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 5/10/2017 by Jamie McGaha, OTD, OTR, COMT, CEASI
Join NovaCare Rehabilitation and Select Physical Therapy as we celebrate National Arthritis Awareness Month! Recognized each May by the Arthritis Foundation, arthritis impacts more than 50 million people in the United States and is the number one cause of disability in the country. Did you know there are more than 100 types of arthritis? Currently, one in five adults is affected by at least one type of arthritis1. By 2030 an estimated 67 million adults will have doctor-diagnosed arthritis, with two-thirds being women2.
The hands are one of the most common sites for arthritis. The most functionally limiting type of hand arthritis affects the base of the thumb, also known as basal thumb arthritis or first carpometacarpal osteoarthritis (OA).
In the past, we thought the only way to alleviate pain from thumb OA was to rest the joint in a splint and not exercise. Now we see too much time in an orthosis can make the thumb weaker and it may even be harder for you to do things when you take the brace off.
New evidence in the field of hand therapy has taught us that there is so much more we can do other than rest and that it is important for the joints’ health to move! We have found that by understanding our own thumb anatomy and learning how to find the correct muscles in the thumb, we can strengthen weakened or disused muscle, helping to stabilize the arthritic joint. We can also decrease overuse and tightness in muscles that are working too hard because others are not helping. Better muscle function and greater stability can contribute to less pain and decrease time you need to rest or use an orthosis.
Not all thumb OA is alike. A visit to your hand therapist would allow you to find out which muscles are tight and which are weak. Together, you and your hand therapist would then design an individualized plan of care for your symptoms related to the activities you desire to do.
The right exercises can be so effective that the joint can become better aligned; this has been shown with healthy thumbs on X-ray3. Your hand therapist can also help you to determine when to wear your orthosis and when not to, so your thumb has the appropriate support at the correct time.
There are many new techniques being used in therapy. It’s even hard for the physicians to keep up to date on all the new techniques! Checking in regularly with a hand therapist may provide solutions to many of your aches, pains and limitations from hand and thumb arthritis.
Barbour KE, et al. Vital Signs: Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitations- United States 2013-2015. MMWR 2017; 66(9); 246-253.
Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006;58(1):26–35.
McGee C, Adams J, Van Nortwick SS, O’Brien VH, Van Heest AE. Activation of the first dorsal ineterossesous muscle results in radiographic reduction of the thumb CMC joint: Implications for arthritis prevent [abstract] Paper presented at The British Society for Surgery of the Hand; January 2015.
Jamie McGahaBy: Jamie McGaha, OTD, OTR, COMT, CEASI. Jamie is a licensed occupational therapist focusing on hand therapy and upper extremity rehabilitation with Select Physical Therapy in Austin, TX. She completes ergonomic assessments and has experience with ergonomic interventions. Jamie is also an assistant faculty member for anatomy at the University of St. Augustine’s occupational therapy program. She is a certified orthopaedic manual therapist for the upper extremity, has current and ongoing research on the subject of thumb arthritis and is a member of the American Society for Hand Therapists and the Central Texas Hand Society.
Posted on 4/19/2017 by Rebecca Miles, MSOT, OTR/L
When I tell people I am an occupational therapist, they generally either respond enthusiastically or nod as if they know what I do (when they really don’t!). Upon first hearing the name, most people think occupational therapists are vocational therapists who help people find employment or get back to a certain job. Because of this, the people who do not know what occupational therapy is are even more confused when I say I work with the pediatric population.
Occupational therapists work with people across the lifespan to do what they need to do, want to do and what they are expected to do. For us, an “occupation” refers to activities that support the health, wellbeing and development of an individual (American Occupational Therapy Association, 2014). This can mean helping someone after a stroke learn how to dress themselves again. In my work as a pediatric occupational therapist, it means I work with children and their families to allow participation and independence in their “occupation" of playing, learning and completing activities throughout their daily life.
Pediatric occupational therapists work across many settings, from schools to hospitals to outpatient centers. Here at Select Kids Pediatric Therapy, I have the opportunity to work with infants and toddlers in their homes and natural environments and to work in a pediatric outpatient center treating children from age three to 22.
Pediatric occupational therapists utilize the most current evaluation tools and clinical standards in determining the appropriate treatment for each child. We start by communicating directly with parents/guardians to determine the family’s goals and priorities. Then, through individualized evaluations, we find solutions to help maximize independence and increase participation in daily activities, including self-care, learning and play.
I work with children on reaching their full potential by addressing deficits that challenge performance of developmentally appropriate skills. For instance, I often help children who have challenges with grasp and handwriting, attention span, moving their body to complete a task, responding to information coming from the senses (like becoming overwhelmed and distraught when there is a loud noise), visual perceptual skills (like finding an item in a busy drawer or knowing what an item is when it is not entirely visible) and activities of daily life (like dressing and feeding). I get to address these skills through play and actual performance of the activities, so that children can engage in their “occupations” and learn while having fun.
I empower families through education and guidance to help the children in their lives grow and learn. It is amazing to be able to spend every day helping children to reach their own individual potential.
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain & process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
Rebecca MilesBy: Rebecca Miles, MSOT, OTR/L, pediatric occupational therapist at our Select Kids Pediatric Therapy center in Virginia Beach, VA.
Select Kids Pediatric Therapy and NovaCare Kids Pediatric Therapy are part of the Select Medical Outpatient Division family of brands. Contact a center near you today for more information on pediatric therapy services.