What is Hip Impingement and How Can PT Help?

By Nick Mazzone PT, DPT, CSCS

What is hip impingement?

 Femoracetabular impingement (FAI) is a condition in which bone spurs grow on the joint surfaces of the hip. These bone spurs eventually lead to irritation of the structures at the hip, which may lead to soft tissue damage such as labrum tears and potentially arthritis.

The two types of FAI are cam lesions and pincer lesions. Cam lesions develop on the head of the femur, therefore affecting the shape of the bone. Pincer lesions form on the pelvic surface of the hip joint. There are also situations in which both of these types of lesions are present.

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What causes FAI?

Cam and pincer lesions may form due to abnormal development of the hip joint during childhood. They may also develop after prolonged pressure on the front of the hip joint over time due to asymmetries in muscle strength among the prime movers of the hip (for example, overactive hip flexors and underactive glutes).

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What can be done to improve FAI?

It is imperative that we address the strength deficits present in this situation. If you have weak gluteus maximus muscles and your hip flexors are overactive, you would expect the hip joint to be sitting in a suboptimal position during functional tasks. In this scenario, you would see the femur sitting in front of its optimal position in the socket. For this reason, you want to strengthen the gluteus maximus muscles in order to realign the hip joint and prevent excessive pressure on the structures in front of the hip. Sometimes it is indicated to stretch the hip flexors, but that should be dependent on the physical therapist’s evaluation. Just because a muscle is overactive and tense does not mean it is short of length. It is also important that we strengthen the lower abdominal muscles to help stabilize the pelvis. This should help decrease the tension in the hip flexor muscles which may have been acting as a pelvic stabilizer (thus leading to overactivity).

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How can PT help?

Your physical therapist will develop a specific treatment plan according to the findings of the clinical exam. While two people may both be diagnosed with hip impingement, they may present in completely different ways and with different impairments to address. For this reason, it is important to be evaluated and treated with a plan specific to you and not a general exercise plan. Your specific treatment plan is aimed at helping you return to your prior level of physical activity without pain.

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Check out this video that shows three simple exercises you can do to help improve your symptoms from hip impingement:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

 

 

Resources

 

Femoroacetabular Impingement - OrthoInfo - AAOS. (n.d.). Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement

 

Main photo retrieved from https://reverehealth.com/live-better/what-is-hip-impingement/

 

Photo of bridging exercise retrieved from http://www.womenshealthmag.co.uk/fitness/find-a-workout/4456/how-to-do-glute-bridges/

 

Photo of cam and pincer lesions retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/femoroacetabular-impingement

 

Photo of muscle asymmetries retrieved from http://www.racquetfit.com/articles/Coaching/controlling_your_posture_and_the_serve

 

Photo of plank exercise retrieved from https://www.waysandhow.com/good-reasons-plank-daily-6-benefits-planks-exercise/

 

Photo of runner retrieved from http://lisabaylis.com/2017/07/15/running-for-wellness/

Thoracic Mobility: Why is it Important?

By Nick Mazzone PT, DPT, CSCS

What is the thoracic spine?

The thoracic spine is the middle portion of the spinal column that connects the neck to the lower back region. It consists of 12 separate segments that serve as connections for the ribs, which protect many vital organs including the heart and lungs.

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Why is mobility here so important?

It is vital that you have adequate mobility in this region because of the interdependent relationship it has with the cervical and lumbar spine. If you do not have enough motion in the mid back, the nervous system depends more heavily on the upper and lower spine to make up for that motion. This lack of thoracic mobility can then be a contributor to neck or low back pain.

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Overhead mobility

We need adequate thoracic mobility in order to move our shoulder joints into their natural end ranges of motion. If we do not have enough mobility here, more strain is then placed on the glenohumeral joint (shoulder ball-and-socket joint). In this case, we usually see a compensatory increase in motion at the shoulder joint that may lead to increased pressure or strain on the soft tissue in this region. This may increase the chance of injury over time. It is also important to note that we need enough thoracic mobility when we perform overhead presses at the gym. If we cannot keep our thoracic spine extended to neutral (straight spine; not hunched over), we would have to compensate by extending the lumbar spine (bending low back in backward direction). This could lead to increased pressure on the discs of the lumbar region, especially when we load the exercise with too much weight.

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Breathing and rib expansion

We just discussed how each thoracic segment is a connection point for the ribs. This means that adequate thoracic mobility is essential for normal expansion of the ribcage while we breathe. When we take a large inhalation, the thoracic spine extends (segment rotates backwards). This allows the ribs to create more space for the lungs to expand. When we exhale, the thoracic spine flexes in order to return to its resting position (flexion would be rotating forward). If we cannot extend the thoracic spine adequately, it limits the amount of air that can fill the lungs. This is important for regulation of the parasympathetic nervous system as well as the cardiovascular system.

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Relationship to legs and lumbar spine during squat

You need normal thoracic extension in order to properly perform loaded lower body movements such as the squat. If you are starting to pick up on the theme of interdependence, you are on the right track here. When you perform a squat with resistance from a barbell at the gym, you are resting the bar on your shoulders. When you do not have adequate thoracic mobility, your center of mass shifts forward. This alters the biomechanics of the entire exercise form the floor to the head and neck. This makes it harder to keep your heels down and keep your buttocks back, which ensures that the load is properly handled by the hips and spine. The lumbar spine would then have to compensate by overextending itself, forcing it to handle more of the load than it normally would have to.

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Check out this video that shows 3 simple exercises you can perform to help improve thoracic mobility:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

 

Main photo retrieved from https://www.t-nation.com/training/tip-improve-thoracic-spine-mobility

 

Photo of ribs and vital organs retrieved from https://www.britannica.com/science/thoracic-cavity

 

Photo of neck and low back pain retrieved from http://posturedirect.com/17-exercises-to-improve-your-thoracic-spine/

 

Photo of overhead mobility retrieved from https://fitnesspainfree.com/the-correct-way-to-mobilize-your-thoracic-spine-with-a-foam-roller/

 

Photo of squat and thoracic spine position retrieved from https://www.ensomovementculture.com/blog-1/movement-training-for-sports-people-mobility/18/4/2017

 

Photo of rib expansion during breathing retrieved from https://newgradphysicaltherapy.com/role-breathing-physical-therapy/

 

What Are Cervicogenic Headaches and How Can PT Help?

By Nicholas Mazzone, PT, DPT, CSCS

 

What are cervicogenic headaches?

A cervicogenic headache is caused by dysfunction in the neck, whether it be from stiff joints in the upper cervical spine or from tension in the muscles near the base of the skull. Pain from this type of headache is typically felt around the skull, temple regions, and eye sockets. The origin of this condition can be traumatic, as in a whiplash injury from a motor vehicle accident, or it could be due to prolonged abnormal load on the joints and muscles of the neck (getactivephysio.com.au).

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What would be a non-traumatic cause of these types of headaches?

The most common non-traumatic cause of cervicogenic headaches is excessive, prolonged load on the joints and muscles of the neck. This is common in people who sit at a desk for most of their day at work. This occurs because the person winds up in a slumped posture in their spine, which eventually leads to what is known as “forward head posture”. This posture leads to increased tension in the muscles at the base of the skull as well as increased pressure on the first three segments of the cervical spine. Over time, this poor sitting posture can cause cervicogenic headaches. Adjusting one’s desk setup to ensure prevention of this situation can be as simple moving the keyboard closer to you. If the keyboard is placed too far away, you will have to slump forward to reach it, which will lead us to the forward head posture discussed above in order to ensure that you can see what is on your screen. Check out the picture below to get a better idea of what your desk setup should look like.

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How can PT help?

Your physical therapist will create a program for you that includes manual therapy, therapeutic exercise, postural training, and stability training. Your program will also include education on how to adjust your desk setup or information on how to alter your current lifestyle in order to help your condition. Manual joint mobilization of the upper cervical spine, soft tissue mobilization of tense muscle tissue, and manual stretching of the region will help soothe the muscles and decrease pressure in the region. You will also be given specific exercises to target the muscles that are weak as well as the muscles that need to be lengthened. While heating modalities can feel good, they should not be the main intervention used in the treatment of cervicogenic headaches.

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Check out this video that demonstrates 3 simple exercises that can help with your cervicogenic headaches:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

Cervicogenic Headaches. (2016, March 09). Retrieved from http://www.getactivephysio.com.au/cervicogenic-headaches/

Desk posture photo retrieved from https://sinicropispine.com/tips-improve-posture/

Main photo retrieved from http://yoffielife.com/sweat-dictionary/cervicogenic-headaches/

Manual therapy photo retrieved from https://learnmuscles.com/blog/2017/11/10/treat-spinal-joint-dysfunction-manual-therapy/

Whiplash photo retrieved from https://www.bouldercentre.com/news/whiplash-diagnosis-and-treatment

A cervicogenic headache is caused by dysfunction in the neck, whether it be from stiff joints in the upper cervical spine or from tension in the muscles near the base of the skull. Pain from this type of headache is typically felt around the skull, temple regions, and eye sockets. The origin of this condition can be traumatic, as in a whiplash injury from a motor vehicle accident, or it could be due to prolonged abnormal load on the joints and muscles of the neck (getactivephysio.com.au).

ACL Tears: Do They Always Require Surgery?

By Nick Mazzone PT, DPT, CSCS

What is the ACL?

 The anterior cruciate ligament (ACL) is a crucial stabilizing structure at the knee joint. When intact, it will prevent the lower leg (tibia) from moving forward on the thigh bone (femur). The ACL is commonly torn in athletes and may require surgical intervention in order to repair it. This structure does not heal on its own mainly due to its poor blood supply and twisted structure of collagen fibers. This twisted structure leads to frayed ends and therefore, cannot heal without assistance (surgery in this case).

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How does someone typically tear their ACL?

 ACL tears typically occur while the foot is planted and the femur twists over the tibia (or vice versa). Sometimes this happens because an athlete’s footwear gets caught on a grass surface, for instance. An ACL tear may also occur when an athlete lands on a straight knee on a hard surface such as a basketball court.

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Can surgery be avoided?

 Surgery is not necessary in all cases of an ACL tear. It would be highly suggested that an athlete who plans on returning to that same level of function receive surgical treatment to ensure that they return to their sport at the same level they were at before they got injured. For a person who tore their ACL but does not plan to partake in athletics or any activities that would require high level stability of the knee, a thorough and specific rehab program can help them return to their normal activities.

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What might a non-surgical ACL rehab protocol consist of?

 In the early stages, it is important to address the swelling and help strengthen the muscles around the knee in a gentle way in order to help normalize muscle activation patterns (acute swelling tends to turn these muscles off!). Once these issues have improved, we can move on to more functional exercises. A program aimed at rehabilitating someone after a torn ACL must address the limitation in the knee that is now missing one of its major stabilizing structures. While we no longer have the static stability that the ACL was providing to the knee, we can absolutely improve its dynamic stability by targeting the muscles around the knee joint. It is important to ensure that we are strengthening the hamstrings since they will act to prevent the forward movement of the tibia on the femur (which is one of the main functions of the ACL!). We must also ensure that we are challenging the stability of the knee in functional positions. This will teach the muscles around the knee joint to act together to keep the knee joint stable (co-contraction).

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Check out this video that shows 3 simple exercises to help normalize the knee after a torn ACL that did not require surgery:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

 

Main Photo retrieved from http://www.stack.com/a/a-new-type-of-acl-surgery-could-have-athletes-back-on-the-field-faster-than-ever

 

Photo of ACL tear retrieved from https://www.reddit.com/r/nba/comments/2ws4zu/science_and_the_nba_digging_in_to_the_anatomy_of/

 

Photo of twisting of knee retrieved from https://www.parisischool.com/acl-what-why-and-how/

 

Photo of ACL repair retrieved from https://www.mocnyc.com/acl-reconstruction/

 

Photo of squat on bosu ball retrieved from http://www.ctialatest.org/lab/lab-equipment-diagram

What is Achilles Tendinitis and How Can Physical Therapy Help It?

By Nick Mazzone PT, DPT, CSCS

What is Achilles tendinitis?

 The Achilles tendon is the thick band that connects the rear calf muscles to the heel. Achilles tendinitis is considered an overuse injury and may be caused by a sudden increase in physical activity and is commonly seen in the running population. Some risk factors for the development of this condition may be improperly fitting footwear, a stiff ankle and foot, weakness of the muscles that act on this region, and over-pronation of the foot during walking or running. If left untreated, this condition can lead to degenerative changes in the makeup of the tendon itself, which will further exacerbate the symptoms. At this point, the condition would be considered a tendinosis.

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What should be done in the early stages of this condition?

 In the early stages of the condition it may be wise to combine active rest with techniques that help decrease swelling.  This would mean refraining from running, long distance walking, or any other higher intensity activity that may have led to this issue in the first place. The active part of this equation would include gentle strengthening and range of motion exercises for the region to help improve blood flow for healing and address some of the issues that may have contributed to the condition in the first place. It is important to elevate the leg above chest level so that gravity can assist in decreasing swelling. If desired, ice can be used in combination with these methods as well.

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What can PT do for me in later stages of this condition?

 Once the acute stages of the condition have passed, it is important to restore normal function of the muscles in this region. Your physical therapist will prescribe a specific program based on your flexibility and strength assessments. Foot posture and stability will also be addressed after screening is completed. Stretching of the Achilles tendon is important; however, it is more important that we gradually reintroduce normal activities to the foot and ankle. Progressive loading of the Achilles tendon combined with eccentric exercise is the gold standard method for healing this condition.

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What does progressive loading and eccentric exercise mean?

 Progressive loading of the Achilles tendon simply means that we will be using specific exercises to gradually increase the amount of pressure that the Achilles tendon is under. For example, early exercises may include an activity performed with a resistance band while the foot is off the ground and later stage exercises may include activities on one leg.

 

Eccentric exercise simply means that we are strengthening the muscle’s ability to contract while it moves from a shortened position to a lengthened position. Most functional activities require eccentric strength. An example of an eccentric-focused exercise would be standing on your toes and then slowly lowering the heel to the ground. The eccentric portion of the exercise is the part where you focus on slowly lowering the heel to the ground (muscle is lengthening).

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Check out this video that shows an example of a program that utilizes eccentric activity with progressive loading of the Achilles tendon:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

 Main photo (green background) retrieved from http://www.achillestendonitis.co.uk/

Photo of anatomy of Achilles region retrieved from https://www.researchgate.net/figure/The-anatomy-of-the-Achilles-tendon-and-the-suralis-muscle_fig1_262230849

Photo of “RICE” retrieved from https://www.quora.com/How-do-I-heal-my-Achilles-tendon

Photo of foot posture retrieved from http://okanaganpeakperformance.com/knee-solution-seminar-recap

Photo of heel raise retrieved from  https://fitness.stackexchange.com/questions/14976/is-this-a-good-at-home-exercise-routine-for-a-beginner

How Can Physical Therapy Help My Sciatica?

By Nick Mazzone, PT, DPT, CSCS

What is Sciatica?

Sciatica is one of the most common symptoms associated with lower back pain. It refers to the sensation of burning pain that tends to radiate from the buttock down the leg. The distance the pain travels is typically correlated to the extent of the irritation effecting the nerves. The name “sciatica” comes from the sciatic nerve, which is one of the largest nerves in the body. The spinal nerves that become irritated are typically those that eventually come together to form the sciatic nerve (from spinal level L4 to S3). Sciatica is not a permanent condition and does not typically require surgical intervention.

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What causes sciatica?

 These symptoms are typically caused by excess pressure on a nerve after it exits the lumbar spine (lower spine). This pressure can come from a herniated disc, arthritis in the lumbar region, and other conditions in which the space that the spinal nerve travels becomes compressed or shrinks.

 

How can physical therapy help improve this condition?

 This condition is relieved by decompressing the region in which these spinal nerves travel. This can be achieved through a specific mobility and strengthening program that includes postural education and awareness training. These specific exercises will depend on the location at which the nerve is being irritated. Generally speaking, in order to decrease pressure in the lumbar region of the spine, you must be mobile in not only the lumbar spine but the thoracic region (mid back) and hips. This will help take pressure off the low back by allowing a more even distribution of movement. Think about it this way: If you are lacking proper mobility in your thoracic spine, your lumbar spine will have to make up for this lack of mobility. This can lead to increased stress and strain in this area. The same idea works for the hips.

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Postural training is important in helping to decrease pain and inflammation in the low back. The pelvis and lower spine are anatomically connected (the lower spine actually sits in the pelvis), and therefore movement between the two will be interrelated. The position of the pelvis will dictate the posture in our lumbar spine during all activities (including at rest!). Depending on where the nerve irritation is occurring, this positioning of the pelvis will either increase or decrease pressure on the nerve. If the irritation is occurring at the point where the nerve exits the spinal canal (at the nerve root), extension of the lumbar spine should help alleviate the pressure by “opening” the region where the spinal nerves exit, while flexion of the lumbar spine may increase pressure due to “closing” of the region. Refer to the picture above for a visual of this phenomenon. “Lordosis” is known as lumbar spine extension, while “flat” spine refers to a flexed spine. The picture below demonstrates these movements.

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Check out this video that demonstrates a simple mobility exercise for the sciatic nerve to help alleviate your symptoms of sciatica:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

 

 

Resources:

 Main photo of sciatica pain in leg retrieved from https://www.magnilife.com/blog/5-effective-ways-for-dealing-with-sciatica-pain/

Photo of irritated nerve retrieved from http://arizonapaintreatmentcenters.com/from-dr-craig-peterson-mva-sciatica

Photo of lumbar flexion and extension retrieved from https://b-reddy.org/making-pull-ups-and-burpees-more-shoulder-and-lower-back-friendly/

Photo of pelvis position and lumbar spine retrieved from https://body-motion.co.uk/injuries/postural-pain/improve-your-sitting-posture/

What is Tennis Elbow and How Can Physical Therapy Help?

By Nick Mazzone, PT, DPT, CSCS

What does tennis elbow mean?

“Tennis elbow” is the nickname given to a condition known to the medical community as lateral epicondylitis (also seen ending in -osis or -algia). This name describes the region from which the pain originates on the outside of the elbow. The lateral epicondyle is the part of the upper arm bone that serves as the origin for all of the muscles that extend the wrist.

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What causes tennis elbow?

Tennis elbow is considered an overuse injury. It typically occurs after repetitive stress to the involved region over time, however one traumatic incident such as a fall or work accident may also cause inflammation in this region. Tennis elbow got its name because it is a common overuse injury seen in those who play the sport. Tennis players tend to hold a tight grip on their racquets while producing powerful forces with their wrist extensor muscles. In certain cases, this may be a recipe for inflammation. Another common population that tends to get tennis elbow is the office worker. Being in a position of wrist extension while typing for prolonged periods may cause repetitive stress to the outside of the elbow.

Here is an example of what your posture should look like while in front of your computer:

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How Will Physical Therapy help me?

Your physical therapist will design a specific treatment plan tailored to your needs based on your background and activity level. The program will consist of soft tissue mobilization to assist in the healing process, stretching/mobility training, functional strengthening of eccentrics (the muscle’s ability to control movement from wrist extension to wrist flexion) and grip strengthening, training of ergonomics and posture, and education on how to prevent the condition from reoccurring.

Your specific program will depend on how you acquired the condition in the first place. An office worker will be trained to alter their desk setup in order to decrease the stress on the wrist extensors. A tennis player may be prompted to consider changing the thickness of their racquet handle or the tightness of the strings. Both of these variables may help contribute to the repetitive stress that occurs during the sport since more force production is necessary to produce the desired effect when these conditions are not optimal.

  This picture shows one way to stretch the wrist extensor muscles.

This picture shows one way to stretch the wrist extensor muscles.

Check out this video for 3 simple exercises to help with your tennis elbow:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

 

Resources 

Main photo retrieved from https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987

Photo of bones of arm retrieved from http://cruxcrush.com/2014/06/26/climber-problems-elbow-injury/

Picture of wrist and finger extension retrieved from http://www.militarydisabilitymadeeasy.com/images/handmuscles/

Picture of ideal desk posture retrieved from xhttps://www.microsoft.com/accessories/en-us/support/ergonomic-comfort

Photo of wrist extensor stretch retrieved from https://www.therapeuticassociates.com/athletic-performance/golf/stretching-for-golfers/

What is Assisted Stretching and How can it help me?

Nick Macaluso

Stretching is kind of like flossing... everyone knows they should be doing it, but who really does it? It’s one of those things that we’re all going to start making into a habit tomorrow, but somehow tomorrow never comes. To our credit though, when we get that cramp in our thigh, or piece of spinach in between our teeth, we know exactly what we need to do. But how do we identify the exact muscles that tend to cramp or spasm, and prevent it from happening? How can we isolate and stretch the muscles we hold the most tension in to prevent and alleviate pain? How can we most effectively just enhance our mobility for a higher quality of life? The answer, Assisted Stretching.

What is Assisted Stretching?

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Assisted Stretching is a hands-on method of stretching in which a person is gently supported through a series of stretches by a trained practitioner. Assisted Stretching is more effective than stretching by yourself because the practitioner stabilizes your joints in positions that allow you both to isolate and stretch one muscle at a time while expanding your fullest range of motion. The benefit to being able to isolate and stretch individual muscles is to give both you and the practitioner a better understanding of where exactly your body may be out of alignment. Perhaps your low-back pain is just a result of tight hamstrings, or your sciatica is just a result of tight glutes. Both of which can be relieved from general stretching, but without the assistance of a trained practitioner, it is nearly impossible to isolate the exact muscle and relieve its tension.

Why is Assisted Stretching so productive?

Aside from being able to realign your body by isolating the muscles being stretched, Assisted Stretching is an opportunity for you to relax and repair your body and mind while still using your time constructively. Many of us after long days or weeks want nothing more than a massage to take the tension out of our backs, necks, shoulders, or hips, but aside from the relaxation, what is the massage doing to prevent that tension from returning? Most of the time, tension builds in areas of our bodies that are either overactive or misaligned due to habitual poor posture. While massages are great, if you’d rather spend your time relaxing AND simultaneously preventing the tension from returning, Assisted Stretching is for you.

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Stretching is one of those things that people spend their lifetime studying and writing about because of its incredible complexity and near infinite amount of benefits. But instead of wasting your time with all that, experience the hype for yourself by scheduling a 20 minute Assisted Stretching session with Nick Macaluso at Evolve Physical Therapy. Sessions run in 20 minute increments and can last anywhere from 20 minutes to 2 hours depending on how long you would like to be stretched. While this service is open to the public, all active patients of Evolve must first speak to their therapist to ensure an Assisted Stretch is right for them.

For more information or any questions, give us a call at 718-258-3300 or contact us today!

How Can Physical Therapy Help My Plantar Fasciitis?

By Nick Mazzone, PT, DPT, CSCS

What is the plantar fascia?

The plantar fascia is a thick band of connective tissue that runs from the lower surface of the heel to the beginning of the toes. This fibrous band of tissue is placed under tension during walking and other activities in which you place weight onto the feet. This tension creates support and stabilization of the arch of foot, which will help stabilize the entire lower extremity during these types of activities.

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What causes this structure to become inflamed?

While the exact mechanisms behind the causes of plantar fasciitis are not completely understood, the condition has been correlated with some mechanical issues at the foot and ankle. One of the more common impairments associated with this condition is inadequate dorsiflexion of the foot. Dorsiflexion is the movement performed when the top surface of the foot comes closer to the front of the leg.

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Another impairment that is commonly associated with plantar fasciitis is weakness of the posterior tibialis muscle. This muscle helps to increase arch height during activities in which weight is placed on the feet.

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This condition can also be considered an overuse injury. For instance, a running athlete may progress their running program too quickly without allowing their body to adapt. This can cause inflammation and pain in the plantar fascia.

What can PT do to help?

Your physical therapist will create a specific treatment plan tailored to your needs and impairments. Most commonly, the treatment will consist of mobility drills and functional stabilization techniques to help support the arch of the foot. These exercises are more effective when performed with weight on the legs in a standing position, as this is more closely related to the way in which these structures actually function in the real world. Your program may start more conservatively depending on your pain and activity tolerance.

The ultimate goal of the treatment is to progressively load these structures so that they become adapted to increased stress. This will ensure that the plantar fascia can handle the demands placed on it during our daily endeavors, whatever they may be. In some cases, a physical therapist will recommend orthotics to help provide support to the arch of the foot.

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Check out this video depicting 3 simple exercises that can be performed to help improve your plantar fasciitis:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

 

Picture of painful foot retrieved from https://www.tcpaindoctor.com/can-prp-help-treat-plantar-fasciitis/

Picture of plantar fascia function during weight bearing retrieved from https://painphysiotherapist.com/2016/05/25/plantar-fascia-rupture/

Picture depicting dorsiflexion of ankle retrieved from http://www.militarydisabilitymadeeasy.com/

Picture of posterior tibialis retrieved from https://www.fixpodiatry.com.au/podiatry-conditions/tibialis-posterior-tendinopathy/

Picture of collapsed arch retrieved from https://www.epainassist.com/sports-injuries/foot-and-heel-injuries/flat-feet-or-pes-planus-or-fallen-arches

Photo of orthotic placement retrieved from https://bestwalkingfeet.com/good-shoes-for-flat-feet/insoles-and-inserts/

Wheeless' Textbook of Orthopaedics. (n.d.). Retrieved from http://www.wheelessonline.com/ortho/Plantar_fascia

 

 

What is the Rotator Cuff and What Does It Do?

 By Nick Mazzone, PT, DPT, CSCS

What is the rotator cuff?

The rotator cuff is the name given to the group of 4 muscles that originate from different positions on the shoulder blade and connect to the humerus (upper arm). These muscles all work together to ensure stability of the shoulder joint during movement (dynamic stability). When isolated, each of these muscles acts on the humerus and moves the shoulder joint in different directions. These muscles are named supraspinatus, infraspinatus, teres minor, and subscapularis.

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Why do we need this dynamic stability?

As we move the arm, these rotator cuff muscles will contract together to help keep the humerus centered nicely inside the cup of the shoulder joint (think ball and socket). If there is an asymmetry in strength among these muscles, the positioning of the shoulder inside the socket may be altered while you move your arm. Over time, this can cause irritation of other tendons, ligaments, and bone in the shoulder region. Some of the common diagnoses associated with rotator cuff muscle weakness are shoulder impingement syndrome and non-traumatic rotator cuff tears.

What happens if the rotator cuff is torn?

The most commonly torn rotator cuff muscle is the supraspinatus. People with supraspinatus tears typically have trouble elevating the arm and may exhibit a compensatory shrugging of the shoulder in order to assist in raising the arm.

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If a partial tear is present, the muscle and tendon have the ability to heal without surgical intervention. In order for proper healing to occur, we must provide an ideal environment for the muscle and tendon to recover. This would include intervention aimed at decompressing the region where the muscle attaches to the humerus, which would be achieved through range of motion exercise and strengthening of all 4 rotator cuff muscles to help produce more efficient movement of the shoulder (to put it briefly).

If a complete tear is present, there are two options that one may follow. The non-surgical route would include strengthening other muscles around the shoulder joint that will help to compensate and act as a substitute for the torn rotator cuff muscle. Fortunately, the shoulder joint was designed to be able to withstand this type of injury and with the right rehab protocol, may return to normal functioning. In cases where this method does not help, surgical intervention is typically indicated. After surgery, patients will be sent to a physical therapist in order to help them return to their prior level of functioning.

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What does physical therapy typically consist of for rotator cuff injuries?

The plan of care will consist of manual stretching and soft tissue mobilization of tense muscles, specific strength and stability exercise to improve the function of the shoulder, range of motion exercises to help normalize joint movement, and movement re-education to ensure pain-free use of the arm.

Check out this brief video for 3 exercises that will strengthen the rotator cuff muscles:

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources

Photo depicting widespread shoulder pain (top photo) retrieved from https://www.myanthemhealth.com/blog/shoulder-paincould-it-be-my-rotator-cuff

Photo depicting different muscles of the rotator cuff retrieved from https://www.slideshare.net/prkhuman/shoulder-impingement-syndrome-24685952

Photo depicting a rotator cuff tear retrieved from https://www.vivehealth.com/blogs/resources/rotator-cuff-tear

Photo depicting the compensatory shoulder shrug during shoulder elevation retrieved from https://healtheappointments.com/chapter-16-the-musculoskeletal-system-essays/5/