Damon Anderson & Associates Physical Therapy (DAPT) was founded in 1988 and for 33 years has helped patients return to their active lifestyles. We are the longest operating physical therapy clinic on the Monterey Peninsula.
Our mission at DAPT is to:
- Relieve Your Pain
The first step is to get your pain under control. Our physical therapists are experts at targeting the source of your pain so we can begin to relieve it quickly.
- Recover Your Function
Our overall mission at DAPT is to help you recover and maximize your function after injury so you can return to and sustain an active and productive lifestyle. For each individual this will mean something different.
For some it may mean competing in a challenging sport at a high level--maybe even division one college athletics or professional level sport. For many others it will mean returning to their recreational activities and work with renewed abilities after injury. In later years it may mean keeping enough physical ability to maintain independent living and enjoy life.
- Teach You How To Participate in Your Recovery
We emphasize empowering you to participate in your own recovery. You will be educated on your particular injury or condition so you will understand how to facilitate your own rehabilitation process. A treatment program is designed to restore your body to a maximum degree possible. You will participate in setting your rehabilitation goals. The rehabilitation program will involve specific exercises, proper body mechanics, expert manual therapy when needed, and treatment to speed up physiological processes involved in healing.
- Provide State-of-the-Art Treatment
We use the most current and evidence based treatment available in physical therapy and rehabilitation. The McKenzie Approach to Mechanical Diagnosis and Treatment method allows us to quickly evaluate spinal and other orthopedic problems and start relieving the pain and disability quickly. A key part of this system is the importance and effectiveness of empowering you to help manage your condition through home exercises and techniques to better care for yourself throughout each day.
- Give Personal Attention
Our physical therapists will apply expert hands on treatment to help restore mobility and relieve pain.
- Provide the Optimal Environment - Facilities and Equipment
Our clinics are equipped with state-of-the-art fitness and rehabilitation equipment.
We have available the latest in physical modalities including many types of electrical stimulation, ultrasound, vasopneumatic intermittent compression, cryotherapy, moist heat, and phonophoresis.
What to Expect at DAPT
- Your injury or condition will be met by a team of highly skilled professionals who specialize in the care of orthopedic problems and sports-related injuries.
- Your physical therapy program will consist of a thorough evaluation, treatment of the injury, or condition, and activities to maintain or improve your level of fitness and daily functioning.
- Concerned professionals will work with you to set realistic goals to help you return to normal activity as soon as possible. We will also teach you how to reduce the risk of reinjury.
- Facilities: Fully equipped physical therapy clinic; Custom designed rehabilitation gym; Treadmills with unweighting capable system; Body mechanics training; Private treatment rooms when needed; Group treatment area for peer interaction, support, and reinforcement of the recovery process.
What We Treat
A Reputation for Quality
Our therapists at Strength Physical Therapy are highly trained to provide quality care for head and neck pain. A thorough initial evaluation helps us identify movement dysfunction that can be addressed with patient education, manual techniques, therapeutic exercise, and modalities. Regular reassessment provides reassurance that we are always working to achieve patient goals in a cost-effective manner.
Priority One – Pain Relief
Severe head & neck pain can be disabling. For this reason, our first priority is pain relief. Treating the underlying causes of identifiable movement dysfunction is the next step toward achieving long-term relief and recovery.
A Hands-on Approach
Hands-on techniques, in most cases, are an essential part of a successful head and neck pain treatment program. Our therapists are equipped with cutting-edge manual skills to assist with the recovery of range of motion, reestablish correct movement patterns, and alleviate muscle related pain and tightness. Coupled with patient education and therapeutic exercise, the results can be dramatic and long lasting.
Evidence is Our Guide
Medical research is continuously providing the clinicians at Strength Physical Therapy with “current best-evidence” guidance so we are equipped to provide the state-of-the-art care to our community members. We look to systematic reviews and random controlled trials to help guide us in the delivery of state-of-the-art care. Coupled with regular attendance to continuing education courses, Strength Physical Therapy has a reputation for providing a high quality service to those in need of head and neck pain rehabilitation.
Physical Therapy for Neck Pain
Visit our Medical Library for more information on neck pain.
The shoulder is the most mobile joint in your body. It is a ball and socket joint made up of 3 bones held in place by muscles, tendons and ligaments. These three bones are:
- Upper Arm (Humerus)
- Shoulder Blade (Scapula)
- Collarbone (Clavicle)
Because of its extreme mobility, the shoulder is highly prone to injury. Some causes of shoulder pain include:
- Arthritis - inflammation to the shoulder joint.
- Frozen Shoulder (Adhesive Capsulitis) - when the shoulder is stiff, painful and has limited motion in all directions.
- Shoulder Dislocation / Instability - when the upper arm bone pops out of the cup-shaped shoulder socket (glenoid). A partial dislocation (sublaxation) occurs when the upper arm is partially out of the socket. Both conditions cause pain and shoulder unsteadiness.
- Shoulder (A-C Separation) - stretching or tearing of the ligaments connecting the collarbone and shoulder blade.
- Shoulder Fractures - broken bone in the shoulder.
- Rotator Cuff Tendinitis / Tear - inflammation (tendinitis) of one or more rotator cuff tendons or a tear that is typically caused by repetitive overhead motions.
- Superior Labrum Anterior to Posterior (SLAP) Tear - injury to the labrum of the shoulder (ring of cartilage that surrounds the socket of the shoulder joint).
- Shoulder Impingement - rotator cuff tendons or bursa are trapped and compressed during shoulder movements.
- Bursitis - inflammation of one or more bursae.
- Tendinitis - inflammation or irritation in the cord-like structure (tendon) attaching muscle to bone.
- Cervical Radiculopathy - pinched nerve in the neck.
- Whiplash - injury to ligaments and muscles in the neck.
- Herniated Disc / Slipped Disc / Ruptured Disc - the outer perimeter of the disc (annulus) in the spine is cracked or torn and part or all of the soft gelatinous part of the center core (nucleus pulposus) ruptures out.
Shoulder pain due to cervical radiculopathy, whiplash and herniated discs is actually referred pain from the neck. Shoulder pain can also result from gallbladder disease (referred pain to the right shoulder) or even a heart attack (referred pain typically to the left shoulder).
Physical Therapy for Shoulder Pain
Visit our Medical Library for more information on shoulder pain.
Low Back Pain
It is estimated that 80% of the human race experiences low back pain at least once throughout their lifetime. Fifty percent of the working population admit to experiencing low back pain each year. Each year 15-20% of the people in the United States have complaints of low back pain. Two percent of the U.S. population is either temporarily or chronically disabled by low back pain. Millions of workers suffer on the job injuries annually which costs 100 billion dollars in lost wages, time, and productivity and medical costs.
It is important to understand that there is an outstanding chance that you will recover from your low back pain in the near future. Research studies have shown that 74 % of those that suffer from back pain return to work within 4 weeks and > 90 % in 3 months or less. Some health care providers feel low back pain is like catching a cold - you experience it and in time it goes away.
To sum it up, there is a good chance you will have low back pain, there is a good chance that you will recover but there is also a good chance that you will experience the pain again. Medical research suggests that an active exercise program will reduce disability and may prevent future episodes of pain.
Physical Therapy for Low Back Pain
Visit our Medical Library for more information on low back pain.
Knee and Ankle Injuries
Physical therapists (PTs) are experts in the art and science of the evaluation and treatment of human movement dysfunctions. We care for people of all ages and treat a variety of muscle, joint and neurological conditions.
* Cited from the academic journal, JBJS (American). 2006;88; Am J Sports Med 1998 May; 26(3).
Surgeons routinely refer post-surgical patients to our physical therapists to help them recover strength, function and mobility.
Our therapists provide one-on-one, evidence-based physical therapy treatment sessions to help facilitate your recovery and return to activities of daily living (ADLs), work, recreational activities and even competitive sports.
The rehabilitative process depends on the injury and type of surgery. We help patients recover and rehabilitate from a variety of orthopedic post-operative procedures, including:
- Knee, hip and shoulder joint replacements
- Reconstruction of any one or more of the four major knee ligaments: anterior cruciate ligament (ACL), medial collateral ligament (MCL), posterior cruciate ligament (PCL), and lateral collateral ligament (LCL)
- Arthroscopic knee surgeries (such as meniscectomies, meniscal repairs)
- Ligament and tendon repair, including Achilles tendon repairs
- Arthroscopic hip surgeries (such as labral repairs)
- Nerve releases (such as cubital tunnel, radial tunnel, carpal tunnel, tarsal tunnel)
- Neck and back surgery (such as fusions, laminectomy, decompression and discectomy)
- Nerve compression release
- Bone or joint fusion (arthrodesis)
- Tendon transfers
- Surgical fixation of fractures, including open reduction and internal fixation (ORIF), a two-part surgery used to fix broken bones where the broken bone is reduced (put back into place) and an internal fixation device is placed on the bone (e.g., screws, plates, rods or pins) to hold the bone together
Some of the therapies used to accomplish the goal of regaining movement and reducing pain, swelling and stiffness may include one or more of the following:
- Manual therapy
- Soft tissue and/or joint mobilization
- Muscle energy
- Gait and balance training
- Transcutaneous electrical nerve stimulation (TENS) - electrical muscle & nerve stimulation
- Therapeutic exercise and functional strength training
- Functional re-education
- Rehabilitative exercises to help increase strength, endurance, motion, balance and coordination
Herniated Discs and Bulging Discs
The human vertebral (spinal) column is made up of 26 stacked bones comprised of 33 vertebrae, which are distributed into 5 regions:
- 7 cervical vertebrae (neck bones in the cervical spine)
- 12 thoracic vertebrae (upper back bones in the thoracic spine)
- 5 lumbar vertebrae (lower back bones in the lumbar spine)
- 5 fused sacral vertebrae (triangular bone wedged between the hip bones in the sacrum)
- 4 variably fused coccygeal vertebrae (at the base of the spine in the coccyx-tailbone)
The spinal column has a series of curvatures and the bones get larger and more stable the further you go down because the lower vertebrae carry more weight than the upper ones. The 33 vertebrae are separated from one another, cushioned and protected by shock-absorbing intervertebral discs (intervertebral fibrocartilage). Ligaments and facet joints connect the individual vertebrae to allow movement and maintain the spine's normal alignment and curvature.
The spinal channel in the center of the spinal column contains spinal fluid, which surrounds the spinal cord and spinal nerves. The strong spinal column protects the spinal cord and nerves. Nerves enter and exit the spinal canal through small openings on each side of the spine between the vertebrae, called foramina.
Herniated Discs and Bulging Discs - Common Causes of Back Pain
Millions of Americans are adversely impacted by back pain each year. Two of the most common causes of back and neck pain are herniated and bulging discs. According to Corporate Wellness Magazine, the total cost to employers for back pain amounts to $34,600 per 100 employees annually. Among the high ticket items are workers' compensation claims for herniated and bulging disc. If left untreated, these injuries could potentially cause irreversible nerve damage and cost thousands upward to hundreds of thousands of dollars to treat. Not to mention the downtime and time away from work needed to recover. That's why it's so important to quickly find out the cause of your neck or back pain and get it treated as soon as possible.
Herniated Disc vs Bulging Disc
People typically use the terms herniated disc and bulging disc interchangeably. But, they are two different conditions. Herniated Nucleus Pulposus (HNP) is the medical term for a herniated disc / ruptured disc / slipped disc (all the same thing). A herniated disc is one where the outer perimeter of the disc (annulus) is cracked or torn and part or all of the soft gelatinous part of the center core (nucleus pulposus) ruptures out. Usually, only a small part of the disc is affected. Herniated discs progress from prolapsed to protruding to extruding and to the final stage of sequestration where the disc material is severed from the main disc structure. The herniated disc itself does not hurt. The pain comes from nerve inflammation caused by discs that herniate near a nerve and compresses it and people with herniated discs are more likely to experience pain than those with bulging discs.
A bulging disc is different than a herniated disc in the respect that the outer wall is weakened, causing it to bulge outward, but not ruptured. Bulging discs are more common than herniated discs and are usually considered a normal part of aging. A bulging disc affects a much larger part of the disc than a herniated disc but only the outer layer of cartilage is involved. Sometimes the entire disc may bulge, but it's usually a quarter to a half of its circumference that's impacted. Although a bulging disc is not a herniated disc, it can become one if the weakened outer wall ruptures due to a sudden injury or great pressure on that disc.
Common Causes of Herniated Discs
Herniated discs are usually caused by degenerative disc changes or an injury but can also be caused by such things as:
- A pre-existing weakness in the annulus,
- A sudden increase in pressure through the disc causing the annulus to tear or crack, or
- A genetic predisposition to disc herniation.
Common Causes of Bulging Discs
The most common cause of bulging discs is degenerative dis disease (DDD), but can also be caused by:
- Sudden unexpected load to the intervertebral discs (e.g., motor vehicle accident or fall)
- Unexpected load or torsion of a disc due to improper or heavy lifting
- Repeated microtrauma over an extended period due to poor posture
- Genetics, smoking and obesity can also be contributory factors
Symptoms of Disc Herniation
People with herniated discs may experience some or all of these symptoms in the extremities and spine:
- Chronic pain at the compressed nerve
- Radicular (nerve root) pain and numbness along the compressed nerve pathway, usually only on one side of the body
- Pain that worsens at night
- Pain that worsens after standing or sitting
- Pain when walking short distance
- Numbness, aching, burning or tingling in the affected area
- Unexplained muscle weakness
- Loss of fine motor skills (cervical) / difficulty walking (lower spinal cord compression)
Symptoms of Bulging Discs
People with bulging discs may or may not be symptomatic. Those who are symptomatic may experience:
- Pain in the back or extremities
- Pins and needles sensation, burning, tingling or numbness in one or more extremities
- Muscle spasms, weakness or overactive reflexes
- Stiff neck, or back
Diagnosing Bulging and Herniated Discs
While these are two different conditions, similar methods are used to diagnose them including:
Spinal X-ray - as the name implies is an image of your spine that passes through the soft tissues onto camera film-like plates. Modern X-rays are usually digital. X-rays help doctors diagnose such conditions as:
- Broken Bones / Fractures
- Disc Degeneration
- Scoliosis or Kyphosis
- Congenital Abnormalities
Computed Tomography Scan (CAT / CT Scan) - painless, quick, accurate and noninvasive 3D images of the spine to rule out spinal column damage.
Magnetic Resonance Imaging (MRI) Scan - detailed images of a spine and surrounding tissues generated by a magnetic field, radio waves and a computer to diagnose certain diseases.
Discogram - mildly invasive X-ray diagnostic test that examines the intervertebral discs to determine if there is a ruptured disc or one with tears. It also helps determine if surgery is needed.
Treating Bulging and Herniated Discs
Nonsurgical treatments for both bulging and herniated discs may include:
- Physical Therapy
- Chiropractic treatments
- Heat / Ice Treatments
- Epidural Steroid Injections
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs) / Muscle Relaxers / Nerve Pain Medications (e.g., Gabapentin)
Your doctor may also suggest lifestyle changes like quitting smoking, exercises to strengthen the muscles in the back, legs and abdomen and weight loss. The goal of these treatments and lifestyle changes is to improve spinal alignment and reduce inflammation without surgery. Surgery should be the last resort and should only be considered if all conservative treatments fail.
Back Pain and Sciatica
Millions of Americans are adversely impacted by back pain each year. Studies show that, at one point or another, approximately 80% of the U.S. population will be affected.
While there are a lot of treatment options available, many of these only address the symptoms and don’t target the actual cause of your pain or handle it for the long term.
What is sciatica?
Sciatica is actually not a condition, but rather a symptom arising from any of several conditions that cause irritation/inflammation of the sciatic nerve. It is characterized by sharp, shooting pain anywhere along the sciatic nerve which radiates from the lower back, through the buttock and down the back of either leg. Symptoms are typically only felt on one side of the body. The sciatic nerve is a major nerve that starts in the lower end of the spinal cord then splits off and runs down the back of each thigh, through the hips, buttocks, legs, and ends just below the knees. It is the longest nerve in the human body and the thickest in diameter.
The three main causes of low back pain and sciatica are:
- Herniated Discs
- Pelvis Issues
About 90% of the time sciatica is caused by a herniated (slipped) disc in the spine. Some of the less common causes include:
- Lumbar Spinal Stenosis
- Tumors in the Spine
- Cauda Equina Syndrome (a rare condition that requires immediate medical attention)
- Other Causes (such as a spinal cord injury)
It is vital to identify the correct cause of your back pain because if the cause is not correctly identified, there is no way to develop the proper treatment plan. Even though the pain may feel like sciatica, it could be something completely different. There are other low back pain symptoms that are similar to sciatica. A common example is piriformis syndrome, where the piriformis muscle in the buttocks spasms and irritates the sciatic nerve. The pain feels very similar to sciatica, but it's a completely different condition that requires a completely different treatment plan. When a person is incorrectly treated for sciatica when they actually have piriformis syndrome, they will not get the pain relief they need and will continue to have problems that could potentially get worse.
Our physical therapists will find the actual cause of your back pain and work with you to resolve it. The goals of effectively resolving your low back pain and/or sciatica includes...
- Identify the true cause
- Create a unique plan for your specific condition
- Relieve your pain
- Restore your normal motion, flexibility, mobility
- Strengthen the supporting muscles
- Return you to your normal activities
Here at Damon Anderson & Associates Physical Therapy, our specialty is Back and Neck Pain. Our therapists are very experienced and have the knowledge and skills to provide a number of different ways to help you reach your health goals.
Your first visit...
- Begins with a full interview and physical therapy examination.
- Afterwards, the therapist will explain to you in English, not medical jargon, where the cause of your problem is coming from.
- YOUR GOALS and YOUR EXPECTATIONS will be discussed and agreed upon.
- Considering those goals, you will learn what successful treatment looks like.
- You and the therapist will discuss this plan and work together to resolve your pain and get you back to your normal self again.
Common conditions we treat:
- Back Pain
- Lumbar Sprains/Strains
- Herniated Nucleus Pulposus (HNP) - Medical Term for Herniated / Ruptured/ Slipped Disc
- Bulging Discs
- Degenerative Disc Disease (DDD)
- Spinal Stenosis
- Sciatica and Leg Pain
- Facet Pain
- Compression Fractures
- Post Surgical Rehabilitation
Leg pain can be intermittent or constant. It is caused by many different things, including wear and tear, overuse, or injuries in joints or bones or in muscles, ligaments, tendons or other soft tissues. Shin splints is a common cause of leg pain, which should not be ignored. Seek treatment right away if you suspect you have shin splints. Otherwise, they can develop into stress fractures.
>Leg pain can also be caused by blod clots, varicose veins or poor circulation. Deep vein thrombosis (DVT) is a life-threatening blood clot disorder that is caused by a blood clot in the leg that can break off and travel into the lungs. Lower-extremity peripheral arterial disease (PAD) is an example of a circulatory cause of leg pain. It's caused by arteries in the legs becoming damaged and hardening, which causes poor circulation in the legs.
Not all leg pain is caused by overuse or injury to the joints, bones, muscles, ligaments, tendons or other soft tissue in the legs. Some types are caused by problems in the lower spine (e.g., sciatica, stenosis) or nerve pain (e.g., peripheral neuropathy, diabetic neuropathy, femoral nerve pain, sciatica, etc.).
Visit our Medical Library for more information on leg pain.
Arthritis refers to pain, inflammation or disease of the joint, although some types of arthritis can also affect other organs such as the heart, eyes, lungs, kidneys and skin. According to the Arthritis Foundation, there are over 100 different types of arthritis grouped into the following categories:
- Degenerative Arthritis - when the cartilage pads that line the joint surfaces wear out. Most common type: osteoarthritis.
- Inflammatory Arthritis - when the immune system attacks the joints and sometimes other organs, even the skin. Common types: rheumatoid arthritis and psoriatic arthritis.
- Infectious Arthritis - when a bacterium, virus or fungus enters and inflames a joint.
- Metabolic Arthritis (also known as gout or gouty arthritis) - high levels of uric acid that the kidneys don't eliminate.
Osteoarthritis (OA) is the most common form of arthritis. It is generally described as the degeneration of the cartilage pads that line the joint surfaces. Joint cartilage, called articular cartilage, covers the ends of bones and acts as a friction-free surface and a cushion. The cartilage does not have any nerve ends nor does it have a blood supply so when it is traumatized, you don't feel much pain nor does it bleed. However, over time these cartilage pads crack and wear away exposing the bone underneath (subchondral bone). The bone thickens, bone spurs (technically called osteophytes) form, and inflammation of the joint occurs.
According to the Arthritis Foundation, 21 million Americans have osteoarthritis. It affects middle-aged people as well as seniors. Factors that increase your likelihood of experiencing an osteoarthritic joint are:
- Weight - the heavier you are the more likely you will experience OA.
- Trauma - joints that have experienced trauma are more likely to develop OA.
- Infection - if your joint was infected in the past, it is more likely to develop OA.
Symptoms include joint stiffness, pain, stiffness after prolonged sitting/lying, catching and grinding of the afflicted joint, redness, warmth, swelling, and difficulty using the involved joint.
It is important that you obtain the appropriate diagnosis from your medical doctor. Once diagnosed with OA, there are some things that you can do to slow its progression. Weight loss, strengthening, physical therapy joint mobilization, aquatic exercise, ice when inflamed, heat with stiffness, and bracing the joint can all help. Ask your rehabilitation specialist which is best for you.
A common question that patients ask is, "Does glucosamine help my arthritis?" More recent studies seem to indicate that glucosamine sulfate does have a positive effect on osteoarthritis. Glucosamine is one of the "ground substances" or important molecules that make up cartilage. Adding this over-the-counter supplement to your diet may have positive effects on mild to moderate osteoarthritis. Some research indicates that glucosamine can provide pain relief and may decrease the progression of the disease. Though not conclusively proven, it is also theorized that glucosamine may even reverse the progression of the disease.
The last resort is joint replacement.
Physical Therapy for Arthritis Pain
Need Help Recovering from a Sports Injury? Looking to Improve Your Sports Performance?
Sports Therapy is the Right Choice
Sports Therapy or sport physical therapy is a specialized area of physical therapy that deals with both acute, chronic, and repetitive injuries in professional, collegiate, high school and recreational athletes. Practice includes the thorough evaluation, treatment, transition back to sport, prevention, and performance enhancement programs.
Often, sports therapists work with post-surgical athletes to help them recover their strength, range of motion, and activities of daily living. To accomplish this sports therapy specialists use techniques such as:
- Manual Therapy (specialized hands-on techniques to facilitate movement, and functional control)
- Therapeutic Exercise - from active range of motion (simply working against gravity), to advanced resistance protocols, sports therapists help an athlete recover the necessary strength to compete in their given sport.
- Heat, ice, taping techniques, and electrical stimulation
- Functional Retraining - all sports require specialized balance, movement patterns, and dynamic flexibility and stability. Sports therapy includes retraining the athlete in their given area of interest or excellence. Examples include helping pitchers recover their throwing mechanics. Assisting football players in cutting, catching, throwing, and backpedaling. Helping basketball players recover the jumping, shuffling, and shooting mechanics.
- Dynamic Strength & Endurance Training - most sports require endurance, balance, and short burst of intense strength output. In the later stages of rehabilitation of athletes, sports therapists transition players to advanced conditioning programs that closely replicate their experience on the court or playing field.
Sports therapists often provide interventions and recommendations to assist athletes with the prevention. This may include pre-participation evaluations, equipment advice, conditioning programs (e.g. ACL injury prevention) and cardiorespiratory conditioning programs that are constructed to assist athletes in a safe transition back to sport.
Sports Performance Programs
After a thorough evaluation of an athlete's strength, neuromuscular coordination, flexibility, and cardiorespiratory fitness, the sports therapist will develop a sports performance training plan to help the athlete achieve their performance goals. Programs are tailored to specific sporting demands and provided to the athlete as a training regime (plan of action); or the sports therapist may coach and guide the athlete through a performance program on a several times/week basis again, depending on the athletes goals and needs.
If You Or Your Teen Athlete Want to Speed Up Recovery, or Maximize Sports Performance, We Can Help.
Call Us Today
Inflammation of the fascia on the bottom of the foot is the most common cause of heel pain.
There are many documented causes of plantar fasciitis. Poor flexibility of the calf muscles, no arch support, a sudden increase in one's level of activity, poor footwear, being overweight, excessive pronation, or repetitive stress conditions (long distance running). Common causes of a bruised heel bone are poor cushioning of the heel due to fat pad atrophy (shrinkage in the size of the fat pad) poor footwear, excessive walking on hard surfaces, and being overweight.
Depending on which medical study you read, anywhere form 8-21% of the population suffers from plantar fasciitis. The pain is typically located at the front of the base of the calcaneus. Less often, the pain extends along the arch of the foot. The result is micro-tearing of the plantar fascia where it attaches to the base of the calcaneus. An ensuing inflammatory response occurs producing pain, swelling, warmth, loss of function (difficulty with any standing or walking), and less often, redness.
Plantar fasciitis is often worst in the morning when one takes his /her first steps out of bed. Theories propose that when we are sleeping, the inflamed fascia is shortening and perhaps attempting to heal. If the problem is chronic, a bone spur may be seen on x-ray.
Currently, we believe that a bone spur is not the cause of the pain but the result of the body's attempt to heal the damaged plantar fascia.
Visit our Medical Library for more information on plantar fascitis.
Ankle sprains are a common injury. They usually occur when the foot is forcefully inverted or turned inward. Grade I (minor tear), Grade II (partial tear), or a Grade III (complete tear into two pieces) damage of the outer ligament complex (the anterior talofibular ligament and less often the calcaneofibular ligaments) is the result. Injuries to the inner aspect of the ankle are rare and often result in a fracture before ligamentous damage occurs.
Signs and symptoms of an ankle sprain include lateral ankle pain, swelling and a sense of instability. Stress X-rays may be helpful in ruling out fractures.
Treatment of an acute injury requires rest, ice, compression, elevation, and bracing of the injured ankle. Early rehabilitation assists in a rapid recovery. Surgery (reconstruction of the ligaments) is only necessary when the ankle is repeatedly sprained.
Visit our Medical Library for more information on ankle sprains.
A strain is the tearing of muscle fibers. Muscle fibers are the individual units that make up your muscles. When you call upon the muscle to perform strong or repeated contractions, you may suffer a strain. To further confuse the layperson, strains are classified into grades I, II, and III. Another way to think of these grades is mild (grade I), moderate (grade II), severe (grade III).
A grade I strain is a mild disruption of the muscle fibers. There may be mild swelling, mild tenderness, and it may be painful to stretch and use the injured muscle.
A grade II muscle strain indicates moderate muscle fiber damage. The pain is moderate to severe, it definitely hurts to use and stretch the injured muscle, and ecchymosis may be present. Ecchymosis (commonly called bruising) indicates that there was internal damage to blood vessels that resulted in bleeding within and around the muscle. This bleeding is often visible under the skin as a purple, blue, red, yellow, and even green in color.
A grade III strain is the most severe. It is the complete tearing of a muscle into two pieces, or separation of the muscle from its associated tendon. There is severe pain, complete loss of muscle strength, swelling is normally present with ecchymosis, and there may be a palpable "indentation" where the muscle is torn. Medical intervention is usually necessary. Typically, an orthopaedist (musculoskeletal specialist) will evaluate your condition and surgical repair may be necessary.
Visit our Medical Library for more information about muscle sprains, which also covers the comparison and contrast between a strain and a sprain.
Tennis Elbow (Lateral Epicondylalgia)
Lateral (meaning away from the midline of the body) epicondylalgia (meaning pain of the epicondyle) is a painful tendinopathy on the outer part of the elbow. The common name for lateral epicondylalgia is tennis elbow but only 5% of the people afflicted with this condition play tennis.
Pain at the elbow may have one or more causes: it could be from the forearm tendons that attach at the outer aspect of the elbow, it could be referred pain from the next, it could be from one or more of the joints at the elbow, or it may originate from the radial nerve that is in close proximity to the elbow joint.
It often occurs with repetitive use of the arm especially with a clenched fist. Most cases are not due to tennis.
Local tenderness and pain with resisted and passive extension of the wrists is common.
Activity modification, anti-inflammatory medications, ice, and progressive stretching and strengthening will relieve most cases. Surgery is only an option in recalcitrant cases.
Visit our Medical Library for more information about tennis elbow.
Tingling / Numbness
Tingling and numbness are symptoms often associated with spinal nerve root compression (nerves being pinched in your neck or back) or nerve compression at specific tunnels that are present in your body. The most common example is carpal tunnel syndrome causing hand numbness, tingling, and pain. We will work to find the source of your tingling and numbness and address the cause in your treatment plan in physical therapy.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a compression of the median nerve within the carpal tunnel. There is pain, tingling, and in severe cases, numbness in the thumb, index middle and ½ of the ring finger. It is typically caused by repetitive tasks involving the hand and wrist. Typing with the wrists resting on hard surfaces can result in this problem.
It is often worse at night or with driving and can lead to loss of grip strength and coordination. As the problem progresses, atrophy (muscle wasting) of the thumb muscles may occur.
Treatment typically consists of splinting the wrist in a neutral position (no bend in the wrist in either direction), anti-inflammatory medication, and most importantly, activity modification such as wearing a padded glove during cycling. Surgical release of the transverse carpal ligament is often performed before muscle wasting occurs. Physical therapy follows to help restore range of motion, strength, and to educate the patient of factors that can lead to a reoccurrence of the problem.
Visit our Medical Library for more information on carpal tunnel syndrome.
A bursa (plural bursae) is a small, jelly-like sac of synovial fluid that acts as a cushion between a bone and other moving parts, such as muscles, tendons or skin to help reduce friction. The human body has 160 bursae. The major ones are located next to the tendons near the large joints, such as the hands, wrists, elbows, shoulders, hips, knees, ankles and feet. Tendons are strong, fibrous cords mainly made of collagen that anchor muscles to joints in the human body. The human body has hundreds of tendons, but fortunately, only a small portion of them are affected by tendonitis.
Bursitis vs. Tendinitis
Bursitis is different from tendonitis (also spelled as tendinitis). Tendonitis involves inflammation or irritation in the cord-like structure (tendon) attaching muscle to bone. The suffix, "itiis", is derived from Greek and it means inflammation. Tendinopathy is a blanket term used to describe the various tendon injuries (e.g., tennis elbow, golfer's elbow, Achilles tendonitis, etc.). The suffix, "pathy", is derived from Greek and it means disorder or disease. Bursitis is the inflammation of one or more bursae. Symptoms for bursitis may include localized pain or swelling, tenderness, fever (feels hot to the touch) and pain with motion of the tissues in the affected area.
Pain for tendonitis is sudden and is usually felt where the tendon attaches to the bone, but can also be felt where the muscle and tendon connect. Other symptoms may include:
- Swelling and usually redness and fever (warm to the touch)
- Tenderness directly over the inflamed tendon
- Pain and a cracking or grating with movement
- A lump or bulge on the inflamed tendon
A chronic tendon problem is called tendinosis because, at this point, the tendon is damaged at a cellular level - noninflammatory degeneration of the structure or composition of the affected tendon. The suffix, "osis", is derived from Greek and it describes a process, condition, or state - usually abnormal or diseased. Unlike tendonitis, which is acute (pain that comes suddenly or results from a specific injury to the tendon), tendinosis pain is chronic (develops slowly and persistently lasts over the long term or persistently re-occurs over time). Tendinosis is the result from continued overuse of a tendon without giving it time to heal and rest.
Tendonitis is typically caused by overuse and characterized by repetitive movements. For example, overuse of the wrists tendons on a computer keyboard or an elbow tendon on a tennis court. Bursitis can be caused by repetitive, minor impact on the bursa or by a sudden, more serious injury. Age can also be a factor because aging tendons are less able to tolerate stress, are less elastic and are easier to tear. Tendonitis can occur anywhere in the body and is identified by where it is found (e.g., tendonitis in the Achilles tendon - the tendon between the calf muscle and the heel - is called Achilles tendonitis, etc.). Bursitis is most commonly found in the shoulder, elbow and hip but can sometimes be found elsewhere, like the knee.
subacromial bursitis is a common cause of shoulder pain, typically related to shoulder impingement of the bursa between the rotator cuff tendons and bone (acromion). Bursitis to the subdeltoid bursa is not as common. Shoulder bursitis is usually caused by a repeated minor trauma, such as overuse of the shoulder joint and muscles or a single more significant trauma, such as a fall.
Elbow bursitis is also sometimes referred to as olecranon bursitis because of which bursa is most commonly inflamed: the bursa at the back of the elbow over the olecranon. The olecranon is the bony part of the back of the elbow - the top part of the ulna. Olecranon bursitis is characterized by a thickness and swelling over the back of the elbow. Most elbow bursitis cases are painless or are only mildly painful and elbow joint movement is not affected.
The greater trochanter and iliopsoas bursae are the two bursae in the hip that most typically become irritated and inflamed. The trochanteric bursa is located on the greater trochanter - the outer bony point of the hip bone. Inflammation of this bursa is called trochanteric bursitis. The other bursa (iliopsoas bursa) is located on the inside (groin side) of the hip. Bursitis of this bursa is sometimes called hip bursitis, even though the pain is in the groin area.
Bursitis often develops as a result of strenuous and/or repetitive activity, particularly among:
- Manual workers, due to heavy lifting, repetitive motion and working for extended periods of time without a break.
- Athletes, after running, throwing, jumping or from aggressive arm motions made in such sports as tennis, baseball, football or even bowling.
- Sedentary people who suddenly push their bodies past their limits.
Aspiration (removal of bursa fluid with a needle) or surgery is rarely necessary. Bursitis is typically treated by one or more of the following methods:
- Protection (from any blow to the affected bursa/bursae), Rest, Ice, Compression, Elevation, Medication (PRICEM).
- Physical therapy.
- Ice and moist heat are used for recurring or persistent bursitis pain.
Treatment for tendonitis may include:
- Rest and restriction of movement
- Reduce the inflammation
- Rehabilitate the affected tendon, joint and muscle
Rotator Cuff Injuries
Rotator cuff tears happen in younger people when they experience a trauma such as a fall. In middle-aged people and seniors, rotator cuff tears are usually the result of a gradual wearing out of the rotator cuff tendon(s). The signs and symptoms of rotator cuff tears are pain in the shoulder often radiating down to the middle of the arm especially when the arm is raised overhead, weakness, and in severe cases, a complete loss of the ability to lift the arm. Diagnostic tests sometimes include an arthrogram (a radio-opaque dye is injected into the shoulder, and if it leaks out of the rotator cuff, it can be viewed on x-ray) or an ultrasound, but an M.R.I. of the rotator cuff is the most common test used for diagnosis.
Treatment in young and middle-aged patients is usually arthroscopic or open repair of the torn tendons. In older patients, activity modification, anti-inflammatory medication, physical therapy and cortisone injections are typical. Surgery is a last resort because it is so hard on the body and many seniors may not survive the affects of anesthesia.
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