Osteoarthritis is the most common form of arthritis. It can happen gradually as the cartilage (protective tissue) at the ends of our bones begins to wear down. These degenerative changes can become painful over time with no clear onset. Osteoarthritis can occur in many joints in our body, but is most common in the hand, hip, knee, and spine. Arthritic joints may feel stiff or swollen and may feel more painful with increased activity and/or with prolonged sitting or standing.

Exercise and physical therapy can be very effective treatments for reducing the pain associated with osteoarthritis. Your physical therapist can work with you with hands-on techniques to improve the range of motion and mobility in your effected joints.

Your physical therapist can teach you specific exercises to help strengthen the muscles around the arthritic joint. Strong muscles can help support the joint leading to decreased pain and irritation. Your physical therapist can also assist you in finding an aerobic exercise, such as walking, riding a bike, swimming, and/or using an elliptical, that is comfortable and enjoyable. Aerobic exercises can help improve blood flow/oxygen to our body, which can lead to better lubrication of arthritic joints.

If you have been diagnosed with or think you may be having pain related to osteoarthritis, give your physical therapist a call. There are many hands-on interventions, as well as exercises, that can help reduce your pain and allow you to move more freely!

Allison Loudenback, PT, DPT

1. When sitting, sit up tall and sit all the way back on the seat, make sure your feet can comfortably reach the floor, use a lumbar support roll, and try to rest arms on a table, desk, or armrests.
2. When standing, stand up tall as if someone was measuring your height, keep your feet hip width apart with your weight balanced evenly between both legs, and try to stand with legs straight, but avoid locking out your knees.
3. Set reminders! Think of something you do a lot throughout the day. Some examples might include checking the time, looking at your phone, or checking your email. Make it a habit that whenever you do this thing, you assess your posture and correct it as needed.
4. Don’t expect perfection. It is very important to recognize that none of us are going to sit or stand with perfect posture all the time, however just being aware of our posture throughout the day can be very helpful!
5. See a physical therapist! If you have implemented these strategies and are still having difficulties with your posture, get in to see your physical therapist! There are many specific exercises that can be done to improve your postural strength!

Allison Loudenback, PT, DPT

What should I expect after my knee replacement? How should I prepare for my knee replacement?

Total knee replacements are becoming an increasingly common surgery. Knee replacements are often performed on patients with severe osteoarthritis, which causes pain and/or buckling of the knee resulting in loss of function, such as difficulty walking, squatting or climbing stairs. (Osteoarthritis is caused by the loss of joint cartilage resulting in bone spurring, commonly known as “bone on bone”). During a knee replacement the ends of the thigh and shin bones are replaced with hardware in order to alleviate the pain produced at the arthritic knee joint.

So, what should you expect following your knee replacement? You can be certain that you will have physical therapy. You will likely start your therapy in the hospital, then transition to an outpatient facility after you return home. Your surgeon might even have you perform exercises before surgery in order to maximize your flexibility and strength, thereby making your post-operative recovery faster. Pre-operative exercises are often prescribed either at the physician’s office, or you may be sent to a physical therapy facility for a one-time visit for exercise instruction.

You can expect to have a substantial amount of knee pain immediately after surgery and for several weeks thereafter due to the trauma of the surgery itself. However, your pain can be managed with the use of prescription pain medication, a walker or cane when walking, and management of swelling with ice, compression stockings and leg elevation. It is extremely important to keep up with your prescribed regimen of pain medication, icing and elevating for the first several weeks after surgery in order to minimize your knee pain and better tolerate your rehab experience.

After a total knee replacement your physical therapy rehab is equally important to having the surgery itself. You cannot expect to have good outcomes with your new knee if you do not put in the time and effort rehabilitating it post-op. Your physical therapist will instruct you in a variety of exercises that will work on improving your knee range of motion, flexibility, strength, swelling and scarring that will ultimately allow you to return to routine daily activities like walking, squatting and stair climbing without pain or the use of an assistive device.

You will likely attend physical therapy for 6-8 weeks after surgery; this varies on an individual basis. Full recovery often takes 6-9 months, and you may still notice swelling for up to 1 year. Your new knee is meant to enable you to perform everyday activities, but not necessarily aggressive or high impact sports such as running, tennis or skiing. Most knee replacements will last upward of 20 years, and you can help prolong the life of your new knee by managing your weight and staying active without over-stressing the new joint with high impact activities, such as those mentioned above.

Kristin Collins, PT, DPT, COMT

Why does my hip hurt? What is hip bursitis? How do I alleviate hip bursitis pain?

If you’ve been experiencing a pain along the outside or front of your hip it may be due to an inflamed bursa sac, otherwise known as bursitis. “Okay, but what is a bursa sac,” you ask? Well, it’s a sac filled with a jelly-like substance that creates a buffer between your bones and the overlying soft tissues. Bursa sacs are present around most joints and work to reduce frictional rub and irritation when you move; however when these sacs are over-compressed (by the trauma of falling on your hip or repetitive use), they can become a great source of pain. While hip pain can be caused by a number of structures other than the bursa, including the joint, labrum, or nerves, bursitis pain typically presents as point tenderness along the outside of the hip.

To help alleviate hip bursitis pain, avoid repetitive activities that seem to produce your pain. Start a stretching routine for the hip muscles. You can stretch the outside of your hip by lying on your non-painful side and dropping your painful leg back behind you over the edge of a bed. You can stretch the front of your hip by lying on your back at the edge of your bed, allowing your painful leg to dangle over the edge of the bed. (Be sure to keep your non-painful leg on the bed with your knee flexed for comfort). To stretch the back of the hip, lie on your back and use your hands to pull your knee toward your opposite shoulder. Hold the stretches for 20-30 seconds and repeat each one 2-3 times. It’s also important to strengthen the hip musculature. To do so, perform straight leg lifts on your back (with opposite knee bent and the foot on the bed to protect your low back), your sides (keep toes pointing forward), and on your stomach (being careful not to over-arch your back). Try 10 repetitions, then rest and repeat.

You may also want to consider using a cane to lessen the weight on the painful joint. (Carry the cane in the hand opposite your painful hip). After exercise or activity try icing the painful area to reduce the inflammation and soreness. If your pain persists, contact your local physical therapist for an evaluation to better determine the source of your pain and appropriate treatment for it.

Kristin Collins, PT, DPT, COMT

Do I need a referral for physical therapy? How can a physical therapist help me? What is the training for a physical therapist?

Since 2013, direct access has allowed patients to be evaluated and treated by a physical therapist without a referral from a physician for up to 42 days. This means that as a patient, you can receive the treatment you need faster and at a lower overall cost. You will receive physical therapy services sooner, because you no longer have to visit your doctor or obtain a prescription before coming to PT. Cutting out that extra visit to your physician also results in reduced health care expenses for you.

Unsure if your symptoms are appropriate for physical therapy treatment? Do not worry. Today’s physical therapists are highly-skilled health care professionals with 7 years of post-secondary education to determine just that.

Recent physical therapy graduates must obtain not only a 4-year bachelor’s degree, but also a 3-year doctoral degree. Within that rigorous curriculum are several hands-on, clinical experiences in which physical therapy students practice under the supervision of a licensed physical therapist. Students must then pass a national board exam before becoming licensed themselves.

Extensive schooling prepares physical therapists to evaluate and treat disorders of an array of bodily systems (A few examples of systems are provided):

• Musculoskeletal system (e.g. muscle strains, joint sprains, bone fractures)
• Neuromuscular system (e.g. spinal cord injuries, multiple sclerosis, Parkinson’s disease)
• Cardiopulmonary system (e.g. cardiac disease, chronic obstructive pulmonary disease)
• Integumentary system (e.g. burns and wounds)

Physical therapists are also equipped to deferentially diagnose, or in other words, distinguish between conditions that may present in a similar manner. This helps determine whether a patient is an appropriate candidate for physical therapy. If a patient is determined inappropriate for physical therapy, then a referral is made to the proper healthcare professional.

The next time you are in need of physical therapy, do not hesitate to contact Mallers & Swoverland Orthopaedic Physical Therapy to schedule an evaluation. Direct access gives you the right to efficient care from skilled physical therapists who are ready to evaluate and treat you today.

Kristin Collins, PT, DPT, COMT

How do I prevent strain at my computer desk? What are computer ergonomics?

Many of us sit in front of a computer throughout our workdays or in the evenings while browsing the Web. Unwanted side effects of our excessive time in front of those screens can include muscle aches, eye strain, and tension headaches. Below are some tips to help avoid these unwelcome physical stresses.

• Place the computer screen directly in front of you at eye level
• Sit up straight, keeping your head and neck in line with your trunk
• Keep your shoulders relaxed
• Use arm rests, keeping elbows bent at 90 degrees with forearms and wrists supported
• Keep the computer mouse within comfortable reach
• Use a lumbar support roll for your low back, placed just above your belt line
• Keep legs supported with feet on the floor or a footstool with hips and knees bent to 90 degrees
• Take frequent rest breaks to stand, stretch and/or walk around

Kristin Collins, PT, DPT, COMT

What causes tension headaches? What is a tension headache? How do I treat a tension headache?

A tension headache is a pain along the scalp, neck or shoulders that is typically mild to moderate in intensity. It is sometimes referred to as a stress headache, and muscle tightness may be associated with it. There are a number of factors that may contribute to tension headaches, including poor posture, eye strain, fatigue, and over exertion. The following are a few tips to help you manage your tension headache pain.

Start by correcting your posture. Poor posture will add increased strain to the muscles in the head and neck, which will likely worsen your pain. For the same reason, you should minimize or take frequent rest breaks from tasks that involve forward, sustained head positioning (e.g. computer work, knitting, sewing, reading a book on your lap).

Gentle stretching of your neck muscles may be helpful as well. To stretch, tilt your ear to your shoulder or your chin to your armpit, and hold 10-20 seconds. Repeat stretches frequently to alleviate muscle tightness and/or soreness. If your headache pain is located at the base of your skull where the top of the neck meets the scalp, you may benefit from laying on your back and resting for 5 to 10 minutes with a tightly rolled hand towel placed beneath your head in that region. Taking a hot shower can help loosen tight muscles as well, while alternating heat and ice can help reduce tension headache pain.

In addition to tension headaches, several other types of headaches exist. If you experience a severe, sudden headache or have other abnormal symptoms, such as numbness, weakness, or visual disturbances, you should consult your physician or physical therapist promptly as it is unlikely you are experiencing a simple tension headache.

Kristin Collins, PT, DPT, COMT

What is runner’s knee? What causes runner’s knee? How do you prevent runner’s knee?

Its summer time, which means many people are out participating in local 5k, 10k, half and full marathons. Consequently, runners are training more often, and may become susceptible to repetitive use injuries in the knee. The two most common knee injuries in runners are patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS).

PFPS is pain under or along the knee cap itself, while ITBS is pain along the outside of the knee that may or may not extend up the side of the thigh toward the hip. PFPS can be caused by misalignment of the knee cap, or a variety of other factors, including hamstring and/or calf tightness, quadriceps or hip weakness, or altered foot/orthotic mechanics. ITBS can be caused by iliotibial band tightness, or other factors such as weak hip muscles, improper footwear, or repetitive overuse, (which means running too often or too far). Both PFPS and ITBS can be aggravated by poor running form.

To combat knee pain when running, first warm up with a brisk walk and dynamic stretching. Wear proper footwear, and alternate your running program with cross training workouts (think squats, lunges, planks, etc.) to help keep hip and core muscles strong and flexible. Cross training is also helpful in avoiding repetitive overuse injuries, because your body is not constantly being stressed by the same repetitive movement patterns incurred with running. Gradually, yet consistently increase your running distance, and avoid over-striding, which can contribute to or worsen existing knee pain. If you are having persistent pain, take some time off, and if necessary seek help from your local physical therapist.

Kristin Collins, PT, DPT, COMT

What is the right shoe for me? Does the shoe matter? What should I look for in a shoe? What kind of shoes are best for flat feet or low arches? What shoes are best for a high arches?

Wearing proper foot attire is important in avoiding foot/ankle pain, not to mention reducing the risk of knee, hip and low back pain. So, what exactly is “proper foot attire?” Obviously high heels are tough on your feet, while athletic/tennis shoes provide cushion and support. However, there are a lot of tennis shoe brands and styles available, which means you have to do some legwork to find the right shoe for you. Here are a few tips to make the process a little easier.

• Choose a shoe with a heel less than 2 inches. Higher heels put more pressure on the ball of your foot, which can lead to calluses.
• Choose a shoe that is wide in the toe box (versus pointed). Wearing shoes that scrunch your toes together can contribute to the development of bunions.
• Choose a shoe that is snug around your heel. If your foot is slipping in and out of the back of your shoe you may develop blisters.
• Choose a shoe with adequate arch support. If you have high arches, you will need more arch support than if you have medium or low arches.
• Try on both shoes before purchasing them. Your feet may be slightly different length, which will affect the fit.
• Not all shoes are created equally. Do not assume all manufacturer shoe sizes are the same.
• Walk around in the shoes before purchasing them. Choose a shoe that is comfortable from the first step versus planning to break them in.
• Choose a shoe that fits your lifestyle. If you are a runner, choose a running shoe. If you’re a construction worker, you will need a quality, supportive boot that meets the fit criteria mentioned above.

Kristin Collins, PT, DPT, COMT

What are overuse injuries? Why do overuse injuries happen? How do you prevent overuse injuries?

Repetitive stress injuries (otherwise known as repetitive strain, repetitive motion, or repetitive use injuries) are just what they sound like – injuries incurred due to repeated stresses or loads on the body over time. These injuries are quite common in the workplace due to employees performing the same daily tasks or maintaining the same sustained positions for several hours each day. Repetitive stress injury is a broad, umbrella term for a variety of overuse conditions, including, but not limited to, carpal tunnel syndrome, elbow tendonitis, shoulder bursitis and trigger finger. While we may often think of repetitive stress injuries occurring in the upper extremities, they do occur throughout all regions of the body, including the spine and lower extremities. Typical symptoms of repetitive stress injuries may include pain, tingling, weakness and swelling.

In order to prevent the development of a repetitive stress injury, you must first consider your own personal job duties and/or recreational hobbies. For example, do you have an office job that requires you to sit in the same position at a computer, typing most of the day? Or do you have a more physical job that demands frequent and repeated lifting, twisting, drilling, or gripping? How about a favorite hobby such as knitting, or participation in a recreational sport such as tennis? All of these activities can lead to differing repetitive stress conditions. No matter which category you fall into, there are keys to helping keep your body free of injury.

To minimize your chance of developing a repetitive stress injury in the workplace or at home, take frequent breaks and/or change positions often, alternating the way in which you perform repeated tasks. Your workplace may have ergonomic recommendations for you as well. If you do experience pain from an overuse injury, then stop or minimize performance of the aggravating activity. It may also be beneficial to perform gentle stretching to the injured tissues in a comfortable range of motion. Icing the region for 10-20 minutes will also help reduce pain and inflammation. If pain persists, it may be appropriate for you to schedule a physical therapy evaluation to help alleviate your symptoms.

Kristin Collins, PT, DPT, COMT