Posted on 6/12/2017 by Heather N. Wnorowski, P.T., DPT, OCS
Across the country, baseball and softball season is in full swing. Whether it’s at a backyard barbecue or an official game, athletes of all skill levels are taking part in America’s favorite pastime.
Over the past few years, a large emphasis has been on the youth athlete and overuse injuries in pitchers. We have learned to monitor pitch counts, plan structured rest and encourage multi-sport participation with athletes.
But what about outfielders, catchers and the weekend warriors who enjoy playing in their neighborhood league?
Common injuries aside from the shoulder and elbow exist in youth and adult baseball/softball athletes, such as back pain, knee pain and Achilles injury. Many overhead athletes have concurrent complaints of back pain or contralateral knee pain (knee pain opposite of their throwing arm). Why?
When you think about baseball and softball, a player is doing rotational movements that require the entire body. Unless they switch hit, these rotational patterns are always to the same side. What then happens is they may overdevelop certain muscular groups on one side in comparison to the other. In doing so, this can cause overuse injuries of these groups or we may injure or strain ourselves doing normal daily activities due to this imbalance.
The easiest way to avoid injury at practice or during a game is to develop a proper warm-up routine. An adequate warm-up usually involves a little bit of sweat, which can be hard to get in the dugout. Try performing some of these full body movements to warm-up quickly and efficiently:
Overhead walking lunge
Heather Overhead Lunge
Split squat with one foot on the dugout bench
Heather Split Squat
Lunge with trunk and arm rotation
Heather Lunge Rotation
Shoulder rotation with banded pull aparts
Heather Band Rotation
PNF diagonal pattern with banded pull aparts
Heather PNF Bands
Incorporating a low back and abdominal strengthening routine into your normal strengthening routine is also recommended. To be most efficient, you need a good transfer of force between the upper half and lower half during throwing or batting. Without a solid core, athletes with lose force and become less effective. Abdominal exercises that require rotation in both directions, isometric holds (planks, side planks), and lumbar extension strengthening should all be incorporated into your programming.
Heather Stretch 1 Heather Stretch 2
Having a good balance of strength (right and left sides comparable) and a solid warm up routine will help to prevent injury and enhance performance. Hopefully these tips prepare you for your season and keep you healthy on the field. Best of luck in your upcoming season!
By: Heather N. Wnorowski, P.T., DPT, OCS. Heather is a staff physical therapist at our NovaCare Rehabilitation center in Sewell, NJ. She earned a doctorate of physical therapy from Widener University and is dedicated to developing efficient avenues of treatment to influence superior patient outcomes.
Posted on 5/26/2017 by Aileen Lysaught, M.S., CCC-SLP
Join NovaCare Rehabilitation and Select Physical Therapy as we shine a light on Better Hearing and Speech Month (BHSM)! BHSM is hosted each May by the American Speech-Language-Hearing Association which works to make effective communication accessible and achievable for all.
Being a first time mother, you don’t really know what to expect after your child is born. My son Rowan was born unexpectedly at 35 weeks. While I was in labor, the nurses warned me of all the complications that may occur with a premature baby. The neonatologist was present for the delivery, and my son was quickly whisked away before I could hold him. While he was being examined by the doctors, I couldn’t wait to hold him for the first time. I could hear him crying as well as the nurse saying, “It looks like he has a tongue tie; my grandson had one, too.”
It seemed slightly ironic, being a Speech-Language Pathologist (SLP), that my son would have a tongue tie; however, I was too overjoyed with his birth to worry about the consequences of this during our first moments together.
When I looked in Rowan’s mouth, I could see he had what’s called a Class 1 tongue tie (the small fold of membrane that normally extends from the floor of the mouth to the midline of the bottom of the tongue attaches all the way at the tip of the tongue). This would significantly impact his ability to move his tongue for feeding.
Our first attempt at breastfeeding was when things became difficult. Being a preemie, he had some difficulty feeding as the sucking pads are not developed in babies born prior to 37 weeks. The tongue tie also made it difficult for him to coordinate the movements necessary for breast or bottle feeding. So, being an experienced SLP, I knew to ask, “When can we have the ear, nose and throat (ENT) doctor come do the frenectomy?”
A frenectomy is a procedure for children struggling with speech or feeding difficulties related to tongue tie. This procedure would help my son improve his feeding skills and get the adequate nutrition needed. The next day, the ENT arrived and quickly performed the procedure. By our first pediatrician appointment the following week, he was back up to his birth weight and then some.
As time went on, I noticed some symptoms in my son that led me to believe he still had tongue restriction and a potential lip tie. He suffered from reflux, which caused him to arch his back and become fussy after feedings. He was gassy and didn’t sleep very well.
Aileen and RowanI began to research as much as I could about tongue tie in babies and children. I took courses and joined support groups for other parents with tongue tie babies and groups in which SLPs would discuss their experiences with tongue ties. I found that some of the other symptoms my son was experiencing could be related to his tongue tie. I also found that many physicians or dentists who are not specially trained in tongue tie may not perform complete revisions, which may result in the need for a second procedure. By this time my son was six months old.
After a lot of research and careful consideration, I went to see a pediatric dentist who was highly recommended and performed successful frenectomy procedures on many of my patients with great outcomes. I was worried, but I couldn’t help but think about how many times I have recommended a family to have the procedure done. The pediatric dentist we saw was extremely knowledgeable.
After he examined my son, the dentist said Rowan’s initial frenectomy was likely incomplete and he would have to use a laser to perform another revision on Rowan’s tongue as well as revise his lip tie. I trusted his recommendation and the procedure took less than five minutes.
I knew the importance of aftercare procedures, including stretching 10 times per day for 10 days and oral motor exercises to improve Rowan’s tongue’s strength and range of motion. I noticed significant improvements in his feeding abilities, ability to babble and gross motor development. Now that Rowan is a little over a year old, has well over 20 words in his vocabulary and is beginning to eat a variety of foods, I couldn’t be happier that he is able to move his tongue freely.
My situation was quite unique being a practicing pediatric SLP with experience in this area. Many mothers struggle and have to give up their attempts at breastfeeding before they discover what may be impacting their child. Many babies have difficulty with weight gain, suffer from reflux or are diagnosed as colicky when the issue lies in their tongue’s ability to function correctly. Parents may not realize their child has a tongue restriction until they have been diagnosed with a speech delay or struggle with a toddler who refuses to eat.
Tongue ties impact many areas of speech and feeding development, and it is important to find knowledgeable professionals to help with the process. It is essential to work with a SLP who can evaluate and identify if a tongue restriction exists and treat the symptoms (speech and feeding difficulties). It is also important to get referrals to an ENT or pediatric dentist to determine if a frenectomy is advised.
Having experienced these issues first hand, I feel that it not only makes me a better mother, but a better SLP. I am dedicated to helping other families overcome these difficulties so their child’s quality of daily life can improve.
Aileen LysaughtBy: Aileen Lysaught, M.S., CCC-SLP. Aileen is a pediatric SLP and the assistant center manager at NovaCare Kids Pediatric Therapy in LaGrange, IL. She has been a practicing SLP since 2010.
Posted on 3/18/2019 by Martin Ryan, C.P., CFO, FAAOP | Comments
How does a prostheses attach? Great question and one that has a number of possible styles for the below the knee patient.
Suspension systems in prosthetics come in a number of configurations. One system common today is the mechanical pin lock system. A pin is attached to the distal liner and inserted to a lock mechanism that provides the interface for suspension. The system is clinically referred to as the Below Knee Prosthesis with a Pin Locking Liner.
Pin lock suspension can be used with patella tendon bearing (PTB), total surface bearing or hydrostatic socket design. With pin lock liners, a silicone liner is rolled onto the residual limb creating a seal between the skin and the liner. The liner has a pin on the end that locks into the bottom of the prosthetic socket. A prosthetic sock may be worn over the silicone insert in order to allow for volume fluctuations.
PUTTING ON THE PROSTHESIS:
Turn the liner inside out. Make sure the liner is clean and dry and has no dirt on it that will irritate the skin.
Make sure a good portion of the bottom end of the liner is exposed and place it against the limb. (Figure 1) With light pressure, roll it up and over the limb. Make sure no air pockets exist between the liner and the skin.
Roll the liner up the limb. (Figure 2) Do not pull or tug. Be careful not to tear or puncture it with fingernails or jewelry.
Pay close attention to the placement of the pin. In most cases, it should be in line with the limb. Be careful not to pierce the liner with the pin.
When using a liner without a fabric cover, a lubricant may be necessary. Consult with your prosthetist to determine the best lubricant for your use.
Add the appropriate thickness of prosthetic sock over the liner, if necessary.
Push the residual limb into the prosthetic socket. The pin will insert into the lock and click down as the limb goes into the socket. It should take some effort to put on the prosthesis. If it clicks down easily, a thicker prosthetic sock may be needed. (Figure 3)
REMOVAL OF YOUR PROSTHESIS:
Push and hold the lock button in and lift the limb out of the socket.
CLEANING AND MAINTENANCE:
The prosthetic socks and sheaths should be cleaned according to the manufacturer’s directions. The soft insert and the prosthetic socket may be wiped out with warm, soapy water or alcohol as needed. Clean socks should be worn every day.
TIPS AND PROBLEM SOLVING:
One of the most difficult concepts to master is how to determine the correct sock ply to wear. Wearing the correct amount of socks is critical for comfort and safety. Your prosthetist and physical therapist will supply you with general guidelines in wearing socks, but if you have questions do not hesitate to contact or visit your prosthetist.
OH NO, IT’S STUCK:
It can happen. You get stuck and the pin will not release. Many times, the sock has covered the pin and is providing in ability of the pin to release.
Do not panic. In most instances, some consistent pulling will release the pin and free the lock. Ask someone to assist you in this process if necessary.
In extreme cases, pour soaping water into the liner next to the skin breaking suction and allow it to release from the prostheses and work free.
Contact your prosthetist.
For more information on the Below Knee Prosthesis with a Pin Locking Liner, please contact a NovaCare Prosthetics & Orthotics centers near you.
By: Martin Ryan, C.P., CFO, FAAOP, is prosthetist for NovaCare Prosthetics & Orthotics. Marty is certified in advanced prosthetic designs for adults and pediatrics. He received prosthetic training at Northwestern University and the Rehabilitation Institute of Chicago. Marty is certified in prosthetics by the American Board for Certification and works out of NovaCare P&O’s Fond du Lac center in Wisconsin. NovaCare Prosthetics & Orthotics is part of the Select Medical Outpatient Division family of brands.
Posted on 2/9/2017 by Melissa Bloom, P.T., DPT, NCS
One of the many myths pertaining to concussion is that you need a big blow to the head to get one, or that getting your “bell rung” isn’t a big deal. In fact, any impact to the head, neck, or body has the potential to create changes to the neurological function of the brain, or cause a concussion. While you most certainly can get a concussion from a high intensity football game or from a car accident, they often occur after what
may seem like a fairly light bump.
I’ve seen people with significant concussion symptoms from slipping and falling on ice, accidentally hitting their head on a cabinet door, getting elbowed in the head, or having luggage hit their head while unloading it from a plane. Additionally, I see patients from motor vehicle collisions where they never even hit their head and I see athletes where no one can pinpoint a specific hit. However, these individuals may be showing signs of post-concussion symptoms after the accident or game.
Similarly, a common myth is that you need a loss of consciousness or at least will “see stars” in order to have a concussion. In fact, a loss of consciousness is quite rare post-concussion, with occurrences of less than four to 10 percent.
An invisible condition
What makes concussions more complicated is their invisible nature. Unlike a cut or even a broken bone where we can see a bandage or a cast, the symptoms of a concussion often go unseen. The most common symptoms are:
Foggy or difficulty thinking
Blurred or double vision
Sensitivity to light or sound
Changes in sleep patterns
Increases in anxiety and irritability
While the symptoms are real and can significantly impact someone’s ability to function, peers, family, co-workers and friends cannot see them.
Return to sport and return to life
Awareness and education are key to help diagnosis concussions and to help those with persistent symptoms get the proper care they need to recover. An important first step can be recognizing anyone who may be showing any of the symptoms listed above that could be connected to anyphysical impact, no matter how much of “just a bump” it was. Despite how or when someone sustained a concussion, an active rehabilitation program can help. Our concussion management clinicians complete comprehensive examinations to assess the multiple systems that are often involved post-concussion and will develop an individualized plan of care unique to each person and case.
In the past, the primary treatment for concussion was rest; it has even been called “cocoon therapy.” However, current research shows that activity and stimulation is better than excessive rest. That doesn’t mean, though, that you should go full force into your previous activities. Symptoms should be monitored and controlled; this may vary depending on the underlying factors specific to a concussion. As long as you have remaining symptoms post-concussion, having an evaluation and treatment plan set for you can help guide your activity levels and ultimately get you back to your normal symptom-free life. Treatments will depend on your individual test results, but will likely be a combination of visual exercises, vestibular rehabilitation, neck treatments, or a sub-symptom exertion program.
Common rehabilitation components
Visual exercises are provided when symptoms are due in part to your eyes not communicating well with each other and the brain. These exercises tend to involve having your eyes work more efficiently to reduce symptoms and increase visual clarity. This can involve simple eye movements or complicated tasks of watching a busy scene with many moving items.
Vestibular rehabilitation is indicated when the inner ears are somehow involved. These treatments can also be varied, but typically involve some type of head movement. You may initially get dizzier with these exercises, but they are effective in eliminating symptoms in the end.
Neck treatments may involve addressing any neck pain you have post-injury. More often than not, neck pain means that the sensors in the neck are not communicating well with the brain, leading to fogginess, dizziness, imbalance, or headaches. Specific exercises can retrain these receptors and in turn eliminate remaining symptoms.
Sub-symptom exertion training is frequently needed post-concussion. These exercises are designed specifically for you based on your heart rate, and are intended to allow the brain to safely heal and handle the physiologic challenges needed for daily physical and mental activities.
Balance and functional training may be included to make sure you are in tip-top condition to safely get back on the field or get back to work, play, and or life.
Unfortunately, there is not a lot we can do for concussion prevention. A concussion is different than other brain injuries where there is focal damage. The changes we see post-concussion are due to sheering or pulling forces on the nerves of the brain, which in turn changes the effectiveness in how they work. Protective devices, such as helmets or mouth guards, cannot prevent these forces from occurring. They are important in preventing skull or jaw fractures or cerebral bleeding, but their limitation with concussion protection is an all too common misconception. In fact, using equipment that does not protect against concussion while perceiving there is preventative value may lead to more risky behavior and possible paradoxical increase in concussion rates.
The best thing we can possibly do is be vigilant about injuries, symptoms and being sure to take the necessary steps toward recovery. We can help you.
Melissa Bloom By: Melissa Bloom, P.T., DPT, NCS. Melissa is a physical therapist with Physiotherapy Associates in Atlanta, GA. Melissa is a board certified neurology specialist. She specializes in vestibular rehabilitation and concussion management and teaches nationally on both topics.
Physio, NovaCare Rehabilitation and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.