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.


TENS: A Drug-free Way to Relieve Pain

Transcutaneous electrical nerve stimulation (TENS) may sound futuristic–even scary–but this method of pain relief is actually a great drug-free way to relieve discomfort from injuries or chronic conditions.

When the TENS equipment is used, patches called electrodes are applied to your skin (“transcutaneous” means “through the skin”) and are attached to a small, battery-operated device that transmits tiny electrical impulses to your nerve fibers. Experts believe that as the TENS unit stimulates the nerve fibers, endorphins, the body’s natural pain reliever, are released, blocking pain signals before they can reach the brain. The combination of these two actions makes the TENS device a successful treatment for pain.

TENS carries a very low risk of side effects, usually involving minor redness or irritation at the site of the electrodes, which can be reduced by adjusting the positioning and settings of the device. Some devices are even designed for home use. These tend to be expensive, however, and despite the relative safety of TENS, it is important to use the devices correctly. Your best bet is to try TENS for a while in a clinical setting and then discuss with us the purchase or rental of a home unit if you find the treatment helpful.

Most people find TENS treatment to be quite successful at relieving arthritis pain, chronic back or neck pain, sprains, tendonitis, and a myriad of other injuries and conditions. There is only one drawback: While the treatment takes just minutes to work, the effects last only around an hour. Thus, some patients will find they need to use the device ongoing, especially with some chronic pain conditions.

However, one of the best uses of TENS is to alleviate intense pain just long enough to enable therapeutic exercise or the mobilization of injured limbs. The use of TENS can make you comfortable enough to get through your physical therapy–the tough but necessary work that helps heal injuries or control chronic conditions–with the ultimate goal of a pain-free (and medicine- and device-free) life.

Don’t Let Shoulder Pain Burden Your Sleep

If shoulder pain keeps you up at night, then it is time to determine the underlying problem and develop a strategy to get a better night’s sleep. For many people, shoulder pain that is particularly noticeable at night is associated with rotator cuff irritation.

The rotator cuff includes the muscles and their tendons that keep your shoulder stabilized. Its important role in facilitating shoulder movement means that an injury can have a big impact on sleep and daily living. The typical rotator cuff injury impedes the normal range of motion (ROM) for the shoulder joint, making simple actions such as reaching overhead or even putting on a jacket painful.

If your sleeping posture is already poor, you can exacerbate a rotator cuff injury. Even if you maintain a healthy posture, the wrong movements and positioning can make you awaken with pain. These can:

  • prevent full recovery for the injured rotator cuff
  • increase the time needed to regain normal ROM
  • put the shoulder under additional stress

To make matters worse, while you sleep your shoulder can become trapped under your head and kept in a locked position for the duration of the night. This can result in reduced blood flow to the joint or cause muscle cramps.

Whether your pain comes from irritation or tear of the rotator cuff, we can design a program to help relieve your discomfort. Approaches may include:

  • modifying sleep posture (placing a pillow between your elbow and trunk)
  • choosing a pillow of the correct height and fill
  • ensuring that your arm does not end up underneath the pillow
  • strengthening your shoulder muscles

Visit our office to find the best strategies to handle your shoulder pain. You deserve a good night’s rest, and with our support, you can soon enjoy a better, pain-free sleep.

Total Knee Replacement with a Hybrid Joint

If you are scheduled to undergo knee replacement surgery, your surgeon has three procedures from which to choose. An artificial knee can be held in place, or fixed, using a cemented, noncemented or hybrid procedure. Your surgeon will decide which procedure is best for you.

The cemented procedure is the most common and produces excellent long-term results, with up to 95% of patients experiencing pain-free knee function for at least 10 years. In this procedure, a grout-like material is inserted between the bone and the prosthesis. As it hardens, it creates a strong bond that holds the artificial knee in place. This allows you to bear weight on the knee immediately. The disadvantages are that the prosthesis may loosen and/or bits of bone cement may shed into the joint, causing inflammation and destruction of bone. Both conditions require surgery to correct.

A noncemented procedure uses a porous prosthesis coated with material that stimulates bone cells to grow into it. The prosthesis and the bone are held together with screws while new bone grows and joins the implant to natural bone. Until this happens, you may be more restricted in weight bearing to enhance ingrowth of bone, making the recovery period longer. Short-term outcome studies have shown that noncemented fixation has success rates comparable to those using cement.

The hybrid procedure is designed to minimize the problems of both the cemented and noncemented procedures. The connections between the lower leg (tibia) and the prosthesis, and the kneecap (patella) and the prosthesis are cemented because this is where most noncemented joints fail. The connection between the thighbone (femur) and the prosthesis is not cemented because a strong cement-free joint tends to form here.

These three types of knee fixation all require different rehabilitation strategies to produce the most functional pain-free joint. We can work with your surgeon to develop a rehabilitation program that increases motion in the knee following surgery, prevents the muscle loss inevitable after surgery, rebuilds muscle strength and prevents stiffness of the new knee joint.

Safe Exercise for Patients with Diabetes

Exercise is as important for those with diabetes as it is for anyone else. The goal of most exercise regimens should be to work out at a moderate intensity for 30 minutes at least five days a week.

Patients with diabetes, however, need to take several exercise-related precautions:

If you already have problems with your leg or foot nerves, choose exercises that will stress them as little as possible such as biking, swimming, rowing or even chair exercises.

If you do not have foot problems, take preventive measures. Choose athletic shoes that fit well and are not too tight, and wear comfortable cotton socks. After your workouts, visually check your feet carefully for any cuts, blisters, sores or minor irritations. Because people with diabetes can be less sensitive than others to foot pain, you need to do this so you can treat any irregularity at its inception, before it develops into something difficult to heal.

Avoid working with heavy weights if you have high blood pressure or diabetes-related blood vessel or eye complications.

Track your blood sugar before, during and after exercise. To avoid possibly damaging blood sugar swings, you need to learn how your body responds to exercise. Work with your physician to determine specific guidelines for you to follow.

Prepare for any incidence of hypoglycemia (low blood sugar) while you are exercising–as at any other time–by always having a source of 15 grams of fast-acting carbohydrates on hand. The most portable include two tablespoons of raisins, five pieces of hard candy or three five-gram glucose tablets. Consider having a second helping available, in case you still do not feel better 15 minutes after taking the first.

Stay hydrated by drinking lots of fluids before, during and after exercise, as well.

If you have diabetes, see us for an individualized program that will take into account your current fitness level and fitness goals. Such a regimen will help maintain your blood sugar levels, increase your strength and range of motion, flexibility, gait, balance, posture, joint mobility and soft-tissue tightness, to reduce the risk of falling and the injuries caused by those falls.

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