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Low back pain has become one of the largest causes of pain and disability in the United States. Billions of dollars are spent on trying to care for and remedy this issue. People are advised by friends, coworkers, and physicians to seek out certain types of treatment such as physical therapy, chiropractic care, medicines, diets, or other newfound treatment approaches.  So what to do? If your back is hurting which track do you pursue? While pain can be a very complex problem there have been ways that consistently show how someone can at least better manage their pain if not altogether get rid of it. The Journal of Pain Research has proposed factors to consider when deciding how to address your pain.  Obviously, physical problems within your muscle or nervous system can be a direct cause of your pain. Structures in your body can become quite sensitive to pain causing a compounding problem that never seems to resolve. Even having a sedentary lifestyle or being deconditioned can cause structural deficits which can cause pain with movements or mobility. Another area can be more of an environmental factor such as work satisfaction, perceptions or demands at your job or even the attitudes of your employer. These can cause a higher risk or predictability of pain.  Some people also say, “I have a ‘high’ or ‘low’ tolerance for pain.” These pain-related beliefs and attitudes can have a real effect on someone’s ability to recover from a painful condition. Often time someone’s expectations, beliefs, or perception of their condition can have a direct effect on their ability to overcome the condition. Our attitude as physical therapists is to educate each individual on their specific condition, so they understand what will positively and negatively influence their symptoms. Also, we promote that the person have an ACTIVE involvement in trying to manage their care. Many studies have shown that individuals who actively participate in managing their condition do better than those who passively receive care.  You may be faced with many recommended options to help take care of your back pain. We would recommend that you first understand that there can be many causes of your back pain and especially many things influencing the level of your perception of pain. We feel a conservative approach such as physical therapy often helps people to manage or alleviate their symptoms. If physical therapy doesn’t work for you, there are other options that you can pursue as well. Give us a call to sign up for a free consultation if you'd like one of our physical therapists to sit down and talk with you about your low back pain, and discuss what PT can do for you.  By: Steve Bartz, PT
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You commonly hear terms like sprain, strain, broken bone, fracture, tendonitis, and bursitis, but do you know what they mean? We’re going to break down some common diagnoses so if your doctor tells you that you strained your hamstring, sprained your ankle, or your child broke their arm, you know a little more about what exactly that means. Strain vs. Sprain  STRAINS are the overstretching or tearing of muscles or tendons (tendons are the dense tissue that connects bones to muscle). For example, if you're carrying something very heavy with poor form and injure your back, it may be a muscle strain in muscles of your back. SPRAINS are the overstretching or tearing of ligaments (the bands of tissue that connect bones together in a joint). A common sprain you've probably heard of is an ACL tear or sprain (ligament in the knee joint), or an ankle sprain (most commonly in ankle sprains the anterior talofibular ligament on the outside of the ankle is overstretched when the foot rotates inward).
Both strains and strains can be debilitating depending on the severity of the tear/stretch. Both can lead to swelling, pain, and limited flexibility. Fracture vs. Break Fractures and broken bones are the same thing. There are many different types of fractures, but all involve trauma to a bone due to the stress on the bone being greater the the strength of the bone.  This stress on the bone that causes is to "break" (fracture) can be caused by different circumstances:
 Tendonitis vs Bursitis  Tendinitis is the inflammation of the tendon (like we talked about earlier, the tendon connects the muscle to bone and is tissue making up a chord-like structure). You've probably heard of rotator cuff tendinitis (inflammation of the tendons that make up the rotator cuff). Bursitis is inflammation of the bursae, which is a fluid-filled sacs that cushions bones and tendons/muscles to reduce friction. Bursas and tendons are located near each other, and tendinitis and bursitis share some common symptoms. Often tendinitis and bursitis often occur concurrently at a given joint. These similarities cause the two terms to be assigned incorrectly when there's pain and swelling at a joint. If you are suffering from a sprain, strain, fracture, or other musculoskeletal injury and live in the Hudsonville, Jenison, Grandville, or West Michigan area and need physical therapy, give us a call! These types of injuries are our specialty and it's our goal to get you better efficiently so you can get back to your favorite activities this Spring!  By: Lisa Pfotenhauer, Cert. Exercise Physiologist It’s Spring again! When you look outside, the robins are back, the thermometer is trending upward, and it’s back to the diamond for one our favorite pastimes, baseball. This leads me to the topic of this blog: the overuse of the young baseball players’ arms.  Kids (or their parents) seem to specialize in sports at younger and younger ages. Many give up the variety of sports to specialize in one at a very young age. Travel baseball teams start as early as 9-10 years old. Some of them are even practicing almost year around. Also, there has been a significant increase in elbow and shoulder injuries in MLB and college pitchers. I believe this is in direct correlation with the number of pitches and types of pitches thrown by these players as they are coming up.  The first factor is the sheer number of pitches thrown. If a player starts at an early age and is talented, he will throw a lot of pitches by his senior year in high school. Let’s face it, the good pitchers are going to throw the majority of the innings. Coaches, player, and parents want to win. But, there are rules in place to look out for kids. The Little League limits 7-8 year olds to 50 pitches per day, 11-12 y.o. to 85 pitches per day and 13-16 y.o. to 95 per day. Their guidelines are well minded but vague. Each player has to be looked at separately. There is a huge difference between a 13 and a 16 y.o. Each child is at a different maturity level, body build, and over all conditioning.
Another factor to take into consideration is the season timeline that they are pitching in. Is it the first game of the year or the last? Even the pitchers in the Majors don’t throw over 100 pitches early in the season. They also have 3-4 months of “off season” to not throw and recover. It is crazy that some young athletes have less recovery time! The second factor is the type of pitches thrown. I am not a fan of throwing curveballs at a young age. I think it’s much more important to work on pitch location and mechanics. Many young pitchers have poor mechanics, and trying to throw a curveball puts extra unwanted stress on the elbow. Dr. James Andrews (renowned orthopedic surgeon) advises not throwing curveballs before the age of 14.  These are just some general guidelines to go by. All kids are different, and each case should be looked at individually. But, the bottom line is, let’s do our best to keep our young athletes injury-free so they can enjoy the great game of baseball. And if you or your athlete is struggling with an injury, don't hesitate to give us a call. We are passionate about helping athletes from the Jenison, Hudsonville, Grandville, Allendale, and surrounding areas make full recoveries, and we believe in educating them with techniques and exercises to prevent future injuries. 616-662-0990  Brian Colvin, MPT We all know someone (or maybe experienced yourself) who has had a concussion. Concussions range in severity, and unfortunately are common in sports, particularly contact sports like soccer, football, hockey and wrestling.  What causes concussions? Trauma to the head, often caused by motor vehicle accident, falls, and sports injuries, causes concussions. Your brain is made of soft tissue, cushioned by spinal fluid and protected by your skull. A blow or bump to the head can jolt your brain, causing it to literally move around in your head. This can cause bruising, blood vessel damage, and nerve injury, which leads to the concussion symptoms we see below.  How do I know if it’s a concussion? Symptoms of a concussion include headaches (this is the most common), nausea, balance problems, sensitivity to light and/or noise, drowsiness, amnesia, trouble comprehending and concentrating, and feelings of being in a fog. When someone experiences a concussion, they may have just one or many of these symptoms, depending on the severity and how they respond.
What should I do if my child or someone I know appears to have a concussion? When do I call the doctor? If your child experienced a blow to the head, it may take anywhere from 2 minutes to a few hours for concussion symptoms to appear. If symptoms of a concussion are apparent, you should consider taking your child to the doctor. If they did not lose consciousness during their concussion, they should wait until symptoms subside to return to normal activity (could be minutes, hours, or days depending on their concussion). They should get lots of rest and take precautions to avoid another concussion, and may be advised to avoid strenuous physical or mental tasks, and take time off from from sports, school, or work. Symptoms normally go away within 6-10 days. If he or she loses consciousness or experiences a neck injury, you should take him or her to the doctor or the emergency room for observation and treatment.  Prevention Concussions can be dangerous, especially because once you sustain one, you are at a three to five times greater risk for experiencing another one. To decrease the likelihood of concussions for yourself or you child, always wear seat belts in the car, wear a helmet when biking, riding a motorcycle, skiing, etc. Have handrails on your staircase and safety gates on your stairs if you have young children. If you child does experience a concussion as the result of a contact sport, make sure they rest from that sport for the amount of time their doctor recommends, because repeat concussions (while their brain tissue and nerves are still healing) are much more dangerous to the brain than the first concussion.  Sources: Clevelandclinic.org: Concussions, January 2015; WebMD: Concussion (Traumatic Brain Injury), 2018; Center for Disease Control and Prevention: Traumatic Brain Injury & Concussion, February 2019  By: Lisa Bartz, C-EP Most of us have heard of shin splints, but I’ll bet than many don’t really understand what shin splints are. Typically if a patient describes pain in the front of the lower leg, it will be diagnosed as shin splints. Let’s talk about the causes and treatment of this condition.  This condition is common in people who do a lot of running, as well as with people who have jobs that involve excessive standing or walking. The pain is typically felt in the front of the lower leg bone, the tibia. It is often described as a throbbing pain, or a deep ache, but also can produce sharp pain as well. The interesting thing is that although the pain feels as if it is coming from the bone, it is typically produced by the soft tissues that attach to the bone. This includes the tibialis posterior muscle, which is attached on the posterior (back) side of the tibia bone. This muscle is active whenever we are bearing weight on our leg. It helps to keep the arch of our foot from collapsing during weight bearing. People who have flat feet/arches would be more prone to developing this condition, as the tibialis posterior muscle will work hard to try to support the collapsing arch.  In terms of treatment, there are a couple of things to consider. First, a precautionary X-Ray or bone scan is often a good idea, as repetitive stress on the shin (especially in long distance runners) can lead to a stress fracture. If this is ruled out, then we treat the soft tissue problem. As always, we want to identify the cause of the problem, not just treat the symptoms. Patients can take anti-inflammatory meds, or ice the painful area, but these will only provide temporary relief and will not address the cause of the pain. We first need to look at the lower leg and foot alignment to see if an orthotic is indicated. If a patient has poor foot structure (especially flat arches, but sometimes excessively high arches), a shoe insert to support the arch can relieve stress from the lower leg muscles (tibialis posterior) that have to work excessively to support the arch. We also want to make sure that the patient has full range of motion and flexibility in the lower leg/ankle/foot region, as well as good muscle strength in the lower leg/ankle/foot region. A gait evaluation and possibly a running assessment are also indicated to identify abnormalities which may be contributing to the condition.
If you have been dealing with shin pain, please give us a call so that we can help you! This can be a difficult condition to treat, but it is treatable, especially with the help of an excellent physical therapist.  By: Mason Riegel, PT Unfortunately, knee pain is common. The good news is, many cases of knee pain can be prevented, treated, and reduced or eliminated with proper treatment and exercise! Here are a few tips for dealing with you knee pain. Remember, knee pain has many causes, and if you’re dealing with acute pain, severe pain, or knee pain from trauma, you should see your doctor or physical therapist to find the cause of your knee pain.
Air squats Backward lunges
Glute bridges Single leg balance
Calf raises Donkey kicks  Clams
Calf stretch 1 Calf stretch 2
Quad stretch Hamstring stretch
When should you see a doctor? If your pain is new, very painful, or persistent, it is a good idea to see a doctor or physical therapist right away and get advice on what treatment you may require or what your next steps should be.  By: Lisa Bartz, Certified Exercise Physiologist (C-EP) We see many people who are frustrated with the speed in which they are progressing. They feel that they should be ready to return to their usual sports or activities right away without having to go through the healing and rehabilitation process.  It is important to remember that your body is trying to heal itself, but this is a process. Soft tissue healing, such as a moderate to severe sprain or strain, can take up to six weeks to recover. Bone fractures often take weeks to heal and after surgery many people have a combination of bone and soft tissue issues that have been surgically addressed and need to heal. Here are some tips to help you through this process from verywellfit.com:  1. Learn about your injury. The more you know about the injury and healing process the more comfortable you will be when you experience pain, stiffness, or even frustration about how things are progressing. You may be ahead, behind or right on track of the typical healing process. By knowing what to expect you can reduce your anxiety about what lies ahead. 2. Accept responsibility for your rehabilitation. It is important to accept responsibility for your rehab program, because only you can control how well you will do with your rehab. While the physical therapist is important, without actively participating in your rehab, you are doomed for failure.   3. Maintain a positive attitude. Try to focus on what improvements you are making rather than your deficits or where you aren't progressing as quickly. You need to be realistic about your condition, but you also need to be optimistic about where you’re headed. Then, when you do see improvements, this will reinforce the behaviors you will need to continue.  4. Have good support. Try to surround yourself with friends, family members, physicians and therapists who will support and encourage you in your recovery. Besides the sense of support, these individuals will hold you accountable for your program. 5. Set appropriate goals. Discuss with your therapist a timeline and set goals along that timeline. This helps you objectively measure where you are at in your program. Ask your physician and physical therapist their expectations for your recovery as well.  6. Maintain your fitness level while injured. Work with your therapist to help establish a fitness routine that will not hinder your recovery from your current condition. Often times someone with a leg injury can aggressively work their upper body and core without having a negative impact on the recovery time for their leg. The same holds true for a hand injury in that you can work your legs more aggressively without hindering your recovery time. A higher level of fitness often helps improve your tolerance to perform various exercises as well as functional activities.  By: Steve Bartz, PT Physical therapists are often asked about our opinion of braces. There are many types of braces, including support braces for the spine, as well as sport/recreational/occupational braces for many areas of the body, including the knee and ankle. My opinion of braces varies on a case-by-case basis. We need to look at a variety of factors to determine whether wearing a brace is appropriate or not.  In general, I am not typically in favor of wearing spinal braces. The exception would be in a post surgical case, where the surgeon has specifically told the patient to wear a brace, normally to prevent movement while the body heals. However, once this healing has taken place, we want the patient to wean out of the brace as soon as possible. The reason for this is that the brace immobilizes the spine, leading to stiffness, loss of flexibility, and loss of strength due to inactivity. The spinal muscles, when operating efficiently, will provide a natural “brace” of support for the spine. If a patient becomes reliant on a brace for their support, their muscles will weaken due to not being used, and their problem actually worsens. There are certain types of braces that I will recommend for a limited time, as long as they are not used as a long term solution. Examples would be a “tennis elbow” brace, a patellar support brace, an ankle support brace initially after an ankle injury, or a shoulder sling. In all of these cases, we are only using the brace for a limited period of time to allow the body to heal, or recover. We are still trying to rehabilitate the body to work properly in the long term, so that the brace will not be needed long term.
Often the trickiest decision regarding braces comes when discussing the use of preventative braces during sports. Examples would be ankle support braces for volleyball or basketball or knee braces for football linemen. In each of these cases, the rationale for wearing the brace is to prevent potential injury by providing additional support for the joints. Strong cases can be made for wearing the braces, as well as for not wearing the braces. There is not even consensus within the medical field as to which is the better option! In summary, the decision about whether or not to wear a brace is often complex and not clear cut. The key is to have a thorough discussion of the pros and cons of bracing, so that each individual patient can make their own well informed decision.  By: Mason Riegel, PT When elbow pain strikes, what do you do? First, let’s take a look at what causes elbow pain. There are many different types of injuries related to the elbow. Today, I want to touch on two of the most common. They are easy to diagnose, easy to treat but can be difficult to totally get rid of the pain. The two most common diagnoses are “Tennis elbow” and “Golfer’s elbow”. Tennis elbow’s clinical name is Lateral Epicondylitis. It is the inflammation of the common extensor tendon of the forearm and is located on the outside of the elbow.  Golfer’s elbow’s clinical name is Medial Epicondylitis. It is inflammation of the common flexor tendon of the forearm and is located on the inside of the elbow.  For the non athlete, there are many things that can cause or bring on these conditions. The two most common are 1) A strenuous or aggressive activity, like swinging a heavy hammer or lifting something very heavy, or 2) A repetitive or overuse activity, such as factory line work or keyboarding. The good news is they are easy to treat! 1. REST. Avoid any activity that causes pain. 2. ICE. I feel that an ice massage for 5 minutes is most effective.  3. STRETCH the affected area. This is done by putting arm straight out in front. Pull wrist up to stretch the flexors for Golfer’s elbow or wrist down for Tennis elbow. Hold stretches for 10 sec for about 5 reps.  4. Lastly, you can purchase a STRAP to wear around your forearm about an inch below your elbow to give you some relief. Now, as I mentioned earlier, although these conditions are easy to treat they can be hard to totally get rid of. Give it a month or so, and if it does not improve with these 4 tips, let your local Physical Therapist give you a hand. One last thing to remember: don’t let this condition go, the longer you wait the tougher these conditions are to treat.  By: Brian Colvin, PT  What do you do when you get a "Charlie Horse" in your leg? How can you prevent them? Typically, Charlie Horses are muscle spasms of either the hamstring or calf muscles. They occur when the muscle is suddenly contracted after being in a shortened state (like waking up in bed with a sharp cramp) or when over-exerting the muscle such as when sprinting. To prevent these it is important to gently stretch the muscle regularly to train it to handle the stretch without going into a spasm. Calf and hamstring stretching can help with this. Long slow repetitive stretches can reduce the chances of the spams, especially before bed. Good diet and hydration may help also. So what do you do in the middle of a Charlie Horse to try to get relief? A very effective but tricky way to reduce a spasm in your calf while in bed would be to immediately role over onto your stomach and let the bed hold your foot in a position that points your toes down (away from you). It is important you do not actively try to point your toes down while getting into this position. By taking the stretch off the muscle, it can relax quicker.   The same is true for the hamstring. Try to pull your knee into a more flexed position using your hand and NOT flex your knee with your leg muscles. Relax and wait for the muscle to relax.
Most people to quickly LENGTHEN the muscle, but this can put the muscle into a sharper spasm. Here, we are trying to shorten the muscle further without contracting it. By: Steve Bartz, PT |
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