Posts in Injury Treament
Early Physical Therapy for Muscle Injuries Accelerates Recovery and Return to Sport

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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Should I Perform This Exercise On Both Sides?

At Mend we provide many treatments to our Boulder Physical Therapy patients, but strength training is the common treatment between all patients and conditions.  Often we prescribe an effective resistance training exercise leading to quick gains in strength.  This rapid increase in strength over the first 6-8 weeks of an exercise program is due to nervous system, not muscle, adaptations to the exercise.  These adaptations include improved communication between nerves and muscles, coordination of muscle firing, and effort by the nervous system to complete the exercise.  As the new exercise is performed each week beneficial effects are noted throughout the body.

Previous research has shown improved balance and strength in limbs, which were or were not exercised.  For example, patients given a right leg balance exercise improved their balance on the right side, as well as, on the left.  In turn patients who were given a left leg strengthening exercise also showed strength gains on the right side.  The mechanism behind these strength gains is called cross education and involves the nervous system’s ability to coordinate the movement required during the exercise.  Untrained limbs demonstrate up to 20% strength gains after completion of the trained limbs exercise program (Munn et al. 2004).

A recent study was conducted on cross education to determine the impact of a 4 week unilateral strength training program on the untrained side.  After 4 weeks of training strength gains were noted in both the trained and untrained legs, but greater gains were noted in the trained limb.  Consistent with prior research only the trained limb demonstrated improvements in muscle size and thickness indicating the untrained limbs gains were mainly due to nervous system adaptations. 

This study adds support to the importance of exercising both limbs when learning a new exercise.  Exercising each side of the body helps establish necessary nervous system adaptations, which lay the groundwork for future muscle growth and strength.  Additionally, athletes and patients who are unable to exercise due to injury, immobilization, or weight bearing status are encouraged to exercise their uninvolved limbs.  This allows the body to maintain strength and attenuate the negative effects of immobilization such as muscle atrophy. 

To learn more about how cross education can help accelerate your return from injury contact your local Physical Therapist

Resistance Training the Aging Adult and Injury Prevention

There are few treatments more effective for the prevention and treatment of injuries and musculoskeletal conditions than resistance training.  Unfortunately, many Americans are not performing enough strengthening to prevent the loss of muscle mass (sarcopenia) which begins to occur in the 3rd decade of life.  After age 30 we begin to demonstrate a progressive loss of muscle mass, strength, and endurance due to the aging process.  Thankfully, this loss can be attenuated with strength training, but not solely aerobic and endurance training (Klitgaard et al. 1990).  This loss of strength becomes a risk factor for many health conditions including low back pain and knee osteoarthritis.  

It is important to note age does not seem to influence an individuals ability to perform strength training exercise.  A review article reported an average strength increase of 25-33% in older adults who began a strength training program (Peterson et al. 2010).  Participants performed 2-3 sets of 8-10 repetitions per exercise targeting major muscle groups 2 to 3 days per week.  These programs have also been shown to improve an adult's quality of life and prevent conditions such as osteoporosis, knee osteoarthritis and back pain.  

It is never too late to begin an exercise program and adults are encourage to speak with a local Physical Therapist to design a safe and effective exercise program to improve their quality of life and athletic performance.  

Dry Needling for Muscle Pain

Dry Needling performed by licensed Physical Therapists is gaining momentum in clinics and research trials across the country.  This intervention can be an excellent treatment for patients suffering from pain and trigger points within their muscles.  Trigger points are hyper irritable bands of tissue contributing to pain, loss of flexibility, and impaired strength in patients.  The dry needling technique leads to beneficial physiological changes in pain, circulation, nervous system function, and muscle performance.  When combined with other proven Physical Therapy interventions such as manual therapy and exercise, dry needling offers patients lasting relief of their symptoms.  

A recent review of available research trials (randomized controlled trials) on the effectiveness of dry needling was performed to determine the treatment's effectiveness on trigger points in multiple body areas (Boyles et al. JMMT. 2016).  19 research trials were investigated by the authors including over 1000 patients.  Authors noted the available high quality evidence supports the utilization of dry needling for multiple muscle groups with improvements noted in pain, range of motion, and quality of life.    These improvements were noted in all regions of the body including the head, trunk and extremities.  

Patients are encouraged to discuss the appropriateness of dry needling for their pain and symptoms with their Physical Therapist.

Chronic Injuries
boulder chronic pain injury treatment solutions

New data shows 1 in 2 Americans report at least one chronic medical condition affecting the musculoskeletal system.  This number far outpaces other chronic conditions affecting the heart, lungs, metabolic system, or cancer.  Examples, include low back pain, knee pain, osteoarthritis, neck pain, and post operative conditions.  Thankfully, research supports treatments provided by Physical Therapists aimed at reducing pain and improving function among these patients.  Do not let nagging injuries or surgeries get in the way of your life and activities.  Ask a local Physical Therapist to assist in your recovery. 

Exercise as Medicine

At Mend, we provide every patient with an individualized exercise program specific to their condition.   These programs are focused to deliver optimal results in the least amount of time possible.  Exercise is one of our most powerful interventions to eliminate pain and restore function without the use of more risky medications or surgery.  The American College of Sports Medicine has launched an Exercise is Medicine campaign to heighten the awareness of this powerful tool.  In addition, evidence continues to mount on the beneficial effects of exercise on our physical, mental, and emotional health, as well as, its' impact on many chronic illnesses. 

A recent literature review in the Scandanavian Journal of Medicine and Sports in Exercise highlighted the evidence behind the use of exercise on 26 chronic health conditions from Depression to Dementia (Pedersen et al. 2015).  The authors explained the exercise parameters most effective to combat each disease, as well as, the evidence on how exercise may impact the development and progression of each disease.  A list of the 26 conditions can be found below.  To learn more about how you can utilize exercise to help treat your condition contact your local Physical Therapist.

Psychiatric Diseases
Neurological Diseases
     Parkinson's Disease
     Multiple Sclerosis
Metabolic Diseases
     Metabolic Syndrome
     Polycystic Ovarian Syndrome
     Type I and II Diabetes
Cardiovascular Diseases
     Cerebral Apoplexy
     Coronary Heart Disease
     Heart Failure
     Intermittent Claudication
Pulmonary Diseases
     Cystic Fibrosis
Musculoskeletal Disorders
     Back Pain
     Rheumatoid Arthritis