Clinical Question

Hip Bursitis

According to the AAOS (The American Academy of Orthopedic Surgeons), hip bursitis is the inflammation of the bursa, a small jelly-like sac that contains a small amount of fluid. Bursas are found in several joints of the body, such as, the shoulder, elbow, hip, knee, and heel. The bursa provides a cushion within the joint.  This helps to decrease the amount of friction between the muscles moving around the joint.

Symptoms of hip bursitis include pain at the outside of the hip joint and side of the leg. The pain can be sharp initially and become achy later. Pain increases at night when side-lying on the affected hip and transferring from a chair after sitting long-term. Pain can also be present with walking, stair climbing, and squatting.

Some causes for hip bursitis can include repetitive stress, landing on your hip during a fall, a leg length issue, and rheumatoid arthritis.

Treatment for hip bursitis may include modifying activities that cause pain, anti-inflammatory medication, using a cane or crutch to take weight off of the affected leg, physical therapy, and possibly cortisone injections.

Physical therapy helps to reduce inflammation in the bursa by the use of ice, ultrasound, stretching, and strengthening exercises.

What is a Stress Fracture?

A stress fracture is an incomplete fracture of bone caused by repetitive stress.  It is found within a weight bearing bone, such as the bones within the foot. A stress fracture has also been termed a “hairline fracture”. Symptoms of a stress fracture include tenderness in the area and pain with weight bearing.

Stress fractures commonly occur in athletes that play sports requiring excessive running.  They also occur in sedentary people who begin to exercise.  This happens because their body is not used to exercise; therefore, it is overwhelmed by the repetitive weight bearing forces.  Stress fractures can occur from muscle fatigue.  Our muscles help to provide stability, support, and shock absorption for our bones.  If these muscles become fatigued, our muscles ability to perform the role of shock absorption decreases.  This causes increased risk for a possible fracture. 

After a stress fracture, rehabilitation consists of decreasing weight bearing on the fractured bone to allow it to heal.  After the bone heals, physical therapy is often recommended to strengthen the muscles surrounding the injured bone to return the patient back to all daily activities and to prevent re-injury.

Types of Medications Commonly Taken by Patients

Pain Medication

Some examples of pain medication are oxycodone, motrin, and codeine.  When you experience pain, the nerves in the body send a signal to the brain so you perceive pain.  Pain medications decrease pain by slowing down or blocking the pain signal to your brain.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

The most common NSAID is aspirin.  Prostagladins are synthesized by cyclooxygenase to cause inflammation.  By taking a NSAID, it inhibits cyclooxgenase.  This prevents this cycle from taking place, causing decreased pain/inflammation.  There are COX1 and COX2 enzymes and aspirin inhibits both.  COX1 enzymes help to protect the stomach and kidney lining.  Therefore, a side effect to taking aspirin is gastric damage and decreased renal function.

Muscle Relaxants

Examples of muscle relaxants are baclofen, flexeril, and skelaxin. Muscle relaxants are used to treat muscle spasm and spasticity.  They are used to decrease muscle excitability by acting on the spinal cord or directly within the muscle fiber. Muscle relaxants increase the activity of GABA (gamma aminobutyric acid) receptors, which inhibit excitatory neurons. This causes the skeletal muscle to receive fewer signals and relax.

All the above medications are commonly taken while receiving physical therapy.  They help the patient to progress through physical therapy by alleviating pain, inflammation, and muscle spasm.  These medications should be regulated by a physician to insure proper dosage and duration of usage.

What is Electrical Stimulation?

Electrical stimulation is a treatment modality used by physical therapists to help relieve pain.  Electrical stimulation uses a low voltage electrical current to stimulate nerves and sends signals to the brain that block or interrupt normal pain signals. It can be used for muscle pain, joint pain, tendonitis and bursitis.

Another use for electrical stimulation is to strengthen muscles. This type of stimulation is called NMES (Neuromuscular Electrical Stimulation). When there is muscle weakness (atrophy), electrical stimulation is used to elicit a contraction of the muscle. The electrical impulses work to retrain muscles to function normally. This is most commonly used after ACL surgery and a stroke.

Electrical Stimulation

How to Prevent Back Injury with Lifting and Household Chores

Many of us have gone to pick something up from the floor or move a piece of furniture and felt some type of back discomfort.  Good body mechanics during lifting or moving objects can prevent back injury by putting less strain on your back muscles.  Listed below are guidelines to prevent back injury with lifting and household chores.

Guidelines to prevent back injury with lifting

  1. When lifting an object, stand with your feet shoulder width apart or 1 foot in front of the other.
  2. When picking something up off the ground, bend with your knees and hinge at your hips keeping the normal curves in your back.  Do not slouch forward.
  3. Also, tighten your lower abdominal muscles (refer to blog topic- Can back pain be prevented?) and maintain the contraction throughout the lift. Your abdominal muscles and your back muscles work together to give support to your spine.
  4. When lifting, keep the object close to your body.
  5. Use your legs and buttocks to straighten back up, not your back.
  6. Carry things at waist level.
  7. If you must reach for the object, stand on a chair or stool.  Do not arch your back.
  8. PUSH, do not pull when you are moving an object.

Guidelines to prevent back injury with household chores.

  1. Washing dishes– to decrease back strain at the sink, open the base cabinet and put your foot up on the ledge to become closer to the sink.
  2. Vacuuming– Walk with the vacuum or lunge forward onto one foot keeping your back straight, rather than bending forward with each push of the vacuum.
  3. Making the bed– Put one knee down on the bed when fastening a sheet to the corner of the mattress or squat to fasten it.
  4. Grooming– Put one hand down on the counter in the bathroom while using the other to brush your teeth or shave. Also, you can put a foot up onto the ledge of the base cabinet as in the kitchen.

Bending at knees for objectLifting objectLifting object

Plantar Fasciitis

What is Plantar Fasciitis?

Plantar Fasciitis is an irritation of the thick ligamentous connective tissue on the bottom of the foot. This band of tissue runs from the heel to the ball of the foot providing support for the arch of the foot.  Plantar fasciitis is common in runners.

Causes of Plantar Fasciitis

1. Over pronating with walking/running– pronation is where the inside of the foot touches the ground more than the outside.

2.  Wearing old shoes– shoes lose their support after approximately 500 miles of wear.

3.  Excessive walking with improper foot support– shoes that do not provide arch support.   An orthotic might be needed to provide increase support to the arch of the foot.

4.  Tight calf muscles

Symptoms:

Pain is felt at the bottom of the heel.  Pain is usually worse in the morning and improves throughout the day.  Pain increases with prolonged standing or sitting.

Treatment:

1.  Rest

2.  Ice

3.  Massage to the bottom of the foot

4.  Stretching– refer to the previous blog topic on Why does my calf cramp?  How do I relieve it?

5.  Night splinting

If the pain is still present, physical therapy can help with Plantar Faciitis.  Consult with your physician or physical therapist to determine the next step for you.    If you have any questions about Plantar Fasciitis, please contact Harbor Physical Therapy.

 

Cause and Treatment for Calf Cramps

Muscle cramps can occur from overexertion, dehydration, an electrolyte imbalance, and inactivity. During a muscle cramp, the muscle shortens causing sudden severe pain. Muscle cramps can develop from pointing your toes in bed.  Also, it is common in women who are pregnant.

If you experience a muscle cramp in your calf, try to walk it off.  If that does not work, massage and apply heat to your calf.  Then, stretch the calf to loosen the muscle and prevent further muscle cramping.

Calf Stretches

  1. Runner’s Stretch– Stand with your hands against the wall, with your feet staggered, lunge towards the wall. The calf you are trying to stretch should be in the back.
  2. Calf Stretch with Strap– sit with your legs in front of you and pull your toes toward your knee.
  3. Calf Stretch on Step– Stand on a step, lower the heel of the cramping leg to get a stretch.  Hold onto a railing for support.

If you are prone to calf cramps, you should stretch regularly.

Runner's Stretch
Calf Stretch with StrapCalf Stretch on Step

How to Reduce Inflammation by Changing your Diet

Swelling and inflammation are problems that can lead to the pain you are feeling.  To help decrease inflammation, and therefore pain, it is important to follow a healthy, well-balanced diet. The Food Guide Pyramid can help you to make wise choices by including a variety of whole grains, fruits and vegetables and eating sugar, sodium and fat in moderation. It is also important to choose more fresh foods and limit processed foods, as these have been known to lead to inflammation.

Grains:

  • Choose whole grains like whole wheat bread, brown rice, and whole grain cereals.
  • Try to avoid processed or refined grains- meaning that they are white and the good parts (fiber and B-vitamins) have been removed.

Vegetables and Fruits:

  • All are good sources of fiber, vitamins, and minerals.
  • Make sure to get a variety of color to get all of the nutrients and aim for at least 5 servings daily.
  • Vitamin C
  • An antioxidant that fights inflammation
  • Supports healthy connective tissue
  • Involved in collagen formation
  • Sources: broccoli, melons, oranges, mango, sweet potato, spinach, collard and mustard greens, strawberries, red bell peppers, kiwi, pineapple, Brussels sprouts, tomatoes
    • Magnesium
    • Works with calcium to promote bone formation
    • Sources: seeds, nuts, legumes, unrefined cereal grains, dark green leafy vegetables
      • Antioxidants and Phytochemicals
      • Have anti-inflammatory properties
      • Choose berries and other brightly colored fruit and vegetables
        • Boron
        • Some studies have shown this trace mineral to help with osteoarthritis
        • Helps cartilage and bone to absorb calcium
        • Sources: apples, legumes, leafy vegetables, carrots, pears, grapes, grains, some drinking water

Fats and Oils:

  • Total fat 25-35% of calories
  • Choose healthy fats from unsaturated sources
    • Olive oil has been shown to reduce pain and inflammation – can be used in place of vegetable oil in baking
    • Focus on Omega-3 fatty acids
      • Powerful anti-inflammatory agent
      • Sources: cold water oily fish (salmon, tuna, mackerel, anchovies, herring, sardines, lake trout), walnuts, flaxseed, canola oil, pumpkin seeds, soybeans
      • Speak to your doctor if you are interested in adding fish oil for flax supplements
      • Limit saturated fat from animal sources to less than 7% of total calories
        • An 1800 calorie meal plan should have <60 grams total fat and <14 grams saturated fat

Dairy:

  • Choose low fat or fat free dairy products daily
    • Low fat calcium products have been found to promote wt loss
    • Calcium
      • Contributes to positive bone growth and maintenance of bone density
      • Sources: low fat/fat free milk, yogurt and cheese, fortified soy milk and orange juice, dark green leafy vegetables, canned sardines and salmon with bones
      • Vitamin D
        • Low levels of vitamin D can lead to more rapid progression of osteoarthritis
        • Sources: fish-liver oil, butter and cream, egg yolks, liver, fortified milk and dairy products, fortified cereals

Protein:

  • Needed to build healthy tissues
  • Choose lean poultry, fish and seafood, nuts, legumes and seeds
  • Fatty red meat may trigger inflammation- choose lean cuts and limit
  • Soy proteins
    • May held reduce pain and inflammation
    • Sources: soybeans, soy nuts, tofu and soy milk
    • Try to limit processed soy foods
Foog Guide Pyramid
Food Guide Pyramid

Written by Julie Katz, Registered Dietitian- Baltimore, MD

 

Sitting Posture at the Computer

How to Maintain Good Sitting Posture at the Computer

We spend a lot of time sitting in front of the computer. Sitting at the computer improperly can lead to injuries at the neck, back, wrist and elbow.  Below are guidelines to help maintain good posture while sitting in front of your computer.

  • To support the low back while sitting, make sure to sit with your back touching the back of the chair and use a lumbar support.  The lumbar support should fill the space in the curve of the low back to avoid pressure on your spine and reduce muscle fatigue in the low back muscles.
  • Your feet should sit comfortably, flat on the floor.  If they don’t reach the floor, use a footstool. Your hips should be slightly higher that your knees.
  • Do not twist or reach while you are using the computer and make sure your work is in front of your body.  Your wrists should be straight and avoid using a wrist rest.  A wrist rest tends to put a strain on the neck and shoulders because it elevates the height of your wrist from the table surface.  Your keyboard should be at elbow level and you want your elbows and upper arms resting close to your body.
  • The computer monitor should be an arms length distance away from you (about 20 inches). Your eyes should be in line with a point on the screen 2-3 inches below the top of the monitor.  Research suggests that having the center of the screen 17.5 degrees below eye level is optimal for neck alignment and for reducing glare.
  • Try to take breaks from sitting because being in one position for too long can stiffen muscles.  A couple of exercises you can do during the day to prevent neck stiffness includes: rolling the shoulders forward and backward, gently rotating your head, and side bending your head to stretch the neck muscles.

Physical Therapist vs. Chiropractor

Many patients are curious about the difference between these two health practitioners.

Chiropractors specialize in manipulating bone structure (such as the spine) to improve the function of the joints and or nervous system.  They are very well known for manipulating the spine to help decrease low back pain.  A lot of patients frequent a chiropractor’s office several times a year for many years to manage their ailments.  A chiropractor has an aggressive approach to treatment.

Physical Therapists specialize in treating injury or dysfunction with exercises, manual techniques, neuromuscular re-education, and postural re-education to improve function throughout life.  A patient will attend a physical therapist 2-3 times a week for on average 6 weeks to improve function/decrease pain and gain education on how to further these gains with independent exercise.  Physical Therapy is a conservative treatment option and one which should be used in the first line of defense against injury.

In my professional opinion, it is in the patient’s best interest to understand the difference between these two disciplines before choosing the treatment option that is appropriate.  With acute injury, one should first go to a physical therapist.  If the patient has tried physical therapy and finds they have not met their goals, then they should look into seeking a chiropractors services.  A chiropractor offers more of an aggressive approach to treatment by using manipulations so a lot of times this is inappropriate for an acute injury, such as a car accident, ankle sprain, sport injury, etc.

If you are unsure what type of discipline best suits you, feel free to contact Harbor Physical Therapy with questions.