Recognizing the Symptoms of a Blood Clot

Posted on March 6, 2013 by Drew Jenk, PT, DPT

The New York Mets seemed to be one of baseball’s unluckiest teams when it came to injuries this past season. Among the many injuries sustained, pitcher Dillon Gee was lost for the season due to a blood clot in his pitching shoulder.

Gee threw 8 innings and got the win versus the Chicago Cubs on Saturday, July 7. The following day, he complained of numbness in his fingers. By Monday, he was diagnosed with a blood clot in his shoulder. Soon after, Gee underwent a procedure to break up the clot with a catheter.

So the question arises: How does something like this occur in a young, healthy, active individual? The answer is somewhat unknown at this time. However, it is most important to recognize the symptoms of a blood clot, and to know what to do if you suspect that you may have one.

Blood clots are often referred to as deep vein thrombosis, or DVT. They are often thought to occur in sedentary individuals and affect mostly the lower extremities. The truth is that blood clots can affect anyone, can occur anywhere in the body, and have the potential to be a life-threatening situation. If not treated promptly and effectively, a blood clot can break off and travel to the lungs, resulting in a pulmonary embolism. A pulmonary embolism is a critical event requiring immediate emergency medical care.

It is important to recognize the symptoms of a blood clot. Symptoms include:

- Heaviness, weakness, achiness or numbness in the fingers or toes

- Moderate to severe swelling in the area often accompanied by warmth of the area

- Unrelenting pain that is difficult to resolve and severe tenderness to the touch

- Discoloration and skin changes

- Large distended veins

Any of these symptoms are a reason for immediate medical attention. Blood clots can be treated effectively and safely if recognized early. So, let your body be your guide; play it safe because sometimes it can really be a matter of life and limb.

Make Physical Therapy Your First Stop for Orthopedic Injuries

Written by: Sports PT Blog Team

Posted on February 25, 2013 by Sports PT Blog Team

A cheerleading injury scare! My daughter is a flyer for her high school varsity cheerleading team and with that responsibility comes many hours of practice each day, including separate sessions of tumbling. While performing a back handspring, she landed off balance and the pain began.

After applying general first aid to her ankle overnight, it became very apparent that the injury was more than a slight bruise. Her orthopedic doctor didn’t have an available appointment for nearly 3 days and we were worried the situation would get worse, especially if she continued to practice with her team.

Fortunately, I learned about Direct Access from Sports PT and knew we had other options. I immediately called the Liverpool, NY clinic and they saw her that day! After a thorough initial evaluation, it was evident that her ankle may have been broken in the landing, and the physical therapist recommended a visit to the orthopedic urgent care that evening for x-rays. Her ankle was broken, but due to the immediate attention provided by Sports PT, we had already begun the healing process.

So what is Direct Access?

It is legislation enacted by the NYS Education Department in November 2006 that allows a licensed physical therapist to provide a patient with treatment in the practice of physical therapy without a referral from a physician, dentist, podiatrist or nurse practitioner, for 10 visits or 30 days, whichever occurs first, provided the licensed physical therapist meets specific requirements. It was designed to be a first line of defense where patients could start treatment immediately to begin the healing process. It also allows for patients to be seen sooner by expert medical professionals rather than clogging up emergency rooms and urgent care centers with these types of issues.

Did you know that physical therapists are some of the best qualified individuals to evaluate an orthopedic injury, next to Orthopedic Surgeons? There is even a research study that presents data supporting the diagnostic accuracy of physical therapists.

At Sports PT, we have physical therapists who meet the requirements in nearly every clinic. If you have an acute or chronic injury or condition that impairs your movement, such as back and neck pain, sprains and strains, hip, knee or ankle pain, tendonitis or a sports injury, I encourage you to contact us to make an appointment! It will save you precious time and may result in lower out-of-pocket insurance expenses.¹ We’ll check your insurance policy for you to make sure your insurance carrier allows for Direct Access. We look forward to helping you soon!

By: Dot Hall, Mother of Patient

Annual Watchfire Honors our Armed Forces and our Flag

Written by: Sports PT Blog Team

Posted on May 28, 2012 by Sports PT Blog Team

Mike Greenlar / The Post Standard

Russell Oakes remembers playing little league baseball as a kid and the friendships he formed at a young age. He graduated from Albany High School in 1965 and when he got word that a few of his little league friends had been killed in Vietnam, he decided to join the Marine Corps. Russell pulled four tours of duty in Vietnam from 1966-1968 and was honorably discharged in 1969. In 2001, he retired from the Department of Defense where he spent more than 15 years as a plan engineer. Russell has nothing but praise and admiration for the men and women who serve our country today.

This past weekend, his time was spent setting up for the Annual WATCHFIRE ceremony at the New York State Fairgrounds in Geddes. This event commences every year at sundown on the Sunday before Memorial Day to pay tribute to U.S. soldiers and veterans. A bonfire was lit at Veteran’s Watchfire Park to properly dispose of thousands of retired and tattered US flags. Over 20,000 people were expected to attend this year’s event.

The watchfire holds an important place in military history. It is said that following a battle or long march, a large fire was started so those missing or lost could locate and rejoin their comrades.¹ Today, the Watchfire also provides the community an opportunity to properly retire unserviceable American flags.

If you have a flag no longer suitable for flying, there are several organizations that will retire your flag in a proper and respectful ceremony including the VFW, American Legion, Boy Scouts of America, Girl Scouts of America and the Marine Corps League.

In honor of National Military Appreciation Month and Memorial Day, we send a heartfelt THANK YOU to Mr. Oaks and to all our U.S. servicemen, servicewomen and their families, for your valiant service and sacrifice.

What Lies Ahead for Yankee Pitcher Mariano Rivera After ACL Injury

Written by: Teresa Hall, PT, DPT, OCS

Posted on May 9, 2012 by Teresa Hall, PT, DPT, OCS

(AP Photo / YES Network)

The words “ACL tear” resound with many sports enthusiasts who know that this is usually a season-ending injury for an athlete. Yankees fans were devastated to hear that superstar closing pitcher Mariano Rivera suffered an ACL tear during batting practice last week. ACL is short for anterior cruciate ligament, a major stabilizer of the knee when cutting, running, and even going up and down stairs. An ACL tear can happen at any age and from many different causes, including sports, falls, and work injuries.

When an ACL tears, some people hear and feel a pop in the knee. They can also have swelling, pain, and a feeling of their knee giving out. Clinical testing of the knee and an MRI would confirm the diagnosis. Some people can rehabilitate their knee after a tear without surgery, especially if they do not need to perform high-level leg activities like running and sports. Other people may opt to have ACL reconstructive surgery instead.

ACL surgery involves taking a tendon from another part of the leg and connecting it in place of the torn ligament or using a graft from a cadaver. The incisions are typically very small and barely noticeable once healed. After surgery, the knee will be put into an immobilizer (knee brace) to keep it straight and stable. Crutches are used to move around, although most people can start to put some weight on the leg almost immediately.

The rehab for ACL reconstruction typically starts in the first 2 weeks after surgery. It is lengthy but very important to restore knee function and a return to prior activities. A typical person, athlete or not, can expect to be in rehab for at least 3 months. The first phase of rehab focuses on regaining full knee range of motion and return to normal walking. The second phase focuses on strengthening and the third on return to sports or work-specific activities. Most surgeons will clear someone for running around 4 months after surgery if they have adequate strength, which is why a ball player is usually out for the season. Time will tell if Rivera is able to pitch at all this year.

What do you think this does for the Yankees chances this year?

Baltimore Raven Terrell Suggs Ruptures Achilles Tendon

Written by: Teresa Hall, PT, DPT, OCS

Posted on May 3, 2012 by Teresa Hall, PT, DPT, OCS

Rob Carr / Getty Images

Bad news for football fans today: top defensive linebacker Terrell Suggs of the Baltimore Ravens will likely be out for the 2012 season because of a ruptured Achilles tendon. This injury is particularly devastating to an athlete because of the prolonged recovery time, which usually means the player is out for a year.

The Achilles tendon is the biggest and strongest tendon in our body, connecting the two powerful calf muscles, the gastrocnemius and soleus muscles, to the heel bone. Its duty is to handle the force of the calf muscle’s powerful contraction with pushing off to run, jump, and even walk. It is usually torn when someone jumps or makes a forceful push-off movement. Less often, it can be torn by something hitting the tendon. The athlete will commonly say they felt like someone kicked them in the back of the leg when the tendon tears.

Achilles tears are very easy to diagnose. A clinical diagnosis can often be made by feeling the back of the leg and squeezing the calf. This is known as the Thompson test. The clinician is looking for the foot to move when the calf is squeezed. If no movement is detected, an Achilles tear is to blame. The diagnosis can also be confirmed with a MRI or ultrasound.

The management of a tear can be conservative or surgical. Conservative treatment involves casting and extensive rehab, and is usually more favorable for non-athletes. Athletes like Suggs will typically have an Achilles repair surgery because of the demands on their body with athletics. A surgeon will open the back of the leg and suture the torn ends of the tendon back together. The patient is then usually immobilized in a cast or boot and not allowed to bear weight for the first 4 weeks or so (protocols vary). The patient will then begin a rehab program aimed at gradually beginning weight bearing and gentle stretching exercises. Strengthening typically begins around 6 weeks post-op, with gradual increase in resistance. The athlete is usually not allowed to run until 6 months after surgery, and full jumping and sport-specific drills sometimes even longer than that. The reason the recovery is so long is due to tissue healing times and the risk of re-rupture, which would be devastating to an athlete. One study found that the re-rupture rate is about 4.5 %, which is consistent with most literature and happens more often in people less than 30 years of age.¹

Fans will have to wait to see the outcome of Suggs’ injury and recovery until next season.

Is NY Knicks Wonder, Jeremy Lin, Out for the Season?

Written by: Tim Abel, PT, DPT

Posted on April 16, 2012 by Tim Abel, PT, DPT

Nathaniel S. Butler/Getty

As a lot of you know, Jeremy Lin, point guard for the New York Knicks, underwent surgery on his knee to repair a torn meniscus. This is really unfortunate for the Knicks because Lin was playing well, and they are fighting for the last playoff spot in the Eastern conference. Lin’s timeframe to return to action was put at 6 weeks.

Although you might not hear about meniscus injuries in sports as much as you do an anterior cruciate ligament (ACL) tear or Achilles tendon rupture, we see a large population of individuals both athletes and non-athletes alike that suffer meniscal injuries each year. The meniscus is a “C” shaped structure in the knee composed of cartilage. It sits between your femur (the thigh bone) and tibia (the shin bone). You have two in each knee, a medial (inside) and lateral (outside) meniscus.

The meniscus has many functions, the most important being shock absorption as your leg supports your body weight, but the meniscus also aides in joint stability, joint nutrition and proprioception. The meniscus is typically torn when someone is twisting, turning, or changing directions with their foot planted on the ground. Symptoms can include swelling, pain along the joint, clicking, and even locking of the knee in some cases. The treatment options for a meniscus tear are typically one of three including rehabilitation (Physical Therapy, PT), menisectomy (removal of injured portion via arthroscopic surgery), or meniscal repair (surgical fixation via arthroscopy). There is also a less common technique called a meniscus transplant, where surgeons replace the injured meniscus with one from a cadaver.

Factors for determining which treatment option will lead to the best recovery are the location and size of the tear. The inner portion of each meniscus is avascular, meaning it does not have a blood supply. Tears in the avascular portion are often removed instead of repaired because of the limited potential to heal. Meniscal repairs are most successful when tears are in the vascular portion of the meniscus, which is located along the outside of the meniscus.

Let’s hope Lin’s injury was in an area with good blood supply, because with the amount of running, cutting, twisting, and jumping in basketball, he is going to need strong, healthy knees. I personally don’t think Jeremy Lin will see any more playing time this season, especially because if the Knicks make the playoffs, they will likely face the Chicago Bulls or Miami Heat, and won’t be around for too long. Do you think Lin will make a comeback this season?

Reference: Dutton M. Orthopaedic examination, evaluation, and intervention. 2nd ed. McGraw Hill; 2008.

Is Kendall Marshall Going to Play? And What is a Scaphoid Anyway?

Written by: Devin Blessing, PT, DPT

Posted on March 21, 2012 by Devin Blessing, PT, DPT

(AP Photo/Zach Gibson)

If you’re a college basketball fan, or just hoping to win some money and/or bragging rights in your office March Madness pool, you may have heard of the injury to the University of North Carolina point guard Kendall Marshall. After UNC’s win on Sunday, reports surfaced that Marshall had fractured his wrist and his return to the NCAA tournament was questionable. Marshall, who was second in the nation in assists this season, is considered by most to be the most indispensable piece to UNC’s National Championship hopes.

So, what exactly is this injury that may keep Marshall from helping UNC make a run at a championship? Marshall fractured his scaphoid bone, a bone at the base of your thumb and wrist. Scaphoid injuries usually occur when falling on your hand causing your wrist to bend backwards, as was the mechanism of injury when Marshall was injured. Complications may occur in the healing process due to a poor blood supply to the scaphoid bone. With Marshall’s promising NBA career ahead of him, proper healing would likely be important to the young but talented point guard.

A fractured scaphoid can either be treated through casting or surgical fixation. If the bone is displaced, the only option is surgery. Sometimes, a nondisplaced fracture will also be treated through surgery if a long period of immobilization is not feasible due to work, sports, etc. The type of fracture Marshall suffered is unknown, but his father released a statement that Marshall had undergone successful surgery on Monday.

Typically, following surgery the wrist is put in a cast or brace and athletes are allowed to play with a club, such as lineman in football who do not require the fine motor use of their hands. That is obviously not an option for a basketball player. Marshall’s status remains a game time decision and will likely be determined by his tolerance to the force of dribbling or catching a basketball. If I were a betting man, I would say Marshall is out for this weekend but has a chance to be back if they make it to the Final Four.

Let us know your thoughts below. Do you think Kendall Marshall will play in the Sweet 16, return for the Final Four (if UNC makes it), or is he done for the tournament?

Reference: Brotzman SB, Meyers SJ, and Lee ML. Scaphoid Fractures. In: Brotzman SB and Wilk KE. Clinical Orthopaedic Rehabilitation. 2^nd Ed. Philadelphia, PA. Mosby Inc. 2003: 50-54.

Helping Overseas in Haiti

Written by: Dan Freed-Pastor, PT, DPT

Posted on February 13, 2012 by Dan Freed-Pastor, PT, DPT

This past December, I joined forces with For Hope International, a non-profit organization, to travel south to the Caribbean for my fourth medical missions trip to serve and treat the people of Haiti. For Hope International works very closely with Haitian medical professionals and students, both educating them through practice and empowering them to better treat their own people in need. I have worked in various parts of the country – from more rural areas like Port Salut in December 2009 before the earthquake, to working at the GHESKIO clinic in the heart of Port-au-Prince with a rehab team of physical and occupational therapists in March 2010 following the devastating earthquake. The 7.0 magnitude quake killed several hundred thousand and left likely double or triple that figure with serious disability.

During my most recent trip, I provided rehabilitation consultations and services out of an established medical clinic in Carrefour, Haiti, with which For Hope International has partnered. We saw a variety of conditions and injuries requiring rehabilitation, some more and some much less similar to those we see here in the U.S.. I was able to provide crutches and canes to those in need that were donated by local Sports PT of NY clinics and their patients. I treated many patients with back pain resulting from manual labor and postural stress (often seamstresses) that benefited from education on body mechanics and correction of maladaptive behaviors. I also worked with a lot of patients that had suffered from strokes, some who weren’t even aware that they had experienced one, and others with amputations or fractures caused by trauma during the quake.

It is a great opportunity working so closely with American and Haitian medical students and physicians, each one of us realizing how much we stand to benefit from learning just a little more about what each other does. Each experience has been extremely different and rewarding in its own way, giving me a whole new perspective on the patients and people with whom I work every day. If there is one thing someone reading this could take away, it would be that there is always hope for rebuilding, even when the mainstream news gives an update on progress that is less than promising.

For more information or to get involved, visit For Hope International.

Mesi anpil (Thank you very much),

Dan Freed-Pastor

Hello World!

Written by: Sports PT Blog Team

Posted on January 25, 2012 by Sports PT Blog Team

Welcome to the Sports PT Blog – our opportunity to put Care in Motion! We treat thousands of patients across NY State every year and are excited to create this resource for all of you – where we can share our expertise, our stories and our people. We hope this interactive forum will in some way create a “community” for you to share your own stories, ask questions and feel supported as you travel through your physical therapy journey.

In addition to providing information and tips on common diagnoses and injuries, we will also be sharing profiles of our staff and clinicians, facility ‘tours’, patient success stories, Sports PT in the community, and more. If there’s something you want to hear about, let us know – we’ll provide the information you’re looking for.

This blog is not a substitute for direct consultation with a physician and/or physical therapist. We recommend that you speak with your MD or PT before attempting any of the stretches or strengthening exercises that may be mentioned here by our physical therapists. If you suspect injury or dysfunction, the best thing to do is to schedule an appointment to come and see us. We will perform a thorough examination and develop a treatment plan specifically for you and your injury.

So here we go! Our blog is in motion…Care in Motion! We invite you to comment often. “Like” and “Share” the posts you find most useful and fun to read. We appreciate your readership and we look forward to sharing with each of you!