Total Knee Replacement Recovery Process

When you need to have total knee replacement, the recovery period tends to lie heavily on your mind. It’s a critical part of getting you back on your feet and into your normal lifestyle again, as without it you will not heal properly. Whatever the reason you’ve had the surgery for, you can, at the very least, know what to expect from the recovery. Below we’ve put together a little timeline for the twelve weeks of rehabilitation, so that you can know what your goals are for your healing.

The Beginning:

Rehabilitation for knee replacement, unlike in some other surgeries, begins pretty much from the moment you wake up from surgery. Within the first twenty-four hours you will be back up on your feet with the help of your physical therapist. It’s actually crucial that you start using your new knee as soon as possible. You’ll be given a set of exercises that will build your muscles up and your therapist will help you through them every day. They’ll let you know how you’re supposed to get in and out of bed (you will be using an assistive device for the next few weeks, so as not to strain your surgery site too much) as well as move around. While you’ll be moving, you won’t be moving much, so you’ll have a nurse to help with changing bandages, dressing, bathing and using the toilet.

It’s the job of your physical therapist to make sure that you understand everything that you’re supposed to be doing to keep your knees responsibly active. You, though, need to be sure to ask questions if you’re not sure, and to keep up with the exercises. Yes, it may be incredibly uncomfortable to get up to use the bathroom, but it’s better in the long run to use a regular toilet than to stick with the bedpans, as strengthening the muscles in your legs is key to full recovery.

Discharge:

By the time of your discharge, you should be able to have increased your exercise and activity. You should also be able to shift to lower pain killer levels at this point. The time spent in the hospital varies from patient to patient, depending on their personal recovery level. Be sure to know what your physical therapist and doctor expect from you so you don’t feel as though you need to rush through your recovery.

Upon discharge, however, you should be able to :

  • Bend your knee to a minimum of 90 degrees
  • Dress and bathe on your own
  • Rely only minimally on your assistive device
  • Get in and out of bed with the least amount of help from assistive device
  • Walk up and down stairs using a walker or crutches
  • Know exactly what exercise and activities your therapist expects from you

Week 4 to 8…

So long as you’re keeping up with your exercise and rehab that your physical therapist has laid out for you, your recovery should be on track. You should, by this point, notice a rather large improvement to your knee and leg. You’ll be able to walk longer, and feel more independent. Talk with your doctor and therapist about returning to work and your usual activities. Sometimes it’s just not feasible to return to your job at the time, depending on your career, but you shouldn’t let that put you off of your recovery. Everyone’s recovery is different; some can start driving again as soon as four weeks after surgery, some take more than six. If you’re not sure you’re ready, than consult with your therapist or doctor.

By the sixth week after surgery, you should be able to:

  • Continue your exercise and rehab easily
  • Notice a decrease in inflammation and swelling
  • Return to everyday activities such as cooking, laundry, light cleaning
  • Walk up to half a mile, and climb stairs easily

Week 9 to 12…

Within these weeks you should notice that you’re returning to your normal lifestyle. You should be able to walk around unassisted for some time without any physical exertion or pain. Housekeeping, driving, shopping and other light work should be able to be commenced without any dire issues. Your therapist will, of course, be monitoring your recovery and should be modifying your rehab as needed. You may end up following some of the following exercise:

  • Toe and heel raises (alternating standing on your tip-toes, and then back onto your heels)
  • Partial knee bends while standing
  • Hip abductions
  • Standing on one leg at a time, for as long as possible
  • Step-ups
  • Bicycling with a stationary bike

Some people may feel as though this period is redundant. You feel fine, you can do almost as much as you could before, and you don’t have much pain. Why do you need to keep up with your rehab? If you want your knee to continue to service you in the long time, you won’t be giving up on your exercises. Those muscles are susceptible to easy degradation due to your recent surgery, and any prolonged lapse in your rehab can take you back weeks in progress.

Diligently following your rehab will have you up and about and returning to your previous lifestyle. You should feel little to no pain at this point, when engaging in normal activities (there are some that you should probably avoid for some time, which we will cover for a moment), as well as no loss in range of motion. It’s important to remember to keep in contact with your doctor and therapist, and follow their instructions to keep your knee in tip-top shape. High-impact sports such as running, aerobics, skilling, basketball and football should probably be avoided in order to keep from injuring your knee.

After about a year, you should be back to 100 percent. It’s important to keep in touch with your therapist, and have periodical check-ups to make sure everything is still running smoothly. If you find that you’re having unexpected trouble with your knee at any point, don’t hesitate to contact your doctor. If you have any other questions regarding the recovery process of a knee replacement, feel free to check out to reach out to us.

Tips For Relieving Knee Pain

Are you one of the millions of Americans suffering from aching or painful knees? You are not alone. According to the CDC (Centers for Disease Control and Prevention) 1 in 2 people may develop painful knee osteoarthritis by age 85. In addition, if you struggle with weight, research shows that 2 in 3 people may develop painful knee arthritis in their lifetime.

The knee is an incredible joint, having to sustain 6 times your body weight in force, while moving through a large range of motion. The knee joint is inherently unstable, held together by a mass of ligaments, tendons and muscles. The knee also takes a beating during your lifetime. It is estimated that you will walk an estimated 200 million steps, therefore it is easy to see why your knees sustain a lot of wear and tear over the years.  

How to Keep Your Knees Healthy

There are a variety of factors that can cause knee pain, but it is important to focus on preventing knee pain from occurring and what can be done to keep your knees healthy.

Here are useful tips to keep your knees working in tiptop condition:

  • Stretch daily – With sitting for prolonged periods, walking, bending and other activities, your muscles and tissues can become tighter. Daily stretching maintains good flexibility in your muscles, tendons and ligaments around the knee. This allows the knee to continue with its normal range of movement in many directions.
  • Strengthen your legs – Since the knee is very unstable, it requires good muscle support and strength. This provides the stability needed to bend properly, walk and run. Studies show that strengthening the quadriceps muscle is very important in preventing knee pain and knee osteoarthritis. *
  • Get a tune up from your physical therapist – Your knee needs to move side to side, back and forth, and rotate. Our physical therapists are medical experts in evaluating these special types of motions called accessory movements. By evaluating and treating your knee on a regular basis, our physical therapists can keep your knees moving as they should.
  • Use ice or heat – Typically, ice is used after a flare-up of inflammation, injury or pain. Heat is used more for chronic swelling in the knee with the purpose of increasing circulation.
  • Keep your kneecap moving – The kneecap or patella is a very important part in knee function. The kneecap protects your knee, but also serves as a pulley for the quadriceps muscle to use. The kneecap tracks up and down in a C-pattern when you bend your knee. Keep your kneecap moving freely by gently pushing it down and up, and side to side. If you find your knee swells, gently lift your kneecap up and away from the joint.
  • Watch your weight – The more weight you carry, the greater the forces and loads on the knee. When squatting down you can increase the pressure on your knee by three-fold. When jumping, you can increase the pressure by 6 times your body weight. Therefore, the closer to your ideal weight, the happier your knees can be.

The most important part in preventing knee pain is keeping your legs flexible and strong. If you are concerned about how your knees feel when you try to walk, bend and run, then give Hess Physical Therapy a call today. Our experts have years of experience evaluating the proper mechanics of the knee and restoring them, for a pain-free future.

*https://www.ncbi.nlm.nih.gov/pubmed/9230035

The Right Diet Makes All the Difference: What You Should Eat and Avoid While Recovering from Knee Replacement Surgery

The first thought you have after undergoing such a life altering procedure like a total knee replacement is having a smooth sailing recovery. There are many successful strategies that work wonders in healing your body such as following your doctor’s orders and engaging in some knee strengthening exercises. But if you’re looking for another excellent way to have a major impact on your recovery, try turning to what you’re eating. Your body has much to repair from loss of important minerals to cells and tissues which means it needs the right nourishment now more than ever. By acknowledging which vitamins and minerals quickly and efficiently assist in getting your body back to normal, you will fly through your recovery.

To get started, check out these five most essential vitamins and minerals to add to your diet.

Zinc.

This mineral takes an important role in cell regrowth as well as keeping your immunity up so making sure you get your daily amount (about eleven grams for men and eight grams for women) will help make your recovery a breeze. With meat being the highest source, you’ll find at least 5 grams towards your daily goal in beef and oysters, 3 grams in turkey, pork, and veal, and although the levels are much lower, those living the vegetarian life will rejoice knowing nuts and seeds also contain the zinc they need.

Vitamin C.

Going beyond just an immunity boost, Vitamin C is a necessary part of forming cartilage and bone as well as repairing tendons, ligaments, and skin. Consuming your required 75mg-90mg is as simple as adding an array of fruits and vegetables to your meal plan. With food out there containing higher levels of Vitamin C than just your typical glass of orange juice, you can indulge in some great dishes like stuffed roasted red peppers and preparing a strawberry or papaya parfait.

Iron.

It’s inevitable to lose blood during an operation and that blood loss is also accompanied by low levels of iron. Seeing how this mineral helps combat blood clotting along with avoiding anemia, in most cases your doctor will prescribe a supplement, but you could do more on your behalf by opting for iron-rich food such as spinach, fish, and even cashews.

Vitamin D

Strengthening your knee is a key factor that follows replacement surgery, so why not give your body a vitamin that amplifies bone density along with muscle and tissue regeneration? If you enjoy flounder or codfish, mushrooms, and love eggs for breakfast or mixed into your salad, you’ll find yourself obtaining the right amount of Vitamin D to get the job done.

Fiber

One of the most important things to add to your diet plan is fiber-rich food. A major complication many people endure after surgery is constipation due to a side effect in their pain killers. To derail any risk of further discomfort, it’s in your best interest to make sure your body is taking in enough whole grain bread, rice, and cereal as well as fiber-packed fruits and vegetables like apples and carrots.

Being aware of the amazing benefits of consuming the right nutrients is only the first step though. It’s important you now acknowledge some foods to take caution with and avoid while you’re recovering from your knee replacement.

Vitamin K.

Although vegetables are a crucial part of any healthy diet, those that are a source of Vitamin K may contribute to blood clotting, which is already a risk factor after surgery. Make it your short-term goal to ditch broccoli, cauliflower, onions, kale, cabbage and any other food that contains this vitamin.

Sugar.

We mentioned earlier how constipation is a culprit in amplifying your pain level which ultimately can place additional stress on your recovering knee. As important as it is to eat food that will help you go, it’s just as important to avoid foods that contribute to constipation such as candy, cake, and other pastries. Furthermore, there’s no nutritional value in these items and with their ability to make you feel full faster, they more often than not take the place of the essential food your body needs to heal.

Dairy.

It isn’t always necessary to completely cut dairy products from your diet, however it can cause constipation for some people because of how difficult it becomes to digest after surgery. Focus on low-fat products like yogurt, skim milk, or cottage cheese and eat these in moderation until you establish whether or not your body can handle dairy, and if not, it’s wise to eliminate it for the time being.

Caffeine.

Since you’re avoiding constipation, you might think having a cup of Joe when you roll out of bed or need a quick energy boost is a safe way to go, but drinks high in caffeine could make matters worse by causing diarrhea. Therefore, it’s best to avoid coffee, soda, and other caffeinated drinks for at least a couple of weeks after surgery.

Alcohol.

Just in case this was questionable, you cannot kick back with a beer while you watch the game. Alcohol causes blood thinning which slows down the healing process as well as risks bleeding and bruising so avoid it entirely.

As always, before altering your diet, consult your doctor to make sure increasing your vitamin intake won’t affect any medication you might be on or to discuss if you need to go a different route such as taking supplements. But overall, adjusting what you eat and what you avoid is an excellent way to have a fast and successful recovery. For more advice on prepping for and healing after surgery, be sure to check out our blog!

Rotator Cuff Tears-Causes and Treatment

Rotator cuff tears are extremely common, especially as we grow older. Up to 30% of the population over the age of 60 have at least a partial rotator cuff tear. In fact, they are so common that many people disregard or are unaware of the symptoms and don’t even realize they have one.

Frequently we hear about rotator cuff tears in connection with baseball players, rowers, swimmers and other athletes.

But did you know that this condition is also common in people who perform repetitive overhead motions or lifting, such as painters, or carpenters?

The risk of a torn rotator cuff also increases with age, because we just start to wear out. If you have been experiencing shoulder pain, you may have a rotator cuff tear. Your shoulder pain may be caused by trauma, an injury, repetitive motions or it may be simply a result of aging.

What is the rotator cuff?

First, it helps to understand just what the rotator cuff is. It consists of a group of four tendons and muscles in the shoulder. These muscles and tendons connect the upper arm to the shoulder-blade. The tendons provide stability to the shoulder and the muscles allow the shoulder to rotate. Damage to your rotator cuff can cause limited range of motion, weakness and pain.

Top 2 Causes of Rotator Cuff Tears

There are two main causes of rotator cuff tears — injury or degeneration.

  1. If you fall and injure your shoulder, or try to break your fall with your arm, or lift a heavy object with a jerking motion, you may have a sudden, or acute tear.
  2. Rotor cuff degeneration occurs when the muscles and tendons wear down over time. Repetitive stress from sports, a job (especially one that requires lifting your arms over your head), or even certain routine chores can cause overuse tears. In addition, as we age, the blood supply to the rotator cuff decreases. Therefore, the body is less able to repair tendon damage naturally. Bone spurs are another effect of aging which leads to shoulder impingement and gradually weakens the tendons.

Common Symptoms

Common symptoms of rotator cuff tears include:

  1. Pain in the shoulder and arm. The pain is commonly located over the outside of the shoulder and upper arm.
  2. Tenderness and weakness in the shoulder.
  3. You may have trouble moving your shoulder, particularly when you are lifting your arm above your head or holding your arm directly out from your body.
  4. Some people find it difficult to go to sleep on the affected shoulder, or pain may awaken them throughout the night.
  5. People who have a rotator cuff tear may have difficulty combing their hair, getting dressed, or doing other activities that require reaching behind their back.
  6. Another warning sign is snapping and crackling sounds when moving the shoulder.

Here’s how to test your shoulder (videos)

Your physical therapist can test the strength of your rotator cuff tendons and establish the extent of the tear.

  1. Which tendon is the most commonly torn? Find out in this video I recorded for people who signed up for our workshop.
  2. What grade is the tear? Learn the 3 grades of tears in this video.
  3. When diagnosing a rotator cuff tear, the doctor may also order an MRI, which can identify both complete and partial rotator cuff tears.
  4. Reducing your risk
    While rotator cuff tears are common, there are steps you can take to reduce the risk or to keep a previously injured shoulder pain-free and functional.

  5. Warming up before any vigorous activity is essential. Your warm up should include stretching your arms and shoulders.
  6. When exercising, use small, controlled movements. Using less resistance with more repetitions will help strengthen the shoulder muscles and reduce the risk of injury.
  7. Resting your shoulders before and during a workout or other vigorous activity can relieve stress on the rotator cuff.
  8. If you have had a rotator cuff injury, frequent stretches as well as messages and cold and hot compresses can relieve mild pain and inflammation.

Treatment

The goal of treatment is to reduce pain and restore strength and function to the shoulder.

Treatment for rotator cuff tears can be either surgical or nonsurgical, depending on a number of factors. These include:

  1. The nature and severity of the tear.
  2. The functional damage
  3. The individual’s regular activity level.

Depending on the nature and severity of your rotator cuff tear, treatment may include:

  1. Medication
  2. Corticosteroid injections
  3. Rest
  4. Physical therapy
  5. Possibly surgery.

Many patients work with a physical therapist to restore strength and motion. A physical therapist can design an individualized treatment plan of exercises, stretches and techniques improve your mobility without putting too much stress on injured muscles and tendons.

If you think you may have a rotator cuff tear, don’t ignore the problem — seek help. If you have an injury to your shoulder and it is very painful, or you cannot move your shoulder normally, seek medical attention immediately. Or if you have had a shoulder problem in the past or home treatment and self-care is not working, call your physical therapist. Rotator cuff tears are frequent, but they are treatable. Seeking treatment will help you minimize or eliminate pain and engage in the activities you love. Generally, the best results occur when the tear is treated sooner rather than later

Yours in good health,

George Hess

Make Your Knee Replacement Experience a Better One: 10 Perfect Exercises for Before and After Surgery

Preparing for a total knee replacement could get pretty overwhelming. Whether your condition resulted from arthritis or an abnormality, your goals are clear– get yourself moving how you used to and be able to fully embrace the daily activities of life without any stress or worry pain will overcome you. But what if there’s something more you can do beyond the surgery? For a successful experience, establishing an exercise plan is in your favor and as long as you don’t over-do it, fear of causing further damage shouldn’t even be a thought. When you are physically fit before undergoing the procedure, you sign yourself up for a faster recovery as you’ll be stronger and more flexible. Here are some exercises to help you prep for your surgery.

  1. Side-lying Leg Raises.
  2. Stability in walking and standing is essential, especially when taking stress off your knee, and that’s why it’s a great idea to put your outer hip muscles to work with this pelvic-strengthening activity. Relax on your side with your legs straight, then proceed by lifting the top leg about a foot or two away from the other.

  3. Clam Shells.
  4. Another beneficial exercise to strengthen your abductor muscles along with your external rotators are clam shells. Engage in this exercise by laying on your side with your bad knee facing the ceiling. With your heels staying in contact the entire time, open and close your legs just like a clam shell.

  5. Thigh Squeezes.
  6. Strong muscles are always a plus-side, and strengthening your quads is the aim here as you prep for your knee replacement. Find a comfortable place to lie down on your back, legs outstretched. Push the back of your knee as close to the surface beneath you as possible, tightening your front thigh muscles. Hold for about five seconds and then relax.

  7. Sitting Kicks.
  8. Keep your range of motion intact with this muscle-working chair exercise. All you have to do is  sit yourself in a posture-perfect position, stretch your leg straight out in front of you, and hold for five seconds.

  9. One-Leg Stands (With Support).
  10. One worry of going through this situation is the falling-risk. When your knees aren’t working to their best effort, keeping your balance feels like a struggle. With this exercise, you help eliminate that risk factor. Use the back of a chair or countertop to support yourself and stand on your damaged leg for around thirty seconds while keeping your good leg off the ground.

    Now even though working out is an essential part of surgery preparation, it’s also beneficial to continue a routine afterwards as it will prevent any complications and keep your knee in tip-top shape as you’ll be improving your strength and flexibility. Here are even more exercises to add into the mix!
  11. Knee Straightening Stretches.
  12. This simple knee-extension exercise is an excellent way to start increasing your range-of-motion after surgery. Begin by sitting properly in your seat with an opposite facing chair in front of you where you’ll place the leg with the knee replacement in a straight, extended position for at least ten minutes.

  13. Knee Bending.
  14. Another brilliant way to enhance your range-of-motion is to engage in bending your knees. The exercise is as easy as the last as you start by sitting in a stable chair which enables you to bend your leg beneath it, and do so as far back as you can, holding for five seconds, and then bringing it back to a resting position.

  15. Leg Lifts.
  16. Don’t let this gentle workout trick you; it is a powerful activity that will have you gaining more control over your new knee as it adds more strength to your thigh muscles as well as helps you gain more stability of your knee. Relax yourself on your bed , laying down and facing the ceiling. Next, fully extend the recovering leg while keeping the other bent to avoid any stress or tension on your back. Lift your healing leg about six inches from the ground, hold for ten seconds, and then relax.

  17. Hamstring Stretch.
  18. One of the most beneficial exercises you can add to your routine is a passive hamstring stretch as it assists you in regaining full knee extension. Prep a stack of pillows or another comfortable source to help with elevation, then lie on your back, fully extend your legs, and place your foot on the elevated object. With this light stretch, your leg will hang freely for about ten minutes.

  19. Lying Kicks.
  20. While laying down and relaxing on your back, doing some lying kicks will not only allow you to maximize your range of motion but help build some muscle! Simply roll up a blanket to place under your knee, straighten your lower leg for roughly five seconds, and then relax again all while making sure the blanket is in constant contact with the back of your knee.

With acknowledging the perfect exercises for before and after knee replacement surgery, there’s one other aspect to fill you in on. We mentioned earlier it’s important you don’t overdo it. Maintaining an exercise schedule of two to three times a day, starting with 10 repetitions and slowly increasing them by five each week after you’re comfortable is the best way to see results with such a routine. Of course, with any exercise program it’s essential to run it by your physical therapist and get any input on what is right for you.

But overall, you can gain confidence, control, and get your life back together with a little perseverance and determination! For more of the best advice regarding your physical therapy needs, be sure to check out our blog!

 

To your healthy knee,
George Hess

Is Your Balance Setting You Up For An Injury?

It’s what gives us the ability to walk on two legs and stays with us our entire life, balance. Our balance and vestibular system develop as we grow from a baby all the way through adulthood, and then begin to decline. Most people don’t know their balance is not optimum until they suffer a sports injury, trip and fall, or lose their balance in the shower. No matter what your age, balance affects your ability to be active.

Can you do this?

  • Stand next to a counter or sink barefoot with your hand gently grasping the counter surface.
  • Put one foot directly in front of the other, so that one heel is touching the opposite toes.
  • Gently lift your hand up, but keep it close to the counter in case you need to grab it quickly. Try to hold this for 10 seconds (only do this if you feel safe or have someone nearby to help you).
  • Now try it with you eyes closed.
  • Do you wobble a lot or even lose your balance? Your balance needs work!

There are many reasons for our decline in balance:

  • Changes in our vestibular system
  • Changes in muscle mass, flexibility and strength
  • Changes in eyesight
  • Diminishing reflexes
  • Previous injuries to ankle, knee, hip or spinal joints

How balance affects sports performance

The more aggressive you are in sports, the better your balance and reflexes have to be. Many ankle, knee, hip and back injuries in running, tennis and other sports are attributed to poorly performing balance. By incorporating simple balance exercises into your workout routine, you can set yourself up for success and prevent injuries, as well as enhance your sports performance.

How balance affects back pain

How you walk directly impacts your back and can actually be a big contributor to back pain. By improving balance, coordination and strength in your hips, pelvis and legs, your spine will be supported and guided, reducing strain. This in turn, helps your back function normally without aggravation and inflammation. Balance activities are an important component of our SPINE Program for relieving back pain.

Preventing falls

According to the Centers For Disease Control (CDC), over 2.5 million adults were treated for nonfatal injuries in emergency departments in 2013. In older adults, falls are the leading cause of fatal and nonfatal injuries. Most people don’t think about keeping their balance in shape, until it is too late and they fall, fracturing an arm, leg or injuring their back. The good news is that most falls can easily be prevented, simply by the regular exercising of your balance system.

What you can do

You can improve your balance, and it involves performing simple balance exercises. Try this easy exercise to strengthen your balance:

Calf Raise

  • Stand facing and lightly touching a wall with your hands.
  • Slowly raise up and down on your toes.
  • Repeat 10 times, rest, then do 2-3 more sets.
  • Try without holding on for a greater challenge.

The first step in preventing an injury or fall is testing your balance and being honest with yourself that your balance needs work. Our physical therapists can make a big difference in improving your balance and vestibular system, improving your ability to be active, safely. Call Hess Physical Therapy today to learn more about our specialized programs and how you can get back to an active, pain free lifestyle!

10 Exercises to Help You Regain Balance and Reduce Your Risk of Falling

From the time we learn to take our first steps, we also begin to learn what it feels like to fall. Likewise, we learn to hold onto things like the edge of a table or our parents’ fingers to avoid falling. This natural avoidance to losing our balance is an important thing to have. According to the Center For Disease Control, one out of five falls will result in a serious injury such as a broken bone or a brain injury. Falls are not to be taken lightly!

On the flip side of that coin, we also cannot stop our daily activities due to the fear of experiencing a fall. Being cautious and avoiding certain activities or areas that may make us more prone to falling is wise, but like the CDC also notes, keeping active is one way of keeping us stronger, which can also help us avoid falling. Another way to help us build strength and fight the potential of falling is by exercising regularly. These 10 exercises, when done under the supervision of your physical therapist, can help you regain your balance and reduce your risk of falling.

  1. Simple Leg Lift – For this exercise, start with a kitchen chair setting in front of you. Steady yourself by holding onto the back of the chair, and raise one foot off the ground by bending your knee and bringing it up toward your waist. (It is preferable that you let go of the chair back so that you are balancing on your own without assistance, but if you’re unsure or unsteady, keep your hand on the chair.) Hold this position for 5-10 seconds, then try closing your eyes and holding the position for 5-10 seconds. Now use the other leg and do the same exercise.
  2. Weight Shifts – Another exercise to begin with is a Weight Shift. Stand with your feet hip-width apart. With your hands to your sides, or on your hips, lift one foot an inch or two off the floor and hold it there for 20-30 seconds. Set it down and repeat with the opposite foot. Do this as many times as you feel you can without getting too tired. As time goes by, the goal is to increase how many reps you do. If needed, you can also use a chair with this exercise to help give you added balance.
  3. One-Legged Clock – Standing on one foot, extend your arms straight above your head, as though you are signaling 12 o’clock on a clock face. Leaving your right hand on the “12,” move your left hand to the three, six, and nine o’clock positions (pausing at each position). Return your left hand to the 12, and repeat the movements using your right hand. Now, switch feet and repeat. To increase your workout, do it with your eyes closed.
  4. Tai Chi – Whether you sign up for a class, or follow along to online videos, Tai Chi has been shown to improve balance for its practitioners.
  5. Yoga – Like with Tai Chi, yoga has also been shown to improve the balance of those who practice it. Again, you can opt to take a class, or you can workout to an online video or DVD.
  6. Heel-to-Toe Walk – This exercise is simple, yet effective. Walk 20 paces forward, heel-to-toe. If needed, do this within arm’s reach of a wall to help you with keeping your balance. After you go forward 20 paces, go backward 20 paces — toe-to-heel. Doing this on a regular basis can help you regain a sense of balance.
  7. Squats – To do a squat, stand with your feet hip-width apart. Bending at the knee, and not the waist, squat down toward the floor, holding your arms straight out in front of you. Pretend you are sitting in an invisible dining chair. If needed, keep a chair in front of you to help you get up and down. This exercise will help strengthen your leg muscles, which is crucial for the prevention of falls. An alternative way to squat: start with your back and heels against a wall. Keeping your arms out in front of you, bend at the knee and slide down the wall to a seated-like position (again, pretend you are sitting in an invisible dining chair). Using your legs, push yourself back to a standing position. Having a wall behind you can be a big help when you’re starting out or if you need additional help with balance.
  8. Back Leg Raises – You can hold on to a kitchen chair when doing these leg raises, or you can place your hands on a wall, whichever is most comfortable for you. Once you have your chosen your preference, you will stand on one leg while raising the other one behind you. Try not to lean forward or bend the knee of the leg you’re raising; just lift your leg as far off the ground as is comfortable for you, hold it for a couple of seconds, and let it back down. Do this for 10 reps, then do the same thing with the opposite leg. This helps to build lower back muscles as well as buttock muscles.
  9. Side Leg Raises – Like with the Back Leg Raises, you can use a wall or a chair to steady yourself with. Then, standing on one foot, lift your other foot out to the side. Go as high as you are comfortable with, hold it for a couple of seconds, and let it back down. Again, do this for 10 reps, then repeat with the opposite leg. This exercise not only helps strengthen your buttocks, but it also helps with your thigh muscles and your hip muscles.
  10. Stability Ball – This ball may look like an over-sized beach ball, but it’s anything but. Just learning to sit on a stability ball can help improve your core strength, as well as your balance. After getting the hang of sitting on it, you can then incorporate it into various workout activities. You can sit on it while using dumbbells, or you can use it while doing sit-ups. It’s a very versatile tool to help improve balance and stability.

While these exercises can be a good starting point to help you improve your balance and reduce your risk of falling, your physical therapist may have additional exercises or variations that they can tailor specifically for you.

To your better balance,
George Hess

3 Ways to Beat Achy Shoulders

Do you find your shoulders aching at the end of the day or when having to lift your arms? Whether your pain is from an old injury or just from moving all day long, try these simple techniques to feel better and stronger.

Why Your Shoulders Hurt

Your shoulders are the most complicated joints in your body and one of the most easily injured. They have to move through an incredible 180 degrees of motion, while still maintaining stability and strength. Some of the most important muscles in the shoulder are actually the smallest.

The rotator cuff is a series of 4 muscles that form a cuff around the shoulder (glenohumeral) joint. Although they are small, they are vital to guiding how the shoulder joint moves. When these muscles are weak or injured, the head of the humerus bone can jam up into the socket of the shoulder blade, causing inflammation and pain.

Try these simple actions to improve the health of your shoulders and alleviate that nagging ache or sharp pain for good.

  • Keep your shoulders aligned by doing postural exercises – The number one reason for repetitive injury and pain in the shoulders is poor posture. With prolonged slouching, the shoulders protrude forward changing the mechanics of the way your shoulders move. This weakens your rotator cuff and shoulder blade (scapula) muscles. It predisposes you to injury.
  • Strengthen your rotator cuff muscles – By keeping your rotator cuff muscles strong, you help guide your shoulder joints throughout the day, lessening the chance for injury and inflammation to occur. A simple exercise to perform is lying on your side with your top arm straight up towards the ceiling. Now slowly lower the arm down towards your hip, but not all the way, then back up to the ceiling. Repeat 10-15 times for 2 sets every other day. Stay within a pain free range of movement. Stop if you have any pain or talk to one of our therapists if you have any questions.
  • Improve your scapula stability – The scapula (shoulder blade) is a part of your whole shoulder complex. It has many different muscles attached to it, pulling at just the right time for proper shoulder movement. Every time you reach, pick up or pull, you use your scapula. Improve the stability of them by performing scapula exercises. A simple exercise is standing against a wall and gently trying to pinch your shoulder blades together, while keeping your arms relaxed. Perform 10-15 repetitions, holding the contraction for 5 seconds.

Recovering from Rotator Cuff Injuries

For active people with rotator cuff injuries, the most commonly asked question is whether or not the injury will heal without need for surgery. In 2012 the American Academy of Orthopaedic Surgeons revealed studies reporting that surgical repair fails in about 57% of rotator cuff cases. Non-surgical treatment of rotator cuff injury succeeds in about 50% of cases. It seems, then, that opting first for a non-invasive method has just as much potential for success as surgery.

Anatomy Of An Injury

Rotator cuff injury is common because the four major muscles involved in rotating the arm in the shoulder socket are used frequently every day. Each time a person moves their arm they are using their rotator cuff. The “cuff” is created by muscles surrounding the shoulder blade, working together to form a cuff of tendons that cover the top portion of the arm bone as it enters into the shoulder socket. The cuff serves to keep the ball of the arm bone properly positioned within the socket.

Lifting is the most common action that will become painful with a rotator cuff injury. You may feel pain as muscle tissue of the rotator cuff is pinched between the bones of the ball and socket joint. This condition may sometimes be commonly called bursitis. Rotator cuff pain becomes more likely in active adults as they age due to the normal effects of wear and tear or repetitive movement. Just as a rope will fray if constantly rubbing against a sharp edge, the tendons of the cuff will also eventually wear and possibly tear. Symptoms are usually noticeable as:

  • Sharp pain down the side of the arm when reaching upward or behind.
  • Throbbing pain at night during sleep.
  • Pattern of pain across the shoulder and down the arm.

Non-Surgical Options

Physical therapy may be the first recommendation by a physician. In addition to a method of treatment, there are also many things an individual can do outside of a physical therapy environment to aid in recovery.

Rest: Rest the rotator cuff by limiting range of motion, especially overhead reaching.

Support: Compression wear is available with devices designed to specifically support the shoulder and rotator cuff. Often called a sling or sleeve, many have designs that integrate heat and ice therapies that further help to reduce inflammation and pain as well as accelerate healing.

OTC Medication: Non-prescription drugs like ibuprofen or naproxen can help reduce swelling and manage pain.

Exercise: It is important to continue to strengthen the affected shoulder and maintain flexibility. However, exercises and stretches should be adapted so as not to further exacerbate an injured rotator cuff that is in recovery.

Flexibility Exercises

Crossover Reach Stretch

  1. Standing or sitting, raise affected arm chest high and reach across the chest.
  2. Using the opposite hand, apply gentle pressure just below the elbow and hold for about 30 seconds.
  3. Switch arms and repeat.

Back Hand Clasp Stretch

  1. Clasp both hands behind you with arms lowered.
  2. Slowly raise clasped hands as long is it does not cause pain. Hold for 30 seconds.
  3. Release hands and relax for 10 seconds then repeat stretch.

Strengthening Exercises

When using weights in exercises to improve strength, select a weight that will not cause pain during use.

Pendulum Swings

  1. Using a table for support, lean over with one forearm resting on the table top, back parallel to the floor, and dumbbell in the other hand hanging straight down.
  2. Gently swing dumbbell back and forth for 30 seconds.
  3. Switch arms and repeat.

Therapy Goals

Treatment approaches for rotator cuff injuries should have in mind multiple goals:

  • Healing the injury.
  • Managing pain.
  • Maintaining range of motion.
  • Moderate immobilization with compression wear and limiting movement will help accelerate healing of the affected muscles. Proper use of ice, heat and over-the-counter medications can give a person pain management options within their control. Commitment to a regular stretching and exercise program will help to prevent atrophy of the affected muscle while waiting for the injury to heal.

    A person does not have to be a professional athlete to experience a painful rotator cuff injury. Such an injury can occur just through the normal effects of aging and the everyday activities a person engages in. Pain from rotator cuff injuries can stay with a person for years. It is also very common to have a repeat performance of injury after a prior injury has healed. That is why once the problem arises it is important for any sufferer of rotator cuff injury to modify their lifestyle to include habits and methods that are pro-active in maintaining rotator cuff health. Don’t perform the recommended flexibility and strengthening exercises only after an injury occurs, make them a regular part of your daily health regimen.

    Also keep in mind that healing properly from a rotator cuff injury can take a very long time. Be patient and stay committed to your physical therapist’s advice on how to care for your injury. For more information regarding rotator cuff health and injury recovery, consult medical experts who are committed to non-surgical approaches first.

Rotator Cuff Recovery Tips

A rotator cuff tear is a common and serious injury. To fully recover from this type of injury it is vital to go through proper rehabilitation. The goal is to strengthen these muscles while not overworking them. Due to the complicated nature of the shoulder joint, it is best to seek the help of a professional when working through your rehabilitation.

The Rotator Cuff Muscles

First, it is important to understand what this injury is, so you know how it will be treated.

The anatomy of your shoulder looks like this; the ball of your shoulder sits in a very shallow socket created by your shoulder blade and collar bone. Holding this ball into the socket and keeping it stable are four muscles called the "rotator cuff". This rotator cuff is made up of the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles provide stability while also allowing for a wide range of mobility.

If you have a "tear" of the rotator cuff then you have torn through one or more of these muscles or tendons. Each person is different but some of the typical signs and symptoms of a rotator cuff tear are as follows:

First would be pain. You should not have shoulder pain as it is not normal and should not be ignored. It warns you that there is something wrong and will continue to get worse unless addressed. Although pain is present, it doesn't always mean that a tear is present as well. A muscle or tendon strain, tendonitis, or bicep issue could also be the culprit. However, these issues can lead to tears in your rotator cuff if left untreated, so be sure not to overwork with pain.

Swelling can also be present with a rotator cuff tear, so if your shoulder is swollen, you should seek medical attention. Another sign would be a loss of motion. If you are unable to raise your arm as high as you were before the pain, then chances are there could be something wrong.

Important Notes

When recovering from this type of injury, you are trying to strengthen these muscles while not over stressing them. You will also be working on regaining as much range of motion as possible. These two factors will make this unlike any workout you have had before. You are not working on building big muscles, like in a regular workout, but working toward stability and flexibility.

You should always consult your doctor or physical therapist about any shoulder injury that you may have. It is your therapist's job to put you through a routine that is suited best for you. It is very important to realize that going beyond what is recommended could hinder your recovery time or worsen your injury in general.

When you begin rehabbing you shoulder, you will most likely begin working with light weights because you are now focused on stability and flexibility. This will cause less fatigue then you may be used to with regular workout. That is OK! The goal is to strengthen, stabilize and regain motion without overdoing it with heavy weight and pain. Each exercise will have a specific amount of repetitions that you will go through. Consult with your therapist regarding these repetitions and exercises.

Keep These in Mind

There are a few important things to keep in mind when working out your shoulder:

  • Don't overdo it with heavy weights. You do not want to lift something that your shoulder isn't able to handle. Make sure to consult your therapist.
  • Important to warm up the shoulder before beginning strength training. Follow your therapist's specific warm up routine.
  • Don't get frustrated during these workouts. These injuries take time to heal and it will take time to return to previous form.
  • Ice will help after workouts to reduce swelling and help your shoulder heal properly.
  • Make sure to give your shoulder the rest it needs. Don't overdo it with unnecessary activity. Avoid any sports or strenuous activity until you are fully healed. If you are unsure, consult your therapist.
  • If you are looking for a more intense workout, you are still able to work lower body. Just be sure to avoid stress to the shoulder as your therapist recommends.

Injured rotator cuffs are serious injuries, but it's not one that you can't recover from with the right therapy and pace. Remember, shoulder rehabilitation takes time and it is important to give your shoulder the proper time it needs. Always consult your doctor or therapist before trying anything on your own, because the last thing you want is to make things worse for yourself.