorporating increased loading to further strengthen your muscles. Speak with us about a specific set of exercises personalized for your situation.

Shed Those Extra Holiday Pounds

The holidays are here once again, with all their edible temptations, and you would like to get into better shape after they have passed. This time you are determined to find an approach that will prevent frustration, keep you motivated and help you achieve your fitness goal.

The first thing you need to determine is your real physical shape. The best way to do this is to schedule a physical examination with your physician for important feedback about your physical condition. Some people will merely have to tweak their conditioning while others will have to work harder.

After completing the physical assessment, it is time to design a physical fitness program. Remember, each facet of fitness is critical, including strength, cardiovascular health, flexibility and balance. When designing a comprehensive fitness program, the following points are important to remember: 

  • Each physical fitness program should include a strength-training regimen to burn calories, improve your balance and body control, and enable your body to burn calories even after you have completed your workout. Importantly, as muscle increases, a rise in general metabolism follows, and you burn more calories at rest.
  • Cardiovascular exercise, such as aerobics, running, jogging, walking, hiking or dancing, is essential to any weight-loss program.
  • Interval training is also important because exercising intensely for brief periods is more effective than maintaining a steady pace throughout. Because such training adds variety to the program, you are more likely to stick with it.
  • Core exercises that work the midsection, oblique muscles and lower back keep your body optimally aligned for whatever activity you are doing (swimming, biking or running), which in turn reduces fatigue.
  • Stretching to increase flexibility and body control will enable your muscles and limbs to reach their limits.

 A successful fitness regimen includes a solid plan and the determination to stick with it. We can provide you with an enjoyable exercise program that will enable–and encourage–you to reach your fitness goal.

Heel-ing Your Achilles Tendon

Although the fibrous Achilles tendon is the strongest band of connective tissue in the body, it is prone to damage, which can necessitate surgery. In one scenario, most of the tendon has degenerated, and the paratenon (the tissue covering the tendon) has become inflamed (paratendonitis), causing pain. Or a person–often a middle-aged weekend athlete playing a sport requiring quick movements like basketball or tennis–experiences a sudden, very painful tear in the tendon. When there is a complete tear, the physician will determine whether surgery or nonoperative management is optimal.

Achilles tendon conditions that require surgery are potentially very painful before and after surgery. In fact, getting a patient to the point of being pain free is one reason that rehabilitation may last so long–sometimes, up to one year.

Because the surgical incision is made in an area of the body that is literally thin-skinned and has a less-than-ideal blood supply, the larger the incision, the greater the chance of poor healing and infection, which can impede the progress of rehabilitation. Thus, patients may wear a brace for up to two months to protect not only the repaired tendon but the incision as well.

Limited rehabilitation therapy–range-of-motion and conditioning exercises, for instance–can be performed while you wear a brace. A removable brace/splint can minimize the likelihood of blood clots, muscle atrophy and joint stiffness associated with a cast, and with it, more rehabilitative physical therapy can begin earlier, perhaps within a few days after surgery. A little later, strengthening exercises may be performed in a pool, allowing the tendon to start to regain its function in the safety of water’s buoyancy. Exercises carried out on land will involve both legs to “share the load.”

Of course, recovery and rehabilitation rates differ for each patient. Generally, a person with a surgically repaired Achilles tendon should be able to walk and swim six weeks postsurgery, while running and other sports drills may be possible within four to six months. Although some pain may linger for a while, at the six-month mark many athletes are ready to initiate a gradual return to sport activities.

We can work with your physician to design an exercise program individualized to your rate of recovery. This way, you can regain strength and range of motion that will permit you to resume your sports activities pain free.

Working Out in the Great Outdoors

Say your gym is expensive, and there are long waits to use certain exercise equipment. Maybe it is time to return to the basics and exercise outdoors.

There is considerable evidence that an outdoor workout can be more beneficial than indoor exercise in several ways, especially to improve your mood and relieve stress. One reason for this is pretty obvious. Instead of the stale, often overheated air of a stuffy gym, outdoors you inhale fresh air, which promotes better health. In addition, outdoor exercise provides vitamin D from the sun, which maintains your calcium balance and may even boost your immunity.

One of the great things about outdoor exercise is that it offers virtually unlimited variety. Running, walking, swimming, hiking are just a few options available in the great outdoors. You can also vary the intensity quite easily. For instance, you could do something as simple as walk the dog–a very low-impact workout–or you can jog with the dog, which adds variable resistance. Raking leaves provides a moderate workout, enabling you to burn off some calories while performing a necessary chore. And hiking up a steep hillside or rock climbing will give you a good cardiovascular workout while providing resistance for your upper body muscles.

Outdoor exercise also benefits the mind. No matter what outdoor regimen you undertake, your mind is more likely to stay alert, preventing the monotony that can set in at the gym. Because safety is an essential component of any good workout, you must be aware of changes in terrain and weather as you walk or run, thus keeping your mind sharp. However, apply common sense to outdoor exercise. Be cautious about exercising in extreme heat or cold, or in icy conditions.

If you decide to transition to outdoor exercise from an indoor workout, we will be happy to meet with you. Together, we can develop a program that makes the most of the experience and meets the goals you have set for yourself.

Don’t Let Pain Cramp Your Style

Significant pain affects many of us. In fact, at one or more points in their lives, about 45% of Americans will experience such persistent pain that they will seek treatment. Pain is the most frequent reason medical care is sought and the number one cause of lost productivity in the workplace, costing employers $80 billion every year. What cannot be measured is the suffering experienced by people in pain.

Because pain is such an overriding issue, Congress declared 2001 to 2010 as the Decade of Pain Control and Research, bringing to the forefront the need to manage this debilitating condition. Significantly, in 2001 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated that the health care provider of a patient in pain has the obligation to assess it seriously (for example, by asking how severe it is on a scale of 0 to 10) and to create a plan to manage it as safely and effectively as possible.

The standards particularly address how pain can be managed among hospital or other care facility patients who may not be able to communicate well about their levels of pain. The JCAHO standards also focus on pain’s complex nature and suggest that both providers and patients need education to help understand it better.

As physical therapists, we have long been aware that pain can be a major complication in a patient’s life. While it can be a great challenge to treat, pain must be addressed systematically and professionally.

No matter the source of your pain–a back injury, a sports-overuse issue or even an unknown incident that has resulted in chronic discomfort somewhere in your body–we have been trained in compassionate, effective pain management. We can assess your individual situation and devise an exercise regimen to improve your quality of life. Talk with us today about setting up a course of treatment to relieve or help manage your pain.

Keep Your Blood Pressure in Check

To lower the risk of high blood pressure, or hypertension, public health officials have urged Americans to reduce their salt intake. In addition to modifying your diet, however, a sensible exercise program is essential to control hypertension.

Significant evidence reveals that moderate exercise for as little as 30 minutes a day may lower blood pressure more effectively than intense exercise. The best exercises to lower blood pressure are endurance activities, such as jogging, walking, running and cycling. Adding resistance training to the overall exercise regimen can help reduce high blood pressure in adults even more. However, the American Heart Association does not recommend resistance training for people with uncontrolled high blood pressure.

It is also important to use common sense when beginning an exercise program by taking the following precautions:

* Have a thorough physical examination, and obtain your physician’s approval before beginning an exercise program.
* Start exercising slowly, and gradually build up frequency and duration.
* Use circuit training for resistance rather than free weights if you already have hypertension.
* Take precautions to avoid dehydration, and be aware of the heat when you exercise.

Remember that nutrition and physical fitness go hand in hand. The recommended daily intake of sodium for healthy adults should not exceed 2500 milligrams, the amount contained in a teaspoon of salt. Because the majority of salt in our diet comes from prepared and prepackaged foods, one way to reduce salt intake on your own is to pay close attention to the amount of sodium listed on product labels and purchase products accordingly. When cooking at home, use seasonings other than salt to enhance food flavor and palatability.

To make the most of your efforts to lower your blood pressure, you will need to visit your family physician regularly. We can work with you and your physician to customize an exercise plan to help you achieve your long-term health goals.

Relieving Ankle Pain with Joint Fusion

If you suffer from a painful arthritic ankle joint and your physician has suggested a procedure called arthrodesis, you may be confused. Simply put, an arthrodesis fuses the bones that form a joint, making it one continuous bone and permanently stiffening the joint. The procedure is used when pain, disability or instability from a diseased joint can no longer be managed with medications, splints or other nonsurgical methods.

Surgeons can choose from two techniques when performing arthrodesis, open or arthroscopic, based on his or her experience and your specific anatomy. In the open procedure, a long incision is made in the skin on the outside of the ankle, giving the physician a direct view of the joint. In the arthroscopic process, a flexible scope about the diameter of a drinking straw is inserted into tiny incisions in the skin. This scope is fitted with a tiny camera connected to a television, and thin instruments are inserted to fuse the bones. Screws, rods and steel plates are used to hold the bones in place while they fuse. If there is bone loss, the surgeon will harvest a piece of bone from the lower leg or pelvis to use as a graft to replace the missing bone.

Barring any complications, you should be able to go home in less than a week, but your rehabilitation could take up to nine months, depending upon the severity of your condition and your surgery’s complexity. Roughly 80% of the patients who undergo this surgery report relief from pain, and most people are able to wear ordinary shoes, although high heels for women are not recommended.

Physical therapy starts the day following surgery, with isometric exercises (involving the static contraction of a muscle without any visible movement in the angle of the joint) performed every two hours. You will be allowed to increase weight bearing during the first few weeks and will be urged to elevate the foot whenever seated. You may find lying on a couch and placing the foot on the couch back helpful. You will be given additional instructions based on the specifics of how the surgery had been completed. Then, six to eight weeks after surgery, you can begin exercises to strengthen your muscles, improve the smoothness of your gait and extend your range of motion.

After a consultation with your physician, we will be glad to create a physical therapy program to help with your recovery. We can suggest specific exercises and design an individualized program for you to perform under professional supervision.

Working Your Way Through Shin Splints

Occurring in the front of the outer leg, shin splints result from inflammation to the posterior tibial tendon and related tissues. They commonly happen to runners or those who walk vigorously. Symptoms include pain in the front of the outer leg below the knee, ranging from dull discomfort to significant pain that increases with activity.

For some people, shin splints occur when they transition from the soft grass of the warmer months to harder indoor surfaces during autumn and winter, increase their usual pace or add distance. The resulting inflammation triggers the pain associated with shin splints.

One treatment for shin splints counsels total rest, but this is frustrating, particularly for athletes. Another approach involves continuing activity and treating the inflammation.

Physical therapy often uses a multifaceted approach. This includes rest to restore a person to pain-free functioning, followed by exercise and lifestyle changes, such as

  • running on a treadmill at a low speed and on a level plane
  • reducing your usual running distance
  • participating in an activity, such as cycling, that does not stress the affected area but maintains cardiovascular fitness
  • choosing and wearing the proper footwear
  • taking anti-inflammatory medications prescribed by your physician (e.g., ibuprofen or naproxen)
  • icing to reduce inflammation
  • taping or arch supports to relieve pain
  • engaging in stretching and strengthening exercises

 Because shin splints can occur when you change your workout or transition to a different running surface, the best approach is prevention, which means talking to us before making changes. We can put together a personalized program that facilitates transitions in training and minimizes shin splint recurrences, letting you get back to running again.

Reducing Surgical Screw Complications

To fix a broken bone internally into position and support it until it is able to bear weight, surgeons have turned to new materials such as stainless steel, cobalt and titanium, which are compatible with the body and rarely cause allergic reaction or implant failures. While metal screws made from these materials are widely used, they can cause complications, some of which may not be noticeable at first.

After the broken bones have been put back into place (reduced), screws are placed through the dense cortical bone of one bone into the dense cortical bone of the other. With this connection holding the broken bones together as they heal, patients usually enjoy a positive surgical outcome. Although the screws are often not removed after healing, they usually do not result in complications for most patients.

However, problems can arise. For instance, your doctor might be concerned that the hole created to sustain the screw can trigger weakness in the bone and surrounding area. Or a screw could shift to another position or even be noticeable at the skin’s surface. Even though most screws stay in place, these issues often mean that a screw must be removed.

Depending on the specific surgery, which can range from anterior cruciate ligament surgery of the knee to shoulder surgery, physical therapy should begin as soon as possible. Taking into account any limitations you have, we can tailor a rehabilitation program to help reduce surgical complications, including those related to the screw.

Targeted exercises performed safely and under guidance can help to

  • strengthen bone and surrounding tissues
  • gently improve your mobility
  • support flexibility and coordination
  • regain muscle strength and range of motion

Further injury is also more likely to be prevented when physical therapy starts early, allowing your body to heal successfully. Talk to us about the best program to complement your surgery and reduce complications.

 

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