What We Treat
PT360 – Atlanta Physical Therapy
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Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain. Pain in the lower back can restrict mobility and interfere with your normal functioning.
Low back pain is one of the most significant health problems. Consider these statistics from the National Institutes of Health (NIH):
70 to 85 percent of all people have back pain at some time in their life.
Back pain is the most frequent cause of activity limitation in people younger than 45 years old.
Neck Pain occurs in the area of the seven cervical vertebrae. Because of its location and range of motion, the neck is often left unprotected and subject to injury.
Pain in the back or neck can be acute, which comes on sudden and intensely, or chronic, which can last for weeks, months, or even years.
Even with today’s technology, the exact cause of back and neck pain is usually unknown. In most cases, back and neck pain may be a symptom of different sources, including any of the following:
-Overuse, strenuous activity, repetitive lifting
-Trauma, injury, or fractures
-Degeneration of vertebrae, often caused by stresses on the muscles and ligaments that support -the spine, or the effects of aging
-Abnormal growth such as a tumor or bone spur
-Obesity due to increased weight on the spine and pressure on the discs
-Poor muscle tone
-Muscle tension or spasm
-Sprain or strain
-Ligament or muscle tears
-Joint problems such as arthritis
-Protruding or herniated (slipped) disc and pinched nerve
-Osteoporosis and compression fractures
-Congenital (present at birth) abnormalities of the vertebrae and bones
Preventative back and neck pain
The following may help to prevent back and neck pain:
– Practice correct lifting techniques
– Ergonomic workplace
– Maintain correct posture while sitting, standing, and sleeping
– Participate in regular exercise (with proper stretching before participation)
– Maintain a healthy weight
– Reduce emotional stress which may cause muscle tension
Rehabilitation for back and neck pain
A back and neck pain rehabilitation program is designed to meet the needs of the individual patient, depending upon the type and severity of the pain, injury, or disease. Active involvement of the patient and family is vital to the success of the program.
The goal of a back and neck rehabilitation program is to help the individual to return to the highest level of function and independence possible, while improving the overall quality of life. The focus of rehabilitation is on relieving pain and improving mobility (movement).
In order to help reach these goals, our physical therapy programs may include the following:
”Exercise programs to improve range of motion, increase muscle strength, improve flexibility and mobility, and increase endurance
”Patient and family education
”Pain management techniques
”Gait (walking) and movement retraining
”Ergonomic assessments and work-related injury prevention programs
Generally, there are three phases to back and neck pain rehabilitation. These include the following:
Phase I: During this initial phase, the physical therapist and treatment team focus on making a diagnosis, developing a treatment plan, and starting treatment to reduce the pain and inflammation. This may include gentle joint mobilization, ultrasound, electrical stimulation, and taping techniques.
Phase II: Once the initial pain and inflammation are reduced, the physical therapist focuses on helping the patient restore normal function. This includes returning the patient to normal daily activities, and starting an exercise program that is designed to help the patient regain flexibility and strength.
Phase III: The goal of this phase is two-fold: educating the patient on ways to prevent further injury and strain to the back and neck, and phase strength and endurance.
Low Back Pain Conditions
Herniated Disc (“Slipped Disc”)
A herniated or “slipped disc” is a frequent cause of mild or moderate low back or leg pain. The soft flexible discs separate the bones in the spine. The discs, which have a rigid outside rim and a soft gel-like center, act as shock absorbers to protect the spinal cord. Activity, stress, or a mechanical problem in the spine can cause a disc to bulge. The damaged or bulging disc may pinch or irritate a nerve root, which can cause leg pain.
Another common disorder of the lower spine is disc degeneration, or osteoarthritis in the spine. As the body ages, the discs in the spine dehydrate or dry out, and lose their ability to act as shock absorbers. The bones and ligaments that make up the spine also become less flexible and thicken. Degeneration in the discs is normal and is not in itself a problem. But pain occurs when these discs or bone spurs begin to pinch and put pressure on the nearby nerve roots or spinal cord.
The sciatic nerve, is composed of several lumbar nerve roots and can become irritated with a herniated disc. Each of the major branches of sciatic nerve travel through the pelvis and buttocks, down the hip, and along the back of the thigh to the foot. The pain of sciatica ranges from a mild tingling to a sharp ache.
Lumbar spinal stenosis
Degeneration of the spine also can result in lumbar spinal stenosis (LSS). This disease involves a narrowing of the canal that houses the spinal cord and nerve roots. A narrowed spinal canal may compress nerve roots in the lower back, resulting in low back pain, and weakness in the legs. Patients often find relief by sitting or standing in a hunched over position, such as leaning on a shopping cart. Symptoms of LSS do not usually occur until after the age of 50.
Degeneration in the spine also can lead to spondylolisthesis, a condition characterized by the slippage of a vertebra in the spine. One vertebra slips forward over another, stretching or pinching the nerves and causing low back pain.
Good posture is important because it helps your body function at top speed. It promotes movement efficiency, endurance, and contributes to an overall feeling of well being.
Good posture is also good prevention. If you have poor posture, your bones are not properly aligned, and your muscles, joints, and ligaments take more strain than nature intended. Faulty posture may cause you fatigue, muscular strain, and, in later stages, pain. Many individuals with chronic back pain can trace their problems to years of faulty postural habits. In addition, poor posture can affect the position and function of your vital organs, particularly those in the abdominal region.
Good posture also contributes to good appearance; the person with good posture projects poise, confidence and dignity.
A healthy back has three natural curves: a slight forward curve in the neck (cervical curve), a slight backward curve in the upper back (thoracic curve), and a slight forward curve in the low back (lumbar curve). Good posture actually means keeping these three curves in balanced alignment.
Strong and flexible muscles also are essential to good posture. Abdominal, hip, and leg muscles that are weak and inflexible cannot support your back’s natural curves.
Hip, knee, and ankle joints balance your back’s natural curves when you move, making it possible to maintain good posture in any position.
Poor posture distorts the body’s proper vertical alignment and the back’s natural curves.
Good posture only has one appearance, but poor posture comes in many unattractive styles.
Our physical therapists focus on re-training your body to sit and stand with good posture so that your spine can heal and recover from injury as well as prevent future injury.
A patient is usually released from the hospital two to five days after surgery and can resume physical activities such as walking almost immediately. Normal postsurgical pain will occur for a few weeks. Physical therapy is usually recommended to help strengthen the muscles of the lower back and abdomen. Total recovery takes anywhere from six weeks to six months, depending on how advanced the condition was at the time of surgery and the patient’s preoperative neurological condition. Healthier patients tend to heal faster. Physical therapy is recommended to speed healing, decrease pain, and strengthen the spine.
Our physical therapists are specially trained to rehabilitate post spinal surgery patients.
Rehab following a knee, hip, or shoulder replacement is an important part of your full recovery from surgery. Physical therapy restores your range of motion, strength, and flexibility to the affected joint. Additionally, you may need help to regain the ability to walk properly and use the new joint for normal activities of daily living. Our physical therapists work within your doctor’s post-operative protocol to get you back to the activity required for work and play.
The knee is the largest joint in the body and it is also one of the most complex. The knee joint is made up of four bones, which are connected by muscles, ligaments, and tendons. The femur is the large bone in the thigh. The tibia is the large shin bone. The fibula is the smaller shin bone, located next to the tibia. The patella, otherwise known as the knee cap, is the small bone in the front of the knee. It slides up and down in a groove in the femur (the femoral groove) as the knee bends and straightens.
Ligaments are like strong ropes that help connect bones and provide stability to joints. In the knee, there are four main ligaments. On the inner (medial) aspect of the knee is the medial collateral ligament (MCL) and on the outer (lateral) aspect of the knee is the lateral collateral ligament (LCL). The other two main ligaments are found in the center of the knee. These paired ligaments are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They are called cruciate ligaments because the ACL “crosses” in front of the PCL. Smaller ligaments help hold the patella in the center of the femoral groove.
Two structures called menisci sit between the femur and the tibia. These structures act as “cushions” or “shock absorbers”. They also help provide stability to the knee. There is a medial meniscus and a lateral meniscus. When either meniscus is damaged it is often referred to as a “torn cartilage”.
There is another type of cartilage in the knee called articular cartilage. This cartilage is a smooth shiny material that covers the bones in the knee joint. There is articular cartilage anywhere that two bony surfaces come into contact with each other. In the knee, articular cartilage covers the ends of the femur, the femoral groove, the top of the tibia and the underside of the patella. Articular cartilage allows the knee bones to move easily as the knee bends and straightens.
Tendons connect muscles to bone. The strong quadriceps muscles on the front of the front of the thigh attach to the top of the patella via the quadriceps tendon. This tendon covers the patella and continues down to form the “rope-like” patellar tendon. The patellar tendon in turn, attaches to the front of the tibia. The hamstring muscles on the back of the thigh attach to the tibia at the back of the knee. The quadricep muscles are the main muscles that straighten the bone. The hamstring muscles are the main muscles that bend the knee.
Finally, a bursa (pl. bursae) is a small fluid filled sac that decreases the friction between two tissues. Bursae also protect bony structures. There are many different bursae around the knee but the one that is most commonly injured is the bursa in front of the patella, the prepatellar bursa. Normally, a bursa has very little fluid in it but if it becomes irritated it can fill with fluid and become very large.
Many knee problems result from the injury of the above mentioned structures. Physical therapy is often effective in treating these conditions if the injury does not require surgery. Also, physical therapy is a vital aspect of rehabilitation following knee surgery.
Our physical therapists have received specialty training in the area of knee rehabilitation to suit your physical therapy needs.
Physical therapy is an important part of the treatment program for people with osteoarthritis. Many people with osteoarthritis may suffer from limitations in their range of motion and weakness. Both can be improved with physical therapy. The primary goals of physical therapy are to decrease inflammation, improve range of motion, and strengthen the muscles surrounding the affected joint. In addition to using exercises to achieve these goals, other techniques may include cold and heat therapy, ultrasound, laser, electrical neuromuscular stimulation, and direct muscle stimulation.
Our physical therapists can help educate you about proper exercise techniques and appropriate activities to minimize stress on the affected joint. We have successfully rehabilitated thousands of patients with osteoarthritis.
Foot orthotics is a general term used to describe any device, arch-support or insole that changes the function and biomechanics of the foot. Orthotics can improve knee, ankle, hip and back pain in a number of ways:
– They can change the distribution of force through the foot and ankle, which can result in a change in the distribution of force through the knee, hip, pelvis and spine.
– They can act as a cushion to reduce the force through the foot and ankle, which can result in a reduction of force through the knee, hip, pelvis, and back.
– They can change the alignment of the foot and ankle, which can result in a change of alignment at the knee, hip, pelvis, and spine. For example, they can control overpronation (rolling in) of the foot, which can result in patellofemoral pain, iliotibial band syndrome, piriformis syndrome, low back pain, sacroiliac joint dysfunction or make the pain from some types of osteoarthritis worse. As the foot overpronates the lower leg and knee internally rotate. Orthotics can help control overpronation of the foot, which in turn, improves the alignment of the knee and thereby reducing lower extremity and back pain.
Orthotics are made of many different materials. Soft orthotics are beneficial if cushioning is required. Semi-rigid orthotics provide more stability while still providing good shock absorption, while rigid orthotics provide maximal support and stability.
Orthotics can be custom made or pre-made and are designed to fit easily into most casual or sports shoes. After an initial break-in period orthotics should feel comfortable. The foot and knees need time to adapt to new orthotics. If the orthotics are not comfortable in 2-3 weeks they may need to be adjusted. Properly designed, manufactured and fitted orthotics should not make feet or knees feel worse.
When used in conjunction with specific rehabilitation, orthotics can serve an important role in the treatment of some types of knee, ankle, hip, back and pelvic pain.
Our physical therapists work with the highest qualified orthotist to fit your needs.
The shoulder complex is made up of three bones, which are connected by muscles, ligaments, and tendons. The large bone in the upper arm is called the humerus. The shoulder blade is called the scapula and the collarbone is called the clavicle. The top of the humerus is shaped like a ball. This ball sits in a socket on the end of the scapula. The ball is called the head of the humerus and the socket is called the glenoid fossa, hence the term “glenohumeral” joint. The glenoid fossa has a rim of tissue around it called the glenoid labrum. The glenoid labrum makes the glenoid fossa deeper. The glenohumeral joint is the most mobile joint in the body.
Articular cartilage is a smooth shiny material that covers the humeral head and the glenoid fossa of the glenohumeral joint. There is articular cartilage anywhere that the bony surfaces come into contact with each other. Articular cartilage allows these bones to slide easily over each other as the arm moves.
The glenohumeral joint is just one of the joints in the shoulder complex. The other two joints are the sternoclavicular joint and the acromioclavicular joint. The sternoclavicular joint allows a small amount of movement to occur between the inner (medial) part of the clavicle and the breastbone (sternum). The acromioclavicular joint allows a small amount of movement to occur between the outer (lateral) part of clavicle and a projection on the top of the scapula called the acromion process. The scapula sits on the back of the ribs and moves as the arm moves.
Ligaments are like strong ropes that help connect bones and provide stability to joints. In the shoulder complex, ligaments provide stability to the sternoclavicular joint, the acromioclavicular joint and the glenohumeral joint. The ligaments around the sternoclavicular joint and the acromioclavicular joint are strong and tight and do not allow for much movement in these joints.
The glenohumeral joint is surrounded by a large, loose “bag” called a capsule. The capsule has to be large and loose to allow for the many movement of this joint. Ligaments reinforce the capsule and connect the humeral head to the glenoid fossa of the scapula. These ligaments work with muscles to provide stability to the glenohumeral joint. The glenoid labrum also helps provide stability to the joint.
Tendons connect muscles to bone. There are four muscles (supraspinatus, infraspinatus, subscapularis and teres minor) that surround the glenohumeral joint. These four muscles are attached to the scapula. They turn into tendons, which in turn attach to the humerus. The tendons of these four muscles make up the “rotator cuff” that blends into and helps support the glenohumeral joint capsule. The muscles of the rotator cuff and their tendons provide stability to the glenohumeral joint when the arm is in motion. The biceps muscle is located in the front of the upper arm. It has two tendons, one of which attaches above the glenoid fossa. This tendon runs down the front of the glenohumeral joint and provides added stability to the glenohumeral joint. There are muscles that stabilize the scapula and others that help move the arm. The rhomboid muscles, trapezius muscle and serratus anterior muscle are a few of the scapular stabilizing muscles. The pectoralis major muscle, the deltoid muscle and the muscles of the rotator cuff are some of the muscles that move the arm at the glenohumeral joint. The upper part of the trapezius muscle also helps “shrug” the shoulder. All of the muscles that are part of the shoulder complex work together in order to move the arm through its many possible ranges of movement.
Finally, a bursa (pl. bursae) is a fluid filled sac that decreases the friction between two tissues. Bursae also protect tissues from bony structures. In the shoulder, the subacromial bursa (also called the subdeltoid bursa) covers the rotator cuff tendons and protects them from the overlying acromion process. Normally, this bursa has very little fluid in it but if it becomes irritated it can fill with fluid, become painful and also irritate the surrounding rotator cuff tendons.
Many shoulder problems result from the injury of the above mentioned structures. Physical therapy is often effective in treating these conditions if the injury does not require surgery. Also, physical therapy is a vital aspect of rehabilitation following shoulder surgery.
Our physical therapists are specially trained to rehabilitate your shoulder injuries.
Sports injuries are injuries that typically occur while participating in organized sports, competitions, training sessions, or organized fitness activities. These injuries may occur for a variety of reasons, including improper training, lack of appropriate footwear or safety equipment, and muscle imbalance.
There are two general types. The first type is called an acute traumatic injury. Acute traumatic injuries usually involve a single blow from a single application of force – like getting a cross-body block in football. Acute traumatic injuries include the following:
– a fracture – a crack, break, or shattering of a bone
– a bruise, known medically as a contusion – caused by a direct blow, which may cause swelling and bleeding in muscles and other body tissues
– a strain – a stretch or tear of a muscle or tendon, the tough and narrow end of a muscle that connects it to a bone
– a sprain – a stretch or tear of a ligament, the tissue that supports and strengthens joints by connecting bones and cartilage
– an abrasion – a scrape
– a laceration – a cut in the skin that is usually deep enough to require stitches.
The second type of sports injury is called an overuse or chronic injury. Chronic injuries are those that happen over a period of time. Chronic injuries are usually the result of repetitive training, such as running, overhand throwing, or serving a ball in tennis. These include:
– stress fractures – tiny cracks in the bone’s surface often caused by repetitive overloading (such as in the feet of a basketball player who is continuously jumping on the court)
– tendonitis – inflammation of the tendon caused by repetitive stretching
– epiphysitis or apophysitis – growth plate overload injuries
Often overuse injuries seem less important that acute injuries. You may be tempted to ignore that aching in your wrist or that soreness in your knees, but always remember that just because an injury isn’t severe doesn’t mean it will go away on its own. If left untreated, a chronic injury will probably get worse over time.
Neck injuries are among the most dangerous sports related injuries. You can hurt your neck through a sudden traumatic injury in sports like mountain climbing, skydiving, horseback riding, gymnastics, diving, rugby, judo, or boxing.
Neck injuries include strains, fractures, contusions, sprains, and a stinger or burner from stretched nerves in the neck. Most neck injuries are caused by impact to the head or neck sustained during a fall or a blow. Your neck can also be injured a little at a time. Too much strain on your neck can cause increasing pain, sometimes only on one side of your neck. Sometimes you may feel only a slight pain when you move a certain way.
Serious head and neck injuries occur most often in athletes who participate in contact sports (like football or rugby) or sports with the potential for falling accidents, such as horseback riding.
Back injuries include sprains, fractures, contusions, stress fractures, and strains and are caused by twists or overexertion of back muscles during bending or lifting movements. These injuries can occur in contact sports like football and ice hockey or in weight lifting, figure skating, gymnastics, dancing, baseball, and basketball.
Hand and Wrist Injuries
Hand, finger, and wrist injuries include fractures, dislocations, and sprains and often occur in contact sports such as football, lacrosse, and hockey. Hand injuries can result from a fall that forces the hand or fingers backward, a forceful impact to the hands, or a direct blow.
Foot injuries can include ligament strains, stress fractures, heel bruises, and a swollen growth plates. Because your feel support all of your weight and must absorb a lot of force over and over again, they can be particularly susceptible to injury. Some people have flat feet or high arches which may require foot orthotics or shoe inserts.
Taking Care of Sports Injuries
Any injury that results in swelling, numbness, intense pain or tenderness, stiffness, or loss of flexibility should be taken seriously.
You should also know the difference between soreness and chronic pain. Soreness is temporary, but chronic pain continues over a greater length of time.
The most important thing to do when you suspect that you are injured is to stop doing whatever sport has caused the injury right away and go see a doctor.
Once the doctor knows the full extent of your injury, he or she usually will recommend physical therapy along with rest and ice to help decrease swelling. Pain relief and anti-inflammatory medicines such as Ibuprofen (like Advil or Motrin) may be prescribed. Splints, casts, and surgery also may be needed, depending on the injury.
Your rehabilitation program will help you stay fit as you recover. Rehabilitation, or rehab, is the process that gets you back in shape and ready for action again. Rehab includes exercise, manual therapy from a physical therapist, and ultrasound. Ultrasound equipment is used to heat the injured area. This heat relieves pain, promotes healing, and increases your range of motion.
Our physical therapists are specially trained at treating sports injuries and have treated athletes from the Atlanta Hawks, WWF wrestlers, and Emory University soccer team.
Physical therapy is important in orthopedics for two primary reasons:
First, orthopedic patients typically have a deficiency that needs to be addressed. For example, patients with carpal tunnel syndrome may have weakness of specific hand muscles that require targeted exercises. Or knee conditions such as chondromalacia may be due in part to muscle imbalance around the knee joint. A physical therapist can teach exercises that specifically target these muscles to improve function and decrease problems.
Second, physical therapists are knowledgeable about surgical procedures, treatment goals, musculoskeletal anatomy, and can tailor their efforts to improve the fitness and well-being of the patient. After a procedure such as a hip replacement or ACL reconstruction, it is important that therapy is guided by the surgical procedure. Some surgeries require protocols from your doctor and must be followed strictly under the supervision of your physical therapist.
At Body Mechanics Physical Therapy our physical therapists are specially trained to treat orthopedic problems. Physical therapists may use the following techniques to rehabilitate your orthopedic condition:
Joint mobilizations are helpful to realign bones that have shifted or subluxed. Additionally, joint mobilizations will decrease edema (swelling) and pain. Joint mobilizations are used in conjunction with muscle energy techniques to correct spinal alignment and decrease muscle tone.
Stretching is vital to maintain good range of motions around a joint. If a patient has stiff joints, normal activities such as opening a jar or climbing stairs can be severely affected. By proper stretching, these functions can be preserved. After an injury or surgery, scar tissue forms, and soft-tissue contracts; this is when stretching is most important.
Strengthening exercises are performed to help the patient improve the function of their muscles. These help to improve strength, increase endurance, and maintain or improve range of motion. Common types of strength training include:
The closed chain exercises are performed with the foot locked in position on the ground – for example a leg squat. These exercises are performed to help balance the muscle strength. By performing closed chain exercises, the weak muscle (e.g. the quadriceps) and its antagonist the hamstrings), will both be exercised and balanced. Open chain exercises, such as a leg extension, do not balance the muscles this way.
Proprioception is the sense of knowing where a body part is in space. This can be difficult to grasp until you lose it, because so much proprioception occurs without conscious thought. When you lose proprioception of an ankle joint after a sprain, you may complain of an unstable sensation of the joint. Proprioception training reteaches your body to control the position of an injured joint.
Ice and Heat Therapy:
Ice and heat are useful to warm up and cool off muscles. In addition, these modalities can stimulate flow and decrease swelling. These can be important aspects of the therapeutic process.
Ultrasound uses high frequency sound waves to stimulate the damaged tissues within the body. By passing an ultrasound probe over the body, deep tissues are stimulated by vibration of the sound wave. This leads to warming and increased blood flow to these tissues.