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

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.

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.

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.

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 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.

Cubital Tunnel Syndrome

By Marianne Pilgrim, OTR/L, CHT

Cubital TunnelMost people are familiar with carpal tunnel syndrome, but few know about a similar condition: cubital tunnel syndrome. While carpal tunnel syndrome affects the median nerve at the wrist, cubital tunnel syndrome affects the ulnar nerve at the elbow.  This is the same nerve that is irritated when you hit your “funny bone” and you feel a tingling sensation running down to your fingers.

The ulnar nerve originates from the spinal cord at the neck, and it runs through the entire arm. This nerve provides sensation to the small and ring fingers and strength to the small muscles of the hand.  The ulnar nerve may be compressed as it passes behind the medial epicondyle, a bony bump on the inside of the elbow.  Cubital tunnel syndrome is a pathologic compression, friction or traction of the ulnar nerve in the elbow region.  Symptoms may include impaired sensation of the small and ring fingers, burning pain, weak grip and clumsiness of the hand.

Common causes of cubital tunnel syndrome include direct pressure, prolonged bending of the elbow, repetitive movement, congenital anomolies, inflammation and bony changes. Conservative treatment of this condition may include use of NSAIDs (non-steroidal anti-inflammatory drugs), education by a therapist regarding proper ergonomics and techniques to avoid aggravating positions or activities, and nighttime splinting or daytime padding of the elbow.  If the symptoms do not respond to conservative treatment, surgery may be required to provide more space for the ulnar nerve. In a procedure known as ulnar nerve transposition, the nerve is moved to the front of the elbow.  Therapy is usually prescribed after surgery to increase range of motion, increase strength and provide scar management.

Hip Pain – Causes and Treatment

By Lisa Gemmel, MPT

hippainThe hip is a ball and socket joint between the femur (thigh bone) and the pelvis. The head of the femur fits into the acetabulum (hip socket). The acetabular labrum, a ring of cartilage inside the joint, acts like a suction cup to keep the joint together. The hip joint capsule contains muscles and tendons that act upon the joint.  It also has two bursas, fluid filled sacs that prevent friction between bone and soft tissue.  The bursa on the outer part of the hip prevents friction between the head of the femur and a band of connective tissue called the iliotibial band.  The other bursa is located in the front of the hip, under the iliopsoas muscle. Any of these structures, as well as the lumbar spine, can cause hip pain.

Some common diagnoses associated with hip pain include osteoarthritis, labral tear, bursitis, tendonitis, iliotibial band syndrome, and muscle strains.  These conditions can be caused by any of the following:  trauma, degeneration, overuse, and structural abnormalities such as leg length discrepancy. Once the proper diagnosis is made, treatment can be initiated.  Treatment can include anti-inflammatory medicines, cortisone injections and physical therapy.  Physical therapy includes therapeutic exercise, modalities for pain and inflammation, soft tissue or joint mobilizations, and instruction in correct movement patterns.