CAO Rehabilitation Blog

Joint Replacement in 2025: Trends and Innovations You Should Know

Thu, 06 Feb 2025 13:21:00 -0500

Joint Replacement Trends to Watch in 2025

By: Dr. Matthew Harb, M.D. (The Centers for Advanced Orthopaedics)

Joint replacement surgery has come a long way, with new trends and technologies transforming how we treat joint pain. One noteworthy trend, which has recently gained national attention, is the decreasing average age of hip and knee replacement patients. In fact, according to data from the Department of Health and Human Services, there was a 211% increase in inpatient hip replacements and a 240% increase in inpatient knee replacements between 2000 and 2017.

Below, we’ll explore the reasons behind this trend and examine other emerging innovations poised to transform orthopaedics in the years ahead:

Younger Patients Are Opting for Surgery:
More active lifestyles and prolonged participation in high-impact activities are leading to earlier cases of osteoarthritis. Advances in surgical techniques and durable implants now make joint replacement a safe and effective option for younger patients.

Importantly, we first assess whether effective treatment can be achieved through non-surgical options such as physical therapy, weight loss or cortisone injections before recommending surgery as the best path forward.
Innovations Are Changing the Game:
Emerging technologies like 3D-printed custom implants, robotic-assisted surgery and “smart implants” that record data promise better precision and outcomes. While still developing, these tools represent the future of joint replacement.
Faster Recoveries Are Here:
Minimally invasive techniques and outpatient procedures mean many patients are back on their feet – and back home – sooner. The focus is shifting toward personalized care, tailoring each procedure to the patient’s anatomy and lifestyle.

With these advancements, joint replacement has never been safer or more effective. If you know a family member or friend living with joint pain, encourage them to consult a CAO surgeon to explore their options and return to the activities they love.

Stay Safe and Active: Preventing Injuries in Racquet Sports

Wed, 07 Aug 2024 10:37:00 -0400

Racquet Sports Safety Tips: Injury Prevention and Management

By: The Centers for Advanced Orthopaedics

As summer brings sunny skies and outdoor activities, it’s crucial to play safely to prevent injuries. Whether you're playing pickleball, tennis, or racquetball, CAO shares some key strategies to help you stay injury-free while on the court this summer.

Know Your Body: Understand your physical limits and wear supportive braces if prone to specific injuries.

Warm-Up Properly: Stretch your muscles, focusing on hamstrings, calves, and quads, to prepare for play.

Focus on Form: Use correct techniques to avoid injuries such as tennis elbow. If you are new to the sport, consider taking lessons from a qualified instructor.

Stay Hydrated: Drink plenty of water, take breaks, and wear appropriate footwear to support your feet and ankles.

Pickleball and tennis offer excellent opportunities to stay active, while working different parts of the body. By following these guidelines, you can enjoy playing racquet sports safely all summer long.

Experiencing Joint, Muscle, or Bone Pain or Injury?

Are you experiencing pain in your bones, joints, or muscles? Schedule an appointment with The Centers for Advanced Orthopaedics. Our orthopaedic specialists will evaluate your problem and create a personalized care plan for your pain or injury.

Introduction to Muscle Activation Exercises

Mon, 29 Jul 2024 18:26:00 -0400

What Are Muscle Activation Exercises?

By: The Centers for Advanced Orthopaedics

Muscle activation exercises are short, isolation exercises that target specific muscles to "wake them up" and prepare them for physical activities. Just like stretching, activation exercises increase blood flow to the muscles and optimize workout results.

Five Activation Exercises Explained

Superman Holds to Activate Your Back - Lie on your stomach and lift your arms, legs, and head off the floor. Hold for 5 seconds and repeat for 3 sets.

Push-Ups to Activate Your Chest - Begin on all fours and engage your core. Lower yourself down until your elbows are at a 90-degree angle, then push back up. Do 5-10 push-ups and repeat for 3 sets.

Band Pull Aparts to Activate Your Shoulders - Stand tall with good posture, hold the resistance band, and begin to pull the band apart. Repeat the exercise 10 times for 3 sets.

Monster Walks to Activate Your Glutes - With a resistance band around your ankles, take wide steps laterally and engage your glutes and core. Repeat for a total of 2 sets in each direction.

Walking Lunges to Activate Your Quads - Take a big step forward with your right foot, ensuring your core is engaged as you lower your back knee toward the floor. Rise to a standing position and repeat with the other leg.

How to Perform Activation Exercises

Perform each exercise at a slow tempo, focusing on the moving body part and engaging the targeted muscle group. To advance the exercise, contract the muscles at the peak of the exercise. For some exercises, a resistance band can be used to increase difficulty and muscle activation.

Activation exercises take only a few minutes and can easily fit into your warm-up routine. They are valuable in preparing the muscles for physical activities and optimizing workout results.

Here are some additional resources about healthy exercise:

Experiencing Joint, Muscle, Or Bone Pain Or Injury?

Are you experiencing pain in your bones, joints, or muscles? Make an appointment with The Centers for Advanced Orthopaedics. Our orthopaedic specialists will evaluate your problem and create a personalized care plan for your pain or injury.

An Insider's Perspective on "Getting Roomed"

Wed, 08 May 2024 18:45:00 -0400

Just One More Question . . . .

By: John Christoforetti, MD, Orthopedic Sports Medicine Surgeon

Maryland Orthopedic Specialists

The four words uttered by a great number of orthopedic sports medicine patients at the end of their visit: "just one more question . . ." It's only natural that the brief time allotted for in-network evaluation of shoulder, hip or knee injury pressures both me and the patient. It's difficult to strike a perfect amount of questions and answers in a comprehensive evaluation and discussion- but we try our best each time. This blog series is dedicated to the most common areas I hear after those four words that let me know our job is not complete. Hopefully it will help patients prepare for their next visit and their four last words will be "thanks I get it!"

An Insider's Perspective on "Getting Roomed"

When you go see your ortho doc, you know there will be lots of paperwork, and a little waiting if you plan to use your health insurance to pay for your visit. What may surprise you is that there are lots of requirements for the office due to government and insurance regulations or policies - and each year of my practice the list grows. It's easy for our patients to feel like they are asked the same questions electronically, on forms or by our staff, and that's frustrating to say the least.

The process of moving from the time you check-in to the time your visit begins with the doctor is known as intake and rooming to healthcare insiders. During this stage, some required things happen like getting your height and weight recorded, reviewing your medications and verifying your pharmacy. I'll cover the "why" on the height and weight in a future post, but I do believe this step is important. For this short blog post, I want to focus on how to win with intake. One tip during this phase is to be aware and accurate of your own information in advance of your appointment- this speeds things up for you when you are with us and also if things need to be "called in" or e-prescribed after you've left. This includes gathering the actual medical records, imaging discs and reports, and being patient with the staff as they collect it all.

In my office, we also ask you to participate with clinical outcomes tracking, which means we use surveys that collect Patient Reported Outcomes (PRO's). While answering digital questions may seem slow, these surveys actually help us understand the true impact of your sports injury or condition. Stay tuned for another blog post dedicated to these PRO's.

Once you've made it to your private room, it is your chance to tell your story. Your story matters and the team is trained to interview you in a way that keeps your visit moving along. They are sports medicine experts known as Certified Athletic Trainers (ATC). I've instructed them on which questions to ask and how to ask them. These include questions about you as a person, your activity goals and challenges, how you've found my office, and your goals for the visit. A tip for this rooming interview: I do ask the staff what you told them and your answers will help us streamline your visit and focus the needed evaluation and discussion. This includes sharing with the staff what questions you will want answered in as clearly and completely as possible- if they can answer them right away, your visit is already ahead of the game!

A last tip is about picking the best attire for the visit. Even if you have an appointment on a work or school day, consider bringing a gym bag with exercise shorts and a top that provides you with coverage for sensitive areas but allows the team to view and examine your shoulders if your trouble is in your neck or arms. You can certainly use the room to change into your exam clothing after the staff completes their interview- we do have paper shorts and gowns if you forget, so don't stress!

At this point, you've been "roomed" and hopefully you have already put yourself and our team in the best position to understand you as a person and get to work on your behalf!

If you or someone you know is suffering from an injury, we encourage you to schedule a consultation with one of our experienced orthopaedic surgeons or therapists at CAO. We are committed to helping our patients achieve optimal outcomes and return to their active lifestyles as quickly and safely as possible. Schedule an appointment with a specialist today!

What is medial epicondylitis?

Wed, 08 May 2024 18:13:00 -0400

Medial epicondylitis, commonly referred to as “golfer’s elbow” can be described as an overuse injury to the medial elbow, or inner surface of the elbow. Muscles that start on the inner surface of the elbow are damaged or develop small microtears due to degeneration of the tendons.

Other Common Names:

Golfer’s elbow
Baseball elbow
Suitcase elbow
Forehand tennis elbow
Common Symptoms

Most common symptoms are pain along the inner surface of elbow to wrist (same side as small finger), pain with resisted wrist flexion (wrist forward), and pain with squeezing/gripping. Muscles that help produce forearm pronation (palm down) and wrist flexion (wrist toward palm) are commonly the muscles involved with this type of overuse injury. These muscle groups all originate from the medial aspect of the elbow. Activities that may cause pain include:

Repetitive forearm rotation
Repetitive wrist motions
Repetitive elbow motions
Excessive gripping, lifting, and carrying
Lifting palms facing up may cause increase pain as well
Serving motion when playing tennis
Weight training

If someone suspects of medial elbow pain it is advised to seek out an orthopedic specialist to ensure accurate diagnosing. There are some initial options a doctor may recommend prior to initiating therapy services. Some of these recommendations include:

Ergonomic keyboard
Wrist immobilization orthosis to avoid using overused muscles
Use of heat or ice for elbow pain
Corticosteroid injections to reduce inflammation and decrease pain
Rehabilitation Management

After seeing an orthopedic doctor, the doctor may recommend Occupational Therapy (OT) services to return to a prior level of function. Rehab for medial epicondylitis can be classified into three phases: Acute, Restorative and Functional. Based on client’s goals the Therapist can incorporate a baseline return to work and return to sport recommendations. Upon arrival at the OT initial evaluation, the OT will collect a series of subjective and objective measurements to further assess plan of care. These items include Pain, Daily routine/tasks, Work demands, Range of motion, Palpation to tender/painful areas, Grip strength, Special testing, Observation of posture, Rounded shoulders, Kyphotic posture, Increased muscle tension in neck and shoulder muscles Treatment Interventions.

Modalities including: Moist heat, Promote lengthening of muscles and increase blood flow to area, Cold pack, Reduce inflammation and pain, Orthotic Intervention, Wrist support orthosis, Pre-fabricated orthosis can be bought at local drug store or the Therapist can make custom made wrist immobilization orthosis, Elbow sleeve, Counterforce brace, Taping, Manual Therapy Techniques, Joint mobilizations, Joint manipulation, Soft tissue massage, Cross friction massage, Dry needling, Stretching, Passive stretches using uninvolved arm (not using muscle power) may be given to patient to help decrease forearm muscle tightness.

Therapeutic Exercise is recommended after the acute phase. The Therapist may progress to strengthening to address certain total arm strengthening and parascapular muscles (shoulder blade), Isometric strengthening exercises for the elbow, forearm, and wrist, Eccentric strengthening, Isometric gripping, and Addressing Posture. The Therapist may address posture to decrease load/force put on distal extremities (i.e. arms, wrists) and increase proximal strength (i.e. core/back muscles) and include Posture stretches and Periscapular strengthening.

If you or someone you know is suffering from a shoulder or elbow injury, we encourage you to schedule a consultation with one of our experienced orthopaedic surgeons at CAO. We are committed to helping our patients achieve optimal outcomes and return to their active lifestyles as quickly and safely as possible. Schedule an appointment with a hand and upper extremity specialist today!

What is Arthritis at the Base of the Thumb?

Tue, 26 Mar 2024 18:25:00 -0400

What is Arthritis at the Base of the Thumb?

Thumb basal joint arthritis is a common condition that causes pain in the thumb with movement and tasks that require grip and dexterity. It involves the degradation of the cartilage between the thumb metacarpal and the trapezium. This can be associated with stretching of the ligaments at the same joint, which can lead to deformity and further joint pain.

Who Gets Thumb Arthritis?

Thumb arthritis usually affects people over the age of 40. Anyone can get thumb arthritis, though some people are more susceptible to it, whether through genetics or heavy use. As we use our hands throughout our lives for everyday tasks, such as writing, sewing, cooking, and doing yard work, the cartilage at the base of our thumbs can gradually wear away and the ligaments can become unstable. This can cause pain and deformity.

This joint has a unique shallow saddle shape that allows our thumbs to move in multiple directions giving our hands the unique ability to perform complicated fine motor tasks. This freedom of movement also means that this joint is susceptible to wear and tear over time.

Symptoms of Thumb Arthritis.

The most common symptom of thumb basal joint arthritis is pain at the base of the thumb, especially with pinching tasks, such as opening bottles, writing, and sewing. Other symptoms include weakness, stiffness, and instability. This can cause people to not only have pain when doing activities of daily living, but to also have a loss of dexterity, often resulting in people dropping and having difficulty handling small items.

Therapy for Thumb Arthritis.

Occupational therapists and hand therapists can help to relieve symptoms of thumb arthritis with orthoses, modalities, education about joint protection techniques and adaptive equipment, and exercises to slow its progression.

An orthosis can be used to rest a painful thumb and to support it during activities. The specific type of orthosis used can vary. For some people an over-the-counter orthosis can provide adequate support, and for those who place high demands on their thumbs or who have significant instability, a custom fabricated orthosis might be necessary.

Utilizing simple joint protection techniques can often help to reduce pain and prevent injury. For example, using one’s forearms and elbows to carry shopping bags avoids placing stress on the thumbs. Additionally, using adaptive equipment can help to reduce the pain during daily tasks. Tools with wide and comfortable grips when using tools and kitchen equipment increase comfort and decrease stress.

Exercises that strengthen certain muscles, such as the first dorsal interossei, can help to increase the stability of the basal joint, which can help to slow the progression of the arthritis. Additionally, exercises that increase proprioception – one’s awareness of movement and position in space – can help to increase stability during functional tasks.

Further Medical Treatment

In some cases, conservative treatment fails to provide adequate relief. In these scenarios a thumb CMC arthroplasty may be the best solution. This can allow people to return to their valued occupations while providing significant pain relief. The most common type of procedure for this is a ligament reconstruction and tendon interposition (LRTI) procedure, in which the trapezium is removed and a tendon is used to provide ligamentous support and to strengthen the joint. The thumb and wrist are immobilized for a period of time after the procedure. Then one will need to attend hand therapy to regain mobility and strength in the hand and wrist. One should expect to return to full use of the affected hand after this procedure, whether that means knitting or doing triathlons. Learn more about basal joint surgery.

If you or someone you know is suffering from a hand injury, we encourage you to schedule a consultation with one of our experienced orthopaedic surgeons or hand therapists at CAO. We are committed to helping our patients achieve optimal outcomes and return to their active lifestyles as quickly and safely as possible. Schedule an appointment with a hand and upper extremity specialist today!

What is Dupuytren’s Contracture?

Sun, 18 Feb 2024 08:56:00 -0500

What is Dupuytren’s?

Dupuytren’s contracture (also called Dupuytren’s disease) is a condition that affects the hand and fingers. It is characterized by the thickening and tightening of the connective tissue beneath the skin of the palm and fingers. This thickening causes the fingers to bend inward towards the palm, making it difficult to straighten them. The ring and little fingers are most affected. In many cases, it affects both hands. Rarely, feet may also be affected.

What is the main cause of Dupuytren's contracture?

The exact cause of Dupuytren's s unknown, but it is believed to be hereditary. It may be environmental as well and linked to smoking, alcoholism, diabetes, nutritional deficiencies, or medicines to treat seizures.

What are the symptoms of Dupuytren’s?

Not being able to lay your hand flat on a table, palm down (called the tabletop test)

One or more small, tender lumps (nodules) in the palm. Over time, the tenderness usually goes away.
The nodules may thicken and contract or tighten. This can cause thick bands of tissue under the skin in the palm of the hand.
Pits or grooves in the skin compressed by the contracted finger. These areas can become very sore and can lead to skin loss if they don’t heal properly.
Fingers are pulled forward
Your hand is not able to work as well

The types of Treatment for Dupuytren’s

There is no cure for Dupuytren’s. The condition is not dangerous. Many people do not get treatment. But treatment can slow the progress of the disease or help ease symptoms. Most common treatments include:

Surgery
Steroid injection
Enzyme injection
Needle aponeurotomy

Rehabilitation for Dupuytren’s

The treatment options described above will likely not be enough to treat the disease. Hand therapy will be prescribed to increase finger motion, strength, and function.

Common treatment techniques that will be provided are:

Range of motion exercises
Massage
Manipulation
Hand splinting

What is Carpal Tunnel Syndrome?

Sun, 18 Feb 2024 08:48:00 -0500

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a condition that affects the hand and wrist. It occurs when the median nerve which runs from the forearm to the hand becomes compressed or squeezed at the wrist. This compression can cause pain, numbness, tingling and weakness in the hand and fingers.

What is the main cause of Carpal Tunnel Syndrome?

Carpal Tunnel syndrome is often caused by repetitive hand and wrist movements such s typing, using a computer mouse for long periods of time. Other factors that can contribute to the development of carap tunnel syndrome include wrist injureis, certain medical conditions such as diabetes or arthritis and hormonal changes during pregnancy.

What are the symptoms of Carpal Tunnel Syndrome?

Carpal Tunnel syndromesymptoms usually start gradually and include:

Tingling or numbness: usually in the thumb and index, middle or ring but not the little finger. You might feel an electric shock in these fingers.

Weakness: You may experience weakness in the hand and drop items. This may be due to numbness or weakness of the thumbs pinching muscles, which are also controlled by the median nerve.

Types of Treatment for Carpal Tunnel Syndrome

Treatment for carpal tunnel syndrome may include:

wrist splints
medication
hand therapy
surgery

Rehabilitation for Carpal Tunnel Syndrome

Hand therapy can be prescribed for both conservative treatment and post operation treatment to help increase decrease symptoms and regain motion, strength, and function.

Common treatment techniques that will be provided are:

Range of motion exercises
Massage
Nerve Glides
Wrist splinting
Strengthening
Ergonomic training

What is Trigger Finger?

Mon, 08 Jan 2024 14:56:00 -0500

What is Trigger Finger?

Trigger finger (also called trigger digit) is a condition that causes a finger or thumb to catch, or get stuck, during motion. It is caused by a tendon getting stuck on a pulley at the base of a finger. When we bend our fingers, muscles in our forearms pull on tendons that are attached to the bones in our fingers. As our fingers bend, these tendons slide through a series of pulleys that hold the tendon in place. Sometimes the pulley at the base of the finger can become thick, making it difficult for the tendon to easily glide through as the finger moves. In mild cases, an involved finger may just be a little stiff in the mornings, and in severe cases, a finger can become completely locked in a position.

Who Gets Trigger Finger?

Anyone can get a trigger finger, but certain factors can cause one to be more susceptible to it. Frequently engaging in tasks that require heavy hand use and tight grip, and place pressure on the palm can increase irritation and can exacerbate symptoms. Conditions that can cause swelling and inflammation in the hand are also correlated with trigger finger, such as diabetes and rheumatoid arthritis.

What Are Symptoms of Trigger Finger?

The most common symptom of trigger finger is a feeling of a catch when bending and straightening a finger. In mild cases this may be infrequent and barely noticeable, but it can become severe enough that it impacts one’s ability to perform daily tasks. It can be exacerbated by tight gripping, which can make it difficult to use everyday objects, such as a fork and knife. Sometimes the trigger is painful, which can make it even more difficult to use one’s hand functionally. In the worst cases a finger can become so painful and stuck that it is almost impossible to fully bend or straighten the finger.

What are Conservative Treatments for Trigger Finger?

Cortisone injections can often help to relieve trigger finger symptoms, and for some people, this is all that is needed.

In many cases, Occupational and Hand Therapy can also help to relieve the symptoms. The goals of therapy are to prevent the affected fingers from locking and to find ways to avoid placing undo stress on the tendon and pulley. Therapists can help people find ways to adapt daily tasks to avoid tight gripping and squeezing. They can also make orthoses that can increase mobility and prevent the affected finger from catching. With rest and avoidance of locking, the symptoms can sometimes resolve.

What Other Treatments Exist?

Unfortunately, in some cases therapy, rest, and injections do not help to relieve the symptoms of trigger finger. In these scenarios surgery may be the best option. In this procedure, the pulley at the base of the finger or thumb is released so that the tendon can now glide freely. Most people will not require any Occupational Therapy after the procedure, but in cases where the affected finger was stiff beforehand, some therapy may be needed to help get full mobility and function back.

Common Hand Injuries

Mon, 18 Dec 2023 10:20:00 -0500

Cubital Tunnel Syndrome

What is Cubital Tunnel Syndrome?

Cubital tunnel syndrome is the term for entrapment of the ulnar nerve in the elbow. Although the nerve entrapment occurs in the elbow, people who have cubital tunnel syndrome experience numbness and tingling in their ring and small fingers. This condition is caused when the elbow is held in a bent position for extended periods of time, when there is prolonged pressure on the elbow., or when there is a traumatic injury to the elbow.

Treatment for Cubital Tunnel Syndrome

Treatment for cubital tunnel syndrome can be done conservatively through occupational or physical therapy; or through surgical intervention if conservative treatment has failed. Conservative treatment includes nighttime bracing through the use of an elbow extension orthosis keeping the elbow straight with a slight bend of 30 degrees. It is recommended to wear this nighttime brace for 3 months to allow symptoms to resolve. Additional therapeutic treatment can include nerve gliding exercises prescribed by your therapist and education regarding computer ergonomic modifications and activity adaptations.

Surgical Options for Cubital Tunnel Syndrome

Patients who have ulnar nerve entrapment in the cubital tunnel may benefit from an ulnar nerve decompression or an ulnar nerve transposition. In an ulnar nerve decompression, the surgeon will release the fascia covering the cubital tunnel in order to decrease the compression and allow the ulnar nerve to glide more fluidly. With an ulnar nerve transposition, the ulnar nerve is moved anteriorly beneath the flexor muscle mass. By moving the nerve from behind the elbow to the front of it, it will allow the nerve to decompress and relieve the numbness and tingling symptoms. Therapy after these procedures should begin within 2 weeks from surgery and the rehabilitation may last from 1-3 months. Therapy after surgery will focus on decreasing scar tissue adhesions, regaining range of motion and regaining functional strength.

Distal Radius Fracture

What is a Distal Radius Fracture?

Distal radius fractures are one of the most common types of fractures. They often occur due to falling on an outstretched hand, sports injuries, or direct trauma. The radius bone is one of the two long bones located in the forearm. People with a distal radius fracture will initially feel pain in the wrist and may experience swelling through the lower arm and into the hand. Distal radius fractures are often diagnosed through imaging tests such as x-rays or CT scans.

Conservative Treatment for Distal Radius Fractures

Distal Radius fractures can be treated conservatively with casting for 4-6 weeks. Once the cast is removed, it is recommended to begin hand therapy with a wrist orthosis. The therapist may make a custom orthosis or the patient may be placed in a prefabricated brace provided by your doctor. The therapist will initially work on regaining range of motion and then will begin strengthening the wrist and hand once cleared to begin strengthening by the referring doctor. A patient should expect a full return to most activities 3 - 4 months after the initial injury.

Surgical Options for Distal Radius Fractures

If a fracture is not able to heal conservatively, surgical intervention may be appropriate. In surgery, your surgeon may use plates, screws, or pins to hold the broken bone in place in order to allow the fracture to heal. Depending on the severity of the fracture, patients should expect to begin therapy 7-10 days after surgery. Occasionally, a patient may be casted postoperatively for up to 4 weeks, and then therapy will begin once the cast is removed. At the patient’s first therapy visit postoperatively, the therapist will fabricate a custom wrist brace that the patient should plan to wear aside from exercises and bathing until cleared by the therapist or physician. The patient will begin range of motion exercises, scar control techniques, and learn techniques to manage swelling. The patient will be instructed to hold off from heavy lifting, gripping, pulling, pushing or weight bearing tasks until cleared by the therapist or referring physician. Patients should expect a full return to most activities around 3 - 4 months postoperatively.

What is a Lateral Ankle Sprain?

Mon, 11 Dec 2023 10:24:00 -0500

One of the most common foot/ankle injuries seen by physical therapists is a lateral ankle sprain. If you’ve played sports competitively or for recreation, the chances are that you have experienced a lateral ankle sprain in some form or fashion. However, something as simple as missing a stair on the way down the steps can be the cause of this injury. By the end of this article, you’ll know a bit more about the anatomy of the ankle, the varying degrees of an ankle sprain, and some basic means of immediate treatment should you or someone you care about experience this injury.

There are two joints in the body that have to balance both stability and mobility more than all the other joints. The ankle is one of them; the shoulder is the other in case you were wondering. If you imagine walking barefoot on a sandy beach, you’ll realize that your foot and ankle has to make many intuitive adjustments to ensure that you don’t have to look down at your feet the whole time to maintain your balance. The fancy word for this is proprioception. It’s the body’s internal mapping system. It allows you to walk with your head up, scanning your environment instead of worrying about where your feet are with every step.

The anatomy of your ankle lends itself to more motion when you turn your ankle inward (this is called inversion) than when you turn your ankle outward (eversion). Therefore, you are more prone to injure the outside of your ankle (lateral ankle sprain) than the inside (medial ankle sprain). Additionally, the structures that connect bone to bone (ligaments) on the medial side of the ankle are far less flexible than those on the lateral side. Therefore, lateral ankle sprains are far more common. It usually occurs when you roll your ankle past it’s normal range of motion and usually occurs in a weight bearing position. The positioning of your foot combined with your body weight will cause a sprain to occur. Consequently, the quality of your proprioception is temporary impaired, which is why you are more prone to re-sprain your ankle in the early stages of recovery than in the later stages.

How serious is a lateral ankle sprain?

There are varying degrees of severity when discussing a lateral ankle sprain. These are rated from grade one to grade three. Grade one is considered a mild sprain. Grade two is considered a moderate sprain. Grade three is considered a strain or complete tearing of the ligament(s) on the lateral side of the ankle. If the grade three strain is severe enough, it can cause damage to the bone that it’s attached to. This is called an avulsion fracture.

When a lateral ankle sprain occurs, you’ll likely experience several of the following symptoms: severe pain, difficulty with weight bearing, swelling around the ankle, heat/warmth around the joint, and a feeling of stiffness compare to your uninjured side. The immediate treatment for these symptoms can be remembered using the acronym ‘RICE.’ It stands for rest, ice, compression, and elevation. You may need crutches for the first few days but it is recommended to try to start gently moving your ankle through the pain to avoid loss of range of motion. Over the counter medication for pain relief may also help but if you are unsure of which medication to use, consult with a pharmacist or with your physician.

If you decide to go and see an orthopedic doctor, you may have an x-ray or MRI done at the doctor’s discretion to determine the severity of your injury. You will likely be referred to physical therapy to expedite your recovery and reduce the risk of chronic loss of ROM. Your physical therapist will assess your pain, strength, and ROM and develop a treatment plan to address your symptoms and gradually improve the stability of your foot/ankle to reduce the risk of re-injury.

If you or someone you know is suffering from an ankle injury, we encourage you to schedule a consultation with one of our experienced orthopaedic surgeons or physical therapists at CAO. We are committed to helping our patients achieve optimal outcomes and return to their active lifestyles as quickly and safely as possible. Schedule an appointment with a foot and ankle specialist today!

What are the types of therapeutic exercises?

Mon, 18 Sep 2023 18:59:00 -0400

Exercise? I Thought You Said “Extra Fries”

Therapeutic exercise is the primary method of rehabilitation used in physical therapy. The purpose of exercise is to improve mobility, strength, functionality and overall capacity of a patient or athlete. This is done through controlled loading of healing tissues including muscles, tendons, and ligaments. Tissue healing timeframes are also an important concept to understand, which helps determine the amount of progression and choice of exercise.

Acute injuries typically involve increased swelling, pain, muscle inhibition and loss of mobility. An early rehabilitation program will focus on addressing these limitations by restoring ROM actively and passively, improving pain levels and increasing muscle activation. Timelines of tissue healing are also influenced by the degree of injury. Minor muscle strains (Grade 1) typically resolve within 1-4 weeks, while larger muscle strains (Grade 2) typically resolve within 1-3 months. A grade 3 muscle strain involves full thickness tearing, and often surgical intervention is required. Research shows that Grade 1 and 2 muscle strains improve quite well with properly dosed therapeutic exercises.

Acute ligament injuries are managed similarly, with primary goals to restore motion, decrease swelling, strengthen surrounding musculature, improve coordination and stability of the joint and reduce strain on the ligament while it heals. More involved ligament sprains can take longer to heal than muscle strains, but progressions in physical therapy will be dependent on the patient’s presentation and exercise tolerance levels.

As an acute injury progresses to sub-acute, physical therapy can continue to progress with intensity and loading of these healing tissues. Some methods of functional strengthening involve concentric and eccentric loading. Concentric is the forceful contraction of the muscle that propels the movement, such as stepping up on a step. Eccentric motion is the controlled lengthening of a muscle, such as lowering yourself down from a step. These exercises are meant to challenge the muscle to a level that causes fatigue while keeping pain levels at a 5/10 or below.

Physical therapy is supposed to be challenging! Some good metrics to understand if a therapeutic exercise is challenging enough for you are the RPE scale (Rate of Perceived Exertion), and the RIR (Repetitions in Reserve) scale. Both are highly correlated to each other. The RPE scale is a subjective effort and difficulty scale from 0 to 10. “Whew! That workout was tough!” Great, that’s probably a 7-8/10. Very scientific, right?! Well, the RIR scale is correlated to it. “Whew! That exercise was tough! I could probably only do 2 more reps until failure.” That’s 2-3 reps in reserve, or 7-8 RPE. The aim is to typically live somewhere in the 6-8 RPE scale, or 2-4 RIR in order to maximize tissue loading with good form.

Is the standard “3 sets of 10 repetitions” of a therapeutic exercise boring to you? Good, it is to me too. Luckily, there are ways to spice things up. Supersets, circuits, high intensity interval training, AMRAPS (As Many Rounds as Possible) and EMOM (Every Minute on the Minute) are all great ways to perform your rehabilitative exercises while challenging endurance, have more fun, and be more efficient with your time! A superset is method in which you select multiple exercises, and cycle through them. An AMRAP is basically a superset, but with a time cap. You also don’t have a determined number of sets to perform, but the goal is to go until you run out of time! “Today’s workout is 15 body weight squats, 12 kettlebell swings, 8 curtsy lunges. As many rounds as possible for 12 minutes. Go!” These different methods of program development can be used from early rehab to end-stage rehab, with the difficulty of exercises being taken into consideration.

As you can see, there’s a lot of planning that goes into developing a therapeutic exercise program. Tissue healing timeframes need to be considered, the type of exercise needs to be considered, as well as the dosage of exercise. The goal pf physical therapy isn’t to just get you back to functional, it’s to maximize your physical potential. It’s to increase your comfort with exercise and develop lifelong habits to promote a healthy lifestyle in the future. And after you finish your difficult workout, you can celebrate by eating French fries. To find a therapist near you visit CFAOrtho.com/rehabilitation.

What is a Meniscus Injury?

Mon, 11 Sep 2023 19:42:00 -0400

The meniscus is a vital structure in the knee joint that serves multiple functions, including shock absorption, load distribution, and lubrication. A meniscus injury can result in significant pain, instability, and disability. This blog is aimed to help understand the anatomy, common injury patterns, treatment options, and outcomes associated with meniscus injuries.

The meniscus is a C-shaped piece of fibrocartilage located within the knee joint. Each knee has two menisci, one on the medial (inner) side and one on the lateral (outer) side. The meniscus attaches to the tibia (shinbone) and is surrounded by synovial fluid, which helps to lubricate and nourish the joint. The meniscus is composed of three distinct layers: the outermost layer, which is composed of dense, fibrous tissue; the middle layer, which is made up of loose connective tissue and blood vessels; and the innermost layer, which is composed of fibrocartilage.

Meniscus injuries are relatively common, with up to one-third of all knee injuries involving damage to the meniscus. Meniscus injuries can occur as a result of traumatic events, such as a sports-related injury, or as a result of degenerative changes associated with aging. In younger individuals, meniscus injuries are often associated with twisting or hyperflexion of the knee, which can result in tears of varying severity. In older individuals, degenerative changes within the meniscus can result in weakening and tearing of the structure.

Meniscus tears are classified based on their location within the meniscus, as well as their shape and severity. The most common types of meniscus tears include:

Radial tears - These tears run perpendicular to the long axis of the meniscus and are often the result of a sudden twisting or hyperflexion injury.

Flap tears - These tears occur when a portion of the meniscus is pulled away from its attachment to the tibia, often resulting in pain, instability, and locking of the joint.

Bucket-handle tears - These tears occur when a portion of the meniscus is displaced into the joint space, often resulting in significant pain, swelling, and loss of function.

The treatment of meniscus injuries depends on several factors, including the severity and location of the tear, as well as the age and activity level of the patient. In some cases, conservative management, such as rest, ice, compression, and elevation (RICE), along with physical therapy, may be sufficient to manage the injury. In other cases, surgical intervention may be necessary.

Surgical intervention typically involves either a meniscus repair or meniscectomy (removal of a portion of the meniscus). Meniscus repair is often preferred in younger individuals with tears located in the outer third of the meniscus, where blood flow is more abundant, and healing is more likely. Meniscectomy is often preferred in older individuals with degenerative changes, as well as in cases where the tear is in the inner two-thirds of the meniscus, where blood flow is limited, and healing is less likely.

Recent advances in surgical techniques, such as arthroscopic surgery, have led to improved outcomes for meniscus injuries. Arthroscopic surgery involves the insertion of a small camera and instruments into the joint through small incisions, allowing the surgeon to visualize and repair or remove the damaged portion of the meniscus.

When it comes to meniscus injuries, choosing the right healthcare provider is crucial for achieving optimal outcomes. At CAO (Centers for Advanced Orthopedics), our team of highly skilled orthopedic surgeons and physical therapists work together to provide comprehensive care for meniscus injuries.

Our orthopedic surgeons have extensive experience in the diagnosis and treatment of meniscus injuries, utilizing the latest surgical techniques to achieve the best possible outcomes. Our surgeons take a personalized approach to care, working closely with each patient to develop a treatment plan that meets their individual needs and goals.

In addition to surgical intervention, our physical therapists play a critical role in the management of meniscus injuries. Our physical therapists are experts in the evaluation and treatment of knee injuries helping our patients achieve optimal outcomes.

At CAO, we understand that meniscus injuries can be challenging and debilitating, but with the right treatment, patients can regain function and return to their active lifestyles. Our goal is to provide the highest level of care possible, utilizing a multidisciplinary approach to ensure that our patients receive the best possible outcomes.

If you or someone you know is suffering from a meniscus injury, we encourage you to schedule a consultation with one of our experienced orthopedic surgeons or physical therapists at CAO. We are committed to helping our patients achieve optimal outcomes and return to their active lifestyles as quickly and safely as possible. Schedule an appointment with a knee surgeon today!

Physical Therapy 2.0

Thu, 24 Aug 2023 09:18:00 -0400

Physical Therapy 2.0

As in any profession, physical therapy has seen growth and change as more research and evidence calls for an updated approach to treatment. There is less and less reliance on passive treatments, such as modalities using ice, heat, and TENS, which are now only being used to complement treatment rather than playing the larger role of the past. The new rehab approach that has become standard care focuses on not just reducing pain in the short-term, but preparing patients for the demands of daily life, sport, or any other personalized goals, as well as reducing risk for further pain or injury. Our goal is to always set the bar high for the quality of care for each patient who walks in the door, adjusting our treatment to challenge them according to their individual needs.

With passive treatment and table-only exercises (sitting/laying exercises) being a thing of the past, the end goal of PT is preparing each patient to get fit for life – whether young or old, physical therapy is appropriate for everyone. However, the end goal of physical therapy involves doing more than the bare minimum, just enough to get out of pain and doing daily activities without pain. It involves strengthening, correcting movement patterns, and loading the injured tissues appropriately to prepare a patient for the future so they are less likely to become injured again, and hopefully get everyone to the point of being even better than where they were before the pain.

So, what does this improved approach to rehab look like?

It will look a little different for each person, but the end goal is the same: progressive loading. The starting point will look the most different, depending on someone’s pain levels, level of irritability, or whether they are post-surgical or not. High irritability means more acute and significant levels of pain are present, and rehab starts with lower-level exercises that are tolerable and will help reduce the pain. With low irritability, the patient can tolerate more activities with lower levels of pain, so exercises that involve greater loading can be the starting point in treatment. In either case, both will gradually increase their load (amount of weight/resistance, exercise difficulty) so that one’s capacity for activity improves.

The end goal of PT is achieving functional strength, such as squatting, deadlifting, overhead pressing, etc. While for some people, these exercises may feel unrealistic, they can be modified, and it may not seem as impossible if thought about as more familiar movements: standing up from a chair is the same movement as squatting, picking up your laundry basket is like a deadlift. These are basic and fundamental movement patterns. Lifting and performing these functional exercises in rehab produce longer lasting strength and abilities. Strength is protective against future injury. For example, quad strength is protective against development of degenerative knee arthritis. Not only will this focused PT approach challenge general strength, but it also incorporates whole body health and includes building aerobic capacity. Muscles do not produce the same forces, and injury risks are higher when they are fatigued. In addition, submaximal aerobic exercise has even been shown to produce global pain relief.

Load causes mechanical adaptations to the tissues so that they are stronger and more resilient to the demands of whatever activity patients need to be able to do. Bone, tendons, ligaments, and muscles are meant to take load and are strengthened by loading them. With loading, just as anything in life, too much of a good thing can become bad. There are two ends of the spectrum: underloading and overloading. Both can lead to injury. Without being physically active, tissues weaken and their capacity to tolerate load decreases so that eventually daily activities or something that used to seem easy, now may cause injury. On the other hand, overloading a tissue too much can also cause injuries, usually seen as overuse injuries. The tissues did not have the capacity to perform that volume of activity. The overloaded tissues need just as much progressive loading as the underloaded but a more gradual increase and starting out with lower loads/volumes. The answer to both overloaded and underloaded tissues is loading them in a gradual and systematic process. Exercise is medicine, and just like medicine, must be dosed appropriately.

Does pain interfere with your daily activities? If so, check out the services at CAO. We offer physicians and physical and occupational therapists who work collaboratively to get you back to the activities you love without pain. Learn more at CFAOrtho.com.

Do I Need Surgery for a Rotator Cuff Injury?

Wed, 23 Aug 2023 15:25:00 -0400

Do I Need Surgery for a Rotator Cuff Injury?

So, what is the rotator cuff?

The rotator cuff is a group of four muscles: the infraspinatus, supraspinatus, teres minor, and the subscapularis. One of their main functions is to depress and stabilize the head of the humerus, or in other words, centralize the ball part of the ball and socket joint that makes up the shoulder. This position is crucial to more efficient mechanics of the shoulder.

I have a rotator cuff injury. What kind do I have?

There are many different types of injuries that can involve any of the four rotator cuff muscles. An injury can occur to the tendons that attach these muscles to the bone which may lead to inflammation also known as tendonitis. The muscles themselves can experience a strain just like any other muscle due to overuse, excessive load, or some type of traumatic event. Strains can vary from a grade 1, which is classified as mild, to a grade 3, which is considered severe and involves a tear. When there is a tear, the tears can further be classified as partial vs. full thickness or incomplete vs. complete. When one or more of these situations occur, there may be a loss of function of the shoulder, including decreased range of motion or lack of strength. In many cases it is common to hear more “clicking” as the shoulder moves or to feel increased pain at specific elevations of your arm.

How do I know I have a rotator cuff injury?

If you suspect you have a rotator cuff injury, you should always check with your doctor for a diagnosis and whether the injury needs treatment. Your provider may recommend starting with an x-ray followed by an MRI (magnetic resonance imaging) to determine the type of injury and its severity.

Signs you should go see a doctor for a rotator cuff injury include shoulder pain that becomes worse, a decrease in range of motion, waking from sleep because of shoulder pain, muscle weakness, or shoulder pain that interferes with your daily activities.

I have a tear; will I need surgery? How do I treat a rotator cuff injury?

The severity of the tear will determine whether or not the doctor will recommend surgery. In many cases, milder or smaller tears can heal with time and an appropriate treatment plan. In the more severe cases of large or complete tears, surgery is more likely to be recommended. In some cases where levels of arthritis and age are high, a shoulder replacement may be appropriate.

Early treatments for a rotator cuff injury usually involve rest and the potential use of nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen to help reduce inflammation and discomfort to the area. In many cases, your doctor might recommend physical therapy which will focus on restoring functionality to the rotator cuff and further protecting it from injury. That could include strengthening muscles that have gotten weak, stretches to improve flexibility and mobility, and other exercises to improve movement mechanics. If symptoms persist, your treating provider may recommend corticosteroid injections to reduce pain and inflammation to further promote the effectiveness of physical therapy.

If you have a rotator cuff injury or even a tear, do not panic. Don’t be afraid to seek licensed medical attention as there are many beneficial exercises that can be learned and performed in the comfort of your home to treat your shoulder and prevent further damage. Schedule an appointment with a shoulder specialist at CAO.