Al-Amal Physical Therapy Center - Cases

Al-Amal Physical Therapy center, we offer one-on-one care with an emphasis on maximizing your potential and preventing re-injury through the use of core stabilization and efficient movement strategies.

Low Back Pain

The low back is composed of bones, discs, joints, tendons, muscles, ligaments and nerves. The spine has 3 main functions. 1.) It connects the pelvis to the trunk and head. 2.) It protects and houses the spinal cord which is made up of billions of nerves that connect the brain to most of the body’s major organs. 3.) The spine provides stability, balance, flexibility, and mobility in order for us to perform our daily activities.

Closer inspection reveals five vertebrae (bones) stacked on top of each other. The lumbar spine is like a hollow, C-shaped curve (called the lumbar lordosis) which is arranged to balance tremendous forces. The curve or lumbar lordosis allows the spine to be 15 times stronger than if it were straight. Within the “hollow” of the spine is the spinal cord. The spinal cord is made up of nerves that, very simply put, wire your brain to your muscles and tell them when to contract. These nerves also are responsible for the sensation of touch and pain among other things. They exit out in between the vertebrae. Between each vertebral body is a fluid filled disc similar to a jelly donut. Healthy discs provide necessary height to the spine, absorb shock, and distribute forces in all directions. Ligaments in Low Back are tough non-elastic structures that attach a bone or bones together.

There are over 140 muscles, that work together to move and stabilize the spine. Many of these muscles are located around the lower back. There are the abdominal muscles, the erector muscles, and the hip muscles, they provide support, help maintain good posture, hold the abdominal organs in the correct location, and act together as your body’s own natural “back belt. Any one or combination of structures can affect the curve or lumbar lordosis.

Mechanical low back pain has been reported to arise from trauma (either chronic or sudden) such as a fall, a motor vehicle accident, twisting, prolonged poor postures, mental stress, fatigue, disc injury, sometimes painful degenerative disc disease, aging, congenital defects, poor flexibility, etc. Causes such as infection, hormonal problems, broken bones, and systemic disease.

Treating Low Back Pain

  • Protecting the damaged soft tissue to prevent further breakdown. The area of damaged soft tissue is protected with rest and positioning. Activities that cause the pain should be avoided while the low back heals. Pain management techniques should be used and your physical therapist will discuss these with you.
  • Increasing the circulation and mobility. This will deliver the proper building blocks, remove inflammatory and waste products that build up in painful tissue(s), and prevent tissue atrophy. Increasing circulation is accomplished by walking and performing painless range of motion, stretching, and strengthening exercises.
  • Correcting the dysfunctions such as weakness, poor posture, and poor flexibility, that caused the problem in the first place. Progressive strengthening exercises, flexibility exercise, and postural/body mechanics education will help reduce the stress on your low back and promote proper repair.
  • Your physical therapist will give you the tools to treat your dysfunctions and create your own customized treatment program.

Possible Treatments such as:

  • Aerobic/Endurance Exercise
  • Core Strengthening Exercises
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Heat Pack
  • Isometric Exercise
  • Low Back Active Range of Motion
  • Low Back Joint Mobilization
  • Low Back Passive Range of Motion
  • Low Back Resistive Range of Motion
  • Lumbar Traction
  • Posture Training
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Scoliosis

Scoliosis is a lateral curvature of the spine. There may be one curve (“C” curve) present or two curves (“S” curve). Scoliosis is technically defined as a lateral curve of the spine greater than 10 degrees. Ten to 20 degrees of curvature is called mild scoliosis, 20-40 degrees is a moderate scoliosis, and greater than 40 degrees of curvature is a severe scoliosis.

In most cases (approximately 80%), the scoliosis is idiopathic in nature meaning there is no apparent cause. It affects all age groups and males as often as females. Symptoms may include pain and fatigue and in severe cases difficulty with breathing, digestion, and walking.

Treatment typically consists of bracing for moderate curves and surgery for severe curves. Physical therapists are your best choice if you are looking for a customized exercise program for your scoliosis. Recommended exercises can decrease pain, stretch tight muscles, and strengthen the core spine/abdominal muscles.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Electrotherapeutic Modalities
  • Heat Pack
  • Low Back Active Range of Motion
  • Low Back Joint Mobilization
  • Low Back Passive Range of Motion
  • Low Back Resistive Range of Motion
  • Posture Training
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals:

  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Neck Pain

Neck pain can be so mild that it is merely annoying and distracting. Or it can be so severe that it is unbearable and incapacitating. Most instances of neck pain are minor and commonly caused by something you did. That is, if you keep your head in an awkward position for too long the joints in your neck can “lock” and the neck muscles can become painfully fatigued. Poor postures while working, watching TV, using a computer, reading a book, or talking on the phone with the receiver held against your shoulder and under your chin can be responsible for neck pain.

Neck pain that persists for many days or keeps coming back may be a sign that something is wrong from a disease, an injury as in an auto accident, or a congenital malformation. As we age, our joints wear out and the discs in the spine dry up and flatten. You may experience pain that radiates into the top of the shoulders or in between your shoulder blades. Occasionally, a pinched nerve occurs and you may feel tingling, pain, and/or numbness radiating into the arm, forearm, hand, and fingers. As always, with persistent pain you should be evaluated and seek treatment from a trained physical therapist.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Neck Active Range of Motion
  • Neck Joint Mobilization
  • Neck Passive Range of Motion
  • Neck Resistive Range of Motion
  • Neck Traction
  • Posture Training
  • Proprioception Exercises
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Decrease Nerve Compression
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Temporomandibular (TMJ) Disorders

The TMJs are the jaw joints. There is one on each side of your head just in front of your ear canals. Like many other joints in the body, they consist of muscles that control joint movement, ligaments that hold the bones together, cartilage that provides a smooth surface for the bones to move on, a disc that helps with proper movement, of the bones, and elastic tissue that helps hold the disc in place.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Iontophoresis
  • Neck Traction
  • Posture Training
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Muscle Strength and Power
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Rotator Cuff Tears

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.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Adhesive Capsulitis / Frozen Shoulder

Adhesive Capsulitis, or a frozen shoulder, is a poorly understood condition in which the deepest layers of soft tissue, called the joint capsule, become diseased. Shoulder range of motion becomes very limited and painful. The cause of a frozen shoulder is still not known but minor traumas, hyperthyroidism, diabetes, psychiatric patients, post-surgical patients, and prolonged immobilization of the shoulder may in some way cause this condition. The disease is characterized as having freezing, frozen, and thawing stages, and is self-limiting.

Physical therapy consisting of patient education, stretching, joint mobilization, and a home exercise program can help speed recovery.

Possible Treatments

  • Active Assistive Range of Motion
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation
  • Posture Training
  • Physical Agents
  • Shoulder Active Range of Motion
  • Shoulder Joint Mobilization
  • Shoulder Passive Range of Motion
  • Shoulder Resistive Range of Motion
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms

Tennis Elbow

It is a painful condition on the outer aspect of the elbow. 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. Local tenderness and pain with resisted and passive extension of the wrists is common.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Elbow Active Range of Motion
  • Elbow Joint Mobilization
  • Elbow Passive Range of Motion
  • Elbow Resistive Range of Motion
  • Electrotherapeutic Modalities
  • Isometric Exercise
  • Iontophoresis
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Golfers Elbow

People that suffer from golfer’s elbow are often involved with racquet sports or golf. As with tennis elbow, they may overuse the forearm, traumatize the elbow by hitting several “fat” golf shots, or have poor swing technique. Pain at the inner aspect of the elbow and reproduction of symptoms with resisted wrist flexion are common.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Elbow Active Range of Motion
  • Elbow Joint Mobilization
  • Elbow Passive Range of Motion
  • Elbow Resistive Range of Motion
  • Electrotherapeutic Modalities
  • Isometric Exercise
  • Iontophoresis
  • Proprioceptive Neuromuscular Facilitation
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Fracture / Dislocated Elbow

Elbow fractures usually involve a fall onto the outstretched arm or a direct trauma to the elbow. With elbow dislocations there may be associated nerve and/or blood vessel injuries. X-rays may show the fracture or dislocation but small breaks may be difficult to see.

Fractures are an emergency and immediate reduction (or placing the bones together to allow healing) is necessary. Bone breaks within the joint need special attention to ensure recovery of proper function of the joints.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Elbow Active Range of Motion
  • Elbow Joint Mobilization
  • Elbow Passive Range of Motion
  • Elbow Resistive Range of Motion
  • Isometric Exercise
  • Physical Agents

Possible Treatment Goals

  • Improve Function
  • Improve Muscle Strength and Power
  • Decrease Postoperative Complications
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Wound Healing

Carpal Tunnel Syndrome

It 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.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Isometric Exercise
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Wrist Active Range of Motion
  • Wrist Joint Mobilization
  • Wrist Passive Range of Motion
  • Wrist Resistive Range of Motion

Possible Treatment Goals

  • Decrease Risk of Reoccurrence
  • Improve Function
  • Improve Muscle Strength and Power
  • Decrease Nerve Compression
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

De Quervain's Tenosynovitis

This is a common condition in which the tendons that extend or straighten the thumb and their surrounding sheaths become inflamed. Pain is located at the base of the thumb and wrist.

De Quarvain’s tenosynovitis is common with repetitive work activities such as wringing and scissoring tasks. Treatment includes rest, splinting, and rehabilitation to restore flexibility, reduce inflammation and modify tasks and activities. Surgery is rarely indicated, but a steroid injection is occasionally necessary.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Hand Active Range of Motion
  • Isometric Exercise
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise
  • Wrist Active Range of Motion
  • Wrist Joint Mobilization
  • Wrist Passive Range of Motion
  • Wrist Resistive Range of Motion

Possible Treatment Goals

  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Distal Radius Fracture, Colles Fractures

These fractures often result from a fall onto an outstretched hand or because of a direct blow. Pain, tenderness, and deformity are common. X-rays are used to rule in/out a fracture.

Treatment for a fracture involves “closed reduction” in which the bones are moved back into alignment. If the bones cannot be moved back into the proper position manually, open reduction and often internal fixation is used. This means that the bones are surgically positioned next to each other and might be pinned, screwed or wired together.

Early intervention/rehabilitation is helpful to reduce pain, increase range of motion, and ultimately restore strength and function. Wrist supports and custom splints are helpful to protect the area so optimal healing can occur.

Possible Treatments

  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Isometric Exercise
  • Physical Agents
  • Soft Tissue Mobilization
  • Wrist Active Range of Motion
  • Wrist Joint Mobilization
  • Wrist Passive Range of Motion
  • Wrist Resistive Range of Motion

Possible Treatment Goals

  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms

Groin Strain (Adductor Strain)

This injury usually occurs in sports where cutting, side-stepping, or pivoting are required. Often, there is forceful separation of the legs or twisting of the toe outward. Signs and symptoms include pain and tenderness in the inner thigh region.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Hip Active Range of Motion
  • Hip Joint Mobilization
  • Hip Passive Range of Motion
  • Hip Resistive Range of Motion
  • Isometric Exercise
  • Plyometric
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Trochanteric Bursitis

A bursa is a fluid-filled sack that decreases shear forces between tissues of the body. Trochanteric bursitis (inflammation of a bursa) is caused by excessive stress on the bursa. Signs and symptoms include pain over the outer aspect of the hip bone, which often is exacerbated when lying on the affected side, standing on the affected leg, or excessive walking. Treatment often includes rest, ice, and compression, physical therapy including stretching and progressive strengthening, and steroid injection may be helpful.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Hip Active Range of Motion
  • Hip Joint Mobilization
  • Hip Passive Range of Motion
  • Hip Resistive Range of Motion
  • Isometric Exercise
  • Iontophoresis
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Hip Osteoarthritis

Osteoarthritis of the hip occurs when the cartilage coverings on ball (the head of the femur) and the socket (the acetabulum) wear out. It is worse when you bear weight on the affected limb. Range of motion is often limited especially internal rotation and hip flexion. Recent studies have demonstrated that joint mobilization and stretching can result in significant pain relief.

Possible Treatments

  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Heat Pack
  • Hip Active Range of Motion
  • Hip Joint Mobilization
  • Hip Passive Range of Motion
  • Hip Resistive Range of Motion
  • Isometric Exercise
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Hamstring Strains

A strain is a minor tear of a muscle. Quick acceleration while running or cutting is most often the cause of hamstrings strains. A minor pulling or a pop may be noted in the back of the thigh. Pain, swelling, and an inability to run will be result. Treatment includes rest, ice, compression, elevation, and physical therapy.

Possible Treatments

  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Heat Pack
  • Hip Active Range of Motion
  • Hip Joint Mobilization
  • Hip Passive Range of Motion
  • Hip Resistive Range of Motion
  • Isometric Exercise
  • Plyometric
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Quadriceps Muscle Strains

Injury is commonly the result of quick sprints or quick stops while running. With a muscle strain, there is localized tenderness or a “bulge” in the tender area of the thigh. The pain is aggravated by lifting the thigh (a straight leg raise), ascending/descending stairs, or getting up from a seated position.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Heat Pack
  • Hip Active Range of Motion
  • Hip Joint Mobilization
  • Hip Passive Range of Motion
  • Hip Resistive Range of Motion
  • Isometric Exercise
  • Neuromuscular Electrical Stimulation
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Meniscal Tears

The menisci are cartilage pads, which function to cushion the compressive loads in the knee. One or both of these pads can be torn which often occurs when the lower leg is forcefully bent and twisted. Signs and symptoms include joint line pain, locking and swelling of the knee. The tear often has a bucket handle or parrot beak shape. Treatment should consist of rest, ice, compression and elevation. Arthroscopic surgery is indicated for a large tear.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isotonic Exercises
  • Isometric Exercises
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Neuromuscular Electrical Stimulation
  • Plyometric
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Anterior Cruciate Ligament Tear

The cruciate (or crossing) ligament stabilizes the knee. The anterior cruciate (ACL) may completely break (rupture) when the knee is bent beyond its normal range of motion or with excessive twisting. Signs and symptoms include a ‘pop’ sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. If knee instability persists, surgery is indicated. The middle third of the patellar tendon, hamstrings, or cadaver ligament may be used to reconstruct the lost ligament.

ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date, suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isometric Exercise
  • Knee Active Range of Motion
  • Knee Passive Range of Motion
  • Neuromuscular Electrical Stimulation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Decrease Postoperative Complications
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Knee Osteoarthritis

Osteoarthritis of the knee occurs when the cartilage coverings on the end of the femur and the top of the tibia wear out. The tibia has two special cartilage pads called menisci (one is called a meniscus). This cartilage becomes flattened, bone spurs form, the joint becomes inflamed, range of motion is lost, there is ensuing weakness, pain and difficulty with walking, climbing stairs, and getting in/out of chairs. Physical therapy can help with recovery of range of motion, strength, walking skills, and pain management. After total knee replacement, physical therapy helps with recovery of range of motion, pain management, strength, balance and walking skills, and endurance. Commonly, patients say, “Why did I have this surgery? I am worse off now.” You must be patient. Give yourself at least 3 months to recover.

Possible Treatments

  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Heat Pack
  • Isometric Exercise
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion
  • Neuromuscular Electrical Stimulation
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Decrease Postoperative Complications
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Patello-femoral Pain

Chondromalacia meaning softening of the patellar cartilage is a common misdiagnosis. Softening of the cartilage can only be detected by directly visualizing the cartilage during surgery. The correct diagnosis for pain and swelling originating from under the kneecap is Patello-femoral Pain.

Treatment includes pain relief with rest, ice, compression, and elevation. Swelling must be controlled. Anti-inflammatory medications, bracing, and physical therapy are often helpful. Progressive strengthening of the quadriceps is essential. Occasionally, foot orthoses may be helpful. Rarely, surgery is required to assist in realigning the kneecap by releasing the tight structures on the outside of the kneecap and reefing the inner structures.

Possible Treatments

  • Aerobic/Endurance Exercise
  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Knee Active Range of Motion
  • Knee Joint Mobilization
  • Knee Passive Range of Motion
  • Knee Resistive Range of Motion camera
  • Plyometric
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Ankle Sprains / Instability

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.

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.

Possible Treatments

  • Ankle Active Range of Motion
  • Ankle Joint Mobilization
  • Ankle Joint Passive Range of Motion
  • Ankle Progressive Resistive Range of Motion
  • Aerobic/Endurance Exercise
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isometric Exercise
  • Plyometric
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Improve ability to bear weight/stand on the leg(s)
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities

Plantar Fasciitis

Inflammation of the fascia on the bottom of the foot is the most common cause of heel pain.

There is poor flexibility of the calf muscles, no arch support, a sudden increase in one’s level of activity, poor footwear, being overweight, 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.

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.

Possible Treatments

  • Ankle Active Range of Motion
  • Ankle Joint Mobilization
  • Ankle Joint Passive Range of Motion
  • Ankle Progressive Resistive Range of Motion
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Gait or Walking Training
  • Isometric Exercise
  • Iontophoresis
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Proprioception
  • Improve Range of Motion
  • Self-care of Symptoms
  • Improve Tolerance for Prolonged Activities

Sprains and Strains

Strains: A strain is the tearing of muscle fibers. Muscle fibers are the individual units that make up your muscles. Strains are classified into: 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. 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. Sprains: Sprains are tears of the ligaments and capsules (tissues around joints). Ligaments are made up of bundles of somewhat elastic, collagen tissue and attach one bone to another. Sprains are classified into: A grade I sprain involves a minimal number of ligament fibers. There may be pain, swelling, and only mild loss of function. A grade II sprain is a moderate or partial ligament tear. There is usually moderate to severe pain, swelling and bruising are typically present, and there is a loss of joint function. A grade III sprain is a complete tearing of the ligament or joint capsule into two pieces. Severe pain, swelling, bruising, and loss of function are associated with a grade III sprain.

Possible Treatments

  • Active Assistive Range of Motion
  • Aerobic/Endurance Exercise
  • Cryotherapy or Cold Therapy
  • Electrotherapeutic Modalities
  • Heat Pack
  • Isometric Exercise
  • Plyometrics
  • Proprioceptive Neuromuscular Facilitation
  • Proprioception Exercises
  • Physical Agents
  • Soft Tissue Mobilization
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Balance
  • Decrease Risk of Reoccurrence
  • Improve Fitness
  • Improve Function
  • Improve Muscle Strength and Power
  • Increase Oxygen to Tissues
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety
  • Improve Tolerance for Prolonged Activities
  • Improve Wound Healing

Osteoporosis

Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.

Treatment Recommendations:

  • A balanced diet rich in calcium and vitamin D.
  • Weight-bearing exercise.
  • A healthy lifestyle with no smoking or excessive alcohol intake.
  • Appropriate testing and prescription medication.

While your doctor plays a key role in diagnosis, bone density testing, and prescribing medications, a physical therapy program helps provide you with a complete treatment solution.

With physical therapy you will experience the following:

  • A personalized posture program, weight-bearing and resistance exercise program.
  • Education regarding Osteoporosis, proper nutrition, and calcium and Vitamin D intake recommendations
  • Risk factors and fall prevention information.

Possible Treatments

  • Core Strengthening
  • Cryotherapy or Cold Therapy
  • Gait or Walking Training
  • Posture Training
  • Physical Agents
  • Stretching/Flexibility Exercise

Possible Treatment Goals

  • Improve Fitness
  • Improve Function
  • Optimize Joint Alignment
  • Improve Muscle Strength and Power
  • Improve Range of Motion
  • Improve Relaxation
  • Self-care of Symptoms
  • Improve Safety

Lymphedema

Lymphedema is the abnormal accumulation of lymph fluid in the tissue that causes persistent and progressive swelling. Lymphedema can occur anywhere in the body including an arm, leg, head or neck, breast, abdomen, or genitals. Primary lymphedema occurs because of a developmental defect in the structure or function of the lymphatic system. Those at risk have poorly developed or malformed lymphatic vessels, sometimes with a family history.

Secondary lymphedema can affect people of all ages who have had breast, gynecological, prostate, melanoma or head and neck cancer treatment which includes lymph node removal and/ or radiation therapy. Non-cancer related causes include infections, trauma and other surgeries. Lymphedema can develop weeks, months or years after surgery. Lymphedema is a progressive condition with no cure, but it can be treated. The standard treatment for Lymphedema is a customized program of complete decongestive Therapy.

Complete Decongestive Therapy Consists of :  

  • Manual Lymphatic Drainage
  • Education in prophylactic methods
  • Specialized compression bandages
  • Fitting for compression garment
  • Patient specific exercises
  • Skin care Ongoing self-care
  • Decongest the swollen area
  • Reduce fibrotic tissue
  • Avoid the re-accumulation of lymph fluid
  • Prevent and eliminate infections
  • Maintain normal or near normal size of limbs

Lymphedema Risk Reduction Practices

  • Avoid Trauma and injury to reduce infection risk
  • Keep extremity clean and dry
  • Apply daily moisturizer to prevent chapping/ chaffing of skin
  • Attention to nail care; do not cut cuticles
  • Protect exposed skin with sunscreen and insect repellent
  • Use care with razors to avoid nicks and skin irritation
  • If possible, avoid punctures such as injections and blood draws
  • Wear gloves while doing activities that may cause skin injury (washing dishes, gardening, working with tools, using chemicals such as detergent)
  • If scratches/ puncture to skin occur, wash with soap and water, apply antibiotics, and observe for signs of infections (redness, warmth, pain)
  • If a rash, itching, redness, pain, increased skin temperature, fever or flu-like symptoms occur, contact your physician immediately for possible infection
  • If possible, avoid having blood pressure taken on the at-risk extremity
  • Wear loose fitting jewelry and clothing
  • Consider wearing a well-fitting compression garment for air travel
  • All compression garments should be fit
  • Avoid exposure to extreme cold
  • Avoid prolonged (greater than 15 minutes) exposure to heat; particularly hot tubs and saunas

Lymphedema and Exercise

  • Exercise is an important part of a healthy lifestyle and can be performed safely for persons with lymphedema and those who are risk.
  • Persons with lymphedema can safely perform exercises using their affected body part(s) when
  • Compression garments are properly worn
  • The affected body part is not exercised to fatigue
  • Persons who are at risk for developing lymphedema can safely perform exercises when exercises are initiated at a low intensity and increased gradually.
  • Before starting any exercise program, you should be medically cleared.
  • Exercise should be started gradually, increased cautiously and stopped for pain, increased swelling or discomfort. Frequent rest breaks should be taken during activity.
  • It is recommended to discuss any exercise program with your therapist prior to starting.