How to Prevent Carpal Tunnel Syndrome

As more of us work from home, we are at a higher risk of developing overuse injuries including carpal tunnel syndrome. This is a common condition that is associated with pain, numbness, and tingling in the wrist and hand. This occurs when the median nerve, one of the major nerves that travels through the forearm and hand, becomes compressed as it travels through the carpal tunnel in the wrist. Common causes of this compression and irritation to the nerve include repetitive hand and finger use when typing and writing as well as poor wrist and hand positioning while performing these activities. Here are some suggestions to help prevent and treat this condition:

  1. Take breaks – If you find yourself doing a lot of typing throughout the day, make sure that you are taking a 10 minute break from typing every hour at the minimum.
  2. Keep your wrists neutral – Avoid excessive bending of the wrists in either direction to avoid increased compression on the nerve. As you type, try to keep your wrists in a neutral or slightly extended position
  3. Focus on posture – The positioning of the rest of your body, including your head, neck, and shoulders can contribute to symptoms all the way into the hands. As you sit at your desk, make sure that you maintain good posture by keeping your head upright, shoulders back, and avoiding a slouched posture.
  4. Stretch – Tightness in the muscles of the wrist and forearm can contribute to your symptoms. As you are taking a break every hour, stretch the muscles by pulling your hand and fingers back towards you and holding for 30 seconds at a time, as seen in the picture below.

 

Assistive Devices: One size does NOT fit all

Walkers, crutches and canes – oh my! Assistive devices are great tools to help those who need them increase both functional ability and safety. When someone is in need of a particular assistive device it is important to not only choose the right device for their needs, but to also make sure that it is adjusted appropriately in order to provide them with optimal function and safety. Often, people are either given or go out and buy an assistive device without any guidance on how to size it correctly. Using a device that isn’t appropriately fitted can cause safety hazards but also can put strain on other parts of your body. Below you will find general guidelines to adjusting common assistive devices.

Walkers 
– Use the buttons on the legs of the walker to make them shorter and longer.
– Make sure each leg leg of the walker is set to the same level.
– The handgrip of the walker should be at the level of the crease of your wrist with your arms down at your sides.
– If the walker is too high it will cause increased bending of the elbows and cause increased strain on the shoulders.
– If the walker is too low it will cause the person using it to slump forward, causing strain to the back.

Canes
– Similar to walkers, the height of a cane should be set to where the handle of the cane is at the level of the crease of your   wrist with your arms down at your sides.
– The potential consequences of setting a cane too high or too low are the same as with walkers with the addition of possible leaning of the trunk which can cause a higher risk for falls.

Crutches
– When sizing crutches, the bottom tips should be a few inches in front and to the side of your feet.
– Similar to walkers and canes, the hand grips the crutches should be level with the crease of the wrist with your arms down at your sides.
– The top of your crutches should be about 2 inches below your armpit.
– If crutches are adjusted too high, it can cause the top of the crutch to put increased pressure on the armpit which can lead to possible nerve damage.
– If adjusted too low, it can cause the individual to slouch over which can put strain on the back but also have an impact on the person’s balance.

These are only the guidelines for a few of the most common assistive devices seen in the community. There are many other types of devices that each have their own sizing standards for optimal use. If you or someone you know needs assistance in sizing a device, please consult a physical therapist to assist you to ensure a proper fit.

Written by: Dr. Taylor Ryan

How does Movement Help Injuries Heal? I’ve got a bone to pick.

If you’ve ever been to a physical therapist, you know that exercise is usually prescribed as the primary treatment for a number of injuries and conditions. Clearly exercise has numerous benefits, but it can sometimes seem counterintuitive to place resistance or load through an injured area — doesn’t it need time to rest and heal? The short answer to that question is generally yes, especially immediately following the injury; however, the appropriate amount of movement and exercise can actually promote healing and recovery.

My goal is to help you understand just how exercise helps restore normal functioning of injured body tissues. This article is part of a series that will discuss how various types of tissue depend on movement to recover. Today’s subject is bone.

In the case of fracture, bone is the exception to the rule of “get it moving ASAP.” Allowing a bone to fully heal is vital to maintaining its structural integrity throughout the rest of your life. However, once it is healed and in cases where the bone has begun to weaken such as osteoporosis or osteopenia, weight-bearing exercise is vital to maximizing its strength and reducing the risk of re-injury.

Exercise helps strengthen bone by increasing its density. Density is typically measured by something called a DEXA scan, which is used to diagnose osteoporosis/osteopenia. Over time, the density as measured by these scans is maintained or increased in response to exercise. However, these increases are site-specific, meaning that exercises involving your lower body will only increase the density of the bones in your lower body (and vice versa with your upper body). Of particular note is that in postmenopausal women — the demographic most affected by osteoporosis — exercise is shown to mitigate losses in bone mineral density. So, after speaking to your physician or physical therapist about which exercises are best for your condition, it’s time to get moving!

Now let’s get specific about the best types of exercise. Exercise that is in an upright position against gravity is considered most effective for improving bone health. Such exercises include walking, jumping, and resistance training with weights or bands. Bone thickens in response to these types of exercise because gravity and the physical pull of the muscle tendons on our bones elicits an adaptive response. Exercises such as swimming, while still very healthy for us, aren’t quite as effective for improving bone density.

Written by: Dr. Scott Newberry

How does Movement Help Injuries Heal? Tendons and ligaments.

If you’ve ever been to a physical therapist, you know that exercise is usually prescribed as the primary treatment for a number of injuries and conditions. Clearly exercise has numerous benefits, but it can sometimes seem counterintuitive to place resistance or load through an injured area — doesn’t it need time to rest and heal? The short answer to that question is generally yes, especially immediately following the injury; however, the right amount of movement and exercise can actually promote healing and recovery from injury. This is where PT comes in.

My goal is to help you understand just how exercise helps restore normal functioning of injured body tissues. This article is part of a series that will discuss how various types of tissue depend on movement to recover. Today’s subject is injured tendons and ligaments.

Tendon and ligament injuries range in terms of type and severity and are broadly categorized as tendinopathies or ruptures in the case of tendons and sprains in the case of ligaments. Examples of tendinopathy include tennis elbow, golfer’s elbow, and Achilles tendinopathy. You may have also heard the term “tendinitis” used with these conditions. Though complex and multifactorial in nature, tendinopathies often involve tissues that have become weakened and painful through repetitive usage. Ligament injuries are usually due to trauma — you’ve likely heard of athletes injuring their anterior cruciate ligament, or ACL.

Tendons connect muscle to bone, transferring the force produced by a muscle into a nearby bone to create movement. Tendinopathies often develop in situations where a person puts a repetitive load through a tendon over a sustained period of time. It is most likely to occur when the level of activity is increased relative to baseline (i.e., too much too soon), such as someone taking up tennis for the first time in a while or playing more matches than usual.

The sustained tendon stresses can cause areas in the tendon to become disarrayed and no longer align with the direction of applied force. In other words, the fibers aren’t able to convert muscle energy into movement as efficiently. The gold standard strategy to disrupt this process is to load the tendon through slow, heavy resistance training which stimulates the tendon to remodel itself and repair the injured areas. Eventually, the tendon becomes strong enough to handle loading without pain.

Ligaments connect one bone to another, protecting joints from moving in directions they shouldn’t. While ligaments are not exactly the same as tendons, the loading principles discussed with tendons allow them to handle higher loads through similar mechanisms — by increasing their thickness and the amount of force they can handle.

One very important thing to keep in mind is that immobilization is very detrimental to the strength and health of tendons and ligaments. Therefore, seeing a PT after injury may give you the best shot at retaining as much function as possible in the injured tissues.

Look out for the next article in the series about bones.

Written by: Dr. Scott Newberry

How does Movement Help Injuries Heal? Cushion for the Pushin’.

If you’ve ever been to a physical therapist, you know that exercise is usually prescribed as the primary treatment for a number of injuries and conditions. Clearly exercise has numerous benefits, but it can sometimes seem counterintuitive to place resistance or load through an injured area — doesn’t it need time to rest and heal? The short answer to that question is generally yes, especially immediately following the injury; however, the right amount of movement and exercise can actually promote healing and recovery from injury. This is where PT comes in.

My goal is to help you understand just how exercise helps restore normal functioning of injured body tissues. This article is part of a series that will discuss how various types of tissue depend on movement to recover. Today’s subject is cartilage, specifically the type that protects your joints from impact and is implicated in the onset of osteoarthritis. This type of cartilage is called articular cartilage. The scope of this article is how exercise helps a joint that is painful due to age- or activity-related changes, not acute articular cartilage injury due to trauma.

Articular cartilage covers the ends of bones where they connect to each other at joints. For instance, there is cartilage covering the end of your femur and the top of your tibia (shin bone) where they meet to form the knee joint. Over time, a loss of thickness in this tissue is normal and not always associated with pain. However, for many people, particularly those who aren’t very active, the loss of tissue can become painful and inflamed. This is termed osteoarthritis. It may seem counterintuitive that something often referred to as “wear and tear” is most common in people who don’t move very much and thus aren’t exerting much wear or tear on their joints. However, there is a distinct explanation for this phenomenon.

Cartilage receives most of its nourishment from nutrients being diffused or pushed into it from the fluid inside the joint. It does not have a very good blood supply like most of our other tissues. Therefore, it is reliant on movement to provide it with a fresh supply of nutrients; if you don’t move often, it doesn’t have a chance to receive adequate nutrition and degenerative changes can take place. The cushioning ability of the cartilage in terms of thickness and strength depends on frequent movement! Therefore, your PT will often address pain related to osteoarthritis using a graded exercise program.

Look out for the next article in the series about tendons and ligaments.

Written by: Dr. Scott Newberry

How Does Exercise Help Injuries Heal? Put some muscle into it.

If you’ve ever been to a physical therapist, you know that exercise is usually prescribed as the primary treatment for a number of injuries and conditions. Clearly exercise has numerous benefits, but it can sometimes seem counterintuitive to place resistance or load through an injured area — doesn’t it need time to rest and heal? The short answer to that question is generally yes, especially immediately following the injury; however, the appropriate amount of movement and exercise can actually promote healing and recovery.

My goal is to help you understand just how exercise helps restore normal functioning of injured body tissues. This article is part of a series that will discuss how various types of tissue depend on movement to recover. Today’s subject is muscle.

Muscle injuries are quite common. A “pulled” muscle occurs when a force strains the muscle fibers beyond their limits, resulting in tears that can range in size from very small to large. A common example of this in the sports world is a strain of the large muscles on the back of the thigh: the hamstrings. Muscle strains usually recover in a matter of weeks, though can take longer depending on severity.

So how does movement help? After the acute stage of the injury passes, generally within 5-7 days, a return to minimally painful movement helps stimulate the building of new proteins which repair the damaged areas. Movement also helps push inflammatory enzymes, many of which can cause our nerves to become more sensitive, out of the affected area while bringing a fresh supply of blood — and with it much-needed oxygen and nutrients — to the healing tissues. Lastly, moving a muscle is critical to maintaining its range of motion and preventing increased stiffness or motion loss. As more movement is tolerated, exercises should be progressed to continue facilitating the healing process, eventually allowing restoration of strength that matches or exceeds the pre-injured state.

Look out for the next article in the series about how cartilage responds to movement.

Written by: Dr. Scott Newberry

Making an Exercise Routine Fit Into Your Lifestyle

The World Health Organization (WHO) recently updated their exercise guidelines for adults to include 150-300 minutes of moderate intensity exercise and/or 75-100 minutes of vigorous intensity exercise. While this is the gold standard recommendation for maximizing the health benefits associated with staying physically active – and there are many such benefits – 2.5-5 hours of exercise per week can prove to be an intimidating prospect for many who don’t have a history or habit of hitting the gym (or home gym) on a regular basis.

I thus want to provide a less intimidating message for you to kickstart the habit of exercising on a regular basis: anything is better than nothing! The fear of failure associated with committing the time and resources associated with the WHO’s recommendations can foster an all-or-nothing mentality. This ultimately results in exercise “kicks” and burnout for many people, even when they have the best intentions of staying committed to fitness. I thus offer you an out: start small. Recent research has found even 30 seconds each of pushups and squats in the morning can yield benefits when it comes to strength and aerobic fitness. If you establish a routine this simple, you can gradually begin adding more exercises over time. Before you know it, it’ll become an embedded part of your day much like brushing your teeth or taking a shower. With time, you may even find yourself incidentally adhering to the WHO guidelines. No better day than today to get started!

Written by: Dr. Scott Newberry

What is a Meniscus Tear?

A meniscus tear is a common injury that occurs to the cartilage in the knee. Each knee contains 2 menisci that help to absorb shock in the knee and stabilize the joint. An injury to these structures can occur as a result of a quick movement such as forcefully twisting the knee while putting weight through it. This can cause pain, swelling, stiffness, and difficulty extending the knee fully.

If the tear is severe enough, surgery may be necessary. However, research studies have shown that improvements in pain and function are similar whether you have surgery or physical therapy.  With that being said, going through a course of physical therapy first is the best course of action in the majority of cases and will help to determine if further action such as a surgery is necessary if you do not fully recover from the injury.

If you have suffered from a meniscus tear, a physical therapist will help you to decrease your pain, restore the movement in your knee, and work on strengthening and stabilizing your knee joint. The goal of physical therapy is to allow you to return to all of the activities that you enjoyed previously while simultaneously decreasing the risk of an injury occurring again.

Written by: Dr. David Reymann
Staff Physical Therapist at Harbor Physical Therapy

The Importance of Prehab

Prehab, short for pre-habilitation, is a type of intervention intended to prevent injury or to prepare one for surgery in order to optimize post-surgical outcomes. In the world of physical therapy and athletics, this can include incorporating strength and stability exercises into athletes’ training programs to prevent injuries when they are on the field.

Prehab can also be helpful for those requiring any type of orthopedic surgery such as a joint replacement or ligament reconstruction. By building up strength and general fitness prior to surgery, the risk of complications post-operatively decreases and the functional recovery tends to be quicker. During prehab, patients are educated on what to expect after surgery which can help them feel more prepared for any adjustments they may have to make including any activity modifications.

Prehab is covered by all health insurances.  This is due to health insurances also seeing the benefits of prehab as it cuts down on sport injuries and duration of physical therapy required after a surgery.  If you are interested in learning more about how you could benefit from prehab, feel free to email Harbor Physical Therapy at info@machtmedicalgroup.com to learn more.

Written by,
Dr. David Reymann

 

What Does “Bone-on-Bone” Arthritis Really Mean?

Arthritis — or, more specifically, osteoarthritis (OA) — is one of the most common causes of joint pain and stiffness. It primarily affects knees and hips due to their nature as high load-bearing joints; however, it is known to impact nearly every joint in the body including the spine, shoulders, and wrists. Many people diagnosed with OA are told that their X-rays show “bone-on-bone” joint degeneration. This may sound quite scary and even unsolvable without joint replacement, but the current osteoarthritis research may surprise you when it comes to risk factors for pain and the effectiveness of non-surgical interventions.

Let’s use knee OA as an example: according to epidemiological data, over 50% of people with X-ray confirmed OA (loss of the cushioning cartilage that protects the knee joint) do not report experiencing pain, stiffness, or activity limitations. Furthermore, progression of OA severity on X-ray does not correlate with progression of clinical symptoms. In other words, the way someone’s knee looks on an image does not predict how much pain they will have. In fact, it is so common for people older than 30 years old to display OA on an image that practitioners have begun calling the diagnosis “symptomatic knee OA” rather than just “knee OA.” You are more than just your X-ray!

One variable that does predict the amount of pain and disability experienced with OA is one’s activity level. The cartilage that helps protect your joints requires nourishment to stay healthy; this nourishment is supplied in part by the movement of the joint. Every time you take a step or do a squat, protective fluid is forced in and out of your knees and hips. As you move more and more, the joints become healthier as more nutrients are supplied to the tissues. Even if there isn’t much cartilage left (“bone-on-bone”) the lubricating fluid can do its job more effectively when you keep the joints moving. This is the reason many people with OA start to feel better with moderate amounts of exercise!

If pain should occur, numerous research studies have found exercise-based interventions, including physical therapy, to be extremely helpful to manage OA. By increasing muscle strength, improving how well joints are being lubricated, and maximizing the health of the remaining joint cartilage, a rehabilitation program can be quite helpful to those in pain. The most important thing to remember is don’t be afraid to move!  If you are experiencing joint pain, contact Harbor Physical Therapy to learn what specific exercises can help improve your symptoms.

Written by:
Dr. Scott Newberry