March Maddening Ankle Sprains in Basketball Players

With March Madness upon us, it is likely we will see fans sporting their collegiate gear, roaring crowds, busted brackets and…ankle sprains? The prevalence of ankle injuries among basketball athletes is high, with ankle sprains being the most common injury. In addition to that, studies have shown that the injury is more likely to occur during competition rather than practice. Players will commonly twist their ankle on the landing after jumping for rebounds, shots, and blocks or when they plant and make quick cuts. More often than not, players will experience an inversion sprain. This is when the ankle rolls inwards and damages the ligaments on the outside of the foot.

We now know that ankle sprains are common, however, the severity of the sprain can vary. There are three different grades to categorize the severity.

Grade 1: Mild or First Degree
At this stage, when the ligaments are stressed with certain range of motion testing, the individual will experience pain due to the ligaments being stretched or slightly torn. A persons range of motion is limited in only one direction and there is limited bruising. There is tenderness and pain strictly over the injured area.

Grade II: Moderate or Second Degree
At this stage, there is slight laxity within the ankle due to the ligaments being partially torn. Instability of the ankle during weight bearing is apparent. In addition, bruising and swelling are present and the edema in the joint will limit range of motion. The individual will complain of diffuse tenderness and increased pain. This sprain typically is the most painful.

Grade III: Severe or Third Degree
At this stage, there is an abnormal increase in range of motion and significant laxity and instability due to ligaments being completely torn. The swelling and bruising is severe, however, the associated pain is less than that of a grade II.

After an athlete experiences an ankle sprain, what is the immediate course of action? Initially, the individual should implement the RICE method and use NSAIDS (i.e. ibuprofen, naproxen) to manage pain and inflammation.

Rest: Avoid weight bearing through the injured ankle.
Ice: Use ice to decrease the swelling. Ice can be applied to the injured area for 20 minutes at a time. Avoid placing ice directly on the skin.
Compress: Use compression bandages (i.e. ace wraps) to reduce fluid build-up and provide stability at the joint.
Elevate: Elevate your ankle using pillows or other supportive surfaces. The ankle should be elevated above the level of the heart to decrease swelling.

The athlete will generally follow-up with a doctor. From there, pending the severity, the doctor will decide if the individual requires crutches, elastic bandaging, walking boot, or cast. The healing time will range pending the grade of the injury.

After the pain and swelling have subsided, what’s next? Physical therapy! The doctor will likely recommend physical therapy to help regain range of motion, strength, flexibility, balance/stability, and ultimately restore function to allow for full return to sport.

Range of motion
The physical therapist (PT) will likely begin by passively moving the ankle, which means the PT controls the movement of the ankle. Range of motion exercises will transition from passive to active. At this point the athlete will control the movement of their own ankle. Exercises such as ankle pumps and ankle ABCs will be introduced.

Strength
As the athlete regains pain free motion, the PT will then introduce exercises to improve strength. These exercises will likely include the use of resistance bands and cuff weights or involve weight bearing to strengthen the muscles surrounding the ankle and foot.

Flexibility
After the ankle joint has been immobilized (via braces/casts) the surrounding muscles will have decreased flexibility. Most often, the gastrocnemius and soleus (calf muscles) are tight. The PT will use manual and active stretches to improve mobility.

Balance/Stability
After injury to ligaments, proprioception is negatively impacted. Proprioception is the sense and awareness of the joint position. When there is loss of proprioception it is accompanied by loss of balance. Therefore, the PT will incorporate balance exercises to improve proprioception and receptor activity within the ligaments to allow for increased control within the joint. The increase of control will allow for greater stability. Common exercises include use of single leg stance, uneven surfaces, or a combination.

Return to Sport Activities
After motion, strength, flexibility, balance, and stability are regained the PT will incorporate activities that mimic the demands of basketball (or any other sport, too!). These exercises will enhance agility and endurance.

Although ankle sprains can be a nuisance to basketball players, they do not have to be a devastating or career ending injury. With time and the guidance of a skilled PT, the injured athlete will be able to return to the court and continue playing the game they love.

References:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978459/
2. https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle
3. https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231
4. https://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=3c31ac5a-19ef-4c97-a8b6-ea1cfe19ac95
5. https://www.roslynphysio.co.nz/pages/13-17/Balance-and-Proprioception

Piriformis Syndrome – Literally a Pain in Your Butt

Has this winter been a pain in your butt? On top of the winter blues and life, are you getting aches and pains in the back, buttock, and leg that just won’t seem to go away? If you answered yes to either of these, you may have piriformis syndrome. Piriformis syndrome occurs when the piriformis muscle is tight or when the pelvis is not in proper position resulting in mild to severe pain in the back, buttock and occasionally down the leg.

So what exactly is the piriformis muscle?
The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint while the sciatic nerve runs underneath this muscle. This muscle stabilizes the hip joint and lifts and rotates the thigh away from the body. During day to day activities this muscle helps us walk, shift our weight from one foot to another and maintain balance. When the muscle gets tight, you get the “pain in the butt”. In the picture below, you can also see how a tight piriformis can pinch on the sciatic nerve causing pain down the leg.

Can physical therapy help get rid of the pain in my butt?
The quick answer is YES!
Often times when patient’s come in with these symptoms, we discover their pelvis is not in the correct position. This may happen from miss-step, crossing legs, standing with more weight on one leg, walking on uneven surfaces, sports and exercise injury, muscle imbalances, poor flexibility, or leg length discrepancy. It is common to see the piriformis tightness is a secondary problem. This is why it is imperative your physical therapist addresses the primary cause by checking hip alignment, leg length, posture habits, body mechanics and the flexibility and strength of the muscles surrounding the hips, glutes, and abdominals. Correcting hip alignment, decreasing tightness, and strengthening the surrounding muscles will help to abolish the pain and prevent future issues. If the primary cause isn’t addressed the pain will come back over time.

Does this sound like you? Does your pain always come back? You may not have address the primary problem yet!

What can you do to help the pain? 

Using a tennis ball or getting a massage to release the piriformis muscle helps! However, to keep the muscle relaxed, it is important to do the following stretches and strengthening exercises to avoid it getting tight again.

Here a few ways to help stretch the piriformis and relieve symptoms (please stop if any stretch or exercise causes increased symptoms or pain).

PIRIFORMIS STRETCH
While lying on your back with both knee bent, cross your affected leg on the other knee. Next, hold your unaffected thigh and pull it up towards your chest until a stretch is felt in the buttock. Hold 30 seconds and repeat 3 to 5 times a couple times per day.

Below are some modifications of the same exercise.

Lay on your back and use a ball to help bring the knee toward your chest. This helps to take pressure off the knee if you have difficult bending your knee.

Sitting in chair, you can do this stretch virtually anywhere and you don’t have to get on the floor. Bring your foot (of the affected side) on your opposite leg. Gently lean forward at the waist until you feel a good stretch in your bum!

SCIATIC NERVE GLIDES

Here are some Sciatic nerve glides that will help to relieve the pain down the leg from the sciatic nerve being pinched. With these exercises, we are attempting to get the nerve to move more freely behind the piriformis muscle. Again, if any of these increase your symptoms, stop doing them.

SCIATIC NERVE GLIDE – Lying on your back
Start by lying on your back and holding the back of your knee. Next, attempt to straighten your knee as much as you are able to feeling a good stretch behind your leg (you may not be able to get it as straight as the picture). Lastly, hold this position and then bend your ankle forward and back as shown. Perform 10 ankle pumps 3 times.

SCIATIC NERVE GLIDE – Sitting
Start by sitting up straight in a chair or on the edge of a bed. Then, extend your knee and hold this position. Next, bend your ankle forward and back. You can also sit toward the edge of the chair and with your leg straight keep you heel on the ground and move your ankle back and forth in this position. Perform 10 ankle pumps 3 times.

STRENGTHENING 

As we mentioned earlier, you can’t just stretch to get results and keep them! So here are a few exercises we recommend to go along with your stretching. These five exercises help to strengthen the glutes and the core. Strengthening these muscles will help to stabilize the pelvis and take pressure off the piriformis so it doesn’t have to work as hard.

HIP ABDUCTION – SIDELYING

While lying on your side, slowly raise up your top leg to the side. Keep your knee straight and maintain your toes pointed forward the entire time. Keep your leg in-line with your body.

The bottom leg can be bent to stabilize your body.

PRONE HIP EXTENSION – BENT

While lying face down with your knee bent, slowly raise up your knee off the ground.

Alternating Leg Extension (Quadruped)

Begin on hands and knees with knees directly under your hips and hands directly under your shoulders. Keep your abdominals tight and engaged throughout this exercise. Raise one leg straight back as pictured without letting your hips drop to one side and without losing your abdominal contraction. Hold for 3 seconds, then return to the start position and repeat with the opposite leg. This is one repetition.

BRIDGING

While lying on your back with knees bent, tighten your lower abdominals, squeeze your buttocks and then raise your buttocks off the floor/bed as creating a “Bridge” with your body. Hold and then lower yourself and repeat.

PELVIC TILT – SUPINE

Lie on your back with your knees bent. Next, arch your low back and then flatten it repeatedly. Your pelvis should tilt forward and back during the movement. Move through a comfortable range of motion.

We know the winter blues can be a pain in the butt, not to mention other life stressors such as work, family,  sicknesses, and chores, so why not get rid of the real pain in your butt – your piriformis syndrome – to help deal with life!

All of these are just a recommendation and may temporarily relieve symptoms and not cure the problem without more treatment. If you need further treatment please reach out to us so we can help!

pictures courtesy of www.hep2go.com

Managing Stress to Improve Heart Health

What is stress?

Stress. We all have it. But where does it come from? And what is it? It’s the monthly bills, the upcoming assignment, driving in the winter weather, getting the kids ready for school, meeting work deadlines, and the list could go on and on. We all experience some type of stress on a daily basis. Stress can be overwhelming when it’s internalized and not properly managed. Therefore, it’s important we address our stressors to ensure they don’t consume us.

Why does it matter how we manage our stressors?

Stress can negatively impact one’s heart health. When we internalize stress, it can cause feelings of anxiety and increase heart rate. Our body then responds by releasing the hormone cortisol. Studies have linked high levels of cortisol to an increase in blood pressure, cholesterol, and triglyceride levels. These changes can damage arteries found within the heart, increase the risk for heart attacks, and increase the risk of cardiovascular disease. In addition, to the natural response of the body, people often choose negative ways to cope with their stress. For instance, they’ll turn to comfort foods, consumption of alcohol, physical inactivity, or smoking. Each of these coping mechanisms can also cause harm to the heart by increasing risk of high cholesterol, high blood pressure, heart arrhythmias, coronary artery disease, atherosclerosis, and heart failure. It’s apparent that stress and harmful coping strategies take a toll on heart health, therefore, it’s crucial we find positive coping mechanisms.

What are positive coping strategies to manage stress?

1. Positive self-talk
Use “I can” statements when approaching stressful situations. This can improve your coping skills during difficult times. In addition, taking time to self-reflect and utilizing a glass-half full strategy can decrease levels of distress. A positive mind set can change perspective and improve one’s mentality with regard to stressors.

2. Physical activity
Exercise can help manage stress because it releases endorphins, which are natural pain-killer chemicals that allow us to feel good. The release of endorphins positively impacts our mood and decreases our levels of stress. Also, engagement of physical activity improves energy levels and cognitive function which can beneficial in combating stressors. Exercise can simply be walking!

3. Time management
Give yourself plenty of time to ensure you are not rushing around. Set the clock ahead 5 to 10 minutes to avoid running late. Make a schedule and stick to it. Stay organized through lists. Things you can prepare in advance, do so. Avoid procrastination. These are all helpful ways to improve time management and avoid unnecessary stressor.

4. Improve sleep
Lack of sleep can heighten our emotional response and increase stress. It’s important we have adequate sleep to fully function. It is recommended adults sleep an average of 8 hours per night. There is a variety of things you can do to improve quality of sleep. Avoid caffeine before bed, avoid excessive alcohol consumption, avoid naps, put technology away, turn the TV off, give yourself adequate time to wind down, and invest in a comfortable/supportive mattress and pillows.

5. Relaxation techniques
Engaging in meditation or yoga, listening to calming music, and using imagery are all good relaxation strategies. Meditation and yoga encourage a mind-body connection. Listening to calming music allows for time to decompress. Use of imagery, such as picturing yourself in nature or on the beach, is a great strategy to escape momentarily from the stressor.

Here are a few of our favorite yoga relaxation poses:

Legs Up on the Wall                Child’s Pose                         Corpse Pose

6. Deep breathing
When feeling stressed, stop, close your eyes, and begin to take big, deep breathes. Inhale through your nose and exhale through your mouth. Continue to deep breath for 3 to 5 minutes. Deep breathing allows for activation of the parasympathetic nervous system, allowing us to enter a state of relaxation. Also, it helps to release tension within the muscles and improve stress relief.

7. Engage in hobbies
Take 10-15minutes of your day to do something you enjoy, whether that be reading, sewing, running, doing puzzles, or anything of the sort. Engagement in hobbies allows you time to decompress and focus your energy on something you enjoy. It keeps you well rounded and provides a mental break.

8. Laugh
Surround yourself with people that make you laugh, watch a funny TV show, look up funny memes, or use any other type of outlet that can provide some sort of comedic relief. Laughter relieves tension within the muscles, decreases stress hormones, improves immune response, releases endorphins (natural feel-good chemicals), and increases blood flow. A dose of laughter has a variety of mental and physical health benefits.

9. Reduce caffeine
Caffeine is a stimulant. If not consumed in moderation, it can increase feelings of anxiety and cause jitteriness. Learn your body’s response to caffeine and know your limits. If you can only handle one cup of coffee, only drink one cup. Don’t go overboard on the caffeine, it may give you a temporary energy boost but that energy may not be worth the side effects.

10. Eat a balanced diet
Eating a well-balanced diet filled with vegetables, fruits, whole grains, lean proteins, and good fats will properly nourish the body and increase energy. This will allow you to properly tackle the day and any challenges you may face.

Does stress overcome you at times? Do you often feel overwhelmed, get heart palpitations or anxiety? We encourage you to start with one or two things on the list to help you battle your stress and begin in the right direction toward better heart health!

References:
1.https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=2171
2. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/stress-and-heart-health
3. https://share.upmc.com/2014/11/how-does-stress-impact-heart/
4. https://www.skillsyouneed.com/ps/stress-tips.html
5. https://www.webmd.com/balance/guide/tips-to-control-stress#1
6. https://www.helpguide.org/articles/mental-health/laughter-is-the-best-medicine.htm/

Physical Therapy Can Help you get “Heart Healthy”

February is American Heart Health Month! In the United States someone has a heart attack every 34 seconds. Coronary heart disease is the most common type of heart disease and kills nearly 380,000 people each year. That comes down to someone dying from a heart disease-related event every 60 seconds according to the Heart Foundation.

What does this have to do with physical therapy?

There are a lot of reasons to not be able to exercise and a few of those we can help with!

Gait/balance issues, pain in joints or the back, and being overweight are the most common reasons patients have a difficult time getting exercise to be more “heart healthy”. As physical therapists, we see many patients with these issues and those patients feel they can’t exercise for fear of falling, being in too much pain, and not being able to control their diet.

If you are suffering from poor balance and gait with a fear of falling, we can help! We see many patients in the clinic who drastically improve balance by training with gentle strengthening, balance and obstacle course practice. Balance is often compromised when our neurological system does not connect with the muscular system well. This could be caused from a previous stroke, injury, neuropathies, falling, or neurological disease. We have special equipment to improve the “proprioception” of the body which simply means where the body is in space. By using swiss balls, uneven ground, small rebounder, hurdles, cones, and resistance bands we can put together a program to help get you better balance. This will help transition you to a program to be able to walk or use a stationary bike. Any form of this exercise will help keep you healthier and moving!
Pain in the joints and back is the most common reason people don’t exercise. We see patients often who state “I can’t lose weight or exercise due to the pain in my knees (or insert any body part that hurts)!” However, after a month or two of therapy, these patients walk out ready to continue with an exercise program with less pain or pain free. These patients then tell us how they wished they would have come sooner!

Pain will occur in the body if there is an imbalance between the muscles, arthritis, or alignment issues. The imbalance in alignment or muscles causes stress on joints, increased tension of the nerves, decreased circulation, and postural deformity. During physical therapy, your therapist will address any and all of the imbalances you may have by performing manual techniques, modalities, strengthening and stretching exercises, and posture education. Manual techniques may include joint mobilization, soft tissue massage, Astym®, dry needling, and muscle energy to correct alignment issues. Exercises will include specific strengthening and stretching to areas that are weak and tight. And modalities may be hot pack, cold pack, electrical stimulation, or ultrasound. Your therapist will help walk you along a plan of care that works well with what your body needs in order to get you pain free and able to walk or begin an exercise program for keeping your heart healthy!

Being overweight can also become a challenge with exercising. Typically starting with a good diet, and a heart healthy diet, will help lose the weight. When exercising, start out slow! Begin by walking 5 minutes 3x/day and work up each week 5 minutes until you reach 30 minutes. The more you move, the more you can quick start your metabolism to burn fat and calories and the more you get your blood flowing. If your joints bother you too much to walk then riding a stationary recumbent bike is helpful to take weight off your joints. Physical therapists can help you get on a program to start cardio exercise and give you a few other exercises to tone and strengthen.

There really is no excuse to not be able to get your heart healthy again! If you are suffering from gait issues, pain, or overweight and need help getting to a good exercise routine we would be happy to help! We are here to support heart health and advocate for more exercise!

Cleaning and Organizing your House in ONE Year

If you are like me, after the Holidays you look at your house and want to scream because of the mess (well more than normal). It looks as if someone ransacked your home, threw everything on the floor, took out the clothes from every dresser and threw it in the laundry room (or left a pile on your bed), and brought all of their leftovers to store in your refrigerator. I have three young kids so my mess may be different then your mess, but nonetheless, we can all say over a year (or maybe it has been 10 years) our cabinets get dirty, we keep things we don’t need, and our house just needs a good re-organization.

This year I am starting a new tradition: divide up the house into 12 rooms/parts and each month take a room to clean and organize. I’m going to share some of my organization tips with you to make things as simple as possible. And just think, after the first year, each year should get easier to do, right?!?!

  1. So where do we start?
  • We start by making our list and dividing the house….no brainer, right?
    Here is how I divided my house for the year:
    Closets and Foyers
    Kitchen
    Living Room
    Bathrooms
    Master Bedroom
    Kids Bedrooms
    Office
    Dining Room
    Laundry Room
    Play Room/Basement
    Storage areas
    GarageThis is just a start! As you go through you may find you need to combine or divide things differently!
  • Under each room write down what you want to accomplish.

For instance, in the kitchen I have clean refrigerator, pantry, inside and outside of cabinets,                organize spices, clean baseboards and windows. In the living room I have to organize toys,                  clean baseboards and windows, frame paintings and hang (because we still have no pictures              up after 5 years!).

Other things you may add can include painting a room, getting a new piece of                                         furniture/storage, going through clothes or dishes, or cleaning the carpet. The list can be                     changed as you go and if you can’t get to it this year during the room clean, there is always                 next year.

Remember, this isn’t just about organizing, but cleaning too! So make sure you add to                         clean/dust the baseboards, windows and screens, and cabinets or floors as you feel necessary.

  • Organize in your planner or write it on your calendar what room you are going to do each month and when.

I recommend to start with the closets first! That way you can clean out some space for things             in other rooms that should actually be stored in a coat or linen closet rather than a dresser or             the corner floor.

Next, I do the kitchen because I spend a lot of time in the kitchen and when the kitchen is                   cleaned and organized, my house feels more clean and organized.

After this alternate based on the amount of work you have in each room. Try to alternate a                 more time consuming room with a room easier to do the following month. When you do this,             you won’t feel so overwhelmed each month to complete the tasks at hand and you won’t want             to give up as quickly! If there is a month you will be gone a lot, make sure to put an easier                   room in that month.

Lastly, make sure you decide when you are going to do it. My kids won’t allow me to take a                 6-8 hour day to get it all done, so I divide each room up into 3-4 days to accomplish it by the             end of the month. If it works for you, then take one day a month and clean the room so it                    doesn’t seem like you are cleaning all the time (I would prefer to do one day a month….that                means only 12 days of heavy cleaning a year!

2. Once we get our listing done we want to create a budget.

As you go through things, you may find you need new or more storage containers, or something       is broken and needs to be replaced, or you have on your list to paint, get new pictures or plants,         etc. Make sure you budget a certain amount each month so it doesn’t end up costing you a                   fortune to clean!

3. And last, set a goal for keeping things and getting rid of things.

As you begin each month set a goal for yourself to determine whether you want to keep it or not.

  • My rule is: if I have not worn it/used it/noticed it in the last 2 years to discard.
  • Make piles: “donate pile”, “sell pile”, “keep pile”. This will especially help in the kitchen, bedrooms, and toys.
  • Make sure if you are donating, you take it right after so it doesn’t sit in the garage.
  • And set yourself limits on selling items such as, if it doesn’t sell by the time I am posting something next month, I will add it to the new donate pile. The last thing you want is the stuff you are trying to get rid of clog up corners of the house because you aren’t actually getting rid of it!
  • Make an electronic, paint, cords pile to be able to get rid of the old stuff that you can’t donate or sell. Search your area for a drop of for these items so when you are done, you know where to take it all.

So who is going to challenge themselves to organize and clean their house with me this year? Remember, if you can make time it is only 12 days of the deep cleaning in a year!