  An ACLR (Anterior Cruciate Ligament Reconstruction) is not only one of the most common sports injuries for level 1 sports (football, soccer, basketball, etc), but is also one of the longest recoveries from a surgical standpoint due a multitude of factors.
That attracts a TON of attention and research over the past few decades. We know more and more about the ACL and how it functions, but injuries continue to go up, to nearly 200,000 injuries per year! What is the ACL? The anterior cruciate ligament is a band of connective tissue that connects the shin bone (tibia) to the thigh bone (femur) and prevents forward movement / shifting and rotational forces of the tibia against the femur. This is critical in overall stability of the knee joint especially when it comes to athletic movements (sprinting, jumping, cutting, pivoting, etc). Types of ACL injuries:
Other Risk Factors Risk factors for ACL injuries include external factors (shoe choice and friction of playing surface, weather) and internal factors (bony morphology, hormonal, neuromuscular risk factors ). Gender Differences Women are 3x more likely to tear their ACL … the reasons are unclear but there are some theories and some factors backed by some research.
Grades of Injury: An ACL injury is classified as a grade I, II, or III sprain
ACL Reconstruction Rehab is a MARATHON. Especially for an athlete, the return to sport timelines are along the lines of 8-12 months depending on the sport and athlete presentation. Rehab consists of attaining prior range of motion, strength, power, agility and working on specific return to sport requirements and skills so that the athlete feels confident with athletic movement and has the objective data to back it up. Although returning back to sport is always the goal, research shows that just 65% of athletes return to their prior level of function and play! This is an extremely low lumber in our opinion and we feel that number should be much higher. This is where the importance of having a therapist that specializes in ACL reconstruction surgical rehab is very helpful due to the specialty of services and specific progressions necessary for a successful return to sport.  You most likely have seen splints in a variety of local drug stores. When seeking relief from pain or injury many of us will turn to a readily available solution, like a generic store-bought splint. However, these generic splints cannot be customized to fit your body, might not even be an appropriate solution for addressing your pain, and oftentimes leave users in more pain or discomfort. What you see is what you get with those splints. Luckily, at Alliance Physical Therapy we provide custom splinting, designed for your body and to address your specific needs, right in the clinic! Custom splinting is the use of temperature-sensitive thermoplastics to either immobilize or mobilize structures to promote healing or function. Hand therapists are experts in fabricating these splints (also known as orthoses) for patients. So…how is a custom splint made? Well the steps are fairly straightforward, but making the splint takes a lot of skill and practice. Because the splint is fitted to each patient’s particular anatomy, we first create a pattern which is then used to cut out a template from a sheet of hard thermoplastic. This template is then heated to over 160 degrees to cause the temperature-sensitive material to become pliable. After it cools down, the material is placed and molded directly on the patient, providing a fit matching the curves and contours of the client and holding the joints in appropriate alignment. Thus, splinting is a very effective way to facilitate a patient’s recovery for a variety of conditions. A common group of diagnoses for which splinting is indicated is repetitive use disorders. These include tennis elbow, golfer’s elbow, DeQuervain’s tenosynovitis, trigger finger, carpal tunnel syndrome, and many others. These types of conditions are caused by overuse of muscles that cross a specific joint or by compression caused by the joint motion itself. Wearing a splint prevents movement of the relevant joint which allows irritated structures to rest, and, along with a therapy program, can resolve symptoms. We also frequently see people after surgery where positioning of healing structures is critical. A custom splint places the hand or arm in the proper position to protect the integrity of the surgery and allow affected structures to heal properly. An “off the shelf” splint is rarely a good idea after most surgeries as a tailored fit is required to influence very specific joints, accommodate any hardware (e.g. pins), and allow for swelling that often occurs after a surgical procedure. The splint can also be cut down over time to allow more movement as healing progresses. Another group that benefits from splinting are those with degenerative arthritis. Osteoarthritis often first manifests at the joint at base of the thumb, also known as the carpometacarpal (CMC) joint. The CMC joint gets a lot of use, especially for those that have occupations that require forceful use of the thumb. This joint can break down over time, leading to joint instability and painful subluxation. A custom splint provides the external support the thumb needs to compensate for the internal support the joint no longer provides. Patients often recognize immediate pain relief with use of a splint and, with accompanying education from the therapist, become more functional with daily activities. Though splinting can be highly effective for a wide variety of conditions, it is only an adjunct to therapeutic treatment. Long-term splint wear is rarely indicated and should be weaned based on healing and symptoms. Splint wear without a therapy program can lead to joint stiffness, weakness, and other problems. Splinting can prevent further injury, but does not repair the body. Splinting and a comprehensive therapy program work hand-in-glove to resolve the underlying pathology while preventing further structural damage. At Alliance Physical Therapy, we specialize in treating the upper extremity and splinting is one tool we use to help patients recover and return to their favorite activities. If you would like to find out if you are a candidate for a custom finger, hand, wrist or elbow splint (Orthoses), talk to your physician for an OT referral or contact our office for a free consultation (307) 328-3228.  What is tennis elbow?
Tennis elbow, also known as lateral epicondylosis, lateral tendinosis, or lateral epicondylitis, is a condition that involves tendons located around the outside of the elbow. These tendons, which anchor muscle to bone, work to extend the wrist or fingers. Over time these tendons degenerate, weakening the attachment site and placing a strain on the muscles. Photo from: orthoinfo.aas.org What are the symptoms of tennis elbow? Patients complain of pain around their elbow, usually on the bony point just above the outside of the elbow called the lateral epicondyle. The area may be tender to touch. Patients may report weakness and an inability to perform their normal activities of daily living, such as lifting a cup of coffee. What causes tennis elbow? Many patients diagnosed with tennis elbow have never played tennis at all! Any activity, such as gripping or repeated grasping, can strain the tendon attachment to the lateral epicondyle. The most common age group is between 30-60 years old, although it can occur in younger and older patients. What is the treatment for tennis elbow? Conservative (nonsurgical) treatment through a physician can include anti-inflammatory medications and steroid injections into the painful area. A physician can also provide a referral to a qualified hand therapist. Surgery is often only considered if the pain is severe, and/or symptoms have been present for six months or longer. What can a therapist do for me? A physical or occupational therapist can provide conservative management for the treatment of tennis elbow, with the goal to return the patient back to normal work, home and sports activities. A therapist can help identify what activities might aggravate symptoms, and discuss activity modifications. A custom-fabricated brace or orthosis for the wrist might be recommended to rest the area. Various treatments can be utilized, such as heat, ice, ultrasound, massage or electrical stimulation and functional dry needling. The therapist will often prescribe stretching and strengthening exercises. Following any surgery for tennis elbow, therapy is important to regain motion and strength. If you have any specific questions about tennis elbow, or want to see if we can help manage and treat your injury, stop by for a free consultation or call any of our 3 Alliance locations for an evaluation.  It's a common misconception that exercise during pregnancy is only safe for women who were physically active prior to becoming pregnant. However, according to the American College of Obstetricians and Gynecologists (ACOG), pregnancy should be viewed as a time to embrace healthier lifestyles regardless of how active or healthy you were prior to pregnancy. (1) ACOG states that it is safe to continue exercising, or begin exercising if you are healthy and experiencing a normal pregnancy (1). There are certain conditions or complications that make exercise unsafe during pregnancy so we recommend always consulting your obstetrician prior to beginning an exercise routine. Once cleared by your doctor, establishing an exercise routine during pregnancy can be very beneficial to you and your baby. In an article released by ACOG, Physical Activity and Exercise During Pregnancy and the Postpartum Period exercise during pregnancy has shown many benefits including;
In regards to exercise, ACOG makes the following recommendations:
Another great source of information, The 2019 Canadian guideline for physical activity throughout pregnancy recommends the following; (The following recommendations are intended for women without conditions or complications that would contraindicate exercise during their pregnancy. Please talk with your doctor to decide what is best for you and your pregnancy.) (2) 1. “All women without contraindication should be physically active throughout pregnancy.” 2. “Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications.” 3. “Physical activity should be accumulated over a minimum of 3 days per week; however, being active everyday is encouraged.” 4. “Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial.” 5. “Pelvic floor muscle training (PFMT) (eg, Kegel exercise) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction on the proper technique is recommended to obtain optimal benefits.” 6. “Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position.” Did you know that less than 15% of women meet the minimum recommendation of 150 minutes of moderate intensity physical activity during pregnancy? (3) At Alliance Physical Therapy, we have a pelvic floor physical therapist and a Postpartum Corrective Exercise Specialist that want to help you navigate this exciting time in your life! We have the skillset to help manage:
Sources:
 Medical Imaging for this article’s purposes consists of MRI, xray, CT scan, etc (there are a plethora of other tests, but these are the most common for musculoskeletal conditions). These are typically seen as the gold standard for diagnosing musculoskeletal injury and conditions. They’re very valuable because they provide a much deeper look at what's going on. They also provide significant insight that we couldn’t receive without surgically going in and looking. For instance, If I fall and twist my knee, and am having instability, pain, swelling, etc. The MRI will do a fantastic job at ruling out an meniscus or ligament tear. This would help the provider and patient in decision making on surgical or non surgical outcomes. THIS IS A GREAT TOOL for many instances. However, it’s not all peaches and cream with imaging. Here’s where it gets tricky. Some conditions are completely normal for most people and medical imaging doesn’t give us the whole story. This is a fact and we know this through the research. A study by Yamamoto (2011), proved that of the 283 subjects, 65.4% showed rotator cuff tears and had no symptoms involving the shoulder. Another study by Nakashima (2015), analyzed 1,211 HEALTHY volunteers with NO PAIN ages 20-70 years for presence of disc bulging. “Most subjects presented with disc bulging (87.6%), which significantly increased with age in terms of frequency, severity, and number of levels. Even most subjects in their 20s had bulging discs, with 73.3% and 78.0% of males and females. (See the visual below for more examples in the study. Remember, these percentages were people WITHOUT pain/symptoms!  Another study done by Herzog (2017) took ONE single patient. The patient had 10 MRIs done in 3 weeks taken by 10 different radiologists. What they found might surprise you! 49 different issues were reported…. but ZERO findings were reported across all 10 reports! This goes to show the degree of high variability in the reported findings of the SAME patient within a short time period.
As you can see, it is extremely important to match up clinical findings with the imaging. This gets even more important with chronic conditions that just gradually came on over time. So if a 50 year old presents with generalized low back pain across both sides of the lower back and wants to get an MRI, a bulged disc is more likely than not going to be present on the MRI ! The conversation quickly can move to discuss surgical options (discectomy or even fusions) when in reality we don’t know for certain if the bulged disc is causing the pain. Especially because there were no signs of radiculopathy (pain down into the leg, numbness, tingling, etc) This is why it’s critical to match clinical signs and symptoms with the MRI. MRIs help exclude serious and sinister issues, but they don’t always tell us exactly what is causing pain. This has led much of the medical community to simply call these common conditions “wrinkles on the inside.” When you hear words like “degenerative disc disease, arthritis buildup, spondylosis, bone on bone” don’t panic. Some amount of this is completely normal with aging! To recap: medical imaging as a GOOD THING. And it provides us with many answers we would otherwise wouldn’t have. However, we need to use caution especially with decision making on more chronic conditions and conditions that don’t match up clinically! Cheers!
By women’s health specialist, Kerry Breen, PT, MPT, ATRIC
You may be wondering what pelvic floor muscle dysfunction is, and how physical therapy can help when your pelvic floor muscles are not working optimally. First, it is helpful to know where the pelvic floor muscles are located and their roles and functions. This helps you to understand how your pelvic floor muscles may be contributing to some of the problems associated with pelvic floor muscle dysfunction, such as urinary incontinence, pelvic pain, and/or pelvic organ prolapse. For a simplistic explanation, the pelvic floor muscles consist of 3 layers of muscles that cover the bottom of your pelvis and have 3 distinct roles. These roles consist of the three S’s: Supportive, Sphincteric, and Sexual. Let’s review these roles in more detail:
Problems with the pelvic floor muscles are very common, and many of us, our friends, or family members may be experiencing symptoms related to pelvic floor muscle dysfunction. In fact, one in four women are experiencing at least 1 pelvic floor muscle dysfunction. As a PT who specializes in women’s pelvic floor evaluation and treatment, I provide education and valuable tools that have a significant impact on the symptoms of pelvic floor dysfunction. Please open the attached Cozean Pelvic Dysfunction Screening Protocol and use this as a tool to help determine if you may benefit from physical therapy. If you have any questions about physical therapy for women’s pelvic health, please do not hesitate to reach out to me at Alliance Physical Therapy.  Putting an end to “1 Rep Max Living”
According to a recent article from, The Lancet, a prestigious medical journal, “Taking into consideration current evidence about the benefits of exercise for older adults, it is unethical not to prescribe physical exercise for such individuals." We all know by now that diet and exercise are key and lead to nearly every positive outcome we could dream up. But how important is it as we age? How many older adult friends, family, peers or acquaintances do you know that are no longer able to live in their home safely? The story usually goes something like this... ‘He/she was active in their younger years, got busy in their middle aged life, slowed down after retirement and after 15 years are not safe alone in their own home due to being a fall risk with a lack of safety awareness to continue living independently. What if we could change that? Is it possible? ABSOLUTELY The number one reason (cognitively intact) adults are no longer able to stay independent and safe in the home? WEAKNESS! They no longer have the strength to get up off the toilet. (one of the most common 911 calls) They no longer have the strength to get up off the floor if they do fall. They require a walker or wheelchair for mobility. They cannot safely tolerate going up and down stairs for activities of daily living (laundry, etc). They cannot safely shop, do laundry, clean, so on and so forth. We call this 1 rep max living! The normal day to day activities (ADLs) are demanding maximal effort instead of being simple, safe and light activity. For example, a healthy adult could hopefully squat 100lbs, pick up and carry a few grocery bags, and lunge their body weight 15x. On the contrary, someone who is max rep living is doing the basics at their maximum intensity! How exhausting and unsafe must that be? Most shockingly, a large majority of people think this is a normal, inevitable part of life! Strength and balance training in older adults is beyond crucial to not only maintain an independent lifestyle, but how about actually enjoying the golden years traveling, keeping up with the grandkids, and gardening into your 70’s, 80’s, and 90’s! THRIVING, not just surviving. With that being said,
If you answered no to any of this three part assessment, it is CRITICAL you start working on your balance, strength and mobility! The next big question … where do I, or my loved ones start? Constantly varied functional movements performed at relative high intensities. Let’s ignore that this is the definition of CrossFit (another article for another time :) Breaking this down: Constantly varied : there needs to be a variety of movements within the program Functional movements: squat, deadlift, lunge, carry, push, pull, press. These 6 things represent the majority of movements in daily life. (picking up groceries, getting off of low seats, etc) Relative high intensities: This is individualized to the person, but either way, the person must be working at a load and intensity that is challenging This can be accomplished at home, at a gym, or if safety is an issue or more guidance is desired, your favorite physical therapy clinic would be happy to work with you. Cue the Older Adult Mobility Improvement Program We developed a program within our clinic to fit this exact need. Our program starts with assessing baseline function with 4 standardized tests to measure strength, balance and fall risk for each individual. Our expert therapists go through the program with the patient and progress strength, balance and mobility while working toward the specific goals set by the patient and therapist. An individualized home program and specific instruction allows for progress to be made each and every day and progress will be reassessed as you move forward with this program. Bottom line = it’s never too late. You can do something about the future to ensure you’re thriving, not just surviving and we can help guide you along in this journey! Cheers!  So... you’re dealing with a pesky injury, having surgery, or looking to improve your function with daily activities...you need physical or occupational therapy! But now what?! Nowadays, you can walk into 5 different clinics, and receive five different treatment plans, with five different possible evaluations/prognosis. This is okay, but it just goes to show that not all therapy is the same!
Before you even hire a therapist, GO VISIT! Stop in, check out the place and ask any questions you have regarding injury. This is a great way to interview and gather a first impression before committing to the first session. With that being said… Here’s 5 things you need to consider when looking for a therapist! 1. They Are Licensed! Above all else, make sure you’re receiving care from a licensed therapist and/or Physical Therapist Assistant. Check for the license/degree on the wall, their business card, or website for credentials. The following are appropriate abbreviations for therapy fields including PT, MPT (Masters of Physical Therapy) or DPT (Doctorate of Physical Therapy) and OTR/L (Occupational Therapist). This seems straightforward, however, there are places of service that may offer “physical therapy” by an individual without appropriate credentials. A physical or occupational therapist is a licensed professional that has passed board certification and rigorous schooling to diagnose impairments and treat musculoskeletal conditions and much more. 2. They Explain Simply and Effectively A good rehab clinician should be able to succinctly and clearly provide you with explanations and treatment plans that are agreed upon and understood. You should be able to leave the evaluation with a clear idea of recovery time and the factors that play into the recovery estimation. A good PT will also be able to answer your questions with terminology and jargon you understand. 3. They Re-evaluate Before starting on the bike, and heading straight into treatment without discussion can have an impact on your treatment. It is important to go over how you are feeling and discuss what struggles you are facing from the last treatment and what you improved on. It is very crucial to have an open discussion with the therapist to have the best possible outcome in your recovery. This ensures that both parties are on the same page and the treatment can be directed accordingly. 4. They Provide Value! This one is huge! Remember you are going for a reason….to increase function, to decrease pain, and to return to some level of activity. The therapist should be showing you every so often where you were vs where you are now and how it relates to your goals. At the end of therapy you should feel like your time and money is worth the value being provided! Now it is important to remember that slow progress is still progress and every situation is different from someone else's. Multiple factors can play a role in rehabilitation time. Bottom line is it takes time to recover and you have to trust your therapist to ensure the results you want. 5. You Feel Heard As a patient, remember you have a choice in your rehabilitation. Take control of your health and make sure to tell the full story and provide information that is important to the injury. By doing that your provider can make a correct diagnosis and plan going forward. We never want it to be the case where you feel confused and left unheard. That is why it is important to pick a therapist that you feel comfortable with and both feel like you are on the same page. BONUS Providing 1 on 1 Care One on one care is not only important, but it should be the standard in physical therapy. After all, we are professionals and by getting treatment with us we are able to give proper feedback, cueing and make modifications so you don’t end up in more pain and dysfunction. Sure, physical therapy technicians are great in some capacity but it is important to have a licensed therapist/therapist assistant helping in your rehabilitation and getting you back to your prior level of function. These are just 6 of the many aspects of an exceptional therapist and clinic. Hopefully this helps your search. Let us know if you have any questions regarding your care! As always, stop by and check us out! |
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