Kareem Hunt Limited Due to Hamstring Injury - Why do Hamstring Injuries Linger?

It's that time of year again where NFL training camp begins.  Unfortunately, the nature of the beast is that players will get injured.  One player who has been dealing with a lingering Hamstring injury is Kareem Hunt.  He initially injured his Hamstring in late May and you can read more about his status here.  However I want to talk briefly about why Hamstring injuries tend to linger especially in athletes.

Typically with injuries, they are diagnosed via MRI and a Hamstring Injury is no different.  Initially, an athlete may undergo an MRI to determine the severity of the Hamstring Injury.  One area that is not clear with the MRI is when can an athlete return to playing their sport.  To summarize a literature review by Greenky et al, they determined that an MRI should be done acutely however there is conflicting research determining the prognostic value.  Basically, they are saying that its great to have an MRI initially however you cannot always determine a person's return to sport status depending on what the MRI says.  Unfortunately we see this in professional sports all the time, their MRI or imaging comes back normal and a person is rushed back only to get injured more severely.  Therefore the take home point is, a Hamstring Injury does not necessarily linger, it just may just take longer to heal and the MRI does not necessarily provide an accurate timeframe.

I take this point into consideration everyday as a healthcare practitioner and I tell people that you cannot cookie cut a person's recovery.  The MRI may look normal after their injury however because everybody is so different it is important to treat the person and not the diagnosis.  In Kareem Hunt's case, it may just appear as a Hamstring Injury however these things take time and should be treated accordingly despite what the MRI may show.  He needs to perform at an elite level and needs to play a full NFL season.  Therefore it's important to take this into consideration for all Hamstring Injuries to get an athlete back to sport effectively and safely.

For more information on Hamstring Injuries click here.

Here is a video with some sample Hamstring Exercises exercises to treat a Hamstring Injury:

Do You Have Frozen Shoulder?

Frozen Shoulder, also known as Adhesive Capsulitis is characterized by a thickening of the shoulder capsule.  When this occurs, it results in adhesions which results in pain and stiffness in the shoulder.


A person with Frozen Shoulder will demonstrate shoulder pain in all planes of motion depending on what stage it is in (there are 3 stages).  Simple everyday tasks such as reaching overhead, reaching out to the side, or reaching behind your back can be painful and limited.  This alone however does not provide a person with enough information to determine if their shoulder pain is caused by Frozen Shoulder.  That is why it is important to also check other factors that have been proven in the research community to guide effective treatment.

How do we determine if a person has Frozen Shoulder?  It is important to look at several different characteristics:

• A person's age
• Frozen Shoulder typically occurs between 40-60 years of age   
• A person's diabetic status
• The incidence of Frozen Shoulder is two to four times HIGHER in patients with diabetes compared to the rest of the population
• A person's gender
• Research has shown a higher risk of developing Frozen Shoulder in females compared to males
• A person's history of injury
• Sometimes a person will develop Frozen Shoulder after having another type of shoulder injury and/or a period of shoulder immobilization
• A person's physical examination
• A person will be limited in a capsular pattern (External Rotation Limitation > Abduction Limitation > Internal Rotation Limitation)

If a person meets this criteria most likely they are suffering from Frozen Shoulder.  The best way to try and regain motion in the shoulder is through physical therapy intervention, specifically with passive range of motion exercises.  Most commonly passive range of motion can be performed with a pulley.

For more information on Frozen Shoulder click here

Here is a video with some sample pulley exercises to treat Frozen Shoulder:

Dr. House Walks INCORRECTLY With Cane

The medical drama House was quite popular when on air.   Dr. Gregory House was a medical genius who was highly dependent on pain medication.  This dependency coupled with other faults made the show very entertaining and I suggest watching if you have not seen it.  Despite Dr. House's deep medical knowledge however, he continuously used his cane to walk incorrectly.  When learning about the use of a cane in graduate school this was always used as an example of what NOT to do.  Check out the clip below starting at the 3:00 mark:

 

First and foremost, the reason Dr. House carries a cane with him is to deal with pain and weakness in his right thigh.  As you can see in the clip Dr. House holds the cane in his right hand and is seen to walk awkwardly through the halls.  He does this repeatedly through out the entire show and I want to reiterate that this is the INCORRECT way to use a cane.  Walking this way promotes a sub optimal and unsafe gait pattern that can cause a variety of issues if performed long term.  Therefore it is important to learn the CORRECT way to use a cane. 

In order to use a cane correctly it is important to ALWAYS place the cane in the opposite hand of the injured lower extremity.  This allows a person to still put some weight through the lower extremity and allows a person to walk optimally.  It is also important to mention that Dr. House's cane may also not have been sized properly for his height.  A cane handle is supposed to come up to the height of a person's wrist while allowing a slight bend in the person's elbow.  In the show there are instances where the cane does not appear to be the proper size.  Therefore it is important to remember that a cane should always be on the correct side and sized properly when dealing with a lower extremity injury.

For more information on proper cane sizing and usage click here

Here is an instructional video showing the proper way to size and use a cane.  It also includes how to safely use a cane on the stairs:

Best Treatment Approach for IT Band Syndrome

The Iliotibial Band (IT Band) is a piece of dense tissue that runs along the lateral portion of the thigh as shown below:

Due to the location of the IT Band, people commonly feel pain along the outside of their knee.  Typically a person feels a sharp burning sensation during activity and this pain will subside once the activity stops.  Also, there is NO traumatic injury to the knee in that it begins to be painful gradually over time.  Due to the location of pain however, it can be mistaken for a knee issue initially.  Potential risk factors for IT Band Syndrome include: IT Band Tightness, Muscular Weaknesses, and those running long distances.    

According to research IT Band Syndrome is best approached with conservative management first.  This conservative program will consist of IT Band stretches several times per day.  Also, it is important to include hip strengthening, specifically hip abduction.  The time frame referenced was a rest period of 2-6 weeks while including stretching, strengthening, and pain management strategies.

For more information on IT Band Syndrome click here

Here is a video demonstration on some great IT Band stretches:

Here is a video demonstration on some great Hip Strengthening.  The Hip Abduction exercise begins at the :28 mark:

Sprained Ankle? Learn How to Treat and Prevent

Ankle injuries are VERY common.  According to systematic review, the ankle joint was determined to be the most common site of injury in 24 out of the 70 sports that were studied.  What is known as a lateral ankle sprain accounts for 85% of ankle sprains.  This is when a foot becomes rotated in and is commonly known as a, "Rolled Ankle." 

The first step in an acute ankle sprain is to determine if an ankle X-Ray is needed.  It is important to differentiate whether it is a fracture or a sprain to continue.  A great tool to use is the Ottawa Ankle Rules, which I wrote about previously and will provide a link.    Once diagnosed with an ankle sprain, it is important to do conservative management, also known as RICE (Rest, Ice, Compression, Elevation).  During this period  it is also beneficial to use some type of immobilization device, whether it is a brace, wrap, or air cast.  The duration for immobilization can be subjective however clinical benefits have been seen for approximately 10 days based on the research.

Once you can tolerate exercise, it is important to start performing ankle exercises to prevent a sprain from recurring.  If not treated correctly, chronic ankle instability can occur which results in a greater likelihood of recurring sprains and ankle injuries.  Patients with chronic ankle instability have been seen to have neuromuscular deficits along with deficiency during balance activities.  Therefore as part of a rehabilitation program it is very important to include these during the process.

For more information on ankle sprains and treatment click here.

Here is a video demonstration for ankle exercises following an injury:

Is A Foot/Ankle X-Ray Needed? Try The Ottawa Ankle Rules

When looking at the research, as many as 12% of patients going to the emergency room are there due to foot and ankle injuries.  Nearly all of these people have an X-Ray performed however less than 15% of these patients will be positive for fractures.  What is this telling us?  This simply means that greater than 85% of people that present with foot and ankle pain have radiographic imaging unnecessarily.  This exposes the patient to unnecessary radiation as well as increases the wait times in the emergency rooms.  Therefore, certain clinical guidelines have been put in place to determine if a person needs imaging based on physical examination.  One of the most highly researched set of guidelines is known as the Ottawa Ankle Rules.

The Ottawa Ankles Rules are clinical guidelines to determine if patients need to undergo a foot/ankle X-Ray based on physical examination.  A study perform by Wang et al in China discovered that the implementation of the OAR decreased unnecessary radiographs by 31.1%  To read more about this study click here.

It is important that the Ottawa Ankle Rules are more well known among patients.  A common question that I and other Physical Therapists get is, "Do I need an X-Ray?"  These are the guidelines that I personally follow when a patient comes to me with an acute ankle sprain.  I am not suggesting to use these guidelines for self diagnosis among patients however I believe its important for patient education.  It is important for patients to understand that examination techniques are proven in the research community and for them to understand how the examination is performed.  Likewise it is important for physical therapists and other healthcare practitioners to understand the Ottawa Ankle Rules when it comes to decision making.

For more information on the Ottawa Ankle Rules click here

For video demonstration of the Ottawa Ankle Rules here is a video:

Prolonged Shoulder Impingement Syndrome Leads to Rotator Cuff Tear

If you have had shoulder pain in currently or in the past, you may have heard the term, "Impingement Syndrome."  This is a diagnosis which usually refers to the Subacromial Space in the shoulder and is known in the medical community as, "Subacromial Impingement Syndrome."  Why is this called the Subacromial Space you may ask?  This is because it is located below a bone in the shoulder known as the Acromion.  What happens with Impingement Syndrome is that due to altered anatomic structures and/or poor biomechanics, two tendons and one bursa become pinched by the Acromion during shoulder movement.  The two tendons that can be involved are the Supraspinatus Tendon and the Long Head of the Biceps Brachii Tendon.  The Supraspinatus tendon is one of four rotator cuff muscles in the shoulder and if left untreated can result in a partial to full thickness tear in the Rotator Cuff.  For more information on the shoulder Rotator Cuff anatomy click here.  The Long Head of the Biceps Brachii Tendon is an extension of the Biceps muscle and can also be torn due to chronic Impingement Syndrome.  Finally, the bursa that may be affected during Impingement Syndrome is known as the Subacromial Bursa.

Subacromial Impingement Syndrome has three stages according to Charles Neer.  Stage 1 is described as having acute but reversible edema and inflammation to the Supraspinatus and Long Head of the Biceps Brachii Tendons.  It is typically seen in individuals who are less than 25 years of age.  The important part of this Stage is that the effects are REVERSIBLE.  When a person has reached Stage 2 which is between ages 25-40, fibrotic changes have begun to happen in the affected tendons and/or bursa.  This is significant because these affected structures are no longer as pliable and strong as they once were, thus increasing the chances of tearing.  Finally Stage 3 occurs in individuals who are typically older than 40 years of age and have had a long history of shoulder pain.  These individuals will have partial to full thickness tears in their Supraspinatus and/or Long Head of Biceps Brachii Tendons.  The moral of this: DO NOT LET IT PROGRESS TO STAGE 3!  If you suspect you have Impingement Syndrome get yourself treated.  A rehabilitation protocol that emphasizes normal shoulder biomechanics, scapular and rotator cuff strengthening has been proven in the research community to relieves symptoms.  You can read more about the research here.

For more information on Subacromial Impingement Syndrome check out our website here.

Examples of exercises for Subacromial Impingement Syndrome can be found below:

Stretching Exercises to Treat Plantar Fasciitis Show the Best Long Term Results

If you have been told that you suffer from Plantar Fasciitis, then you know the struggles associated with it.  You may feel pain in your heel during your first steps in the morning.  If you are an athlete you may notice that when you train, the pain improves after you are warmed up however it reappears after the training session.  If left untreated however, it can lead to degenerative changes in the Plantar Fascia and lead to a chronic tendinopathy.  In the extreme cases it can lead to tearing the Plantar Fascia which happened to NFL Quarterback Peyton Manning in 2015 as reported by ESPN.  Therefore to avoid further injury, it is important to treat it appropriately.  

Treatments for Plantar Fasciitis include medications, physical therapy, and surgical intervention.  As an evidence based practitioner in healthcare it is important to consult the most updated research articles for optimal patient treatment.    In a recent systematic review (Petraglia et al, 2017), it was determined that of the treatment interventions out there, "specific stretching for the treatment of Plantar Fasciitis are the best statistically long term results."  With stretching exercises it is possible to relieve your symptoms and has been proven in the research.

For more information about Plantar Fasciitis click here

Here are some sample stretches for Plantar Fasciitis:

Eagles Wide Receiver Alshon Jeffery Played Every Game with Torn Rotator Cuff in 2017-2018

Anybody who watches the NFL knows that Alshon Jeffrey had a spectacular season in 2017-2018.  This included the Philadelphia Eagles winning the Super Bowl and was aided by this catch:

It is surprising to find out that Jeffrey played in the Super Bowl with a torn Rotator Cuff in his shoulder.  It's even more surprising to learn that Jeffrey tore his Rotator Cuff BEFORE the season even began.   Many people have had torn Rotator Cuffs and are unable to even lift their arm on their own.   You're probably asking yourself, "How did that guy play and avoid surgery?"  Jeffrey is one of few athletes who uses a travel Physical Therapist.  His name is David Reavy and he flew out to Philadelphia once a week during the NFL season to treat Jeffrey.  His treatments included flexibility and strengthening for the shoulder joint in order to keep Jeffrey playing at a high level during the season.  To read more about his rehabilitation process click here

Since winning the Super Bowl, Jeffrey has had surgery to repair the tear in his shoulder.  It is important to note however that despite having a tear or anatomical abnormality, you can still perform at a high level!

For more information on the shoulder Rotator Cuff click here

Here are some sample stretches and exercises for Rotator Cuff injuries: