Adhesive Capsulitis – aka Frozen Shoulder


Adhesive capsulitis is the medical term for the more commonly used phrase “frozen shoulder.” The capsule of the shoulder thickens and tightens, contributing to pain and loss of motion in the shoulder. There is no known cause for adhesive capsulitis; however, risk factors include diabetes, previous shoulder surgery, and hyperthyroidism. Some statistics show that up to 20% of diabetics may develop adhesive capsulitis compared to only 5% of the general population. The condition is also more prevalent in women around menopause.


The first sign of adhesive capsulitis is often pain. Next is loss of motion and function of the arm. The shoulder may continue to be dysfunctional for several months. It is typically diagnosed by clinical exam, as X-ray and MRI findings are usually insignificant but can help to rule out any other causes of your symptoms.


Adhesive capsulitis of the shoulder can resolve on its own in about a year without treatment however, both conservative and surgical interventions can help to speed your recovery. This condition is most commonly treated with NSAID medication, steroid injections and physical therapy to restore motion. The rehabilitation process is painful and involves aggressive range of motion activities for the shoulder, as well as the therapist moving your shoulder for you. A home program is typically included as well. It is essential for the patient to perform their exercises in PT and at home to restore the movement in their arm.

People with adhesive capsulitis often make a full recovery with no residual effects. Get help from a qualified PT if you suspect you may have the beginnings of adhesive capsulitis to get moving again. Motion is lotion for the joints!


Treating Vertigo and Balance Disorders


Dizziness is a very common symptom that people may have at some point in their lives. From 2001 through 2004, 35.4% of US adults aged 40 years and older (69 million Americans) had experienced vestibular, or inner ear, dysfunction leading to dizziness.1


Some common causes of dizziness are vertigo, stroke, medication side effects, and sinus congestion, to name a few. Vertigo is caused by crystals in the inner ear getting lodged in the wrong place. Sometimes this can happen from a head injury or force to the head, but most of the time it happens for no reason at all. People who suffer from vertigo will complain of severe room-spinning dizziness, which may make them nauseous or even vomit. Many people describe vertigo as feeling like they had way too much to drink and then lay down. Vertigo can also impact balance and cause falls.


If you experience a sudden onset of dizziness, the best advice is to go to the emergency room or call your physician. It is important to rule out any significant causes, such as a stroke or cardiac event. If it is ruled to be vertigo, the physician may prescribe anti-dizziness medication and refer to a physical therapist (PT) who specializes in “vestibular therapy.” This specialized PT may be able to get rid of the vertigo in one visit.


The treatment for vertigo is usually very easy for the patient to tolerate. The patient will be given a thorough exam, and will then be led through what is called the Epley Maneuver. The Epley maneuver basically repositions the crystals back into a place in the inner ear where they won’t cause dizziness or loss of balance. The physical therapist will have the patient quickly lie down on their back with their head facing the symptomatic side, then turn the head slowly around about 270 degrees to the floor. The patient will then be instructed to sit up.


Most people report immediate relief, but some may take a few visits before they feel completely better.  The sooner they seek treatment the better to prevent any falls.


At Sports PT, we have three physical therapists that specialize in Vestibular Therapy. Becky Korosi and myself offer treatment in Tonawanda and Susan Kim at our York Avenue facility in Manhattan also offers this treatment. If you are suffering from vestibular dysfunction and have questions or are seeking treatment, please contact us directly.


What Lies Ahead for Yankee Pitcher Mariano Rivera After ACL Injury

(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

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.


How Exercise Can Help Combat Osteoporosis


Osteoporosis is a growing problem in the American population with very serious consequences. Osteoporosis is the thinning of bone tissue and loss of bone density over time due to loss of calcium and phosphate, which make the bones strong. Osteopenia is the loss of bone density, but not severe enough to be classified as osteoporosis. In the United States today, 10 million individuals already have osteoporosis and 34 million more have low bone mass, placing them at increased risk for this disease. One out of every 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture in his or her lifetime. (1)


One of the best methods to increase bone health and mass is performing exercise. Certain types of exercise are more effective at building bone than others, most notably weight bearing exercise. Weight bearing does not mean lifting weights, but rather performing exercises in standing positions where your bones have to carry your body weight. Bones will get stronger when they are subjected to increased stress. Good bone building exercises include: walking, jogging, dancing, stair climbing, and tai chi. These exercises should be performed for 20 minutes, 3 days a week for best results. Poor bone building exercises include: swimming, biking, spinning, and light stretching.


Of course, if you have osteoporosis or bone loss, check with your physician before beginning any exercise program. Most people are able to exercise very safely and increase their bone mass effectively through exercise.


Sitting for Prolonged Periods


We now live in a time where many of us are sitting for most of the day at work. What do we then do after we commute home in our car, bus, or train? The answer is probably sit for dinner, then sit and watch TV. With the workforce becoming increasingly more computerized and less manual labor, a new breed of couch potato-related problems have emerged.


The Facts:


Prolonged sitting (more than half the day) leads to increased risk of:

  • Heart disease
  • Metabolic disorders
  • Obesity
  • Some types of cancer

            Click here to find out more about these risks.


Sitting takes a toll on our musculoskeletal system:

  • Sitting shifts a person’s center of gravity to the middle of their chest rather than the hips, increasing stress on the neck and shoulder muscles. This can lead to nagging neck pain at the end of the day.
  • Another common complaint from prolonged sitters is low back and/or sciatic pain, a burning pain that travels down the back of the leg. A flexed sitting posture increases pressure on the discs in the lower back and also decreases blood supply to the nerves making them more irritable.


What can be done?

I get it…you need to sit at work. However, there are a few things you can do to decrease the bad effects of prolonged sitting. One thing I commonly suggest is to set a timer for 30 minutes on your Outlook calendar or use a kitchen timer. When it dings, get up and walk a little bit. It’s easy to get caught up in work and lose track of time, so the timer is a great method to remind your body to move and get some blood flowing. Another recommendation is to make your workstation inconvenient. Put that printer across the room. Move your calendar to the bookshelf. Get your phone off your desk. This will force you to get out of the chair. You could also do some stretching or exercise while watching TV instead of sitting on the couch. This will not only feel good, but can help to counteract some of the risks of prolonged sitting.