Category: Denver physical therapy

Little League Elbow

  • Elbow pain is reported to affect between 20-26% of the little league baseball players in America. Making little league elbow the most common injury in little league baseball.
  • Chip Review @ (13:35): Sabritas – Tubros Flamas (Thank You Judy Bloomburg)
  • Trivia question of the week @ (11:07): How many dots are there on a pair of dice?
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Brief overview of the episode:

Elbow pain is reported to present in 20-25% of little leaguers. That is a really significant number. When up to a quarter all participants in an activity deal with a similar injury then it is certainly time to look into ways to limit that.

Little league elbow is due to repetative valgus overload due to the throwing motion. This affects pitcher more than position players but that does not rule out position players. Most often pain is located on the inside of the elbow. It can also present on the outside and the back as well.

This pain pattern occurs because there is tension strain on the medial structures of the elbow. The medial epicondyle, epicondylar apophyasis and the collateral ligament are tensioned and become stressed. On the lateral aspect of the elbow there are compressive forces on the radial head and the capitellum. More concerning is the stress that overhead throwing places on the growth plate. Damage to the growth plate can result in permanent deformation.

Most kids will present with pain, decreased throwing distance and velocity, swelling, loss of elbow range of motion (specifically straightening the elbow) and on x-ray there is often a change present. Recover times vary from 6 weeks to 3 months depending on the extent of damage.

The best treatment is also the best prevention. Work on mechanics, pitch counts, strengthening of the arm, shoulder and para-scapular muscles, as well as the rotator cuff, core and legs. It is also a good idea to avoid year round participation in a single sport.

Other episodes you might enjoy:  

Core/Abdominal Wall: Episode 35

Stretching: Episode 25

Tennis Elbow and Golfers Elbow: Episode 7

 

Tibial Tubercle Osteotomy

  • Tibial tubercle osteotomy (TTO) is a surgical procedure that is often done to help individuals who are have patella instability or are dealing with osteoarthritis. This procedure moves the attachment point of the patella tendon.
  • Chip Review @ (14:11): Red Rock Deli – Fire Roasted Jalapeno (Thank You Peter Jennings)
  • Trivia question of the week @ (11:14): Which planet is closest to earth?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
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Brief overview of the episode:

Tibial tubercle osteotomy also know as tibial tuberosity osteotomy or TTO is a procedure that changes the attachment point of the patella tendon in hopes to improve the stability and tracking of the patella. This surgery becomes an option in the case of individuals who are recurrent patella dislocators or who are dealing with retro-patella arthritis and have not had improvement with non-surgical treatment.

This is done by separating the tibial tubercle from the tibia and moving it medial or lateral (less common) and then affixing it in place with screws. There are currently two acceptable techniques the Emslie-Trillat and the Fulkerson. With the Emslie-Trillat a straight cut is made across the tubercle. With the Fulkerson the cut is done in an anteromedial fashion. A third technique exists called the Maquet technique in which the tubercle is anteriorized by fully separating it and placing a bone graft behind it. This method should not be used at is has lead to necrosis and is much more likely to fail.

On average this surgery is performed more frequently with women under 30. It has been reported that 75% or more of individuals who under go a TTO will return to prior or improved level or sport function.

 

Other episodes you might enjoy:  

Patella Dislocation: Episode 128

Patellofemoral / Patellotibial Ligaments: Episode 113

Patella Femoral Pain Syndrome: Episode 32

 

 

Patella Dislocation

  • Patella Dislocations make up between 2-3% of all knee injuries. They are most common in young female athletes and are usually due to a number of factors: genetics, mechanics, activity and trauma.
  • Chip Review @ (10:36): Kettle Brand – Farmstand Ranch
  • Trivia question of the week @ (09:30): The “First Lord of the Treasury” is better known as?
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Brief overview of the episode:

Patella dislocations account for between 2-3% of all knee injuries, they occur most frequently in younger, female, athletes. Some of the common causes include: shallow trochlear groove, trauma and a powerful quad contraction with knee flexion and external rotation.

As with most dislocation, unfortunately, if you have had one you are more likely to have another. This does not necessarily mean that you will have a second only that your chance is higher. To better prevent a dislocation it is important to address not just quad and hamstring strength but to increase hip strength.

The most important of which is hip abduction. This will prevent the knee from moving into adduction and internal rotation. A position that places the patella in a shallower portion of the trochlear groove and makes it easier to dislocate.

Other episodes you might enjoy:  

Patellofemoral / Patellotibial Ligaments: Episode 113

Patella Fracture: Episode 85

Patella Femoral Pain Syndrome: Episode 32

 

 

Piriformis Syndrome

  • Piriformis syndrome is a common diagnosis for pain in the buttock. It is often attributed to issues related to the sciatic nerve but that’s not really the cause. In more than 80% of cases it has to do with some kind of trauma or repetitive motion not an anatomical difference of the piriformis muscle and sciatic nerve.
  • Chip Review @ (17:35): Yaokin – Mr. Cabbage Taro – “Sauce Flavor” (Hugh Thank you to Steve-O)
  • Trivia question of the week @ (15:12): How much poop does a rhino make in a single defecation?
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Brief overview of the episode:

Piriformis syndrome is the literal pain in your butt. Other symptoms include low back pain, numbness, difficulty walking, pain with sitting/squatting/standing/bowel movements and tenderness. Sometimes this is called deep gluteal syndrome, extra-spinal sciatica or wallet neuritis.

The reason that the piriformis muscle is so famous is because it can have a unique arrangement with the sciatic nerve. There are 6 other muscles in this area that can also play a role and that is why primary piriformis syndrome makes up less than 15% of cases.

Secondary pirifomris syndrome is by far more common. This is usually due to some kind of trauma, muscle holding, gait patterns or other issue further down or up the kinetic chain. That will then present as pain in the buttocks.

Women are affected 6x more than men. This seems to be due to an increased q angle as this impacts the relationship between the quadratus femoris and the OS Coxae.

Most people you experience piriformis syndrome will get better with short-term activity modification and exercises. Surgery is not often recommended even in cases of primary piriformis syndrome.

Other episodes you might enjoy:  

Lumbar Strain: Episode 123

Lateral Shift: Episode 106

Sciatica: Episode 34

Knee Capsular Corner Injury

  • A capsular corner injury of the knee is not often talked about but is often present for individuals who are dealing with instability of the knee and are having a more difficult time returning to activity. We’re talking primarily about posterolateral and little about posteromedial corner injuries of the knee.
  • Chip Review @ (17:35): Sabritas – Receta Crujiente – Chiles Rojos (Thank you Khem)
  • Trivia question of the week @ (15:12): How fast would Santa’s sleigh have to travel to deliver presents to all the children in the world?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
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Brief overview of the episode:

Knee capsular corner injuries are not commonly referred to but they result in long-term instability of knee. The current incidence has not been widely reported but at least currently appears to not be that common. The incidence goes up depending on mechanism.

A direct blow into a posterolateral direction, hyperextension or other high-energy trauma is the most likely mechanism to injury the posterolateral corner of the knee capsule. Symptoms beyond instability include tendernesss, swelling, bruising, standing varus and varus or hyperextension varus during gait.

In most cases a corner injury of the knee does not occur in isolation. They are most common with posterior cruciate and anterior cruciate ligament ruptures.

 

Other episodes you might enjoy:  

Posterior Cruciate Ligament (PCL): Episode 112

ACL Recovery: Episode 13

Knee Pain: Episode 2

 

Partial Articular Supraspinatus Tendon Avulsion (PASTA) Rotator Cuff Tear

  • The Partial Articular Supraspinatus Tendon Avulsion better known as a PASTA is the most common tear of the rotator cuff. It is present in up to 37% of the population and accounts for 90% of all partial thickness rotator cuff tears.
  • Chip Review @ (12:44): Feast & Fury – Creamy Horseradish
  • Trivia question of the week @ (08:32): What is the best selling board game of all time?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
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Brief overview of the episode:

In this episode we discuss the PASTA rotato cuff tear. PASTA is an acronym for Partial Articular Supraspinatus Tendon Avulsion. This is a partial thickness tear of the supraspinatus. It is thought that the presents of this type of tear is between 17-37% of the population at any time. People 80 and over will show this tear 80% of the time. Upward of 90% of all partial thickness tears of the rotator cuff are PASTA type tears.

Some common characteristics of individuals with a PASTA are, overhead athletes, younger people and being a smoker. Symptoms include pain, weakness and loss of range of motion.

Unfortunately this tear has a tendency to increase as time passes. This seems to be due to a combination of activity, poor vascularization and thinner and less organized collagen. Physical therapy is recommend early and in almost all cases regardless of the size of tear. The goals are to reduce pain, increase range of motion and strength and eliminate the need for surgery.

Other episodes you might enjoy:  

Corticosteroids: Episode 122

Upper Trapezius vs Levator Scapulae: Episode 117

Proximal Biceps Injuries: Episode 93

 

 

 Bunion

(Hallux Valgus)

  • In this episode: Bunion is one of the more apparent foot changes that can occur. This is usually due to shoe wear and is more common with certain activities. Good news lots of it can be modified through an exercise program that focuses on your feet.
  • Chip Review @ (11:45): Kettle Brand – Pepperoncini (Thank you Djimmer)
  • Trivia question of the week @ (09:58): What is the most abundant metal on earth?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
  • Thanks for listening!!

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Brief overview of the episode:

Bunion is a fairly common bony change that occurs at the big toe. Usually due to tight and or high-heeled shoes forcing the metatarsal to angle outward and the phalange to angle inward. This can sometimes also result in extra bone growth. This change can be pain free bur will also affect foot function.

Due to the alignment change there is often a reduction in range of motion, altered gait pattern, redness and possibility calluses. Many of these issues can be address by changing shoe wear. Making sure the new shoes allow for adequate spaces for the toes. There are also a number of exercises and movements that can be done to help reverse some of the changes.

If you’ve had bunions for 30 years you are not likely to reverse the course of your foot change completely but there is always some improvement that can be made.

Other episodes you might enjoy:  

Foot & Ankle Health with Dr. Mohammad Rimawi: Episode 40

Morton’s Neuroma: Episode 49

Plantar Fasciitis: Episode 11

 

Lumbar Strain

(Weight Lifters Back)

  • Lumbar strain also known as weight lifters back, low back pain, pulled back, my back went out, strained back and lumbago is a really common issues. It is likely that everyone will deal with this at some point in their lives.
  • Chip Review @ (19:49): Trader Joe’s – Cornbread Crisps
  • Trivia question of the week @ (18:23): In geology, how long is an eon?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
  • Thanks for listening!!

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Lumbar strain is one of the most common reasons someone will go to their primary care physician or the emergency room. It occurs as a result of trauma, overuse, sports, slips and falls. Sometimes called weight lifters back, lumbago, back strain, pulled back and is a result of a muscle, tendon or ligament injury of the low back.

The most common muscles injured are the quadratus lumborum, multifidus, gluteus medius, gluteus max and piriformis. These are muscles of the low back and the buttocks/hip. Symptoms will included low back pain, spasming and being sore to the touch.

Most people will have some reduction in symptoms with walking, short duration stretching and ice/heat/NSAIDS. In most cases it is not necessary to see a physician or have imaging done. Symptoms will improve in 1-4 weeks and should fully resolve in less than 8 weeks.

Low back pain is most often a result of some activity and usually you know what caused your pain. There is high likely hood that you pain will improve with gentle movement and activity and there is not a serious underlying pathology.

Other episodes you might enjoy:  

Lateral Shift: Episode 106

Core/Abdominal Wall: Episode 35

Low Back Pain: Episode14

 

Corticosteroids

 

  • Corticosteroids are used to treat a range of issues. From asthma, lupus and organ rejections too rashes and inflammation. They have been hailed as a wonder drug and for some people they are but there are some side effects to we aware of.
  • Chip Review @ (11:50): Feast & Fury – Habanero Hickory BBQ
  • Trivia question of the week @ (09:28): How many black keys are there on a traditional piano?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
  • Thanks for listening!!

To Subscribe, Review and Download select your preferred hyperlink below 

Brief overview of the episode:

Corticosteroids are used to suppress inflammation and immune response. They are commonly used to treat lupus, asthma, arthritis, autoimmune disease, as an anti-rejection medication, Addison’s disease, and for diagnostic purposes. Glucocorticoids are natural produced by the adrenal glands from cholesterol with Cortisol being the basis for corticosteroids.

Most people are familiar with cortisone, hydrocortisone and prednisone but there are many other versions all used to treat different areas. Corticosteroids can be administered in an number of routes, oral, pill, cream and injection. Oral is the most common.

Prednisone is the most common oral corticosteroid. This form of administration means the corticostroids travel around the entire body. Which leads to a great potential for side effects because more systems are involved. Thankfully short-term use is not typically associated with any meaningful issues. Long-term use does however present some issues.

Some of the more common and concerning side effects include, glaucoma, skin thinning, diabetic issues, bone health issues, immune system suppression (when that is not the desired use) and both high and low blood pressure.

When corticosteroids are used and monitored appropriately there is little concern for significant side effects.

Other episodes you might enjoy:  

Neuropathy: Episode 118

Rhizotomy: Episode 116

Role of Modalities in PT: Episode 90

Groin Injury

  • Groin injury is an issue that most commonly affects athletes that participate in kicking, skating and change of direction sports. Most groin injuries are mild and result in a short period of discomfort and inability to participate.

  • Chip Review @ (13:35): Boulder Canyon – Jalapeno Cheddar

  • Trivia question of the week @ (10:51): Which US state produces the most potato chips?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

 

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Brief overview of the episode:

           Groin injury is more common in sports that involve kicking and skating. It has its highest prevalence in soccer and ice hockey. Men are more commonly affected than women. Injuries is determined by grade where , Grade I is most common with Grade III injuries begin rare.

            Grade I consists of less than 5% involvement of the muscle belly and typical presents with pain tenderness and no bruising. Grade II has greater than 5% involvement of the muscle or tendon with sharp pain, bruising and loss of strength and ROM. Grade III is a complete rupture and presents less than 2% of the time.

            Most people of injury their groin will be able to continue to participate in their chosen sport or need only a brief time away to allow for pain to reduce.

            Prevention is the best approach and consists mainly of lower extremity strengthening with some additional focus on hip adduction strength, abdominal wall strength and hip stability.

 

           

Other episodes you might enjoy:  

FAI/Hip Labrum: Episode 21

FAI/Hip Labrum: Episode 21

Greater Trochanteric Bursitis: Episode 28

 

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