WRAPPED UP WITH TAPE By Michelle Olson PT

Have you been wondering what all that pink and blue tape you saw on the Olympic athletes was?  It is called Kinesio tape.  Kinesio tape has been used for decades, most popular with athletes in the last decade.  During the 2012 London Olympics many athletes were seen with all sorts of taping over their bodies from volleyball players with tape on their abdomens or shoulders to track athletes with tape on their legs, even some Ping-Pong players.    Kinesio tape is used to Re-educate the neuromuscular system, reduce pain, optimize performance, prevent injury, and promote improved circulation and healing.  As you can see, Kinesio tape is used in many different ways, however the main purpose is to inhibit or facilitate the normal response of soft tissue.

Kinesio tape was developed with texture and elasticity or stretch, to closely mimic that of living human skin.  Kinesio taping works by activating the neurological and circulatory systems to promote the body’s natural healing process while providing support and stability to muscles and joints without restrictions.   The tape microscopically lifts the skin when applied with the proper degree of tension.  In doing so this can trigger the receptors in the somatosensory system and facilitate the lymphatic drainage system.  The Kinesio tape can be applied over muscles to reduce pain and inflammation, relax an overused muscle, and/or to support muscles in movement.

The elastic property of the tape allows for full motion and use of your body without limitations in movement, as opposed to rigid taping methods that we have seen used in the past with injuries. With many injuries it has been found that it is not necessarily the joint or the bone, but the muscles or imbalance of the muscles that is the source of the pain.

The tape itself is latex-free and wearable for days at a time.  It is safe for pediatric to geriatric patients, treating orthopedic, neuromuscular, neurological, scar management, and many other medical conditions.  Evaluation of the deficit, injury or disability is necessary in order for a trained professional, such as your Physical Therapist, to apply the tape and achieve the desired result.  Physical therapist use Kinesio tape as yet another tool to help restore your health and activity level; it is not used as the sole treatment in most cases and is combined with specific exercises/stretches to balance the body.

How are you viewing the world around you?

Are you or your child looking at the world from a different viewpoint? Is your head tilted to the side preventing you or your child from seeing straight? Torticollis, also known as “wryneck”, is a condition in which a child’s head is tilted.   Torticollis can also be seen in adults as well as children, but most commonly found in infants.  Congenital Torticollis is seen in infants and typically caused by either a tightening of the anterior muscles of the neck, a flattening of the back of the head or a combination of the two.  The flattening may be due to poor positioning of the fetus in-utero, damage to the muscles or blood supply to the fetus’ neck, or a low level of amniotic fluid.  The tightness of a specific muscle pulls the head sideways toward the shoulder, turning the face in the direction of the opposite shoulder, and bringing the head forward to the chest.  Habitually spending time in this position frequently causes other neck muscles to tighten.  The inability to turn the head symmetrically may restrict a child’s ability to freely see, hear, and interact with his/her environment.  This can potentially lead to a delay in development.

In adults and older children, torticollis is more often categorized as: Inherited, Acquired or Idiopathic.   Inherited Torticollis is due to specific changes in your genes.  Acquired Torticollis develops as a result of damage to the nervous system or muscles.  Idiopathic Torticollis is the name given for an unknown cause.

Treatment of the condition is determined both from presentation of symptoms as well cause of the torticollis.  Treatment may include medical intervention or physical therapy.  Physical therapy may include moist heat, mechanical or manual traction, soft tissue mobilization, massage, and stretching of the specific neck muscles.  With older adults, physicians may prescribe medication to relax the muscles or injections to temporarily relieve the torticollis prior to beginning physical therapy.  With young children it is extremely important to have the parent involved with developmental activities (ie. positioning/holding) and education.  Congenital Torticollis is most successfully treated if started prior to 3 months of age.   The key component in the recovery of this condition is early intervention, physical therapy, education, home exercise, and parent involvement.

Those Pesky Ankle Sprains

How many people out there have twisted their ankle?  I would say more than half of us have twisted our ankle at one time or another.  It may have been caused by landing on someone’s foot after coming down with a rebound, maybe cutting wrong on a soccer field, rounding one of the bases on a baseball field, or even slipping on the dreaded ice that has been around the hill country lately!  Whatever the cause, the result is still the same: swelling, tenderness, and pain around the ankle.

Ankle sprains can range from mild to severe.  On the outside of the ankle there are 3 large ligaments.  The most commonly injured ligament is the anterior talofibular ligament.  It is stretched or torn when the body lands on a foot that is pointed down and inward.  Some studies say as many as 95% of all ankle sprains are this type.   The body responds with quick, sharp pain especially with weightbearing.  Followed by bruising, tenderness, and swelling along the injured ligament.

What can I do for it?  Everyone should follow the simple PRINCE technique for the first 24-72 hours.

P: protection such as an air splint

R: rest or use crutches until you can walk without pain

I: ice for 10-20 minutes every hour for the first 24-72 hours

N: NSAIDS such as Advil or Motrin

C: compression such as an ACE bandage

E: elevation above your heart for 2-3 hours a day

If that doesn’t take care of your ankle, then you may need to head to your doctor for a proper diagnosis.  Your doctor will test all your ligaments, possibly order Xrays or MRI, but only if needed.  Your doctor may also order some physical therapy.  It has been shown that early mobilization/movement in a pain free range is the most important step to a quick recovery.  Simple ankle pumps, towel curls, and ABC’s can be started immediately. Your physical therapist will design an individual plan to restore your full active range of motion, improve your weightbearing tolerance, decrease your pain, increase your strength, improve your proprioception, and return you to your prior level of activities whether that is intense athletics or walking around your yard.

So, if you have a pesky ankle sprain and need some help, please call Kethley Physical Therapy . Stay tuned next month as we discuss how Kethley Physical Therapy is “Keeping Dripping Springs Moving!”

To Lift or Not To Lift?

What do you know about aging muscles? Most people do not realize that we reach our peak strength in our 30’s, and there is a gradual decline every decade after that. Loss of muscle mass then starts to accelerate in our 50’s. However, advancing age is only partially the culprit. Declining levels of activity are also responsible for losses in muscle mass. There are multiple health implications that result from lack of activity.  They can range from an increased risk of falls, trouble lifting objects like boxes and dishes overhead, climbing up and down stairs, and standing up from a sofa or getting up from the ground.

When we think about lifting weights, what normally comes to mind are action movie stars with huge muscles, and catch phrases like “I’ll be back.” But the everyday non-movie stars need strength and power too! Every time we stand up from a chair, we sit up in bed, pick up a grandkid or pet, we require power from our muscles. The strength we have when we are young will not remain over the decades unless we continue to use it.

How do we fix this problem? Adults of all ages should perform regular exercise, and it is never too late to begin a weight lifting program. Studies have shown that older adults adapt very well to a weight training program that consists of 2-3 workouts per week, and have noticeable increases in muscle mass. Another great aspect about weight training is that it has been shown to increase bone density and fight osteoporosis (thinning of bone). Aerobic training provides many great health benefits, however has not been shown to increase bone density.

Weight training recommendations for older adults are the following: a frequency of 2-3 days per week (two is preferred to allow enough recovery time), 8-15 repetitions, and 2-4 sets. The recommended intensity is 60-80% of a person’s 1 repetition-maximum. The 1 rep-max (or 1 RM) is a calculation of the maximum amount of weight a person can lift in a single repetition for a given exercise. There are various ways to calculate the 1 RM, and all should be performed carefully under the supervision of a professional.

As with any health condition, consult with your doctor before making any changes to your exercise program, or beginning a new one, and be sure to work with a licensed physical therapist  trained in working with the older population.  You can go to www.APTA.org and search for more information on the benefits from weight training.

By: Brenda Walk, SPT

Sports Injuries

Football, basketball, soccer, cheerleading, baseball, softball, swimming, marching band, volleyball, track, dance, tennis, and golf are just a few of the athletic activities that we participate in on a day to day basis. Sports injuries can range from plantar fasciitis from running too much, patellar tendonitis from jumping, then all the way to a torn anterior cruciate ligament after sprinting for the game winning touchdown.  As you can see, injuries are just a part of playing sports and if we play long enough, we will get hurt.

There are two types of sports injuries: overuse and trauma.  Traumatic injuries such as bruises to fractures are most common in contact sports such as football, rugby, and soccer.  Overuse injuries are due to repetitive stress of a certain tendon or muscle leading to tendonitis.  The first phase of healing starts with inflammation which is characterized by pain, swelling, heat, and loss of motion or function.  This inflammatory stage typically last 5-7 days.  One of the most common treatments is R.I.C.E. (rest-ice-compression-elevation).

Proper training and preparation are the best ways to prevent a sports injury during the season.  Strengthening your primary sports muscles and your core during the off-season is a big step. Making sure that your body is strong enough is key when playing sports. While in season, a warm-up program has been found to decrease injuries.  First perform some type of aerobic activity like jogging or jumping jacks to get your heart rate elevated and get some blood pumping to all your muscles.  Then, perform a series of static stretches of at least 30 seconds for 4 repetitions for each muscle.  After participating in your sport, follow it by another round of static stretches.  Another good tip in preventing an overuse injury is to make sure that you play different sports using different muscle groups.    Doctors believe that fatigue is a contributing factor to most injuries. Stopping an activity at the first sign of fatigue can prevent most sports related injuries.

If injured, seek out the advice of your physician and a physical therapist to help minimize your down time. Physical therapists are the primary medical professional to seek after an injury for treatment and further prevention. Physical therapy treatments such as interferential stimulation, kinesiotaping, ultrasound, ice, and iontophoresis all accelerate the healing process. Using different pieces of exercise equipment such as a bicycle, eliptical, or swimming pool will also help to decrease the impact of most sports allowing your body to heal quicker.

Science of Supplementation (2 of 3): Protein Supplements

Last month we discussed the benefits of fish oil for the body and mind.  This month we will look at some of the latest research on protein supplementation.  There is a great deal of research on how beneficial protein is for athletes to develop and maintain skeletal muscle, but we are going to focus on how it may affect a person recovering from a large surgery such as a total knee arthroplasty/replacement.

Protein is one of the three essential components in the human diet, along with carbohydrates and fats.  Protein provides the raw material for both muscle construction and repair, keeps a balanced pH level in the blood, helps the immune system, the endocrine system, and the transmission of nerve impulses.   All of these systems contribute to the overall health of a person and their energy level.  When a person has a large surgery, their body is working overtime to restart all the systems in the body and heal the injured area.  The body must get rid of and work through the anesthesia and other necessary medications.  Constipation, fatigue, diarrhea, and weakness are common side effects to surgery, and the last thing on most people’s mind is eating healthy.  This is where the additional of a protein supplement may have a great benefit.  Before we go any further, nutritional experts all agree that the best way to ingest protein is to eat a well-balanced natural food diet.  Some typical food sources of protein are eggs, cheese, milk, chicken, seafood, fish, beef, pork, lamb, veal, soy, nuts, and legumes.

If the body has a shortage of protein, a supplement will assist in the correction of the deficiency.  The body will not be able to repair and maintain muscle structure if it is in a protein deficient state.  On the other hand, if too much protein is ingested, it puts additional strain on the liver and then the kidneys. So, you must pay attention of how much protein you are getting in your diet especially after an injury to the muscloskeletal system.  When using a protein supplement, it has been shown to be more effective if consumed 30-60 minutes after exercise.

It is in my professional opinion, that a person should increase their protein intake after a large surgery to help balance and keep their body in a muscle repair mode.  The faster your muscles repair, the faster you recover.  The extra protein should first be ingested through a balanced diet and then through a protein supplement.  The supplement can be in the liquid form (like Boost or Ensure) or powder/pill form that you put in a shake.  If you have any other questions, please refer to your physician and/or nutritionist.

Written by:  Jeremy Kethley, PT

Running from the Injury

Whether you have just started running, training for a marathon, or running for recreation, injuries happen.  There are said to be 5 top injuries that affect most runners:  plantar fasciitis, achilles tendonitis, shin splints, chondromalacia, and iliotibial band syndrome.  Prevention of these injuries and early treatment are key so they do not affect the entire summer.  We have discussed plantar fasciitis in a previous article.  For the purpose of this article, we will concentrate on achilles tendonitis.

Achilles tendonitis is as an inflammatory condition of the achilles tendon, the large band, or tendon connecting the calf muscles with the back of the heel bone.  When this tendon undergoes too much stress it can tighten and be forced to work too hard.  The stress can cause the tendon to become inflamed, which in time can build scar tissue.

Have you felt dull or sharp pain along the back of the ankle? The pain can be felt anywhere along the back of the tendon, however usually it occurs close to the heel.  An inflexible ankle with redness or heat over a painful area, a nodule that can be felt on the tendon, and/or a cracking sound with ankle movement all can be indicators of achilles tendonitis.  The pain may occur gradually over a few days to months dependent upon the acute vs. chronic state.  This also determines whether the pain fades as the run continues and eases with rest or is constant.

Prevention includes stretching, hydration, strengthening, and proper shoe apparel.  Remember, a short warm up prior to stretching your calf muscles is important!  You should not stretch a cold muscle!  If an injury does occur, early detection followed by a short rest from running and rehab will hasten the recovery.  Rest from running and seeking the advice of a Physician are the first steps, anti-inflammatory medications, ice, and Physical Therapy to follow.  The goal of Physical Therapy is to reduce pain and inflammation, identify and correct the mechanics contributing to the injury, strengthening any muscle imbalances, and education to get you back running. Remember achilles tendonitis can be caused by a muscle imbalance at the hip or knee and that is where the professional guidance may be necessary. If taken care of properly, most injuries only last a few weeks and then you can return to running.

Physical Therapy: Is it for me?

Physical therapy is described by Wikipedia as a health care profession primarily concerned with the remediation of impairments and disabilities and the promotion of mobility, functional ability, quality of life and movement potential through examination, evaluation, diagnosis and physical intervention carried out by licensed physical therapists.  In simple words, physical therapists get you moving.  Our motto at Kethley Physical Therapy is “Keeping Dripping Springs Moving!”

When to see a PT?  Anytime is the answer that I prefer although realistically with everyone’s busy lives and schedule, it will not be until some pain is present before you seek treatment.  Your body has 206 bones and 600+ muscles and with all its moving parts, sooner or later it will have some trouble.  Pain is your body’s response to a movement dysfunction.  PT’s are the best at discovering the source of the pain whether it be in your shoulder, back, knee, or any of the other 360 joints in your body.

How do I see a PT?  In the state of Texas, physical therapists have direct access to evaluate anyone.  However, we cannot treat you unless the plan of care is signed by a medical doctor.  So it is best to go see your doctor and ask to go see a physical therapist.  We accept referrals from any medical doctor, dentist, surgeon, chiropractor, podiatrist, nurse practioner, and physician assistant.  Your doctor will decide whether or not further diagnostics are necessary.

What does a PT do?  After a complete evaluation, a physical therapist will discuss your goals and the treatment plan.  We use a combination of techniques consisting of pain reducing modalities (electrical stimulation, kinesiotaping, ultrasound, iontophoresis, parafin, ice/heat), therapeutic exercises, neuromuscular re-education, gait training, mechanical traction, education, therapeutic activities, and/or manual therapy that may consist of joint manipulation/mobilization, soft tissue mobilization, and nerve glides.  As you can see, physical therapist have a ton of resources at our fingertips to help keep you moving.

So the next time you are having foot pain from running too much, back pain from lifting wrong, or knee pain when you get up in the morning, go see your doctor and ask them for physical therapy.  We can get your joints moving and help restore your prior level of function.  

Back Pain?

Did you know that 80% of people have experienced back pain at some stage in their life? Well it’s true, but that doesn’t mean that you have to live with back pain. Back pain can be caused by a number of structures, and can be resolved or prevented with physical therapy. Discs, nerves, muscles, ligaments, and joints can all be culprits of your back pain.

The most noted cause of back pain is the herniated disc. This may be because of the extreme pain it may provoke as the disc irritates the nerve that can affect the leg all the way down to the foot. The disc itself is a fluid filled fibrous ring that attenuates compressive forces of the spine. The disc can be disrupted or herniated due to repetitive movement such as bending over, or by one traumatic incident such as a fall. Either way, if you experience this kind of pain, you may benefit from physical therapy and should see your doctor as soon as possible. Because the longer you let your back pain continue, the longer the healing process will take. Now we’ve talked a little about herniated discs, it is important for you to know that 60-70% of people walking around with no sign of back pain have herniated discs. So even though you may have a herniated disc, it may not be the cause of your back pain.

Back pain can also be caused by a combination of muscle imbalance, including weakness and tightness, ligamentous tension or lack there of, and joint dysfunction. This kind of back pain most often eludes MRI’s and X-Rays. It is not easily seen through imaging, but can be distinguished by your physical therapist with strength and flexibility testing, palpation of bony landmarks, and with special tests to determine type of joint dysfunction. Reduction of the joint dysfunction by your physical therapist will decrease muscle and ligamentous tightness. After that, strengthening your core musculature is a huge part of recovery from back pain. This is where prevention of having another episode of back pain begins.

As we age, the chance of having another episode of back pain increases. The toll of gravity, poor body mechanics, and our previous back pain can be the culprit of spinal arthritis, or degenerative back pain. This kind of back pain may be called degenerative disc disease (DDD), spondylosis, or spondylolisthesis. This is where your disc height decreases leaving less space for the nerves, and your spine starts to slowly slip one vertebra on the other causing further narrowing of space for the nerve. This type of back pain is relieved by introducing flexion to the spine and incorporating core strengthening exercises into your daily routine to stabilize the spine.

If you are experiencing back pain, see your doctor as soon as possible and schedule a physical therapy examination. It may be the best thing you will do for yourself this spring!

New Year, New You?

Article written by:  Erin Kethley, MPT

After the overindulgence that the holiday season seems to inevitably bring, it’s no wonder that many people make New Year’s resolutions that involve getting healthier.  In fact, it is estimated that about one third of New Year’s resolutions involve weight loss and/or beginning an exercise program.

Sounds like a great idea, right?  But, unfortunately, all too often these resolutions are short-lived.  Many times people start out too aggressively and find themselves suffering with excessive soreness or even an injury.  The key is to start out slowly and gradually progress your exercise program.  People often forget that they didn’t get out of shape overnight so they shouldn’t expect to become physically fit overnight either.

If you start to start to experience pain or get injured, you should not try to work through it.  Pain is our bodies way of letting us know that something is not right.  But, it doesn’t mean you should abandon your whole exercise program either.  Modifications can be made to accommodate your injury.  For example, a shoulder injury doesn’t prevent you from doing leg exercises.

If you are experiencing any type of pain with exercise, it should not be ignored.  Most of the time, acute injuries are significantly easier to treat than more chronic ones.  For example, if you are experiencing shoulder pain, it could be some tendonitis caused by an impingement in your shoulder joint.  Some over-the-counter medication may reduce the pain, but will not fix the problem.  Physical therapy can address any underlying muscle weakness or imbalances that could be the culprit.  If the underlying issues are identified early and treatment is initiated, these acute injuries are usually easily and quickly treated. But, conversely, if you continue to ignore painful symptoms and wait to seek treatment until the condition is much worse, then treatment can be long and much slower.  In our previous example, that simple shoulder tendonitis could end up resulting in a rotator cuff tear.

Don’t let pain or an injury de-rail your New Year’s resolutions this year.  Seek treatment at the first sign of pain or injury in order to prevent that acute problem from becoming a chronic and potentially costly one.  As always, Kethley Physical Therapy is working every day towards our goal of “Keeping Dripping Springs Moving!”

Happy New Year to you and your family Kethley Physical Therapy