Posts tagged strengthening
Which Muscles Should I Strengthen For Knee Arthritis
knee-arthritis-hip-strengthening-exercises

Knee osteoarthritis is a common and increasing diagnosis that is contributing to an rapid rise in total knee arthroplasty surgery in the United States. Knee Osteoarthritis leads to disability in greater than 10% of those over 55 years, however manual therapy and exercise has shown to be twice as successful compared to a home exercise program in short term pain and function. More importantly, research has shown this Physical Therapy approach can postpone or prevent the need for knee replacement. One of most common complaints from patients with knee arthritis is pain with walking or ascending/descending stairs. Weakness of the quadriceps, hip adductors (inner thigh) and abductors (outer hip) are crucial to improving stair climbing and squatting ability.

A recent study (Hislop et al. 2019. Br J Sports Med) aimed to find the benefit of adding hip strengthening exercises to quad strengthening exercises among people with Knee Osteoarthritis. Authors randomized participants with knee arthritis into one of two groups: knee strengthening or knee and hip strengthening. Consistent with clinical practice, the authors found a decrease in patient related pain as well as improvements in patient function in patients who combined hip and knee strengthening exercises compared to knee strengthening exercises alone.

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How Heavy Should I Load My Achilles Tendon After An Overuse Injury?
achilles-tendon-exercise-treatment

In the achilles tendinopathy (artist formally known as tendonitis) research two main themes have emerged. First, there is little to no evidence to support the use of injections of any kind into an injured tendon. Authors have advocated against steroid injections due to the risk of tendon rupture outweighing any potential benefits. Studies have also been limited in the use of PRP (platelet rich plasma) injections for tendon pain. Significant methodological concerns have impacted this area of research including the lack of large human trials, lack of placebo or alternative treatment (exercise) comparison, and small sample sizes. Without improvements in this line of research, PRP remains an expensive, experimental treatment compared to other proven treatment strategies.

Strengthening exercises remain the gold standard of care, both in the research and our Boulder Physical Therapy practice, for these tendon injuries. Although eccentric exercise was first published in the late 1990s as an effective treatment for tendinopathy, many other forms of strength training including isometric and isotonic exercise have also been shown to be effective. The key take home message from these trials remains the same, injured tendons must be progressively loaded based on their clinical presentation to recover. Initially improvements in a patient’s symptoms and function are secondary to improved strength of the surrounding muscles while long term improvements are attributed to structural healing of the tendon (remodeling).

A recent review of the evidence highlights the importance of intensity or resistance during achilles strength training exercises for patients with mid portion achilles tendinopathy (Murphy et al. Br J Sp Med. 2019). Authors reviewed the available literature on the use of heavy eccentric training for this patient population compared to a wait and see or traditional Physical Therapy approach (modalities, massage). They reviewed the data from 7 studies and reported heavy eccentric training may be superior to a wait and see approach and traditional Physical Therapy. Authors also found a trend showing these heavy eccentric exercises may be less effective than other forms of exercise (isometric, isotonic).

This review is consistent with our current understanding on tendon management. Tendons should be progressively loaded based on the tendon’s tissue tolerance and irritability. Although eccentric exercise has become popular, other forms of exercise and loading strategies should also be considered as part of the tendon loading plan of care. When it comes to tendons, one size does not fit all.

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Higher Amounts Of Exercise Correlated With Greater Reductions In Neck Pain
deep-neck-flexor-exercise-chronic-pain

With the hypervigilance in abstaining from opioid prescriptions due to the opioid crisis, there has been an effort in determining alternate ways of providing analgesic effects for those in chronic pain. One of the most consistent modalities to help benefit with treatment is exercise. There has been many studies exploring the analgesic effect of exercise on pain and dysfunction as compared to pharmacological treatment. However, there has not been any literature supporting the appropriate dosage and intensity of exercise.

A recent study (Polaski, AM et al. PLoS One. 2019) performed a meta-analysis of many studies using exercise to help treat and manage chronic pain. The studies ranged from many different durations and intensities with different populations, all experiencing chronic pain. The researchers found a positive correlation between duration of exercise and decrease in neck pain. Duration could be constituted for amount of time during exercise, and/or number times exercising throughout the week.

If you are experiencing chronic pain, please seek counsel with your health provider to help guide you in designing a exercises program with the appropriate duration.

Upper Cervical Spine Treatment Improves Outcomes In Patients with Jaw Pain and Headache
boulder-jaw-pain-TMJ-TMD-treatments

Temporomandibular joint (TMJ) pain or Temporomandibular Disorder (TMD) is a painful condition limiting a patient’s ability to utilize the joint moving the lower jaw on the skull. When painful this joint limits an individual’s ability to eat, speak, and yawn. Pain is often felt in front of the ear over the joint surfaces. In addition to joint pain, patients often experience significant soft tissue and pain in the muscles involved in the aforementioned functions.

The upper cervical spine composed of the upper two vertebrae and the skull has an important contribution to TMJ function. These two regions of the upper quarter work closely together during normal head, neck, and jaw movements. Researchers and clinicians often find restrictions in the mobility and motor function of the upper cervical spine in patients with jaw pain. In our Boulder Physical Therapy practice, we find optimal outcomes after treating both regions in patients with jaw pain. A recent research article supports this treatment approach.

Calixtre and colleagues examined the impact of upper cervical manual therapy and deep cervical flexor strengthening in patients with TMD and headache (J Oral Rehabil. 2018). Authors randomized 61 patients to either upper cervical mobilizations and strengthening exercises or a control group. Patients in the intervention group received manual therapy and exercise interventions over 5 weeks. Authors reported significant reductions in both headache symptoms and oral, facial pain in the intervention group. This study highlights the importance of examining and treating adjacent body regions to the area of a patient’s pain.

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What Is The Best Exercise For Painful Muscles?
painful-muscle-muscles-treatment-exercise

Muscles can be a significant source of pain in our bodies. Chronic muscular pain may be found locally over the muscle or can be felt in an area distant from the muscle known as referred pain. Multiple Physical Therapy interventions including dry needling, foam rolling, and soft tissue mobilizations can be utilized in the short term to reduce these symptoms. Conversely, long term relief of muscular pain requires examination of the muscle to determine why it remains painful.

Muscle imbalances are a common reason behind these chronic symptoms. Muscles worked above and beyond their normal function will become painful over time. A common example in the hip is the TFL muscle in the presence of glut weakness. Short term solutions can target the TFL but long term relief is found by strengthening the glut muscles allowing them to perform their appropriate function at the hip in turn relieving forces across the TFL. A second muscle imbalance is found when the painful muscle is not strong enough to withstand the forces applied during activity. The long term strategy with this type of imbalance is to strengthen the muscle of interest. A recent research study examined the impact of strengthening this type of chronic muscle pain.

Anderson and colleagues examined the neck muscle performance of patients with neck pain compared to their pain free peers (Bio Med Res Int. 2014). Patients with painful neck muscles were randomized to either 10 weeks of high intensity neck strength training, general fitness training, or a control group. As expected, significant weakness was found in the patient’s painful muscles at baseline compared to their asymptomatic peers. Authors reported improved strength capacity of these painful muscles following the focused strength training program. Improved functional tolerance of the painful muscles allows these muscles to be more resilient to the forces applied to them each day.

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Elastic Band Resistance Training Found Equivalent To Gym Based Machine Weight Training
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The benefits of strength training are well established including improved bone density, metabolism, flexibility, body composition, and mental health. In addition, utilizing a strength training program 2-3 days a week on non consecutive days also slows the rate of sarcopenia or muscle loss due to aging. One of the main barriers individuals report for not exercising is time limitations and convenience of exercise. Driving to the gym to utilize an expensive membership may prevent individuals from strength training due to these barriers. A recent study demonstrates strength training does not need to be done in a gym to be effective.

Lima and colleagues randomized healthy middle and older aged adults to a resistance training program utilizing either conventional weight machines or resistance bands or a control group (J Sports Sci Med. 2018). Individuals in the exercise groups trained 3 days a week for 12 weeks with exercises designed to target the upper and lower body. The authors reported each of the exercise groups improved strength and functional capacity but no differences were noted between groups. It appears the most important training variable is not equipment but rather consistency to a resistance training program, as well as, choosing a challenging intensity during each exercise. Elastic resistance bands remain a low cost and portable option for individuals wishing to get stronger without going to a gym.

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