THE THREE MOST COMMON KNEE INJURIES

Knee Injuries

The knee is an essential part of our anatomy, allowing us to stand upright, sit down, run, and engage in countless other activities. When healthy and strong, our knees work like an engineering masterpiece. If a knee injury occurs, even the most basic movements can quickly become extremely difficult, if not impossible to perform. If you’re experiencing knee pain then read on. In this post, we will discuss the basic anatomy of the knee, in addition to outlining the 3 most common knee injuries seen by physical therapists.

Knee Anatomy

The knee joint is actually a modified hinge joint, meaning the joint allows one to flex and extend the leg, along with a small amount of internal and external (side-to-side) rotation. The entire knee joint consists of bones, ligaments, tendons, cartilage, and other vital tissues. Nearby muscles in the calf and the main supportive muscles in the upper leg — the quadriceps and the hamstrings also play a huge role in overall knee health. While any of these components could incur an injury, the 3 most common injuries are patellar tendonitis, a ligament injury (ACL, MCL, LCL, PCL), or a meniscus (cartilage) injury.

Patellar Tendonitis

This injury occurs when the tendon that connects the knee cap (patella) to the shinbone (in the calf) becomes inflamed. This injury is sometimes referred to as “jumper’s knee” as the injury often occurs from excess stress placed on the knee after landing from a jumping motion. Many athletic activities require these types of movements, and obesity can also put excess stress on this tendon as well. Pain can occur in front of, on the side, or even in the back of the knee cap. It’s very important to receive prompt medical care if a person suspects they have patellar tendonitis. Without proper treatment, the tendon is likely to become weaker and weaker, with the injured person becoming increasingly unable to perform even basic movements such as climbing stairs.

Both physicians and physical therapists have special tests they use to determine whether or not a patient may be experiencing patellar tendonitis. Once diagnosed, a physical therapist can first help by providing treatment that decreases inflammation and reduces pain. As the patient feels more comfortable a physical therapist will introduce stretching exercises, then eventually working toward strengthening exercises for surrounding muscles that help support the knee cap.

Ligament Injuries

Ligament tissues are tough, fibrous material that connects to bones — in this case, the knee bones. The 4 most common knee ligament injuries are found in the ACL (anterior cruciate ligament), the LCL ( lateral cruciate ligament), the PCL (posterior cruciate ligament) or the MCL (medial collateral ligament). All of these ligaments play a role in surrounding the knee cap and connecting it to bones in the upper leg and calf areas.

A ligament injury often manifests with sudden and severe pain, followed by knee-buckling and the inability to bear little or no weight on the injured extremity. Many patients report hearing a snap or popping sound coming from the knee when the injury first occurs. It’s important to seek immediate medical attention to determine the extent of the injury. Mild cases may require only RICE (rest, ice, compression, elevation) treatment, but more serious cases will require physical therapy and perhaps even surgery. Physical therapy goals will include working on reducing pain and inflammation, gradually increasing range of motion, and lastly, increasing strength of surrounding muscles and tissues to help support the affected ligament.

Meniscus Injury

Each knee has 2 menisci — cartilage that provides cushioning between the thigh bone and the shinbone (in the calf). A tear to one of these pieces of cartilage typically occurs from a sudden pivot or rotation of the knee joint. Any athletic activity that involves sudden stop and pivot motions can result in a meniscus tear, but even heavy lifting or deep squatting can result in this type of injury as well. Knee menisci also tend to weaken with age, thus patients with knee arthritis may eventually experience a torn meniscus.

A meniscus injury will result in pain around the kneecap, especially when touched. Many patients report hearing a popping sound when the injury first occurs. Often a patient will feel as if their knee is locking or catching on something within, and they may feel as if their knee is about to buckle.

Physical Therapy Can Help

Physical therapies include effective treatments such as laser therapy, designed to reduce pain and increase healing blood flow to the area. Therapists will gradually introduce stretches designed to maintain and eventually increase range of motion, followed by strengthening exercises for muscles that support the menisci.

If you are experiencing knee pain and would like to know more about how to recover from a knee injury, please contact Hess Physical Therapy at one of our 3 locations!

Our locations:
Kennedy: (412)-771-1055
Crafton: (412)-458-3445
Allison Park: (412)-487-2787

THE TOP 10 THERABAND EXERCISES FOR ROTATOR CUFF/SHOULDER INJURIES

Many people assume if they incur a shoulder/rotator cuff injury that it automatically means their injury will require surgery, but that is not necessarily the case.  In many cases, other non-surgical treatments like physical therapy can help patients avoid surgery by using specific stretching and strengthening exercises.  When administered by a physical therapist, these exercises can stretch tight muscles, help promote the proper range of motion in the arm and shoulder area, along with gradually strengthening muscles surrounding the shoulder area so that all of the shoulder components maintain their health and ability to perform certain tasks.

Rotator Cuff Definition and Injuries

Surrounding the shoulder joint is a group of tendons and muscles.  This group is called the rotator cuff and they provide the support necessary to keep the top of the arm bone firmly in the socket area of each shoulder.

There are several reasons why the rotator cuff area may become injured.  Beyond traumatic injuries such as vehicle accidents and sports injuries, the most common causes of rotator cuff injuries stems from individuals who routinely perform physical tasks that require them to keep their arm(s) lifted.  Painters, carpenters, and others in the construction industry often end up with rotator cuff injuries due to the nature of the work.  Age is another factor that plays into developing rotator cuff injuries, most likely due to a sedentary lifestyle that weakens muscles over time.

Sometimes simple inflammation will occur in the shoulder, but in other cases, an actual tear occurs in a muscle.  Whether or not surgery is required, depends upon the severity of the tear.  Anyone with a rotator cuff injury should receive an accurate diagnosis from their physician.  In many cases, the doctor will prescribe a series of physical therapy treatments, which will allow the individual can regain the full use of their shoulder.

10 Theraband Exercises for the Rotator Cuff

  1. External rotation @ 0 degrees of abduction – This exercise requires the patient to hold the Theraband at waist height with the hand of their injured arm, forearm across their waist.  The next step is to rotate the forearm 90 degrees so the hand is pointing outward, then return the forearm back to its neutral position.  This strengthens the muscles attached to the shoulder blade including the infraspinatus, teres minor, and the supraspinatus.
  2. Internal Rotation @ 0 degrees of abduction – Once again the patient will hold the band at waist level, only this time the starting position is with the hand in front at a 90-degree angle to the body.  Rotate the arm inward until the forearm is resting at the waist, then slowly return the forearm to 90 degrees.  This strengthens the internal rotator cuff muscles including the iliac crest and the latissimus dorsi.
  3. External rotation @ 90 degrees abduction – To start, lift the affected arm to the side until the elbow reaches shoulder height.  Extend the hand forward to grasp the band placed at about shoulder height and lift it up until the hand is pointing to the ceiling.  Then come slowly come back to starting position.  Do not rotate the hand at all throughout the motion.  This is another exercise to strengthen the infraspinatus and teres minor.
  4. Internal rotation @ 90 deg abduction – In this exercise, the patient will actually stand with the band behind them.  Place the resistance band handle in the hand, with the hand pointed to the ceiling.  The elbow should be at shoulder height.  Move the hand forward until it is facing forward, then slowly lift it back up until it is facing the ceiling again.  This will strengthen the pectoralis major, the deltoid in the arm and the rotator cuff.
  5. PNF D2 Flexion Pattern –  In this exercise, the band is positioned at hip height on the opposite side of the affected arm.  Cross the affected arm over the body and grasp the resistance band.  Slowly bring it across the body and lift the arm up in the air at a diagonal.  This exercise strengthens the posterior (back) of the shoulder and the deltoid in the arm.
  6. PNF D2 Extension Pattern –  Similar to the D2 flexion pattern, this exercise begins with the Theraband positioned high enough so the patient can grasp the band handle while their affected arm is fully extended upward.  The next step is to slowly bring the handle down and across the body, then return to starting position.  This exercise focuses on the muscles on the posterior side of the shoulder.
  7. Rows with elbows flexed to 90 degrees – With the Theraband positioned at waist height, stand far enough back from the band to start with the arms fully extended.  Grasp the handles and pull until the elbow are just slightly behind the waist, then return slowly to starting position.  The muscles strengthened in this exercise are the rhomboids and middle trapezius.
  8. Shoulder extension with elbows @ 0 degrees – Face the band positioned at a height where the arm can be fully extended.  Without bending the elbow, slowly pull down the arm until the hand is resting comfortably by the side of the body, then return the arm to the starting position.  The deltoid, latissimus dorsi, and middle trapezius are the muscles strengthened in this exercise.
  9. Punch out exercise for serratus anterior strengthening – Place the resistance band around the mid-back area and grasp the band on each side.  In a slow punching motion, bring the band forward as far as one can reach, then slowly come back to starting position.  This exercise helps to stabilize the scapula area by strengthening the serratus anterior muscle.
  10. Shoulder scaption –  Stand on the resistance band on the affected side.  Grasp the band and pull it up and slightly forward, then slowly return to starting position.  This exercise strengthens the supraspinatus and deltoid muscles, along with the rotator cuff area.

Want to know more about physical therapy for rotator cuff and other shoulder injuries or need a piece of Theraband?  Stop at Hess Physical Therapy and schedule an evaluation with one of our doctors today!

Our locations:
Kennedy: (412)-771-1055
Crafton: (412)-458-3445

THINK YOU HAVE CARPAL TUNNEL SYNDROME? TAKE THESE 3 SIMPLE HOME TESTS

With the advent of the heavy use of technology devices throughout the general public, people experiencing Carpal Tunnel Syndrome or CTS, seems to be on the rise.  Although CTS is still primarily seen in individuals who rely heavily on their hands in order to perform work duties, as in the case of manufacturing jobs, professional cleaning, sewing or packing jobs, for the average person the plethora of opportunities to overuse their hands is increasing as well.  More and more, people are using computer keyboards both at work and daily at home, along with texting on their phones and/or playing video games.  Fortunately, there are many solutions for this uncomfortable and painful medical issue.

CTS – Definition and Symptoms

At the base of each hand, there is a narrow passageway called the “carpal tunnel”.  This tunnel houses the tendons that move the fingers, along with the median nerve which extends from the forearm to the palm of the hand.  When an individual overuses one or both of their hands, the tendons inside the carpal tunnel area can become irritated and swollen.  This swelling can compress the median nerve, resulting in numbness and pain in the affected wrist and hand, and in some cases the forearm and arm.  Left unchecked, CTS can eventually cause hand weakness, so it is important to receive timely medical treatment for this issue.

Along with the pain and numbness during intensive hand/wrist activities, many CTS-affected individuals report chronic issues with numbness, burning and tingling of their hands and fingers while they are sleeping.  During sleep, most individuals either bend one or both of their wrists at various times, causing further irritation to tissues in the carpal tunnel area.

Risk Factors

According to the National Institute of Neurological Disorders and Stroke, women are three times more likely to be affected by CTS.  It is theorized this occurs because women generally have smaller wrists than males.  Carpal tunnel issues generally occur first in an individual’s dominant hand, although it can affect both hands, at the same time or at different times during an individual’s life.  The institute also reports that people with metabolic disorders such as diabetes will typically have increased susceptibility to carpal tunnel issues, since these types of disorders often directly affect nerve function.  People who extensively use their hands, whether from work-related activities, hobbies or other recreational activities, are also at greater risk for developing carpal tunnel issues.

Construction worker with jack hammer.

Tests

If you suspect you have Carpal Tunnel Syndrome, you should get an official diagnosis from a physician.  There are other medical issues including a pinched nerve in the cervical (neck) region and a pinched nerve in the elbow region (tennis elbow) that can mimic CTS, so it is important not to self-diagnosis and attempt to treat hand/wrist pain and numbness on your own.  While you are waiting to see your physician, there are some at-home tests you can perform that potentially can help determine whether CTS is an issue or not.

The first test is called, “Tinel’s Sign”.  To conduct this test, place the affected hand on a flat surface, with the palm facing up.  With the opposite hand, tap the middle area on the affected wrist, right at the crease of the wrist or slightly below.  If you experience any numbness or tingling from the tapping, you might have CTS.  The next test is called, “Phalen’s Test“.  This test requires an individual to place their hands in front of them, elbows out to the side, with fingers pointing down to the floor, while pressing the backs of the hands together.  Hold the position for 60 seconds.  If the test increases numbness, burning, tingling and/or hand pain, this could be an indication of CTS.  Lastly, is the “Reverse Phalen’s Test”.  This requires a patient to maintain the position of the arms and elbows as in the Phalen’s Test, except the hands are placed palm-side together, with fingers pointing up, much like a praying position.  Hold the position for 60 seconds and then evaluate for any increased signs of pain, numbness or tingling.

Summary

Not all cases of CTS will result in surgery and the sooner an individual begins treating their CTS, the less likely their case will require surgical intervention.  There are many treatments available that can resolve CTS including rest, ice, wearing wrist splints during sleep, and a series of physical therapy appointments where patients can learn how to stretch and strengthen muscles in and around their forearms, hands and wrists.  Physical therapists can also make recommendations on how to improve work areas, including the proper positioning of hands and wrists in order to reduce strain.

If you would like more information about physical therapy treatment for CTS, please contact one of our 3 offices and speak to a doctor today!

Our locations:
Kennedy: (412)-771-1055
Crafton: (412)-458-3445
Allison Park: (412)-487-2787

TOP 3 EXERCISES TO REDUCE BACK PAIN CAUSED BY LUMBAR SPINAL STENOSIS

As the body ages, the spine tends to experience some unfavorable changes. One of these changes can result in conditions, such as Lumbar spinal stenosis. This condition is caused by a narrowing of the spinal canal in the lower-back due to bone or tissue growing in the opening of the spinal column. There are various symptoms that indicate you have Lumbar spinal stenosis, such as increased pain in the legs while walking, numbing, cramping, stiffness in the legs and thighs, and lower-back pain. In the most extreme cases, individuals can experience a loss of bladder and bowel control.

These symptoms may not be noticeable right away. However, symptoms may become more prominent overtime. It’s important that you do not ignore these symptoms. Instead, you should seek professional help, such as a physical therapist. Physical Therapy has become a proven alternative to alleviating pain associated with Lumbar spinal stenosis. Physical therapist will recommend treatments that will improve your body’s condition and overall health.

With that said, here are the top 3 exercises to help reduce lower-back pain caused by Lumbar spinal stenosis:

1. Single-Knee To Chest:

This exercise is effective for those recovering from lower-back injuries, those who are suffering lower-back pain, and those who have arthritis. Performing this stretching exercise will help ease pain and release tension in the spine.

How-To Perform

  • Lie on your back with you knees bent and your feet flat on the floor.
  • Leaving one foot in place, bring one knee towards your chest, while pressing your lower back into the floor.
  • Hold your raised knee with both of your hands and pull it towards your chest

Perform this exercise between 15 and 20 seconds and then repeat with your other leg.

2. Double-Knee To Chest:

Similar to the single-knee stretch, this exercise stretches your lower-back, hamstrings, and glutes, helping to alleviate pain in the lower-back.

How-To Perform

  • Lie on your back with you knees bent and your feet flat on the floor
  • Bring one knee to your chest and then proceed with the other. (Don’t raise both legs at the same time)

Perform this exercise for 15-30 seconds and then lower your legs one at a time. Rest for 30 seconds and then repeat 2-4 times.

3. Posterior Pelvic Tilt:

This exercise is great when it comes to healing lower-back pain. Performing this exercise will improve strength and stabilization of the core and pelvis, which means that you will lessen your risk for injury and pain.

How-To Perform

  • Lie on your back with your knees bent about 2-inches apart, and your feet flat on the ground. Be sure to relax your arms by your side.
  • To ensure that your back is flat against the surface, press your belly button towards your spine.
  • Tighten your abdomen muscles and begin to thrust your pelvis up slightly. Hold for up to 10 seconds.

If you need help adapting to this exercise, try this alternative:

Use a Chair: Placing your feet on a chair, bend your knees at a 90-degree angle so that your legs are perpendicular to the floor. Then, proceed to thrust your pelvis up slightly and hold for up to 10 seconds.

Exercises should always be performed on a comfortable surface and should never increase your pain. Exercising will reduce the symptoms of Lumbar spinal stenosis, improve flexibility, and increase your overall well-being. Staying active is the best thing you can do to effectively manage your symptoms. If you have any questions or concerns about Lumbar spinal stenosis or you want to know more about exercises for lower-back pain, call Hess Physical Therapy today and let one of our doctors get you back to a pain free life.

Our locations:
Kennedy: (412)-771-1055
Crafton: (412)-458-3445
Allison Park: (412)-487-2787

WHAT IS A MENISCUS TEAR?

Have you ever heard people talk about torn knee cartilage? What they really mean is a torn meniscus. Anyone who’s ever had a meniscus tear knows how this condition can cause excruciating pain and affect productivity. Actually, this type of knee injury is quite common. Here’s what you need to know about the meniscus, along with what’s involved in a meniscus tear and how physical therapy (PT) is a viable treatment option.

Basic Knee Anatomy and Functions of the Mensicus

The meniscus consists of two pads or rubber cushions of fibro-cartilaginous tissue that form a “c” or crescent shape. To better understand what’s involved in the meniscus, picture how your knee joint is formed by three bones that come together. These bones include the femur (thighbone), the tibia (shinbone) and the patella (kneecap). Each knee joint contains two menisci.

Your meniscus serves two important functions. Besides filling the space between the bones of your knee and stabilizing the knee, the meniscus is also a shock absorber between the tibia and the femur. Think about how your knees are subjected to significant stress just by doing your daily activities.

In fact, the stress placed on your knee when taking a single step is about 2 to 3 times that of your body weight. When you run or exercise, the force is even more. But when your meniscus is working properly, the force involved in each step is distributed evenly so that your knee is stabilized when it’s extended, flexed or makes circular movements.

People Most at Risk

In most cases, a meniscus tear is a result of turning or twisting quickly. These injuries normally happen from lifting heavy objects or playing contact sports, such as football, as well as non-contact sports that involve a lot of jumping.

Age is another factor as older people are more at risk. This is because the meniscus becomes weaker as you age. Males are more likely to be injured than females. Other high-risk groups include people serving in the Army or Marine Corps.

Common Diagnostic Tests for Meniscus Tear

  • Physical examination—This involves a doctor examining your knee and checking for tenderness at the area of the meniscus, which can indicate a tear.
  • The McMurray test—This test entails your doctor bending your knee and then straightening and rotating it to see if there’s a clicking noise, which reveals a meniscus tear.
  • MRI (magnetic resonance imaging) scans may be ordered, especially when there’s swelling. MRIs are able to reveal a better view of the soft tissue in your knee joint and can show where the tear is located, besides its severity.
  • X-rays—Even though you can’t see meniscus tears from X-rays, they can still show the reasons for knee pain, such as osteoarthritis.

Nonsurgical Treatment Options

Nonsurgical treatments can be effective for treating small tears. These treatments, known as the RICE protocol, include rest, icing the affected area, compression and elevating your leg above the level of your heart. Taking NSAIDS (non-steroidal anti-inflammatory drugs) can also help in pain relief.

Arthroscopic Surgery

When nonsurgical treatments don’t work, arthroscopic surgery may be needed. This procedure involves a tiny camera that’s inserted through a portal or small incision, enabling a surgeon to clearly view the interior of the knee. Next, miniature surgical instruments are inserted through tiny incisions for repairing or trimming the tear.

Physical Therapy

Physical therapy is one of the best ways to treat a meniscus tear. Physical therapists use a treatment known as NMES (neuromuscular electrical stimulation) for improving knee strength. They also prescribe specific exercises that can help in restoring total movement to an affected knee. Furthermore, patients are shown exercises they can do at home for their conditions.

Studies Showing That Physical Therapy Is Just as Effective as Surgery

Several studies have been done showing physical therapy to be just as effective as surgery for treating meniscus tears. For example, a study done at Brigham and Women’s Hospital in Boston involved half of the patients, ages 45 and older, receiving only physical therapy, while the other half underwent surgery.

After a six-month period, both of the groups showed significant improvement in pain levels and functionality. Only 30 percent of the 351 participants who received only physical therapy chose to have surgery following six months of starting the study. This was because their symptoms had not improved. However, those remaining in the physical therapy group continued to improve throughout the next six months and showed just as much improvement as the patients who did have surgery.

Considerations and Warnings

  • The meniscus used to be considered as just a muscle remnant, rather than an essential part of the knee, so surgeons removed the meniscus. This resulted in a loss of shock absorption in the knee.
  • The first arthroscopy for meniscus repair was done in 1969.
  • Younger people with meniscus tears, under age 30, are more likely to get meniscus tears because of engaging in sports activities.
  • When treatment begins early, such as within three weeks of being injured, the injuries are usually repaired.
  • It’s important to recognize the common symptoms that can suggest a torn meniscus. Besides pain, these include swelling, stiffness, a locked knee, not having a full range of motion in your knee and feeling as if your knee is collapsing.
  • If you’re overweight, it can help to lose weight to reduce your odds of getting a torn meniscus.

If you struggle with orthopedic pain, visit the physical therapy specialists at Hess Physical Therapy where we treat all types of orthopedic related conditions. Contact our team at Hess Physical Therapy via phone at any of our 3 offices or refer to our website www.hesspt.com for further contact info.

Kennedy: (412)-771-1055
Crafton: (412)-458-3445
Allison Park: (412)-487-2787

DOES CLASS IV LASER THERAPY REALLY WORK?

DOES CLASS IV LASER THERAPY REALLY WORK?

When you hear the word laser, you generally think of eye correction or internal surgery – or maybe Star Wars. But lasers are also used in physical therapy, often in conjunction with other types of therapy. They’re also a good alternative or addition to medication.

Laser therapy is different from light therapy in the concentration of light as well as the effectiveness of certain treatments. Laser therapy involves “coherent light” (no abrupt phase changes within the beam), and monochromatic (of one ‘color’). This all works through a process known as photobiomodulation. Photobiomodulation helps damaged cells return to normal, generally with repeated, small sessions. Light therapy has been successful in treating such symptoms as depression and peripheral neuropathy, a problem often associated with diabetics. Lasers, however, can go a little deeper. The laser has a focused beam of light with the ability to penetrate up to 5 centimeters, depending on which laser is used.

There is a general agreement among professionals that orthopedic conditions benefit from laser therapy. Laser therapy in physical therapy implements the use of an applicator that covers a larger treatment area as well as the depth of penetration. Laser therapy stimulates collagen synthesis, promoting healing. Many patients have found relief in their symptoms after a few short treatments designed for their specific needs.

Laser therapy can treat arthritic pain and stiffness; muscle and joint aches and pains and increase in local blood circulation. Laser therapy also stimulates ATP production, the energy source of all cells, as well as accelerating the inflammatory process, thereby accelerating wound healing. Additionally, there is an overall decrease in pain and swelling, partly due to increased lymphocyte activity helping to modulate the inflammatory process. This makes laser therapy beneficial for both acute and chronic pain.

Laser therapy is not considered a dangerous treatment. In fact, it is safer than many invasive treatments. However, not everyone or every symptom is a candidate for laser therapy. Laser therapy is not recommended for treatment of cancer, during pregnancy or over a hemorrhage, endocrine or thyroid gland. Nor is it used when a patient is taking photosensitizing medications. Protective eyewear must always be worn in any laser treatment.

There have been previous versions of the laser but professionals and clients both agreed that it did not deliver the necessary results. With the class IV laser (LiteCure Fxi Unit), therapists are findings better results and happier clients.

Some of the benefits of the class IV laser include:

  • Compression which removes superficial absorbers and reaches targeted tissues
  • Therapists can manually work tissue while delivering energy;
  • The tighter beam of the class IV laser minimizes energy loss and
  • A refractive index that minimizes light loss due to skins and lens composition similarity.
  • This consistency allows therapists to deliver the same effective treatment with each session.

Hess Physical Therapy is proud to be one of the only offices offering this type of therapy in the area.Our therapists are well trained in delivering the best treatment to their patients with long-term successful results. The professionals at Hess are ready, willing and available for those wanting to get more information on this innovative product and the benefits it can offer their clients. Additionally, Hess offers individualized skilled PT services as well as workshops for a variety of ailments, including rotator cuff and shoulder; balance and dizziness; foot and ankle, knee pain as well as back pain and sciatica.

For more information on this and other treatments, or to see if laser therapy is right for you, contact any of our 3 offices or refer to our website www.hesspt.com for further contact information.

DO YOU HAVE ACHILLES TENDONITIS?

Your Achilles tendon has an important job. It is the strongest tendon in your body. It helps you point your foot down, rise up on your toes and push off when you walk or run. The Achilles tendon, also called the calcaneal tendon, is a band of fibrous tissue at the lower end of the calf. It connects the calf muscles to the heel bone. But this powerful tendon is also subject to painful injury.

What is Achilles Tendonitis?

Tendonitis, (also called tendinitis) is the inflammation of a tendon. The part of the tendon known as the watershed zone contains the weakest blood supply. Watershed zones are particularly vulnerable to inflammation and possibly rupture.

Insertional Achilles tendonitis affects the lower part of the heel, where the tendon is attached. Noninsertional Achilles tendonitis refers to fibers in the middle portion of the tendon which have broken down, swollen and thickened.

Anyone can injure their Achilles tendon, but it is most common in active individuals. Injuries to the Achilles tendon can result in a difficulty walking, climbing stairs, or participating in other recreational activities. Factors often lead to an injury include:

  • Extreme training (particularly running on hills.)
  • A change in an athlete’s training, such as increased intensity, or a change in playing surface.
  • Excessive pronation, (rolling inward on the foot) or ankle instability (rolling of the ankle.)
  • Chronic ankle instability, or a recurrent “giving way” or rolling of the ankle
  • High heels may shorten the Achilles tendon, making it more prone to injury
  • High-arched feet
  • Some forms of arthritis
  • Aging, which reduces the blood supply to tendons.

Bursitis and tendonitis are common types of soft tissue inflammation. These conditions frequently occur in the ankles, knees, elbows, hips, or wrists. Fluid-filled sacs called bursae help bone, muscle, and tendons work smoothly together. Inflammation of one of these sacs is called bursitis. Tendons connect muscles to bones and inflammation of a tendon is called tendonitis. In some cases, the tendon can partially or completely tear.

Do You Have Achilles Tendonitis?

If you think you may have injured your Achilles tendon, you can try this simple home test. While lying on your stomach, squeeze your calf muscle. If the tendon is still connected, the foot should point. If you are still experiencing discomfort or mobility problems, you should consult your doctor for a thorough physical examination.

If you do have an injury, your doctor may recommend a combination of treatments. These may include:

  • Rest, which may mean anything from limiting workouts to complete rest for a period of days or weeks.
  • Elevating the foot, to minimize swelling.
  • Ice packs, which reduce pain and inflammation.
  • Compression bandages and orthotic devices. For those with insertional Achilles tendonitis, heel lifts may be helpful.
  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen, help reduce pain and swelling.
  • Steroid injections may reduce swelling, but also has potential risks.

Depending on the severity of the tendonitis, healing generally takes anywhere from a few days to six weeks.

In the case of tendon rupture, your doctor may recommend surgery. This is often performed in an outpatient setting and typically takes an hour or less. The patient is usually able to return to full activity by six months after surgery, although full recovery may take at least a year.

For Achilles tendonitis, physical therapy can relieve your pain. It can allow you to regain your strength and function so that you can gradually return to your normal activities. Physical therapy treatments often include:

Strengthening exercises to help you build up weakened muscles and protect you from another injury.

  • Stretching and flexibility exercises. These help prevent your tendon from shortening.
  • Exercises to improve coordination and endurance.
  • Massage, to increase circulation and flexibility.
  • Ultrasound heat therapy, which promotes healing.
  • Class IV Cold Laser Light Therapy

For more information about Achilles tendonitis, contact Hess Physical Therapy via phone or visit our website www.hesspt.com for further contact info. We will work with you and your doctor to create a physical therapy plan for your recovery.

Our locations:

  • Kennedy: (412)-771-1055
  • Crafton: (412)-458-3445
  • Allison Park: (412)-487-2787

DO I HAVE HIP BURSITIS?

What is hip bursitis?

Hip bursitis, also called trochanteric bursitis, affects many people every day. It is characterized by pain and/or stiffness in the hip which is worsened with pressure, and potentially redness and swelling. The pain is caused by inflammation of the fluid-filled sacs, called bursae, which cushion the bones, tendons, and muscles near your joints. Normally part of a cushioning system to ease joint movements, inflamed bursae can make moving quite painful.

The hip is the largest and highest weight-bearing joint in the body, so it’s no wonder inflammation can occur around it. Where the femur (upper leg bone) meets the pelvis, a ball-and-socket joint sits which gives you your range of motion in your hip. It is held in place by large ligaments, muscles, and tendons, and coated in thick cartilage to make your everyday motions easy, and pain-free. However, problems such as trochanteric bursitis can arise and make movements quite painful. Inflamed bursae are further irritated by any hip movements around them, making hip bursitis a debilitating condition, especially for those who are physically active.

What causes trochanteric bursitis?

The most common cause of trochanteric bursitis is repetitive, often high-intensity movements. These are often things such as running, cycling, stair climbing or standing for long periods of time. These repetitive movements over time can cause inflammation in the bursa of the hip. Runners are at great risk of developing trochanteric bursitis.

Injuries can also cause hip bursitis. A fall, for example, can cause your hip to take a hard hit. The trauma and force of the fall can cause the bursa to swell. A ripped tendon from a fall or overuse injury can cause inflammation in the bursa sacs. Lying on your side for extended periods, particularly side sleeping, can put pressure on the bursae, causing trochanteric bursitis to occur. Hip surgery, such as hip replacement with a prosthetic joint, can cause temporary bursitis as part of the post-operative recovery process. Be sure to follow your surgeons’ instructions for post-surgical care.

Trochanteric bursitis can be a secondary condition to a preexisting disease, such as rheumatoid arthritis and gout. The flare-up of these inflammatory diseases can cause irritation and inflammation in the bursae of the hip if they are affecting the surrounding area.

What are the symptoms of trochanteric bursitis?

The main symptom of trochanteric bursitis is pain in the outer hip area. This pain is often worsened by putting pressure or lying on the painful hip. Furthermore, the pain will be worsened by walking, running, or any other movement of the hip. Initially, the pain may be very sharp but will lessen to more of a chronic ache. The affected leg may also show some swelling, with heat or redness near the site of the pain as a possibility.

Some symptoms may be more severe and require the intervention of a medical specialist. If you experience sudden, severe, debilitating pain, particularly that shoots down your leg, sudden inability to move your joint, or a fever with your pain, you should consult your primary care provider immediately. They will be able to refer you to your next course of action.

Physical Therapy for Treatment of Hip Bursitis

Developing hip bursitis is not the end of your running or cycling career. A trained physical therapist can help you develop a plan to improve your strength, range of motion, and posture, and decrease your pain to get you back to your prior level of function. It is very important to heed the advice of your physical therapist and follow your treatment plan as closely as possible to avoid further injury or re-injury. Contact one of our Hess Physical Therapy offices for an individualized plan specifically targeted towards your case of trochanteric bursitis.

Our locations:

  • Kennedy: (412)-771-1055
  • Crafton: (412)-458-3445
  • Allison Park: (412)-487-2787

CHOOSE THE RIGHT FOOTWEAR FOR FOOT PAIN

Statistics estimate the average person will walk anywhere from 100,000 to over 200,000 miles in their lifetime. These astounding figures should tell us that we owe a lot of our ability to move around and engage in physical activity, to the work performed by our humble feet. When a person takes care to wear proper supportive footwear, they can accomplish some amazing feats of physical performance. Conversely, without proper footwear, a person’s feet and/or ankles become much more prone to injury. Of course, many injuries can be avoided simply by wearing the right footwear when engaging in physical activity. Here’s what you need to know about finding the best footwear for your foot pain or ankle pain.

Foot and Ankle Anatomy

The necessity of good footwear actually begins with describing the anatomical components of the feet and ankle areas. The toes make up the topmost portion of the foot. Toes play an essential role in maintaining good balance during movement. They also play a substantial role in supporting the weight of a person’s body as a person reaches the end of a single step and begins to take another. The sole of the foot is the area underneath the foot that extends from the bottom of the toes all the way to the heel. The sole plays a major role in bearing a person’s body weight. It must also be flexible enough to handle all the twists and turn movements found in physical activity.

The arch component of the sole plays a critical role in absorbing much of the shock that occurs during activities such as walking or running, through a network of tough ligaments (plantar fascia) and tendons attached to the tarsal and metatarsal bones of the foot. The last component of the foot, the heel, contains the largest bone throughout the entire foot region. When a person takes a step, their heel is the first part of the foot to strike the ground, thus experiencing most of the initial impact of every single step.

Last but not least, is the ankle region. The ankle connects the foot to the leg, of course, however, it also contains multiple joints that play a crucial role in allowing the foot to maneuver into a variety of positions, including up and down and left and right.

The Anatomy of Good Footwear

Understanding the various components of the foot and ankle region and how they all work together, allows a person to then understand why footwear should support the toe region (toe box), the sole of the foot, the arch and heel areas, and both ankles as well. Wearing footwear that does not provide the proper space and support means a person becomes more susceptible to foot issues such as heel pain, inflammation of the plantar fascia (plantar fasciitis), arch problems, and/or toe issues such as blisters, bunions, etc.

Wearing good footwear means wearing shoes that are neither too small or too large. There should be a 1/2″ space between the top of the toes (whichever one is tallest) and the top of the shoe. The toe box should allow at least 1/4″ on both the inside and outside areas of the toes. To determine whether the sole of a shoe is supportive, try twisting it back and forth as if wringing out a wet towel. The more difficult it is to perform the motion, the more sole support the shoe possesses.

It’s also important to evaluate how the shoes fit and feel during physical activity. Walk around the store for a few minutes, jog a few steps in place if you are looking for running shoes, and do some quick starts and stops if you are looking for shoes to wear for tennis or basketball. Lastly, look in a mirror from the front, the side, and the rear, to assess if the shoes provide proper ankle alignment.

How Physical Therapy Can Help

If you’ve tried selecting footwear for foot pain on your own without success, you may have a foot problem* such as fallen arches (flat feet) or an excessive arch. People with flat feet are more susceptible to overpronation, which is a condition where the ankle(s) collapse inward. Those with an excessive arch often experience problems with over supination, where their ankle and feet bow outward giving the impression they are almost walking on the side of their foot.

A professional physical therapist can help diagnose foot issues and assist in correcting foot problems by recommending stretching and strengthening exercises to combat weaknesses, along with providing expertise on how to select the right footwear. If you or someone you know experiences repeated foot problems during physical activity, we can help. Please contact us via phone at:

  • Kennedy: (412)-771-1055
  • Crafton: (412)-458-3445
  • Allison Park: (412)-487-2787

Or refer to our website, www.hesspt.com ,for more information.


*Those with diabetes should check first with their physician regarding proper footwear. In general, a physician will likely recommend special diabetic shoes that are solid with a wide toe box, however, it’s always a good idea to consult with the doctor primarily responsible for treating your diabetes.

4 COMMON TYPES OF HEADACHES AND HOW PHYSICAL THERAPY CAN HELP WITH PAIN RELIEF

If you suffer from headaches, you know how they can rob you of enjoying your everyday life and make you less productive. It’s important to identify the type of headache to know the best way to treat it. Here are four common types of headaches and their causes, along with how physical therapy can be highly effective in treating pain.

1. Tension Headaches

This type of headache, which involves a steady, dull mild to moderate bilateral pain (both sides of the head) is the most common type of headache as 75 percent of all headaches are tension headaches. They’re often caused by emotional or physical stress and occur from the contraction of muscles covering the skull, which results in pain.

To treat the problem, people learn better ways to manage stress. Physical therapy is extremely effective in reducing pain from tension headaches.

2. Cluster Headaches

These headaches, which mainly affect males, are typified by a severe, sharp pain that quickly develops. In most cases, cluster headaches occur in the eye area. Besides pain, other symptoms may include eye redness, nasal congestion and tearing in one eye. Even worse, these can last from six to 12 weeks.

The main way to treat a cluster headache is by changing your diet, along with eliminating alcohol, smoking, and other triggers. Breathing exercises and headache medications can also help.

3. Migraines

Migraine headaches affect about 38 million Americans and typically attack females. These are characterized by a throbbing in the head. While the pain is usually on one side of the head, some people have pain on both sides.

This type of headache, which may be accompanied by nausea, vomiting, light and/or sound sensitivity, can be so debilitating that it can cause people to be bedridden for several days. It’s usually treated with prescription migraine medications, along with diet changes and resting in a quiet, dark area until symptoms subside.

4. Sinus or Allergy Headaches

Sometimes, headaches are caused by allergic reactions. The type of pain from a sinus or allergy headache is normally in the sinus region or in the front of the head. Often, people who think they have a sinus headache are actually suffering from migraines. In fact, as many as 90 percent of patients who tell their doctors they have a sinus headache learn they really have a migraine.

Sinus headaches are commonly treated by using nasal steroid sprays and decongestants designed to thin out mucus buildup causing sinus pressure. Because sometimes sinus headaches can suggest a sinus infection, you may need to see your doctor for an antibiotic prescription.

How Physical Therapy Can Help

The best way to treat many kinds of headaches is by getting physical therapy. To treat tension headaches, physical therapists instruct patients on stretching exercises, such as neck stretches. This helps in loosening tense neck muscles that cause tension headaches. Relaxation techniques are also used, such as deep breathing methods. Furthermore, they encourage patients to make changes in their workplace setup, such as making adjustments to computer monitors or using headsets for talking on a telephone.

Cervicogenic headaches (neck headaches) are also highly treatable using physical therapy. This type of headache stems from neck issues, causing head pain, and is classified as a secondary headache since its symptoms are produced from outside the head. To treat pain, physical therapists use manual therapy for improving neck function and correcting posture. As a result, a patient’s neck is allowed to heal and recover, so it begins functioning better, resulting in headache relief.

Headaches originating from jaw dysfunction, causing pain, can be treated with physical therapy. By using manual therapy, specific exercises, and soft tissue mobilization, physical therapists improve jaw function, which results in pain relief. Night guards are prescribed to patients who grind their teeth during sleep so that the jaw and its surrounding muscles can rest.

As for migraine headaches, stretching exercises prescribed by physical therapists can be beneficial for reducing discomfort. Therapists teach migraine patients on the most effective ways for using modalities, including icing and relaxation techniques. They also show family members and caretakers massage techniques for easing pain.

Tips for Reducing Headache Pain

  • When first sensing a migraine headache (the aura stage), take your migraine medication before the headache sets in.
  • Heat therapy can help with pain due to blood vessels constricting. This involves applying a heat pack to the back of your neck. Taking a hot shower can also be effective.
  • Applying ice packs to the top your head or neck can work in relieving pain.
  • Using a humidifier can help reduce pain from a sinus headache because dry air can cause sinus irritation, which triggers headaches.
  • Instead of consuming caffeine, drink water since caffeine can be a trigger for headaches.

If you’re tired of suffering from pain, why not discover the many benefits of physical therapy. Contact our team at Hess Physical Therapy via phone at any of our 3 offices or refer to our website www.hesspt.com for further contact info.

  • Kennedy: (412)-771-1055
  • Crafton: (412)-458-3445
  • Allison Park: (412)-487-2787