Top Five Advantages of Telehealth for Physical Therapy

Telehealth saves time

Telehealth physical therapy sessionYou’re busy; we all are. Some days you don’t have time to get in your car or on the subway, travel to a medical office, and change from street clothes to workout clothes, investing up to an hour before you’ve even started treatment.

If you’re working from home, you may be wearing your exercise clothing already, and you can just connect with your physical therapist online to have treatment from your home. Telehealth lets you fit physical therapy into your schedule more easily.

Virtual visits reduce Covid-19 risk

While we take every precaution at our therapy center, taking public transportation to get here can put you in close contact with people you don’t know.

You’re more likely to build an exercise habit

Many repetitive-stress injuries and medical issues arise from lack of exercise to strengthen or stretch muscles. When you get in the habit of regularly doing a therapeutic exercise routine at home, you’ll be more likely to prevent recurrences of the problem after formal treatment ends.

Your physical therapist can evaluate your home setup

When your therapist can see how you have your workstation set up, it’s easier to recommend ergonomic adjustments that reduce the likelihood of repetitive motion injuries. If you have balance issues, your therapist can spot obstacles in your home that might increase the risk of a fall.

Telehealth improves accessibility

Some patients are unable to drive or travel on public transportation. Telehealth eliminates the need for a caregiver to bring them to appointments.

Physical Therapy After Hip Replacement Surgery

When do you need hip replacement surgery?

A total hip replacement (THR) is often recommended when a patient has significant arthritis in a hip joint. When arthritis causes hip pain that interferes with walking, sleeping or standing up, you may benefit from a THR.

What are the types of hip replacement surgery?

Hip replacement surgery removes damaged bone and cartilage, and replaces the damaged joint with an artificial hip. There are three surgical approaches to total hip replacements.

  • Posterior approach: The surgeon makes an incision through the back of the hip near the buttock.
  • Anterolateral approach: The incision is through the side of the hip.
  • Anterior approach: The incision is through the front of the hip.

The posterior and anterolateral approaches require precautions after surgery, such as refraining from crossing your legs for 4-6 weeks after surgery. Some surgeons advocate the anterior approach for several reasons. This technique may do less damage to major muscles, resulting in less post-surgical pain. It may expedite your ability to walk without an assistive device such as a walker or cane, and it may shorten rehabilitation time by five to seven days.

What can I expect after a total hip replacement?

Soon after surgery, often on the same day, you will be out of bed and bearing your full weight on the affected leg if you can tolerate the pain. Patients usually start walking with a walker, then progress to crutches, and then to a cane during the three to four weeks after surgery. By the fourth week, you can usually walk on a level surface without an assistive device.

What is the recovery time after hip replacement surgery?

Most patients return to work about one month after surgery. Patients can generally resume driving about four weeks after THR on the left hip, and six weeks post-surgery for THR on the right side. Physical therapy for THR usually lasts four to six months, but can take as long as one year in patients with other significant health issues.

How can physical therapy help me recover from hip replacement surgery?

Rehabilitation is crucial after a total hip replacement, and it is a good idea to start physical therapy before having total hip replacement surgery. Flexibility and strengthening exercises before surgery can improve your ability to recover from the surgery. Following surgery, your physical therapist will show you exercises to improve your strength and range of motion. Therapy may also include massage and electric stimulation.

Three phases of physical therapy:

  1. The first phase of post-surgical rehabilitation is designed to reduce pain and swelling. Treatment may include massage therapy, electrical stimulation, ice, compression, light exercises, and elevation of your affected leg.
  2. The second phase of physical therapy focuses on increasing your range of motion, improving your mobility, and strengthening your muscles. Hands-on joint mobilization, passive range of motion, and therapeutic exercises will help you accomplish these goals.
  3. The final phase of rehab will allow you to regain your full strength, restore your balance and coordination, and maximize function of your new hip. You’ll continue with therapeutic exercises tailored to help you return to full function.

Can physical therapy help me avoid hip replacement surgery?

Physical therapy will not prevent you from needing hip replacement surgery, but it can dramatically facilitate the rehabilitation of your new hip. The sooner you begin physical therapy, the faster you will return to full function.

Use It or Lose It: Osteoporosis and Exercise

Osteoporosis weightlifting graphicOsteoporosis is a disease in which bones become thin and brittle. The weakened bones are more likely to break, sometimes with little or no trauma, especially the bones of the wrists, hips and spine. These fractures can lead to severe pain, loss of height, and permanent disability. Although osteoporosis primarily affects those over 60, the time to start thinking about prevention is much earlier; even children can take steps to reduce the risk of this disease.

Healthy bones are continuously broken down and rebuilt, gaining mass when the rate of rebuilding exceeds the rate of breaking down. Bones reach their greatest mass around age 30, and usually start to lose mass sometime after age 35. The thicker your bones are at their peak, the less likely they are to get too thin when you’re older. While you can’t add mass after bone thickness peaks, you can take steps to avoid losing the mass you have.

Weight-bearing exercise increases bone mass in those who are young enough to build bone. Walking, running and stair climbing are everyday activities that require your bones to support your weight. A diet with sufficient calcium and vitamin D is also necessary for building bones. Once you’ve passed the age where you can add mass, it’s vital to continue weight-bearing exercise in order to keep from losing too much of the bone you have.

Risk factors for osteoporosis include a family history of the disease, lack of exercise, weighing less than 127 pounds, getting too little calcium and vitamin D, and excessive cola drinking. Women are four times more likely than men to get osteoporosis.

For those who already have osteoporosis, exercise is a good way to improve balance, which can prevent falls that might break weakened bones. Walking is a good choice, because it brings weight to bear on the bones without the added impact of an activity like running, which could stress weakened bones to the point of breaking. Strength training can also help slow mineral loss, but people with osteoporosis may need to avoid activities that stress the spine, such as excessive forward bending and heavy lifting. A physical therapist can design a strength-training program that will allow someone with osteoporosis to exercise safely.

Shoulder Instability and Weakness

Shoulder instability may follow a traumatic injury, or it can result from repetitive motions that weaken the shoulder joint.

What is shoulder instability?

The shoulder is the connection of three bones: the arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The head of the humerus is a ball that fits into a socket, and it is held in place by muscles, ligaments and tendons. Weakness in the joint increases the risk that the ball will pop completely out of the socket (dislocation) or come partway out (subluxation).

A fall may cause the initial dislocation or subluxation, and the injury weakens the shoulder’s supporting structures. The joint then becomes susceptible to subsequent dislocations or subluxations. Repetitive motions involving the shoulder can also cause weakness and instability. Sports such as football, basketball, baseball and soccer increase the risk for injuries that lead to shoulder instability.

Treating shoulder instability with physical therapy

While surgery is sometimes necessary, most cases of shoulder instability and weakness can be treated with physical therapy. Strengthening exercises, heat, cold, massage, ultrasound and electrical stimulation are some of the treatments that may be helpful.

Shoulder Labral Tear

Shoulder_Labral_Tear2 Q & A with Robert Ortiz, P.T.

Q.   What is the shoulder labrum, and how does it get torn?

A.   The labrum is a ring of cartilage that surrounds the shoulder socket. It helps to keep the ball of the humerus (the upper arm bone) in place. The labrum can be torn by a shoulder dislocation or subluxation. Overuse or the effects of aging can also tear the shoulder labrum.

Q.   What are the symptoms of a torn shoulder labrum?

A.   A torn labrum usually causes pain in the shoulder. There may also be instability in the shoulder, or a catching sensation in the shoulder when you move your arm.

Q.   How is a shoulder labral tear treated?

A.   Physical therapy can improve range of motion and strengthen the muscles that support the shoulder. If physical therapy does not eliminate symptoms, surgery may be needed.

Q.   If I have surgery to repair a torn labrum, why do I still need physical therapy?

A.   After surgery to repair a torn labrum, physical therapy will help you regain range of motion and strength in the shoulder.

Q.   How long with the physical therapy take?

A.   You may need several months of physical therapy to recover from a torn shoulder labrum.

Posterior tibial tendonitis

Posterior_Tibial_transTreating Posteriar Tibial Tendonitis With UltrasoundPosterior tibial tendonitis is an injury to the tendon that connects the posterior tibialis muscle to the foot. This tendon helps turn the foot during walking, and it also supports the arch of the foot. Trauma or repetitive stress can injure the posterior tibial tendon, producing pain and swelling on the inner side of the foot or ankle. Patients may experience gait problems, and some may develop a flat foot, or their toes may point inwards or outwards. Treatment in the early stages includes resting the tendon, either by modifying activities or using a shoe insert or a cast. Anti-inflammatory medication is usually recommended. Physical therapy may include ultrasound and massage to reduce pain and swelling, and exercises to strengthen and improve range of motion in the muscles that support the foot’s arch.

Triangular Fibrocartilage Complex Tears

Triangular Fibrocartilage ComplexBy Nancy Simpkins

Do you have a feeling of catching inside the wrist joint, pain on the ulnar side of the wrist (near the pinky), or a clicking sound when you move your wrist? If so, you may have a tear in your triangular fibrocartilage complex (TFCC).

The TFCC is a structure made up of ligaments and cartilage in the wrist. It enables the wrist to move in six different directions, and is sometimes referred to as the “wrist meniscus.” A fall onto an outstretched hand can cause injury to the TFCC.  Sports that involve gripping something, such as tennis and gymnastics, increase the risk of TFCC injury.  This type of injury becomes more likely after age 30, when degenerative changes in the TFCC begin.

After a TFCC injury, hand therapy can help stabilize the joint. Therapy may include splinting and grip exercises. Treatment for a torn TFCC may include surgery.

Resistance Isn’t Futile: Swimming for Fitness

by Nancy Simpkins

swimming3-1For people with joint problems, exercise can be agonizing. Swimming provides them with a painless way to improve cardiovascular fitness and build muscle strength. “I had a patient who was headed for a knee replacement. She weighed close to 300 pounds, she could barely walk, and she had severe osteoarthritis,” recalled Hector Mayo, clinical director at Grand Central Physical Therapy and Hand Therapy. “I told her that losing weight would help, but she had reached the point where she couldn’t support her own weight, and most exercises were too painful.” Mayo recommended that the woman take up swimming, and she lost weight and avoided the need for surgery.

Pros and Cons of Swimming

A swimmer’s body weighs about 90 percent less in the water than it does on land. This is due to the force of buoyancy, which causes the water to push up as the body’s weight pushes down. With less weight on the joints, swimming has one of the lowest injury rates of any sport. In a 2005 study of young athletes published in Archives of Disease in Childhood, researchers found that more than five times as many soccer players had suffered two or more injuries than a comparable group of swimmers had. Mayo estimates that in his career as a physical therapist, he has treated a handful of injuries caused by swimming, compared with hundreds of injuries sustained by golfers, and thousands of injuries due to running.

Arthritis sufferers can reduce symptoms by swimming in warm water. Exercising in warm water raises body temperature, which dilates the blood vessels and increases circulation. This usually decreases joint stiffness and swelling, with a corresponding reduction in pain. The Arthritis Foundation recommends pool temperatures between 83 and 88 degrees Fahrenheit for moderate water exercise, and somewhat cooler temperatures for vigorous swimming.

Swimming is one of the few exercises that use all the major muscle groups, and because water is much denser than air, swimming provides resistance that strengthens muscles in the same way that weight training does. As an aerobic activity, swimming provides benefits to the cardiovascular system, including strengthening the heart and lowering blood pressure.

Even if you never learned to swim, or you just don’t want to get your hair wet, you can still benefit from water exercise. Chest-deep water supports about two-thirds of the body’s weight, so water aerobics provides the benefits of exercise with minimal stress on the joints.

How to Avoid Swimming Injuries

Although swimming injuries are rare, they do occur in competitive swimmers or those who train intensely. The repetitive motions used in swimming strokes can cause overuse injuries such as swimmer’s shoulder, also known as impingement syndrome, or breaststroke knee.

Swimmer’s shoulder is most often associated with the overhead arm motions of the freestyle and butterfly strokes, although the backstroke can also increase the risk of this condition. Poor swimming technique and overtraining cause the muscles to become fatigued, which results in the swimmer using more strokes to cover the same distance. The tendons in the rotator cuff become inflamed, causing pain that can be constant or brought on by certain motions.

Breaststroke knee usually refers either to an irritation of the bursa in the knee, or to a sprain of the medial collateral ligament of the knee. Both can be caused by improper kicking technique.

Treatments for both swimmer’s shoulder and breaststroke knee include rest, ice, and nonsteroidal anti-inflammatory medications such as ibuprofen. Patients with severe cases sometimes receive corticosteroid injections. For patients with swimmer’s shoulder, physical therapy usually helps to improve rotator cuff flexibility and strengthen shoulder muscles. For those with breaststroke knee, physical therapy can strengthen the muscles surrounding the knee and increase the knee’s range of motion. If your bursa is swollen, your doctor may remove fluid with a needle.

Simple precautions such as warming up and stretching can reduce the risk of swimming injuries. With proper preparation, almost anyone can benefit from this very safe sport.