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: