Therapy Archives

What Is Tendonitis/Tendinopathy?

Before we discuss tendonitis treatment, let's first consider the anatomy! Tendons connect our muscles to bones, and therefore are the main way that we produce force.1 Before the 90s, it was thought that inflammation was the primary cause of tendon pain, so people used to call these issues “tendonitis”. As more research came out focusing on the damage in the tendon (primarily due to degenerative changes) being the main driver for both pain and decreases in function, this terminology shifted to “tendinopathy” (largely based on the work of Mafulli et al.). 2, 3

Stages of Tendinopathy

So, there has been damage to a tendon, and the most prominent model currently followed is Jill Cook’s three-stage model (reactive, disrepair, degenerative).4 The first stage, reactive tendinopathy, has also been called the “injury” stage, and is typically an acute response.5 Another way of putting this is you may have jumped into something too rapidly or advanced load or volume too quickly. An example of this could be starting a new workout routine or doing a lot of repetitive movements. Another potential mechanism is direct trauma – let’s say that you fell directly on your knee or shoulder. This could trigger the reactive stage as well.

The second stage of tendon disrepair has also been called the “failed healing” stage, where changes in the extracellular matrix become more pronounced, and the tendon is thus more susceptible to the damage. Typically, this occurs when that initial stage continues to be handled poorly and advances to this stage. An example of this would be continuing to work out or perform the same repetitive motions once you already have tendon pain.

The final stage is the degenerative stage, also labeled the “clinical presentation,” as this is typically when patients seek medical attention. This is when tendons are most susceptible to ruptures, and also where we start to see large scale degenerative changes in both the extracellular matrix and within the tissue cells (which is what may lead to those ruptures).

Symptoms of tendonitis include difficulty and pain with movement, joint stiffness, swelling, and a “crackling” or grinding sensation.

I think I have tendonitis/tendinopathy. What do I do now?

Seeing a physical therapist is a great place to start for tendonitis treatment. Our skilled doctors of physical therapy will identify contributing factors such as muscle imbalances or improper biomechanics (movement of joints and muscles). Based on this evaluation, a personalized exercise program is developed, incorporating targeted stretches and strengthening exercises to gradually restore the affected tendon's integrity and flexibility. Manual therapies, such as soft tissue and joint mobilization, can further aid in reducing pain and promoting blood flow. Additionally, our doctors of physical therapy will educate you on proper body mechanics and ergonomic practices to prevent future recurrence.

I shouldn't start physical therapy for tendonitis treatment unless I have imaging first, right?

Medical imaging, such as ultrasound or MRI, is not always necessary to diagnose tendonitis. In many cases, a skilled healthcare professional, such as a physician or physical therapist, can diagnose tendonitis based on a thorough clinical examination, medical history, and a discussion of symptoms. Our highly trained doctors of physical therapy will assess your pain, range of motion, strength and functional movements in addition to your symptoms and medical history.

Tendonitis can often be effectively managed and even resolved with physical therapy alone, especially in mild to moderate cases. Physical therapy plays a significant role in promoting healing, reducing pain, and restoring normal function to the affected tendon and surrounding tissues.

If you think you are dealing with tendonitis/tendinopathy, request an appointment so we can help get you back to the activities you enjoy!

Written by Matt Harper, PT, DPT, CSCS

References

1. Canosa-Carro, Lorena, et al. "Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice." Disease-a-Month 68.10 (2022): 101314.

2. Khan, Karim M., et al. "Time to abandon the “tendinitis” myth: painful, overuse tendon conditions have a non-inflammatory pathology." Bmj 324.7338 (2002): 626-627.

3. Maffulli, Nicola. "Overuse tendon conditions: time to change a confusing terminology." Arthroscopy: The Journal of Arthroscopic & Related Surgery 14.8 (1998): 840-843.

4. Cook, J. L., and Craig R. Purdam. "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy." British journal of sports medicine 43.6 (2009): 409-416.

5. Fu, Sai-Chuen, et al. "Deciphering the pathogenesis of tendinopathy: a three-stages process." BMC Sports Science, Medicine and Rehabilitation 2 (2010): 1-12.

Photo by Alan Calvert on Unsplash

Posture Tips for the Office or Working From Home

Everything we do every day–sitting in traffic in our cars, sitting at our desks at work, and scrolling through social media on our phones-can cause major issues for our overall health and well-being.

Our bodies have not been able to adapt to the postural stresses we place on them because we were designed to move rather than to be in static positions for long periods of time. The World Health Organization classifies physical inactivity as “one of the leading risk factors for death worldwide."

Even people who work out every day are still considered “sedentary” if they spend the remainder of their time sitting. Being sedentary increases the risk for a variety of health issues, like diabetes, high blood pressure and cancer, in addition to orthopedic problems like decreased tissue and bone quality, poor joint health, tight muscles and muscle breakdown. This can lead to neck and shoulder pain, back pain, knee pain, as well as breathing problems and headaches.

What "Bad" Posture Looks Like

No one is able to maintain perfect posture 100% of the time. The postural muscles that surround the spine and shoulders are made to work at a low level of effort all the while we are upright. These muscles are easily over-worked when we assume poor postures because they get stretched and therefore are unable to work as efficiently. The most common example of postures that over-tax our muscles is working at a computer that is too low for our eye level, such as a laptop. This causes increased stress on the lower back, upper back, and neck and can actually lead to changes in the joints of the spine and lost range of motion, stiffness and pain, including headaches.

Benefits of Posture and Mobility Exercises

The spine has several different kinds of support to help keep us upright. The postural muscles are the first line of defense, but these muscles can weaken over time. We then depend on the ligaments that connect our vertebrae together to keep up sitting in an upright posture, but these too can get slowly stretched out and weakened over time from poor posture. Too much sitting can also decrease the overall health and mobility of our joints. All of these effects of poor posture are preventable and most of these effects can be reversed or prevented with a daily mobility program and by alternating between sitting and standing.

So, What Can You Do to Help Your Body?

Following a daily mobility routine is an effective way to prevent the effects of static postures. The majority of the following exercises can be easily performed at a desk or at home.

Chin Tucks

Upper Back Extensions

Press Ups (Cobras)

Foam Roller Chest Openers

Try to limit sitting to 30 minutes at a time. For every 30 minutes you spend sitting, spend 2 minutes standing or walking around. This will give your body a break, give your muscles a chance to move and give you an energy boost! Use a lumbar support roll whenever seated. Perform the suggested daily mobility exercises 1-2 times per day. Strengthening the body’s postural support muscles can also be very helpful for helping you maintain better postural health. Check out our YouTube channel for helpful tips on how to optimize your desk setup.

Click here to schedule a visit with a PT. We can develop an individualized strength and mobility plan to keep you healthy and moving well.

Written by Alyssa Lindau, PT, DPT
Fayetteville, AR

Photo by Tim van der Kuip on Unsplash

Maintaining Balance as We Age

Balance is the ability to distribute weight in a way that will let us hold a steady position. Balance begins with a nonstop stream of information gathered by several systems in the body. The visual system (your eyes) helps you to orient yourself in space. The musculoskeletal system (muscles, joints, tendons) contains special sensors that provide you with awareness of your body and movements in space (proprioception or kinesthesia). The vestibular system (inner ear) provides information about head position, spatial orientation, and motion. All three of theses systems are continually sending their findings to the brain. This flood of data gets processed and the result is the ability to stand, move, perform tasks and remain balanced. Strength and flexibility are also other important components of balance. They are required to keep the body upright and under control. Good balance relies on the muscles of the feet, legs, buttocks, abdominals, and torso.

As we age, we lose the function to balance through loss of sensory elements, decreased ability to integrate information and issue motor commands, and loss of musculoskeletal function. What can you do to fight this loss? Resistance training and weightlifting will build strength and stamina. Yoga, tai chi, and Pilates will help with flexibility. Simple activities, such as standing on one foot while brushing your teeth or cooking, always rising from a chair without using your arms, practicing walking backwards or heel-to-toe in a straight line all directly target balance. Researchers have found that balance begins to decline in midlife, starting at about age 50. In one recent study, adults in their 30s and 40s could stand on one foot for a minute or more. At age 50, the time decreased to 45 seconds. At 70, study participants managed 28 seconds. By age 80 and older, they lasted less than 12 seconds standing on one foot.

Because the aging process can affect vision, strength and balance, adults 65 and older are at elevated risk for falls. However, falls are not a natural part of aging and can be prevented.

Balance and Fall Risk Assessment

Physical Therapists can examine you and assess your balance and risk of falling. Guidelines published by the American Geriatrics Society and British Geriatrics Society (AGS/BGS) recommend screening adults 65 and older for fall risk every year. A balance and fall screen may include questions about your history of falling in the past year, and if there was a need for medical attention. Even if you have not fallen, a comprehensive evaluation and balance training are key in preventing potential slips and trips, helping you live without the fear of an accidental fall. Physical therapists will use balance re-training exercises, gait training, safety training, and muscle strengthening to help those who are struggling with balance issues due to injury or aging.

Request an appointment to have one of our Doctors of Physical Therapy assess your balance and help prevent falls.

Written by: Dr. Carrie Ward, PT, DPT
Fayetteville, AR

Photo by Raphael Renter on Unsplash

Debunking Myths: The Truth About Physical Therapy

Physical therapy is often misunderstood as a passive process that only helps relieve pain. However, there’s so much more to it than that! We’re dedicated to educating people about what physical therapy is really all about, and what is can do for you. Physical therapy is a valuable tool for reducing pain, improving function, and enhancing your quality of life.

Myth #1: Physical therapy is only for those who have suffered an injury.

While physical therapy is certainly beneficial for those who have sustained an injury, it can also help individuals who are dealing with chronic pain, movement difficulties, or other conditions that impact their physical function. Whether you’re an athlete looking to improve your performance or someone who simply wants to feel better, physical therapy can help.

Myth #2: Physical therapy is passive and boring.

One of the biggest misconceptions about physical therapy is that it’s a passive process that simply involves lying on a table while a therapist applies heat or ice. However, the reality is that physical therapy involves active participation by the patient. Our therapists work closely with each patient to develop an individualized treatment plan that includes a variety of exercises and activities designed to improve strength, flexibility, balance, and overall function.

Myth #3: Physical therapy is painful.

While physical therapy can sometimes be uncomfortable, it should never be unbearable or cause excessive pain. We prioritize patient comfort and always take care to adjust our treatments to meet the needs and comfort levels of each individual patient. Our goal is to help you feel better, not to worsen your pain.

Myth #4: Physical therapy is only for older adults.

Physical therapy is not just for older adults! In fact, it can be beneficial for people of all ages, from children to older adults. Whether you’re an athlete looking to reduce risk of injuries or someone who simply wants to maintain good physical health, physical therapy can help you reach your goals.

At Rise Physical Therapy, we’re committed to providing our patients with the highest quality care and the best possible outcomes. Our team of expert therapists are here to help you achieve your goals and get back to the activities you love. If you’re looking to reduce pain, improve function, and enhance your quality of life, don’t hesitate to contact us today to schedule a consultation!

Written by: Dr. Kyler Offenbacker, PT, DPT, OCS, CSCS
Fayetteville, AR

The Amazing ACL

With a total of roughly 250,000 ACL ruptures annually in the United States, it is time we begin to understand more about this important, yet easily misunderstood, ligament.

The ACL, or Anterior Cruciate Ligament, originates at the end of the femur (thigh bone) and inserts at the top portion of the tibia (shin bone). It has two major fiber bundles that combine to provide stability in the knee. The ACL is responsible for resisting anterior translation of the tibia (forward movement of the shin bone) and internal tibial rotation (torsional forces).

It is most injured in a non-contact mechanism. In fact, 70% of all ACL injuries are non-contact. This means that the ligament fails without any external force to cause the injury. This happens, most commonly, from a pivot, quick change in direction, or twisting of the knee.

The other mechanism of ACL injury can occur by means of contact, which most commonly happens when the knee goes into hyperextension with a direct blow to the joint. In both circumstances, the person will feel a “pop” in the knee which is due to the ACL tearing. There are many reasons the knee joint may “pop” that may not be of concern but are felt with ligamentous rupture most of the time when the injury occurs.

Generally, a person sustaining an ACL injury does not experience much pain or discomfort immediately, as adrenaline and protective mechanisms of the brain take over. However, in the circumstance of true ligamentous rupture, the knee will begin to swell, bruise, and become stiff over the next several hours. It may become more difficult to bear full weight through the joint, and most typically will be associated with feelings of instability, such as the knee “buckling” or “giving out.”

Unfortunately, ACL tears are very debilitating for the function and performance of the knee. It is likely that an athlete will be unable to participate in their sport at peak performance or without risking further injury to the knee. Time spent in rehab is typically 9+ months from the date of surgery and requires extensive effort, drive, and determination. However, with the motivation and encouragement in therapy, anyone can overcome this injury to safely return to sports, and/or do the things they love.

If you or someone you know is concerned about an injury to the ACL, it is best to schedule a visit to see your provider. There is non-invasive special testing that is sensitive and reliable to assess for ACL injury before you schedule any imaging.

If your therapist believes you have ruptured your ACL, they will explain your options and guide you in the next steps to start your journey of recovery. You will likely undergo magnetic resonance imaging, or MRI, to confirm your diagnosis while also assessing other anatomical structures within the knee that may be involved. From there, your goals and outlook will be discussed between your physical therapist, orthopedic surgeon, coach, parent, athletic trainer, etc. Collaboration is key, and your care should be individualized by an expert in ACL rehab and recovery.

Want to learn more about ACL rehabilitation? Stay tuned for more information in the future on what happens next following surgical reconstruction of the amazing ACL.

My daughter tore her ACL in September and started her post-op ACL Journey in November! Jacob has been great. He is very knowledgeable about the process! He is very kind and patient with her. He makes PT fun! He has been able to answer all questions thoroughly to my daughter’s understanding. We are almost 5 months post-op and the improvements from day one we have seen are remarkable! Kudos to Jacob, he is the best!

Written by: Jacob Davies, PT, DPT
Fayetteville, Arkansas

Featured image by Eagle Media Pro on Unsplash

Does PT actually work?

The only question that matters. Here’s what a recent large study found: “In the year following their initial complaint to primary providers, the sample of people in the study who went to physical therapy directly spent an average of $1,871, compared to $6,664 for those who were first sent for an MRI. The patients who received physical therapy first were less likely to receive surgery and injections, and they made fewer specialists and emergency department visits within a year of primary consultation.” [link]

Category: Therapy