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: