Children, Sports and Exercise

Getting your child involved in sports is an excellent way to encourage exercise and prevent childhood obesity. This is a proud feeling for every parent, and the expectation is that the child will have fun, gain confidence and interact with other children in the process.

To determine what your child will enjoy participating in, help him / her decide by accompanying the child to different games and a variety of sports. The more sports and environments the child is made aware of, the higher the probability that the child will be able to pick a sport and enjoy it.

It is important to make sure that the child's sporting activity is age appropriate. In general, toddlers (aged 2-5) are too young to comprehend most organized activities and the importance of 'rules'. They need unstructured play to develop movement skills, attention span and social maturity. From the age of 8 and above, children can participate in team sports and group exercise.

If your child does not like athletic activities, take the opportunity to spend more time with your child and encourage physical activity with regular walks, swimming, tossing a ball around, or simply kicking a ball back and forth. Be creative and mix it up so your child does not get bored.

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Importance of Safety First

Unfortunately, children can get injured while playing sports. When this happens, consult a physician immediately. In most cases, the physician may recommend the services of a physical therapist with extensive training in anatomy and physiology. The therapist will work closely with the physician to help your child recover as quickly as possible.

Specially trained in anatomy and physiology, a physical therapist will design a delicate, yet effective exercise program to help restore muscle balance and improve mobility in your child. The therapist will be aware of the child's limitations and will do everything possible to facilitate recovery as quickly as possible. Children tend to get restless during recovery, and a physical therapist will patiently work with the child to achieve compliance during the recovery process.

Physical therapy helps to heal, strengthen, and improve motion by treating your child's injured area with a variety of exercise techniques that incorporate fun and playful activities. With physical therapy, you can expect your child to recover quickly and resume athletic activity.

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Message From Your Physical Therapist

The Right Physical Therapist For Your Child

Although physical therapy can help children in the recovery process following an injury, there is a lot more that the therapist can do. As a parent, you can expect the physical therapist to use a variety of techniques to strengthen muscles and improve joint mobility. The therapist will make the exercises fun and interesting, and your child won't realize that he or she is 'being treated.' As a parent, you should encourage your child to participate and 'play along' with the treatment. The physical therapist may use play techniques including crawling, playing follow the leader, facilitating balance and coordination activities using beams, balls and other objects.

After an injury, a physical therapist will help your child regain full potential, allowing your little bundle of joy to experience the pleasure of sport and grow physically and emotionally in the process. Your child will look forward to the 'play sessions' and be an active participant in the recovery process. If your child (or another child that you know) is recovering from an injury, give us an opportunity to help the child return to normal as quickly as possible. Give us a call today, 561-833-1747, flaglrcorf@aol.com

Physical Therapy Helps!
Physical Therapy In Sports: Golf Highlight
Posture, fitness, and flexibility are critical to help remain fit and injury-free for any sport, particularly golf. The achievements of professional golfers like Tiger Woods, Phil Mickelson and Lorena Ochoa highlight a new athleticism associated with a sport that was once considered "leisurely." Today's men and women golfers, both amateurs and professionals, are training to be stronger and more flexible, capable of far powerful swings than ever before. According to the American Physical Therapy Association (APTA), awareness of proper posture and the importance of fitness and flexibility are just as important for weekend golfers as they are for professional athletes. Most athletes, including golfers spend thousands of dollars each year on new and improved equipment, but the most important piece of equipment is the human body. Did you know: In 2005, Golf Digest calculated that the countries with most golf courses per capita were: Scotland, New Zealand, Australia, Ireland, Canada, United States, Sweden, and England (countries with fewer than 500,000 people were excluded). The number of courses in new territories has been increasing rapidly. There are over 35 million people that play golf in the United States alone. Golfers need to take the time to work at their game and their conditioning if they want to excel in the game. Golfers should have access to a physical therapist who can assess their physical abilities and provide individualized training programs that address muscle imbalances, body mechanics, strength, posturing and cardiovascular fitness.
Golf Conditioning By Your Physical Therapist
Just like any professional sport, there has been a significant increase in injuries among professional golfers, primarily because of the increased physical stress and intense training associated with the sport. Strength, flexibility, and endurance are just as important as exceptional driving distance and keen putting skills. It is now the norm, not the exception, for professional and non-professional men and women golfers to work with physical therapists to improve these factors. For golfers to improve their swing, it is vital that these programs be tailored to their individual skills. There are certain types of training that may actually hinder - not help - athletes. What works for someone else may not work for you! Call us today to find out what you are missing in your training as you aim to excel at your sport. We can help condition you for all sports, not just golf.
Keeping Injuries Away
Professional golfers make it look easy, but the golf swing is actually one of the most difficult and complicated movements in all of sports, requiring stability in some joints and flexibility in others. The ability to coordinate motion, strength, and function throughout the swing play a large role in preventing injuries. A better swing means a more accurate ball strike, greater distance, and less stress on the muscles and joints. Our physical therapists work with individuals in all sports. We have observed that recreational golfers often complaining of spine-related injuries, including upper and lower back, shoulder and neck pain. Leisure golfers attempt to swing with the speed and force of professional athletes, but did you know that with each swing 7 to 8 times a golfer's weight is directed into the spine? With this kind of force, it's easy to damage discs and strain muscles. Multiple core (not just abdomen) stabilization exercises are critical for golfers. Pilates programs are an example of excellent injury-prevention tools that can ultimately help golfers improve their performance. Golfers of all ages and abilities should make a habit of the following: Warm up and stretch before teeing off. Spend at least 20 minutes warming up and stretching all the major muscle groups, especially the back and extremities, before practice or play. Don’t wait until you are on the course before stretching because that is neither practical nor conducive to a thorough stretch. Don't forget the cardiovascular conditioning. Fatigue can result in poor performance due to a lack of coordinated body movements. To keep endurance up and muscles warm and conditioned, we suggest golfers walk the course whenever possible, as continued aerobic conditioning is an essential component of golf fitness. If you or a friend require help or need information to direct you to the proper care please call. The Flagler Institute for Rehabilitation, Inc. 561-833-1747

Temporomandibular Joint (TMJ) Dysfunction and Physical Therapy

The temporomandibular joint (also known as TMJ) is located in front of the ear on either side of the head where the upper and lower jaws meet. It is used throughout the day during activities like talking, eating and chewing.

In most cases, TMJ dysfunction requires a visit to a dentist or orthodontist. Physical therapy is not normally considered the first choice for treatment. However, it is important to note that the muscles of the neck and jaw are closely connected to the muscles of the shoulders and neck. Weakness or dysfunction in the neck and shoulder muscles affects the muscles surrounding the jaw and this is one of the (several) causes of TMJ problems. These muscles are some of the most actively used in the body. As a result, untreated TMJ dysfunction has the potential to evolve from a mere nuisance to a rather debilitating condition.

In the early stages, an individual may experience difficulty talking, chewing, yawning, sneezing, and swallowing. Over a period of time, the symptoms can get worse. They may include headaches, ear pain, bite problems, clicking sounds, and locked jaw.

What Causes TMJ Dysfunction?

Causes of TMJ dysfunction include teeth grinding, habitual gum chewing or nail biting, dental problems (jaw abnormalities or missing teeth) and trauma or injury to the jaws. Occupational tasks (holding the phone between the head and the shoulder, staying hunched over the computer for extended periods of time) that trigger muscle imbalances in the neck and shoulder also play a role.

When muscle imbalance is a contributing factor, the TMJ attempts to compensate for the misalignment. Normally, TMJ motion is smooth and coordinated, allowing the jaw to move in several directions including side to side, forward / backward and open / close. When the movement becomes imbalanced, the result is increased strain on the ligaments and the muscles of the jaw. This can lead to a number of symptoms including jaw and facial pain, clicking and popping when opening and closing the mouth, difficulty opening the jaw, neck pain and headaches.

Stress is a common trigger for TMJ dysfunction. Self-awareness and relaxation techniques can be beneficial. Avoiding hard, crunchy, or chewy foods help reduce pain. Hot or cold towels can alleviate swelling or muscle spasms and further help in pain reduction.

Significance of Physical Therapy

A dentist can evaluate TMJ problems and may recommend a dental appliance or dental work. However, if TMJ dysfunction is associated with headache or pain in the jaw, neck or shoulders, ask for a referral to a physical therapist.

The therapist will evaluate the TMJ to determine the degree of strength, mobility and tension in the surrounding muscles. This information serves as the foundation for an exercise program to address muscle imbalances. Strengthening, stretching, and relaxation techniques prescribed by the physical therapist will help reduce pain and restore function.

Untreated TMJ dysfunction can result in impaired concentration, inability to chew food (leading to poor nutrition), difficulty sleeping and psychological distress. If you are experiencing any of the symptoms of TMJ dysfunction, consider the services of a physical therapist as part of your treatment. Physical therapy can reduce the pain and limitation associated with TMJ problems and speed up the recovery process. We look forward to hearing from you, and will be happy to answer any questions you may have.

 

Please call if you need help or a referral to a MD.

The Flagler Institute for Rehabilitation, Inc.

561-833-1747

Physical Therapy Helps!

The Hidden Link Between Sleep and Pain

This is typically a time for new year resolutions. For most individuals, this involves exercising and healthy eating, but sleep is equally (if not more) important. One of the best things you can do for yourself this year is to try and get enough sleep. In fact, did you know that there is a correlation between sleep and pain?

Some people sleep longer because they are in pain, while others cannot sleep at all. P...ain affects the way a person sleeps and a lack of sleep can intensify pain. Individuals who suffer from chronic pain may experience sleep disorders. In fact, pain is one of the causes of insomnia.

Sleep disorder symptoms include difficulty falling asleep, waking up in the middle of the night, waking up early in the morning, restless sleep, and overall dissatisfaction with the quality of sleep. The consistent interruption of sleep triggers a vicious cycle of sleep deprivation and increased pain. The less sleep a person gets, the more intense the pain can become.

Strategies for Improved Sleep

If pain (or any other reason) is affecting the quality of your sleep, start by identifying the cause of the problem. The first step is an assessment of the sleeping environment and lifestyle habits. Here are some questions to answer:
•Is the bedroom a quiet place and are all lights switched off? Is there a television or laptop (and associated glare) in the bedroom?
•What are you sleeping on? How old is the mattress? Does your pillow provide enough support for your neck and head?
•What are you eating and drinking before you go to sleep? Are you consuming caffeinated beverages late in the day? Are you eating big meals close to bedtime?
•Are you sleeping at the same time every day? Are you avoiding stressful conversations or situations before going to bed?

By facilitating an environment that is quiet and comfortable, you will set the stage for sound sleep. A physical therapist can also help you sleep better by teaching you techniques such as autogenic relaxation, progressive muscle relaxation, and visualization.

Message From Your Physical Therapist
"Don't Lose Sleep Over It"

If pain is affecting your sleep patterns, physical therapy can play a big role in the recovery process. The combination of pain and lack of sleep creates a vicious cycle that can get progressively worse, if left untreated.

Fortunately, a physical therapist can identify the underlying cause of pain and create a plan for lasting pain relief. Using a combination of hands-on techniques (including joint mobilizations and massage), the therapist will help reduce muscle tension. This will help you sleep better. A therapist will also design a stretching and strengthening program to restore muscle balance and reduce pain; restoring normal sleep patterns.

If you have pain and are losing sleep over it, reach out to us, your physical therapy providers. We'll help you reduce pain and sleep better. We don't want you to lose any more sleep over this and it is time for you to start living a pain-free life.

Call us today.
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Car Accident? Physical Therapy Can Help

Each year, 2 million people suffer from whiplash related to car accidents in the United States alone. Studies using high-speed cameras and sophisticated crash dummies have revealed that rear impact car accidents result in a condition called ‘whiplash’. This forces the bones of the lower cervical spine (the neck) into hyper-extension (backward bending motion) while the bones of the upper neck are suddenly thrust into hyper-flexion (forward bending motion). In a split second, the normal curvature of the cervical spine is disrupted and the consequences can range from mild to serious. A sudden, abnormal motion to a sensitive region like the neck causes damage to the soft tissues (ligaments and muscles) of the cervical spine. This leads to inflammation and pain. Common symptoms: The most common symptoms related to whiplash include: Headaches Neck pain and stiffness Shoulder pain Dizziness Jaw pain Arm pain/weakness/ tingling Back pain

Physical Therapy Helps Recovery

Recent studies have shown that physical therapy may be the best choice to decrease pain, improve mobility, and minimize lost productivity as a direct result of whiplash-associated disorders. In a study in the Journal of Rheumatology (2007), a systematic review was performed of the existing literature on neck pain related to car accidents. The evidence strongly supported the use of stretching/strengthening exercises and mobilizations. Also, treatment with physical therapy was less expensive in the long run and reduced long-term disability compared to other treatment options. An article in the Emergency Medical Journal (2006) compared two groups of individuals recovering from car accidents. The first group received mobilization and exercise therapy (components of physical therapy) and the second group was treated with medication and a cervical collar. The group that received physical therapy had significantly less headaches and other symptoms related to whiplash compared to the second group. If you or someone you know has been injured in a car accident, the best thing you can do is to have them call our office today. The longer you wait to seek the expertise of one of our licensed physical therapists, the more prolonged the recovery process is likely to be. Don’t wait, pick up the phone and schedule an appointment right away.

An Active Approach To Be Pain-Free Again

In most cases, the potential for recover is high, especially with the right care as early as possible. A return to activity as soon as possible helps significantly. Although symptoms may be around for a while, the pain will improve within a few days or weeks. Be sure to continue with the medicines prescribed by your doctor to aid with early movement. Remember that prolonged inactivity does NOT help. Keep moving - it's important. Avoid staying in the same position for too long to avoid tightness and loss of flexibility. Exercise plays a big role in recovery. Simple neck and shoulder exercises are safe and effective. Stretching, strengthening and coordination exercises should be done regularly each day. Some soreness after exercise is to be expected. It is not a cause for concern. Physical therapy, in conjunction with standard medical care, has been shown to be the best choice to decrease pain, improve mobility and help you return to normal daily activities after a car accident. We can help you. Just contact us to see what we can do for you. If you have had a car accident, the first step toward recovery starts with us. Schedule your risk free appointment with your physical therapist. Let us help you return to a healthy, pain-free life once again.

Rehab For Rotator Cuff Injuries:

Acute Phase

Physical Therapy

Pain control and inflammation reduction are initially required to allow progression of healing and initiation of an active rehabilitation program in patients with a rotator cuff injury. This can be accomplished with a combination of relative rest, icing (20 min, 3-4 times per d), and acetaminophen or an NSAID. Have the patient sleep with a pillow between the trunk and arm to decrease tension on the supraspinatus tendon and to prevent blood flow compromise in its watershed region. Patients are instructed to continue the pain control techniques at home, work, or vacation as part of their exercise program. The home exercise program builds on itself through each phase of the rehabilitation process, and carry-over should be monitored.

Other Treatment

Corticosteroids delivered directly to the site via injection can be considered to allow further progression of the rehabilitation program. Place injections into the subacromial space, avoiding direct injection into the rotator cuff tendon. Advise the patient to limit activity that involves high-tensile loads (eg, maximal overhead throwing) for 2-3 weeks while the tendon is potentially at risk after injection, particularly if the patient exhibits rotator cuff muscle weakness. These injections need not be given to patients with complete rotator tears, especially if surgery is being considered.

Recovery Phase

Physical Therapy

The recovery phase from a rotator cuff injury must include several components to be successful. These include the following: (1) restoration of shoulder ROM, (2) normalization of strength and dynamic muscle control, and (3) proprioception and dynamic joint stabilization.

Restoration of shoulder ROM

After the pain has been managed, restoration of motion can be initiated. Codman pendulum exercises, wall walking, stick or towel exercises, and/or a physical therapy program are useful in attaining full pain-free ROM. Address any posterior capsular tightness because this can lead to anterior and superior humeral head migration, resulting in impingement. Posterior capsular tightness is common in athletes performing overhead motions (particularly throwers), because the posterior muscles and capsule are greatly stressed during the follow-through phase of the throwing motion. This activity places large eccentric loads on the posterior capsule and posterior rotator cuff musculature and can result in microtrauma and inflammation, followed by scarring and contracture.

Many overhead athletes have a great degree of external rotation with restriction of internal rotation. This was once thought to be a normal adaptation to the demands of the sport. The tight posterior capsule and the imbalance it causes forces the humeral head anterior, producing shearing of the anterior labrum and causing additional injury. Stretching of the posterior capsule is a difficult task to isolate. The horizontal adduction that is usually performed tends to stretch the scapular stabilizers and not the posterior capsule. If care is taken to fix and stabilize the scapula, which prevents stretching of the ST stabilizers, the objective of posterior capsule stretching is obtained. The focus of treatment in this early stage should be on improving range, flexibility of the posterior capsular postural biomechanics, and restoring normal scapular motion.

Initially, ultrasonography to the posterior capsule followed by gentle passive prolonged stretch may be needed. Closely monitor ultrasonography use to avoid heating an inflamed tendon, which worsens the situation. Instruct the patient about proper posterior shoulder stretches with the scapula fixed, which should be performed after a period of aerobic exercise. Such exercise results in increasing the core body temperature. The increase in core temperature makes the tissues more extensible and allows for greater benefit from stretch. Each stretch should be held for a minimum of 30 seconds, although stretching for 1 minute is encouraged. Postural biomechanics are important because poor posture (eg, excessive thoracic kyphosis and protracted shoulders) increases outlet narrowing, resulting in greater risk for rotator cuff impingement. Restoring normal scapular motion is also essential because the scapula is the platform upon which the GH joint rotates; thus, an unstable scapula can secondarily cause GH joint instability and resultant impingement. Scapular stabilization includes exercises such as wall push-ups and biofeedback (visual and tactile).

Strengthening

Perform strengthening in a pain-free range only. Begin with the ST stabilizers. The scapular stabilizers include the rhomboids, levator scapulae, trapezius, and serratus anterior. Shoulder shrugs, rowing, and push-ups isolate these muscles and help return smooth motion, allowing normal rhythm between the scapula and GH joint. Then, turn attention toward strengthening the rotator cuff muscles. Position the arm at 45° and 90° of abduction for exercises to prevent the wringing out phenomenon, in which hyperadduction can be caused, stressing the tenuous blood supply to the tendon of the exercising muscle. Avoid the thumbs-down position with the arm in greater than 90° of abduction and internal rotation to minimize subacromial impingement.

Many ways to strengthen muscles are available. The rehabilitation program usually starts with isometric and co-contractions, progresses to concentric contractions, and finally incorporates eccentric contractions as part of the preparation for return to sports. Using the baseball thrower example, the most important muscle conditioning is that of eccentric control. Eccentric forces are the most damaging to muscles, and if the patient is not fully rehabilitated and conditioned, injury occurs or reoccurs. Additional strengthening techniques that can be used are progressive resistive exercises (PREs), Thera-Band (Hygienic Corporation; Akron, Ohio), and plyometrics. Use of isokinetic exercises has been debated because they are not performed in a functional manner. Probably the best use for isokinetic exercise machines is for objective side-to-side comparison of strength and progress made in strength rehabilitation. Incorporate endurance training into the program as it advances. When strength is restored, continue a maintenance program for fitness and prevention of reinjury.
 

Proprioception

Proprioceptive training is important to retrain neurologic control of the strengthened muscles, providing improved dynamic interaction and coupled execution of tasks for harmonious movement of the shoulder and arm. Begin tasks with closed kinetic chain exercises to provide joint stabilizing forces. Then, as the muscles become reeducated, one can progress to open chain activities, which may be used in sports or tasks. Capsuloligamentous structures contain sensory afferents, which respond to motion and changes in joint position, whereas musculotendinous structures sense muscle length and tension. Injury can affect these afferents, which require retraining much like restrengthening the muscles. In addition, proprioceptive neuromuscular facilitation (PNF) is designed to stimulate muscle/tendon stretch receptors for reeducation. In a 1965 report, Kabat described shoulder PNF techniques in detail.^[26]

Surgical Intervention

Indications for operative treatment of rotator cuff disease include partial-thickness or full-thickness tears in an active individual who does not have improved pain and/or function within 3-6 months with a supervised rehabilitation program. An acromioplasty is usually performed in the presence of a type II (curved) or type III (hooked) acromion with an associated rotator cuff tear. Athletes with rotator cuff pathology secondary to GH instability also need to have this addressed. In surgical candidates, early repair is useful to avoid fatty degeneration and retraction of the remnant rotator cuff musculature. Functional recovery should be stressed, and, in a patient who can achieve pain-free activities of daily living in the setting of a rotator cuff tear, surgical repair may be avoided. Surgeries including muscle transfers and debridement are generally reserved for massive, irreparable rotator cuff tears. A latissimus dorsi tendon transfer is one type of treatment for irreparable rotator cuff tears that has demonstrated improvement in shoulder function, range of motion, strength, and pain relief.^[27]  Attempts to enhance healing in rotator cuff repair have included the use of platelet-rich fibrin matrix applied to the tendon-bone interface at the time of rotator cuff repair; this technique, however, has no demonstrable effect on tendon healing or vascularity, manual muscle strength, or clinical rating scales. Whether fibrin matrix is the ideal substrate to enhance tissue healing remains unknown, and perhaps other forms of growth factors may prove to be better at enhancing tissue healing following surgery.^[28]

Maintenance Phase

Physical Therapy

Return to task-specific or sport-specific activities is the last phase of rehabilitation. This phase is an advanced form of proprioceptive training for the muscles to relearn previous activities. It is an important phase of rehabilitation and should be supervised properly to minimize the possibility of reinjury. Rehabilitation begins at a cognitive level but must be practiced so that transition to unconscious motor programming occurs. All various phases of shoulder injury rehabilitation may overlap and can progress as rapidly as tolerated, but all should be performed to speed recovery and prevent reinjury.

At the conclusion of formal therapy sessions, patients should be independent in an ROM and strengthening program and should continue these exercises, initially under supervision and then completely on their own. A natural tendency exists for patients to abandon the home program once they feel better; however, patients must be encouraged to continue a maintenance exercise program to prevent symptom relapse. Athletes are often tempted to return to their overhead throwing sport too soon after recovery of the acute phase.

 

Sports Injury Rehabilitation 101

Injuries can occur in any sporting activity. Professional athletes in particular, are prone to injuries due to the excessive wear and tear associated with the demands of competitive sport. The right exercis...

e program to maintain strength, flexibility and stability can help athletes recover quickly after an injury, empowering them to resume athletic activities.

Sports injuries, by definition, include injuries involving the musculoskeletal system. The musculoskeletal system includes the bones, tissues, muscles, and cartilage. Every injury is different and every person heals differently. The purpose of rehabilitation is to help the injured tissues recover in a controlled and supervised manner. It takes time for an injury to heal, and it's best to seek the guidance of an experienced physical therapist during this time. The therapist can design a safe and effective recovery program specifically geared towards the individual's abilities. A physical therapist can identify the cause of the injury and create a treatment plan to prevent future injuries.

Some of the most common sports injuries include sprains, strains, shin splints and knee injuries. If you or someone you know is injured, schedule an evaluation with a physical therapist as soon as possible.

 Physical Therapy - The Right Choice

A physical therapist is a healthcare professional with extensive training in the musculoskeletal system. The therapist can work closely with athletes to assess muscle imbalance, range of motion and functional requirements of that particular sport. For example, a baseball pitcher may need a shoulder stabilization program and a basketball player may need a speed and plyometric (explosive strength) training program. The physical therapist can evaluate, identify, and plan a sport-specific injury prevention program.

As part of the treatment process, a therapist will prescribe an exercise program consisting of stretching (to improve mobility) and exercises (to improve strength). The goal of physical therapy is to reduce pain and improve function as quickly as possible. Along with exercise, rest is an important part of the recovery process. The physical therapist will help you to balance rest and exercise to recovery in an optimal manner.

Don't Wait For an Injury...

An injury is the last thing anyone wants. Without proper rehabilitation, the damage can get worse. In fact, did you know what physcial therapy helps not only with treatment, but also with prevention of athletic injuries? Also, it doesn't matter if you play professional sports or are a weekend warrior. Working with a physical therapist requires time and patience, but it's worth the effort. It's a great way to come back to the sport you love and enjoy, while minimizing the chances of re-injury.

If you or someone you know is an athlete, consider working with a physical therapist. In fact, you don't have to wait till you are injured, because a physical therapist can help an individual improve athletic performance and minimize injury. A preventive, proactive approach is important. After all, prevention is better than cure. Don't wait till someone gets injured because there is a lot that a physical therapist can do to save you from an injury. Schedule an evaluation with us, because we can design the right program and get you great results. It doesn't matter if you are a recreational athlete or participate in competitive sports, we can help you. We look forward to hearing from you.

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