Posts tagged physical therapy treatments
Physical Therapy Accelerates Recovery From Rotator Cuff Tears
shoulder pain-rotator cuff tear-physical therapy-treatment

Rotator cuff tears are a common finding among middle aged adults with shoulder pain, but are also found among their peers without shoulder pain. Many of us will develop these tears as we age and as we have discussed in previous blog posts there is no difference in outcomes at 1 or 2 years if a patient elects for surgery or Physical Therapy for treatment of their symptoms. Our interventions in Physical Therapy are designed at optimizing shoulder function through manual therapy and strength training exercises allowing patients to return to their prior levels of activity without symptoms. Thankfully many rotator cuff tears improve over time due to the natural history of this injury, but a research study suggests Physical Therapy may accelerate this recovery if utilized early in a patient’s recovery.

Dickinson and colleagues studied 55 patients with rotator cuff tears for up to one and half years after the onset of their symptoms (J Shoulder Elbow Surg. 2019). Patients were broken into two different groups based on their utilization of Physical Therapy interventions. Authors reported patients who received Physical Therapy in the first three months after the onset of their symptoms reported greater improvements in pain and function compared to patients utilizing other interventions such as medication or a wait and see approach. Importantly, Physical Therapy was found most effective in the first 8 week of treatment with limited benefits after this 8 week time frame. Patients are encouraged to utilize Physical Therapy early in their recovery process to accelerate their recovery.

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Should I see a Physical Therapist or a Physician first for my pain?
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Time and money are two finite resources especially in today's healthcare environment of rising deductibles and decreased access to primary care services.  Thankfully in Colorado patients have a choice on who to see first for their muscle, tendon, and joint pain.  State law enables Coloradans to see a Physical Therapist without a prior referral.  This care model, direct access, has been utilized since the early 1950's to reduce costs and improve outcomes for patients with musculoskeletal pain.  Currently, fortune 500 companies, the U.S. military, and large hospital systems utilize this model of care due to its' safety, cost and clinical effectiveness, and ability to decrease wait times for patients.  Below is a summary of the latest research comparing cost and prognosis for seeing a PT first for your musculoskeletal pain.

Low Back Pain – 2nd most common reason patients seek medical attention

            Patients save $1996 if they see a PT first vs. guideline based care (Hahne et al. 2016)

            Patients saved $1543 if they saw a PT first before a MD (Denninger et al. 2017)

Neck Pain – lifetime prevalence of up to 70%

            50-75% of patients report symptoms at 1 and 5 yr follow up (Hush et al. 2011, Carroll et al. 2006)

            Patients save $800 if they see a PT first before MD (Korthals de Bos et al. 2003)

Headache

            Manual Therapy more effective than primary care or exercise alone (Hoving et al. 2002, Gross et al. 2004).

            Beneficial effects seen up to 1 and 2 year follow up

Shoulder Pain – 2nd most common cause of musculoskeletal pain

            50% of patients report symptoms at 6 months (Winters et al. 1999)

            Physical Therapy accelerates recovery compared to usual medical care (Bergman et al. 2004)

            Physical Therapy reduces short and long term disability vs. primary care (Peek et al. 2015)

Elbow Pain

            Decreased healthcare utilization and costs with Physical Therapy treatment (Bisset et al. 2006)

            Lowest recurrence rate seen with PT treatments (Coombes et al. 2013)

Hip Osteoarthritis

            Physical Therapy delays need for hip replacement (Svege et al. 2015)
Knee Osteoarthritis

            Physical Therapy accelerates recovery vs. wait and see (Deyle et al. 2000)

            Manual therapy and exercise twice as effective as exercise alone (Deyle et al. 2005)

Ankle Sprains

            72% of patients report symptoms at 6 months (Braun et al. 1999)

            Physical Therapy accelerates recovery vs. rest, ice, compression, elevation (Green et al. 2001)

            

 

 

 

 

 

 

Early Physical Therapy for Muscle Injuries Accelerates Recovery and Return to Sport
boulder-muscle-injury-treatment

Muscle injuries (strains) are a common injury among both inactive and active people.  These injuries can become recurrent and lead to significant losses in function and sport participation.  Research has previously shown injections such as PRP (platelet rich plasma) are costly and ineffective to treat these muscular injuries.  Conversely, these injuries require Physical Therapy and early, progressive loading of the injured tissue to both promote healing and re establish its' pre injury tensile strength.  The main question remaining is how soon Physical Therapy should be started after an acute injury.

A recent study in the New England Journal of Medicine conducted a randomized controlled trial of 50 amateur athletes who sustained either a thigh or calf muscle strain (Bayer et al. 2017).  Athletes completed the same rehabilitation program but were randomized to either early Physical Therapy (2 days) or delayed Physical Therapy (9 days after injury).  The rehabilitation program consisted of 1 week of frequent stretching followed by 2-4 weeks of daily, progressive loading of the injured tissue.  The final phases of the Physical Therapy rehabilitation program consisted of dynamic loading with increased resistance 3 days a week and finally completed the return to sport phase in weeks 9-12 consisting of functional exercises and heavy strength training 3 days per week.

As expected, the authors showed a 25% faster return to sport in the early vs. delayed Physical Therapy group (62.5 vs. 83 days).  Importantly, the authors showed no increase in risk of injury among the athletes who completed the early vs. late rehabilitation programs.  Authors reported this study supports the importance of early loading compared to immobilization of injured tissue.  Previous research has shown immobilization impairs connective tissue cells and their ability to heal and return to pre injury composition.  Authors stated the "importance of regular and controlled mechanical loading early after trauma" to facilitate an optimal return to activity.

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Changing Foot Strike Pattern in Distance Runners

In our Boulder Physical Therapy practice, the examination of a runner's gait is a critical part of the evaluation giving us insight into the factors which either precipitated or perpetuated a running related injury.  The forces transmitted across the body in running can be 2-4 times body weight and must be absorbed efficiently to reduce abnormal loading in a given body region such as the knee.  Foot strike pattern in a runner is one variable shown to reduce abnormal loading across the lower extremity.  In the knee example, changing from a rear to a fore or mid foot strike pattern can reduce impact forces across the knee joint.  

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Changes in a runner's step rate per minute is an easy way to change a runner's foot strike pattern with higher rates usually associated with more fore and mid foot strike patterns.  A recent article in the International Journal of Sports Physical Therapy examined 40 runners who ran at least 10 miles per week in a heel strike pattern (Allen et al. 2016).  The authors used video analysis to determine the athlete's foot strike pattern then asked the runner to run at 5, 10, and 15% above their preferred step rate to determine the rate increase's impact on their gait.  With each increase in percentage the runner's demonstrated less foot inclination (ankle bend) and thus less heel strike.  Specifically, the authors found the heel strike pattern changed to a non heel strike pattern at 10 and 15% above the preferred step rate.  

To learn more about how Physical Therapy Gait Retraining can reduce your injury risk and improve your running performance contact a local Physical Therapist. 

Injections for Knee Osteoarthritis

Knee osteoarthritis is a common condition in aging adults leading to pain and reduced performance of daily and recreational activities.  Manual therapy and exercise remain a hallmark of conservative care for this condition and have been shown to delay or prevent the need for a total knee replacement.  In addition to exercise, corticosteroid injections are often proposed to patients in order to reduce pain and improve patient participation.  A recent study in the Journal of the American Medical Association examined the impact of these injections in patients with knee arthritis.

Henriksen and colleagues studied 100 patients and randomized them to either a corticosteroid injection or a placebo injection prior to undergoing Physical Therapy 3 days a week for 12 weeks.  These patients all had evidence of knee arthritis on x ray and reported pain with daily activities including walking.  All patients improved through the course of the study, but no significant differences were noted at 2, 14, or 26 weeks between the group receiving a corticosteroid injection or a placebo.   The authors concluded there was no additional clinical benefit of a steroid injection and Physical Therapy compared to Physical Therapy alone.  Thus, Physical Therapy was the main reason for the patient's improvement.   

Patients with knee osteoarthritis are encouraged to seek out a local Physical Therapist to implement an effective rehabilitation program.  

Treating Knee Pain in Runners

As the snows melts many of us will return to the amazing Boulder trail system for our training runs.  This popular form of exercise comes with tremendous health benefits, but can also place some runners at risk for running injuries such as knee pain.  Patellofemoral Pain (pain on the front of the knee) is the leading cause for medical consultation attributed to a running program (Taunton et al. 2002).  

Authors have suggested multiple reasons for the pain including training errors (too much volume, too soon), weakness and/or tightness in lower body muscles, and poor control of the lower extremity during the running gait cycle.  Loads on the knee joint have been measured at 4-5 times body weight during running (Roos et al. 2012) with higher loads noted in runners with knee pain (Davis et al. 2010).  Physical Therapy remains the gold standard for treatment of this disorder due its' unique ability to identify and treat the specific factors contributing the symptoms in this group of athletes. 

Prior research on knee pain in runners has shown gait retraining to be an inexpensive and effective treatment for reducing pain and improving function.  In particular, cuing to to improve step frequency and to land softer can significantly reduce impact forces at the knee during running.  A recent article in the Journal of Sports Rehabilitation expands on this research and highlights the impact of a multimodal treatment program for runners with knee pain (Esculier et al. 2016).

The authors included 21 runners with > 3 months of knee pain who were running at least 15 km per week.  These runners must have at least 3/10 pain with running and report pain with stair climbing, kneeling and squatting to be included in the study.  All of the runners were evaluated by a Physical Therapist for their running gait as well as an assessment of strength, flexibility, and control of their knee during functional testing.  Each runner underwent treatment for 8 weeks based on this initial examination performing exercises at home in addition to treatments with the Physical Therapist.  Runners were instructed to increase their step frequency to reduce the loading on their knees, as well as, to land softer to reduce the vertical loading on their legs.  

75% of the runners reported success with improved knee pain and function following the treatments.  Interestingly, the 5 runners who reported low to moderate success did not demonstrate significant changes in the forces across the knee at the end of the trial.  These athletes may require further gait retraining to make a significant impact on their symptoms.  

This study highlights the importance of running gait retraining, without the need for expensive bio-mechanical equipment, and strengthening exercises on improving pain and function among runners.  To learn more about how you can improve your knee pain and get back to running contact your local Physical Therapist.