By Mai Vu, Physical Therapist
We all have family, friends, neighbors who are females that participate in sports. Participation in athletic activity is a great thing, especially with obesity rates on the rise. This is especially true for children and adolescents. However, there is such a thing as over-doing it. One consequence of “over-doing” it is something called the female athlete triad.
The female athlete triad is a term that is used when the following three conditions exist: eating disorder, loss of menstruation (also referred to as amenorrhea), and bone loss (also referred to as osteopenia or osteporosis). If parents, coaches, and friends pressure the athlete to excel, this can contribute to the disorder. It can occur with athletes of any sport. However, females that participate in sports that encourage a lean physique are more likely to develop this disorder. Examples include gymnastics, cheerleading, diving, and dance.
Eating disorders
This is usually the first sign that there is a problem. This can be eating too little (anorexia) or binge eating that is followed by purging (bulimia). Purging can take place in different ways including vomiting, taking laxatives, or taking enemas.
Amenorrhea
Generally, it is considered abnormal when 3 menstrual cycles in a row are missed. This is usually due to a loss of body fat.
Osteoporosis
This is a loss of bone mineral density. This can happen due to malnutrition from the eating disorder.
The consequences are serious; the female athlete triad can lead to a permanent loss in bone density, resulting in an increased risk for fractures. Severe long-term cases can even be life threatening.
Warning signs:
Poor body image
Stress fracture
Fatigue
Anemia
Dizziness when standing up quickly (also referred to as orthostatic hypotension)
Cold hands and feet
Weight fluctuations
Prevention/Treatment:
This disorder is complicated, involving both emotional and physical aspects of the athlete. Parents, coaches, counselors, doctors, athletic trainers, and physical therapists should be on board when addressing the issue of the female athlete triad. Treatment includes diet modification, exercise modification, psychosocial support, and possibly hormone replacement therapy.
Recognition and prevention are they keys to avoiding permanent damage.
Here are some places to get more information:
NCAA Coaches Handbook
http://www.princeton.edu/uhs/pdfs/femaleathletetriad.pdf
American Dietetic Association
www.eatright.org
Female Athlete Triad Coalition
www.femaleathletetriad.org
Photo Credit: Dimodi
Exercise Your Joints
By Saralyn Switzer, Physical Therapist
Almost everyone has heard of the term “arthritis.” Most likely it affects themselves or someone they know. It is important everyone is clear on what arthritis is and what exercises can improve their ability to participate in the things they love to do.
Arthritis affects joints and the soft tissues and connective tissues around them. Over 100 diseases and conditions fall into this category and include osteoarthritis, rheumatoid arthritis, lupus, juvenile rheumatoid arthritis, gout, fibromyalgia, bursitis, rheumatic fever, and Lyme disease. Osteoarthritis, rheumatoid arthritis, and fibromyalgia are the most common. There is an estimated 26.9 million adults in the US with osteoarthritis (OA), 13.9% 25 years old or older and 33.6% 65 years old or older. Rheumatoid arthritis (RA) affects 2 million adults in the US.
Osteoarthritis, or “degenerative joint disease,” most often affects the hip, knee, foot, and hand — but can affect other joints as well. Degeneration of joint cartilage and changes in underlying bone and supporting tissues lead to pain, stiffness, movement problems, and activity limitations.
Rheumatoid arthritis is characterized by chronic inflammation of the joint lining. Symptoms include pain, stiffness, and swelling of multiple joints. The inflammation may extend to other joint tissues and cause bone and cartilage erosion, joint deformities, movement problems, and activity limitations. Rheumatoid arthritis can also affect connective tissue and blood vessels throughout the body, leading to inflammation in a variety of organs, including the lungs and heart.
Fibromyalgia is a pain syndrome involving muscle and muscle attachment areas. Common symptoms include widespread pain throughout the muscles of the body, sleep disorders, fatigue, headaches, and irritable bowel syndrome.
Because of these physical symptoms, people with arthritis tend to be less active and then be at more risk for other medical conditions. Health conditions such as high blood pressure, anxiety, depression, diabetes, heart disease, and obesity could all result from inactivity. Psychological stress and coping difficulties, financial burden of the loss of income, and social problems are all real issues that individuals with arthritis may be facing. Therefore, there are multiple aspects to the treatment of arthritis including medical management with medication, education, injury prevention, physical activity, weight management and nutrition, and surgery.
The limitation that arthritis brings on the joints and activity level is different for every person with arthritis. The recommended beginning level of exercise duration for adults with OA of the hip or knee is 60 minutes to 150 minutes per week. This should be low impact and moderate intensity aerobics, like water exercise, cycling, or walking. Also recommended is 2 days per week of muscle strengthening. People with fibromyalgia and RA are recommended to also include stretching, yoga, tai chi, and deep breathing in addition to the aerobic activity of walking or water exercise to help decrease pain and improve function, general health, and sleep. Exercise sessions can start with 10 minutes at a time and increase as strength and endurance improves.
To start this process the best thing to do is speak with your doctor to determine which treatment is appropriate for you. If you are facing flare ups of joints and limited movement or overall deconditioned and weakness due to arthritis, your doctor may recommend seeing a physical therapist to begin a prescribed exercise program and address your specific limitations.
References:
www.moveforwardpt.com
www.arthritis.org
http://www.hindawi.com/journals/jar/2011/681640/ Benefits of Exercise in Rheumatoid Arthritis
By: Kelly Ann Young, Physical Therapist Assistant
If you are like most women, you would love to wear beautiful high end heels such as Manolo Blahniks. But, are you thinking of the damage you could be causing your body? Lower back pain and degeneration of the spine, ankle injuries, and neck problems are just some potential difficulties the wearer could face. Wearing high heels often puts you at greater risk of developing arthritis in the knees. However, the biggest problems facing high heeled fashionistas are foot problems such as bunions, hammer toes, corns, calluses, neuromas, and blisters. About 80% of these patients end up needing surgery to correct their impairment.
Definitions of some common foot problems related to high heel wearing:
Bunions:
Bunions are bony protuberances at the base of the big toe. The most common cause of
bunions is hallux valgus or the angling of the big toe in towards the other toes. Bunions are most common in women, and the cause is usually wearing unsuitable footwear. (http://orthopedics.about.com/cs/footanklesurgery/g/bunion.htm)
Hammertoes:
A hammertoe is curled due to a bend in the middle joint of the toe. They are commonly caused by shoes that are too tight in the toe box or shoes that have high heels. This may cause your toe to be forced against the front of your shoe which results in an unnatural bending of your toe and a hammer-like or claw-like appearance. (http://www.mayoclinic.com/health/hammertoe-and-mallet-toe/DS00480)
Morton’s Neuroma:
Morton’s Neuroma is a foot condition caused from an abnormal function of the foot that leads 
to bones squeezing a nerve usually between the 3rd and 4th metatarsal heads. One cause can be from wearing pointed toes and/or high heels. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain. (http://www.thefootworksstore.com/mortons-neuroma-i-21.html)
Tips on wearing high heels:
- Try to keep the heel height as low as possible. Select heels no higher than 2 inches in height.
- Limit wearing time and change into flats when you can.
- Avoid pointed toe shoes. The pointed and small toe box can cramp the foot and toes leading to problems such as hammer toes, bunions, calluses, blisters, and neuromas. There should be at least ½ inch of space between your toes and the front of the shoe.
- Stretch your legs and lower back before and after wearing heels to avoid added strain on these areas. Massage your feet afterwards.
So before you step into those high heels for a night out on the town, consider the effects on your body and how to minimize them.
By Helene Mitchell, Physical Therapist Assistant
Core stabilization, or core strengthening has been around for many years and has been incorporated into sports performance training programs, exercise programs such as Yoga, Pilates and Boot Camps. In Physical Therapy and rehabilitation, core stabilization means that activation of the trunk muscles must occur first in order for us to create a stable base of support that allows us to move our arms and legs. Making the trunk muscles stronger keeps the spine stable and helps the body stay balanced with movement; preventing falls and injury.
Most people think of the “core” as just being the abdominals (stomach muscles) when in fact the “core” muscles run the entire length of the torso from the hips to the shoulders. When these muscles contract, they stabilize the spine, pelvis and shoulder girdle and create a solid base of support. This allows us to stand upright and move on two feet, shift our weight and move in any direction. This distribution of weight protects the back from injury. An effective core conditioning program needs to target all muscles of the core to be effective.
Benefits of Good Core Strength:
A strong core:
• Reduces Back Pain and Prevents Injury
• Improves Athletic Performance
• Improves Postural Imbalances
Exercises that Build Core Strength:
The most effective core strengthening exercises work the torso as a solid unit with both front and back muscles contracting at the same time. The most basic core strengthening exercise is Abdominal Bracing where you try to pull your navel in toward your spine without holding your breath. Most core strengthening exercises don’t require equipment and include:
• Planks: Position yourself face down on hands and balls of feet. Straighten arms. Tighten stomach muscles and lift hips to form a straight line from head to toe. Hold 15-30 seconds. Do not let hips sag to the floor.
• Basic Push Up: Position yourself face down with hands under shoulders and on balls of feet. Tighten stomach muscles and bend elbows to lower chest towards the ground. Keep neck in neutral by gazing towards floor. Straighten elbows to complete one repetition. Do not let hips sag to the floor.
• Bridging: Lay face up on flat surface, knees bent and arms by sides. Slowly raise buttocks and hips, keeping stomach tight. Slowly lower hips again. This completes one repetition.
• Supermans: Lay face down on flat surface with arms stretched overhead and straight legs. Tighten stomach muscles and simultaneously lift arms and legs into the air a few inches then slowly lower them.
Other exercises include the use of stability balls, medicine balls, kettlebells, wobble boards, yoga and pilates. These particular exercises should only be performed under the supervision of a trained professional and when beginning any type of exercise program, always consult your physician first.
Photo Credit: Joe Shlabotnik
By Mai Vu, Physical Therapist
Often, we hear people complain about pesky “knots” in their necks, shoulders, or backs. Not only can these knots be a nuisance, but they can also cause pain, limit range of motion, and have a negative impact on daily activities. A muscle “knot” is a commonly used lay term; health care professionals often refer to these knots as trigger points.
What is a trigger point?
Trigger points are nodules that can form within tight bands of muscle. They can also be located in tendons, ligaments, skin, joint capsules, and scar tissue. When pressed, they often produce local pain or referred pain (pain elsewhere in the body).
Why do trigger points form?
There are a number of aggravating factors such as muscle overload, stress, trauma, infections and other diseases, and unhealthy lifestyle choices.
Types of trigger points
Active – actively refers pain (locally or to another part of the body)
Latent – the trigger point is present, but does not actively cause pain; however, it may elicit pain when pressed
Key – activates other trigger points
Satellite – has been activated by a key trigger point
According to Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual:
- Around 75% of pain clinic patients have a trigger point as the sole source of their pain
- The following conditions are often diagnosed (incorrectly) when trigger points are the true cause of pain: carpal tunnel syndrome, bursitis, tendinitis, angina pectoris, sciatic symptoms, along with many other pain problems
- Arthritis is often cited as the cause for pain even though pain is not always concomitant with arthritis. The real culprit may be a trigger point, normally activated by a certain activity involving the muscles used in the motion, by chronically poor posture, poor body mechanics, repetitive motion, structural deficiencies such as a lower limb length inequality or an asymmetrical pelvis, or nutritional deficiencies.
How are trigger points treated?
Treatments can include one or more of the following: massage/trigger point release, mechanical vibration, ultrasound, electric stimulation, stretching, muscle energy techniques (MET), proprioceptive neuromuscular facilitation (PNF), and either injections with a local anesthetic or “dry needling”. Eliminating the aggravating factor is also important in keeping trigger points at bay.
By Dr. Jay Mazzella, DC, Clinical Director
Common causes of neck pain include watching TV, using a computer, reading a book, ortalking on the phone, especially with the receiver held on your shoulder or under your chin. Fortunately, this pain usually subsides within a short period of time, particularly if you discontinue the offending activity for a while. On the other hand, chronic neck pain, the kind that doesn’t go away or that keeps “coming back,” can be a far more serious and debilitating problem.
Current treatment of chronic neck pain runs the proverbial gamut, from anti-inflammatory and pain-relief medications to group gymnastics, neck massage and manipulation. Neck-specific strengthening exercises have also been suggested as a potential treatment option. In a recent study designed to evaluate this potential, 76 men and women with chronic neck pain received active care, home care, or simple recommendations on exercising.
Active care included postural control exercises, relaxation training to reduce muscle tension, and cervical muscle endurance/coordination training. Home care comprised a neck lecture and training on exercises to be performed at home. The third treatment protocol (the control group) received a lecture on neck care and general recommendations to exercise. Patients in the active group reported greater satisfaction, reduction in pain severity, and improvements in working ability at three and 12-months compared with the home group and the control group.
If neck pain’s putting a crimp in your day, it’s about time you did something about it. For more information on neck pain and the various treatment options available to you, schedule an appointment with us for a complete evaluation. For information on line, visit www.EastpointeChriopractic.com.
If you have questions as to how much of your care may be covered by your health insurance, contact our desk staff and ask about a COMPLIMENTARY INSURANCE VERIFICATION.
By Saralyn M. Switzer, PT, DPT, Doctor of Physical Therapy
Since the summer has ended and fall is here we remember how much we enjoyed the warm weather and being in the pool. Many people are more active in the summer since everyone enjoys going outside walking on the boardwalk or in the park, running, biking, swimming, hiking, and other outdoor activities. This active pace is hard to carry over into the colder, winter months once we are forced indoors more. The time is rapidly approaching when we will not want to exercise outside and we must start thinking of fun indoor alternatives. Swimming and pool exercise can be performed in an indoor pool to continue the benefits of this activity year-round.
Pool exercise:
- increases endurance by doing continuous cardiovascular exercise in the water
- builds strength due the constant resistance from the water
- is conducive to relaxation and promotes flexibility by using the buoyancy of the water that lessens the weight of gravity on the joints
- improves circulation by using the water pressure to help the fluid in our arms & legs return easier to our heart
- improves balance
- improves chronic pain conditions, joint pain, and back pain
With all these benefits, who wouldn’t want to get in the pool this winter?
Now that you want to exercise in the water, what type of exercise can you do? As with any exercise program, aquatic exercise should focus on increasing endurance, strength, and flexibility.
Endurance or cardiovascular exercise can include walking in the water, kicking across the pool with a kick board, and doing cycling while floating on a noodle, or good old-fashioned laps
Strengthening exercises include standing at side of pool doing leg kicks backward, sideways, and forward on each leg; squatting at the side of the pool; leaning your back against side of pool and squatting so your shoulders are under water then pushing and pulling the kick board like you are making waves without letting your body come off the wall.
Flexibility can include traditional stretches performed in the water such as a runners calf stretch standing at the side of the pool facing the wall with one leg back, or hamstring stretch with one foot up on the step or ladder in the pool. The best part of stretching in the water is using the buoyancy ability to float. This can be done by using noodles to help you float and move through more motion until a stretch is felt. To stretch your hip, put one noodle under your arms to float and then put another under one knee while the opposite leg hangs down. Other types of flexibility exercise can be tai chi or yoga poses adapted for the water.
These are just some examples of many different types of water exercises. What you choose will depend on your fitness level and comfort with the water. Many community pools offer water exercise classes to help get you started. Local colleges or universities may offer pool membership to the community. Also, physical therapists and personal trainers who specialize in aquatic exercise can help you develop an aquatic exercise program that is right for you. So, keep that bathing suit out for the winter and start swimming!
*Before starting any exercise program including aquatic exercise, clearance by your medical doctor is important. Remember, swimming or exercising in a pool with a life guard is the most important safety rule of water exercis
Photo Credit: Royal Challengers Bangalore
How Deep Breathing Exercises Can Help
By Physical Therapist Assistant Kelly Ann Young
Our entire state was affected in some way or another with the recent hurricane. In the days following the storm, it became apparent that our job as physical therapists was not just in physical healing, but helping with emotional healing as well.
On our first day back in the office, we were operating on generator power with some lighting. We were unable to operate our electrical stimulation or ultrasound machines and we had no ice or hot packs. We relied on our hands and hearts to soothe peoples aching muscles and broken hearts. They had been physically battered by days of moving furniture and preparing for the storm, cleaning up flooded basements and homes, and enduring days without power, yet they trickled into the office one by one and proved that the resilience of our patients is commendable.
Physical therapy can help you relax and deep breathing may be useful following a stressful event:
Deep Breathing Exercises:
- Sit comfortably with your back straight. Place one hand on your chest and the other on your stomach.
- Breathe in through your nose. The hand on your stomach should rise and the hand on your chest should not move much.
- Exhale through your mouth, gently pushing out as much air as you can. The hand on your stomach should move in as you exhale and the hand on your chest should not move much.
- Continue to breathe in through your nose and out through your mouth slowly trying to inhale enough so that your stomach rises and falls. Repeat for 5 minutes.
- If you become breathless at any point, resume normal breathing.
This small act may not seem like much, but studies have shown that practicing deep breathing can decrease blood pressure and heart rate and has also been shown to “enhance the way one feels and relax from daily stresses, resulting in better focus and mental stamina.” according to www.Saagara.com.
Photo Credit: Tojosan
By Helene Mitchelle, Physical Therapist Assistant
Medial Tibial Stress Syndrome, more commonly known as “Shin Splints”, accounts for 11% of running injuries in men and 17% in women due to repetitive forceful activity on hard surfaces.
Symptoms:
• Pain of the lower front portion of the leg (shin)
• Pain with running, standing, walking and performing repetitive weight-bearing activities
• Pain with pointing toes downward
• Pain with going down stairs
• Pain disappears when activity stops
Causes:
• Excessive downhill running
• Sudden increase in frequency or intensity of running
• Inappropriate or worn out footwear
• Excessive foot supination or “bowlegged”
• Sudden change in training surfaces from softer to harder
• Tight calf muscles
Treatment:
• Avoid downhill running and running on hard surfaces
• Modify footwear/orthotics
• Decrease intensity of training and incorporate active rest
• Calf stretching
• Manual therapy
• Heel raises
In rare cases, shin splints can progress into “Compartment Syndrome”. This is when swelling in the injured area puts pressure on the muscles, nerves, and blood vessels. This requires prompt medical attention to ensure that permanent damage does not occur. In addition to the symptoms described above, symptoms of compartment syndrome include:
• Decreased sensation in the affected foot
• Paleness of the skin
• Decreased or absent pulses in the foot
• Weakness of the muscles in the foot/ankle
By Mai Vu, Physical Therapist
Shoulder pain is one of the most common complaints that we see in our office. Some common causes of shoulder pain are:
Tendonitis – This occurs when inflammation is present in tendons. Tendons are the structures that connect muscles to bones.
Bursitis – This occurs when inflammation is present in a bursa. A bursa is a fluid-filled sac that helps to decrease friction when the body moves.
Tears – Tears can occur as a result of trauma such as a fall, or they can occur slowly over time. Tears can range from a microscopic level to a complete tear where the muscle or ligament is no longer attached.
Radiculopathy – This occurs when there is a problem with the nerves from the spine. The nerves from the neck travel across the shoulder and down the arm. When there is a problem in the spine, pain can be felt along the path of the nerves.
When there is shoulder pain there are many structures that may be involved, including:
- Rotator Cuff which is comprised of 4 different muscles (supraspinatus, infraspinatus, teres minor, subscapularis)
- Long head of the Biceps Tendon Subacromial Bursa Acromioclavicular Joint – this is where the clavicle (collar bone) meets the scapula (shoulder blade)
- Glenohumeral Joint – this is where the scapula (shoulder blade) meets the humerus (upper arm bone)
- Labrum – this is part of the glenohumeral joint
- The muscles, bones, and nerves from the neck (cervical spine)
- The muscles, bones, and nerves from the trunk (thoracic spine)
We will cover some of these topics in more detail in later posts.