An Accelerated Protocol for Rehabbing a “Popeye Sign” Injury

By: Drew Jenk, PT, DPT

 

Have you ever wondered what it would be like to have biceps that look like Popeye’s? For some it’s a grim reality that they’re facing. In the orthopedic world, we often refer to a ruptured distal bicep tendon as a “Popeye Sign.” It’s typically caused when a person contracts his or her bicep forcefully in response to a powerful, immovable force. I used to see cases after a hurricane when I worked in Florida. People would be out in the elements trying to tie up their boat, and a giant wave would yank the boat and the rope that they were holding. If that sounds painful, it is. A distal bicep tendon can also rupture when a person overexerts the bicep muscle while lifting something that is simply too heavy.

 

There are many different ways to deal with this type of injury, but the most common is surgery. The good news is that the rehab process has grown increasingly faster, thanks to new technology and improved surgical techniques. In fact, Dr. Todd Battaglia and I have developed an accelerated protocol with these advances in mind. A chapter about the protocol will be included in a soon-to-be-published textbook: Techniques in Shoulder and Elbow Surgery. 

 

So if you come up against a hurricane or a window that was nailed shut, try to resist the urge to flex your biceps, if only to avoid a painful injury. But if you do develop a bulge that only Olive Oyl would find attractive, go see your doctor and ask about advances in surgery and rehab. Be your own advocate and ask about an accelerated rehab protocol. If you find yourself with any questions, the professionals at Sports PT are always glad to provide counsel.

 

Image Source: AAOS.org

Bringing the Olympic Spirit to Improve Patient Care

By Nicole Nolan, PT, DPT, and Alyssa Tallo, PT, DPT

 

Why should Sochi have all the fun? In our Greece and Webster clinics, we’ve decided to hold an Olympics of our own. Our version of the Games includes seven exercises, which all help patients to increase core and hip stability, muscle endurance as well as increase power. And who doesn’t like a healthy competition? Here’s a look into our events:

 

1. Fastest Marble Pickup: Facilitates intrinsic muscle activation of feet, and speed of movement facilitates fast twitch muscle fibers.

 

2. Longest Plank: Accelerates core stability and trains patients to maintain a neutral spine.

 

 

3. Single Leg Hop: Trains patellar tracking with ballistic exercises and increases the power of lower-extremity muscles. The exercise also determines return-to-sport readiness.

 

4. Upper Bike: Provides an active warmup for upper-extremity injuries to increase blood flow and tissue extensibility.

 

 

5. Longest Bridge: Facilitates core stability and teaches hip movement versus lumbar spine movement.

 

6. Longest Wall Sit: Builds quadricep muscle strength and endurance as well as trains proper posterior hip excursion.

 

7. Highest Vertical Jump: Trains patellar tracking with ballistic exercises and increases the power of lower-extremity muscles. Like the single leg hop, this exercise determines return-to-sport readiness.

 

All of these challenges can be easily incorporated into your own routine!

 

How do you stay motivated to push yourself during physical therapy or normal exercise routines? Share with us in the comments below!

 

Feel free to reach out to Nicole at our Greece location (585-227-2580) or Alyssa at our Webster location (585-347-0202) for an evaluation on how these exercises might help you. 

 

Groin injuries: a painful reality for Olympians and other athletes

 By: Devin Blessing PT, DPT, OCS

 

Groin injuries are certainly not foreign to the weekend warrior playing a game of pickup basketball, soccer, or hockey. These injuries do not discriminate, as they have a major impact on elite athletes of all sports. As just one example, groin and abdominal injuries were reported to affect as much as almost 20% of NHL players in the ‘96-’97 season, with a 23% recurrence rate1. The impact of groin injuries will also play a major role in the Sochi Olympics.

 

In the 2010 Olympics in Vancouver, one of the most exciting (and surprising) stories was the USA Men’s Hockey Team making a run to the Gold medal game. One of the heroes in 2010 was Buffalo Sabres goaltender, Ryan Miller. For the Sochi Games, many American hockey fans are looking to Los Angeles Kings goaltender, Jonathan Quick, to carry Team USA on another historic run. Quick has enjoyed great success since the 2010 Olympics, winning a Stanley Cup and the Con Smythe Trophy for MVP of the playoffs in 2012. That success will be difficult to duplicate in Sochi since Quick is coming off a serious groin injury that caused him to miss 24 games from November to early January.

 

But you don’t have to be an Olympian to suffer the agony of a groin injury. The good news? Those of us who play sports can learn how to reduce our own risk, thanks to a better understanding of some key muscles. Research shows us that muscle imbalances play a major role in injuries to the groin and abdominal area. A study done by Tyler et al showed that NHL players who suffered groin injuries had 18% lower hip adductor (groin muscles) strength than healthy players. Healthy players had hip adductor strength that was 95% of their abductor strength, compared to 78% in injured players. Also, there was no correlation with flexibility of adductor muscles to injury.2

 

So what does this mean? For one thing, you can stop all of that groin stretching since it won’t prevent injury and doesn’t feel very good anyway. Instead, by strengthening your adductors, you can reduce your risk of suffering a groin strain.3 A few exercises to get you started are sumo squats and a lunge matrix including front, side, and reverse lunges.

 

You also shouldn’t forget about the core, as this will play a role in pelvis positioning and any lower body injury. It gets a little more complicated from here, but a forward pelvis tilt depicted in the picture below will put your adductors in a lengthened position, predisposing them to injury. Also, unpublished data by McGill in 2009 linked holding a sidebridge for more than 70 seconds to reduced injury in NHL players, including no sports hernias. You can also make your core strengthening more functional by trying the Pallof press exercise seen here:  http://www.mensfitness.com/training/the-palloff-press.

 

So the next time you’re ready to go out onto the playing field or ice rink, try some of these exercises to keep your groin injury-free!

 

Sources:

 

1. http://www.ncbi.nlm.nih.gov/pubmed/10512343 

2. http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/sojc/05_06/dec05/TylerAssociation.pdf

3. http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/sojc/05_06/dec05/TylerEffectiveness.pdf

PT Provides a Natural Alternative to Pain During Pregnancy

By: Heather Kidder, PT, DPT

 

Six million pregnancies occur in the United States per year. Of these pregnancies, 80 percent of women will report experiencing low back pain during the pregnancy, of which one-third will rate their pain as severe to completely debilitating. In fact, approximately 700,000 pregnant women are placed on bed rest each year due to pain. Physical therapy is an excellent natural alternative to bed rest; it can help women manage their low back pain while pregnant, allowing them to focus on the arrival of the new addition to their family.

 

During pregnancy, the female body experiences quite a bit of change over the span of 40 weeks.  As one example, it releases a hormone called relaxin, which is responsible for relaxing the ligaments surrounding the sacroiliac joint (SIJ) to allow the birth of the baby. Due to the increased laxity of the joints within the low back, joints may become misaligned, creating pain. In addition to this hormone, the growing fetus causes the expectant mother’s belly to grow in size, creating an increased curve in the low back and shifting her center of gravity forward. Furthermore, it is typical for a woman to gain 30 to 50 pounds during her pregnancy, which will create increased compression forces within joints, create muscle imbalances, and cause the arches to fall. All of these bodily changes can further lead to poor force placement within the low back, leading to lower back pain.

 

Physical therapy is a safe, natural, and cost-effective alternative for the management of low back pain during pregnancy. It has even been shown to decrease sick leave for pregnant women when done with a program consisting of exercise and education. It is safe for women without a high-risk pregnancy to be active and exercise throughout the nine months leading up to their baby’s birth. Some proven exercises that can be performed during physical therapy are pelvic tilts, sit-to-stands, bridging, and rowing. In addition to these exercises, a physical therapist can assist with postural re-education and appropriate hip and pelvic joint alignments through muscle energy techniques (MET). A trained physical therapist will also take into consideration the postures and positions in which exercises are performed.

 

On average, labor can last 12-18 hours for a first-time pregnancy. Exercises should be performed for endurance, not in short bursts, to help a woman prepare for the marathon of labor. Additionally, labor and delivery can occur in multiple postures/positions – from lying on your back, to sidelying, to maintaining a quadruped position.

 

Pregnancy is a natural process for the female human body. Many changes occur quickly over a 40-week period, which can lead to poor force application with functional daily tasks. This in turn causes the low back pain that one-third of the pregnant population rates as severe to completely debilitating, and at times leads to early sick leave or bed rest.  Physical therapy is a safe, natural, and cost-effective alternative for management of low back pain during pregnancy. It can help prepare the mother-to-be for the physical demands of labor – and the wonderful delivery of her newborn.

 

References 

 

  • Depledge J., McNair P., Williams M. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Physical Therapy. Dec 2005; 85; 1290-1300.
  • Foti T., Davids J., Bagley A. A biomechanical analysis of gait during pregnancy. Journal of Bone & Joint Surgery. May 2000; 82; 625-633.
  • Hall, J., Cleland J., Palmer J. The effects of manual physical therapy and therapeutic exercise on peripartum posterior pelvic pain: Two Case Reports. The Journal of Manual and Manipulative Therapy. 2005; 13; 94-102.
  • Irion, J. Bed rest and physical activity in pregnancy are not mutually exclusive says physical therapist. Alexandria, VA. April 24, 2007.
  • Sawyer, L, Montgomery S. Types of Back Pain in Pregnancy. Spine Health. Jan 2000; p 1-4.
  • Noren L., Ostgaard S., Nielson T.F., Ostgaard H.C. Reduction of sick Leave for lumbar back and posterior pelvic pain in pregnancy. Spine. 1997; 22 (18): 2157-2160
  • Nilsson-Wilmar L., Holm K., Oijerstedt R., Harms-Ringdahl K. Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized trial with 3,6, and 12 months follow up post partum. Spine. 2005; 30 (8): 850-856.
  • Gutke A., Sjodahl J., Oberg B. Specific muscle stabilizing as home exercise for persistent girdle pain after pregnancy: randomized, controlled clinical trial. J Rehab Med. 2010; 42(10): 929-935.
  • American Pregnancy Association. Promoting Pregnancy Wellness. 2010. Available at: http://www.americanpregnancy.org. Accessed December 12, 2010.
  • Mogren I.M., Pohjanen A.I. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine. 2005; 30 (8): 983-91.
  • Sabino J, Grauer J. Pregnancy and low back pain. Musculoskeletal Med. 2008; 1 (2): 137-141.
  • Stuge B., Even L., Kirkesola G., Vollestad N. The Efficacy of a Treatment Program Focusing on Specific Stabilizing Exercises for Pelvic Girdle Pain after Pregnancy: A Randomized Controlled Trial. Spine. 2004; 29 (4): 351-359.
  • Baby Center. Positions for Labor. 2010. Available at: http://www.babycentre.com. Accessed December 12, 2010.
  • American College of Obstetricians and Gynecologists. Exercise during pregnancy. 2010. Available at: http://www.acog.org. Accessed December 12, 2010