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I have heard plenty of people complaining recently about how expensive health care costs are especially after a hospital stay or surgery.  So what if you could avoid an expensive surgery?  

What if you could see a healthcare professional, receive exercises that help to decrease your symptoms, and then utilize the knowledge you learned to manage your symptoms without having to continue to pay for treatment and without having to pay toward a ridiculously high hospital bill?  Well the research shows that physical therapy can be just that remedy versus surgery for spinal stenosis.  If cost is not your concern, then perhaps time is.  When properly managed, patients that undergo back surgery should then be treated with physical therapy for improving function, strength, and stability in the back. 

For those of you who don’t understand what spinal stenosis is, it occurs when there is a narrowing of the spaces between your vertebrae (bones that make up the neck and back) resulting in pressure on the spinal cord or nerves.  This pressure can result in pain, numbness, tingling, or weakness in the arms or legs.  Occasionally, it can also affect bowel and bladder function. 

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Read more: PT vs. Surgery for Spinal Stenosis

Wearing high heels has become almost like a rite of passage for young girls entering adolescence and adulthood.  The problem is that this particular fashion trend holds so many negative side effects both immediately and later on in life.  As with so many choices we make when we are young, we must often pay the consequences as we age.

Believe it or not, high heels began as a means for wealthy men to protect themselves from the mud and muck on the ground back in the 14th century.  Now, women have adopted the trend simply as a fashion statement.  While those pretty pumps may make your calves look great, the negative effects may not be worth the looks.  So why do high heels get such a bad rap? What problems do they actually cause?

First off, when you stand on your toes and lift your heels off the ground (known as plantarflexion); your ankle is placed in a less stable position which leaves you more prone to spraining the ankle ligaments.  This position also places increased stress on the peroneal and lateral gastrocnemius muscles which are located in the calf and help support the outer side of your ankle.  If these muscles are already weak, then placing more stress on them by wearing high heels can leave you prone to injuring the muscles.  This also leaves you more prone to spraining the ankle ligaments due to having less muscle support to prevent you from “rolling” the ankle.

In addition to ankle injuries, the feet take quite a beating from wearing heels.  Due to the effects of gravity, the toes are forced to take an excessive amount of pressure through a typically narrow toe box.  The pressure placed on the toes from frequent high heel wearing contributes to hammertoes, bunions, corns, calluses, and toe nail problems.  These deformities can become so severe that surgery may be required to realign the joints of the feet.

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Read more: What Are High Heels Doing to Your Feet and Posture?

If you have been following the recent trends in sport injury treatment or are an athlete yourself, you may have heard reference to PRP.  The abbreviation stands for platelet-rich plasma.  So what exactly does PRP do and how is it effective for healing?

Plasma is a component of blood.  The plasma in blood contains proteins called growth factors that assist with healing. PRP is plasma with a higher concentration of platelets than what is naturally found in blood.  When someone is being prepped to receive PRP injections, that individual’s blood is drawn and platelets are separated from other blood cells in order to produce PRP.  The resulting substance is then injected in the area that requires healing in order to speed the healing process.

This description of the effects of PRP makes it seem like a “cure-all” for healing nearly any ailment of the body.  So what’s the catch?  PRP is still an experimental treatment; therefore, the procedure is typically not covered by insurance and instead conducted at a self-pay rate.  Also, not all of the effects are known.  Stimulating growth in a particular area with PRP may have the potential to trigger the growth of cancer cells, but the validity of this theory is untested and unknown.  Additionally, PRP has been shown to be ineffective for certain conditions.  The discrepancy in effective treatment may be due to the area of the body being effected, the age of the individual receiving the injections, the type of injury (ex. acute or chronic), and the protocol used by the doctor for performing the injections (ex. number of injections in a series).  PRP may even be inhibitory for certain conditions like bone healing due to the nature of bone healing being different from that of muscles and tendons.  A decrease in the healing effects may also occur if the body feels that it is being overstimulated by healing factors and, in turn, shuts off certain healing processes. 

Then what conditions are treated with PRP and where has it been effective?  PRP has been shown to be effective in the treatment of chronic tendon injuries, especially lateral epicondylitis (tennis elbow).  Its effectiveness on chronic Achilles tendonitis or patellar tendonitis has demonstrated some positive trends, but it is unclear if PRP is more effective than traditional treatments.  Despite the publicity and trend toward using PRP for sport related injuries, there is no definitive proof that these injections provide any change or enhancement in the healing process for acute (recent) injuries to muscles and ligaments.  However, the treatment continues to be utilized for acute sport injuries and the research continues.  PRP has been used to assist with healing in surgeries for rotator cuffs and knee ligament repairs, knee arthritis, and fractures; however, the evidence is either inconclusive or demonstrates little to no changes in the rate of tissue healing.  One Italian study even showed an inhibitory effect when used for treatment of a rotator cuff injury.

It is important to note that if someone chooses to receive PRP injections for his/her particular condition, the injection itself will not cause immediate relief of symptoms like one would expect from cortisone.  There will likely be pain at the injection site, the area should then be immobilized for approximately 7-10 days, ice and anti-inflammatories should be avoided, and return to sport (if that is the intention) should be slow.  As stated previously, PRP injections are still being researched.  As more studies are done, there will be more evidence to rely on in order to determine the effectiveness of this particular treatment.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=A00648

Platelet Rich Plasma (PRP) – Lecture by Christopher T. Donaldson, MD at Saint Francis University

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Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.