Posted on 1/22/2021

While sports might continue to look a little differently this year due to the COVID-19 pandemic, the safety for our athletes remains a top priority. Our athletic trainers and physical therapists provide crucial education for the protection of our athletes while they are participating in their long-awaited sports seasons, as well as provide comprehensive therapy to aid in the recovery of any injuries sustained.

One of the most prominent, but often less understood, sports injuries is the concussion. There are many myths and misconceptions about concussions, but they can occur from any impact to the head, neck or body. A concussion starts with a physical impact and can be a direct hit to the head or an indirect hit, such as the rebound of the head/neck in a football tackle. The obvious hits are the easiest to recognize; however, the less obvious hits are harder to catch and may lead to missed symptoms.

While not all hits lead to a concussion, it is important that we are on the lookout concussion symptoms. Parents, coaches and teammates should be educated on common symptoms in order to prevent the athlete from playing through injury. Symptoms can include:

• Headache
• Dizziness
• Fatigue
• Feeling foggy
• Difficulty thinking
• Imbalance
• Sensitivity to light or sound
• Blurred or double vision

The presentation of these symptoms may start showing immediately or be delayed up to 24 hours.

It is also important that a thorough assessment be performed to rule out that an injury has not occurred before returning to play. Playing through a possible concussion or missing concussion symptoms overall is a safety concern and could delay return to sport. Always think, “When in doubt, sit them out.” This assures the athlete rests initially for 24-48 hours to allow the body and brain to rest and heal.

During this resting period, to the athlete should avoid mental and visual strain as well as excessive activity. This includes anything that increases your symptoms, such as watching television, playing video games and being on the computer and/or phone.

Most concussions will resolve themselves within 7-10 days, but approximately 15-20% of patients present with lasting symptoms – most notably headaches – which may be the result of delayed healing. Initially, resting the brain helps decrease prolonged symptoms and extended healing times. After the initial resting phase, best practice is to begin an active recovery. Physical therapy intervention can set athletes up with an appropriate exertion program that is safe for the brain.

Our centers offer a variety of opportunities to work with therapists specializing in concussion rehabilitation who help to establish the underlying cause of prolonged symptoms. Each comprehensive examination focuses on the most common factors that may lead to delayed healing, including physiologic recovery (Is your brain healed enough to tolerate activity) and visual and vestibular involvement (Are your eyes or inner ears playing a role in your symptoms? Is the neck involved?).

Our evaluation and treatments are backed by evidence that will help patients recover more quickly in order to safely return to symptom-free participation in their respective sports.

By: Megan Brainerd, P.T., DPT, COMT. Megan is a physical therapist with Select Physical Therapy in Summerville, SC.

Select Physical Therapy and KORT are part of the Select Medical Outpatient Division family of brands. 

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Posted on 1/20/2021

Does your child suffer from bowel and bladder issues? If so, did you know that pediatric physical therapists can help to treat conditions including constipation, urinary incontinence, daytime and nighttime wetting, holding bowel movements and refusing to have a bowel movement?

As a pediatric physical therapist, I believe in a family approach to care and assess muscle strength and muscle imbalances in the body, specifically the pelvic floor. I address body awareness and coordination of muscles so that children can urinate and have a full bowel movement effectively and efficiently. To do this, I use exercise, proper breathing techniques for fun and relaxation, books, videos, play and biofeedback (a way that kids can get “in tune” to their pelvic floor by watching their muscles in a mirror or using a machine) to help children understand their body and take control.

Let’s talk a little bit about where this journey typically starts for a family – potty training. There is so much information on potty training methods, yet there is a relatively small amount of quality research to support or disprove most of the methods. The most successful method will be the one that both you and your child agree on. It is important that you both feel motivated and confident throughout the process.

No matter what method you choose:

• Be consistent.
• Never scold or humiliate.
• Never prohibit from toileting.
• Make sure you know where toilets are when you are outside of the home.
• Reward attempts and successes.
• Incentives do not need to be store bought; spending time together is special enough.
• Make it fun!

Awareness of bladder sensation and control begins in the first and second year of life. Voluntary voiding control begins at two to three years of age. An adult pattern of urinary control should be developed by four or five years of age. It’s not about starting at a certain age, it’s about starting when your child is ready.

According to the American Academy of Pediatrics (2006), your child should show the following signs when they are ready to potty train:

• Is dry at least two hours at a time during the day or is dry after naps
• Bowel movements become regular and predictable
• Facial expressions, posture or words reveal that your child is about to urinate or have a bowel movement
• Can follow simple instructions
• Can walk to and from the bathroom and help undress
• Seems uncomfortable with soiled diapers and wants to be changed
• Asks to use the toilet or potty chair
• Asks to wear “grown-up” underwear
• Can sit on a potty, maintaining the physical position and attention, for a short time
• Is able to communicate bodily sensations such as hunger or thirst
• Demonstrates interest in watching and imitating others’ bathroom-related actions
• Communicates the need to go before it happens

Typically, we see children urinate six-to-eight times per day and have five-to-seven bowel movements per week.

I, too, have been on the potty training adventure with my son Devin. It is not always an easy road, and having a professional to talk with is helpful. Devin was potty trained before I was trained in dysfunctional voiding, but it would have been useful to know about massaging the belly to promote a bowel movement, deep breathing for relaxation of the pelvic floor muscles, and the plethora of kids’ books about potty training.

If you have questions or concerns, please contact your local pediatric therapy center to schedule a complimentary 15-minute consultation to assess the needs of your family’s potty training adventure.

By: Dawn Meller, MPT. Dawn is a pediatric physical therapist and pelvic floor specialist with RUSH Kids Pediatric Therapy in North Aurora, Illinois.

RUSH Kids and KORT are part of the Select Medical family of brands. 

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Posted on 1/6/2021

Basketball is arguably one of the most popular sports in America, especially among children and young adults. From March Madness to the NBA finals, people love watching and playing basketball. The love for the game does not take away the risk that it carries for injury, though. Whether played recreationally or in an organized league, there are injuries that arise, and some are more common than others.

Outside of head injuries, the most common basketball injuries typically involve the lower body. Some of the most common ones include:

1. Ankle sprains – Nearly half of all basketball-related injuries involve the ankle and foot. From “rolling” an ankle, to landing awkwardly, to getting stepped on, playing basketball leaves athletes open to injury. Treatment for ankle injuries, specifically ankle sprains, involve ICE - ice, compression, elevation - and physical therapy, dependent on the seriousness. 
   
   Most injuries can be treated without a trip to the doctor’s office; however, if there is pain directly on top of the outside bone and you are unable to walk a couple steps, a trip to urgent care could be necessary. Typically, with the right exercise plan, an athlete can be back to their sport in two-to-six weeks.
2. Thigh bruises – Getting a knee to the thigh can be one of the worst pains for a basketball player. Because of this, more and more athletes are beginning to wear compression garments with thigh padding. If hit hard enough in the thigh by an opposing player, the muscle can tighten up and bruise. 
   
   Typically, these injuries can be played through; however, some deep tissue massage by a licensed professional is often needed to help loosen up the muscle. Outside of massage, ICE is recommended.
3. Knee injuries: ACL/Meniscus/Patella tendon – Knee injuries are very common in basketball. The three most common knee injuries include the anterior cruciate ligament (ACL), Meniscus and patella tendon. If you watch or play basketball, you have likely heard of these injuries. 
   
   An ACL tear is probably the most talked about. The ACL is one of the bands of ligaments that connect the thigh bone to the shin bone at the knee. If an ACL is torn, it generally requires surgery and months of physical therapy to return to play. 
   
   The meniscus is the little brother of the ACL. Every knee has two, and oftentimes they are injured along with the ACL. The meniscus is the cushioning of the knee joint. Without them, the thigh bone would sit directly on top of the lower leg bones, which would get uncomfortable quickly. Treatment for meniscus injuries can vary from ICE, to surgery and physical therapy, to just physical therapy. 
   
   Lastly, patella tendonitis, typically known as jumper’s knee, is the most common knee injury. It is a result of inflammation of the patella tendon which connects your kneecap to your shin bone.  Jumper’s knee can usually be healed with a personalized exercise plan from a physical therapist.
4. Jammed fingers – Jammed fingers are exceptionally common in basketball. They normally occur when the tip of the finger hits the ball “head on” without bending. This motion can lead to swelling in the finger and immediate pain. 
   
   Although uncomfortable, this injury isn’t usually serious. Jammed fingers typically heal without medical interventions or trips to the emergency room. Buddy taping (taping the finger to the finger next to it) and ice can you heal in as little as a week. However, if pain or swelling persists, a trip to your doctor or a consultant with a physical therapist may be necessary.
5. Concussion – Concussions make up about 15% of all sport-related injuries, not just basketball. Most of these injuries are typically managed either by an athletic trainer alone, an athletic train and physical therapy or by an athletic trainer in combination with a doctor or other health care professional. A concussion is brain injury that occurs after an impact to the head, neck or body. In basketball, a few examples of when concussions occur is when an athlete hits their head on the hard gym floor or when there is a head-to-head, head-to-elbow, head-to-shoulder, etc., collision. After a concussion is diagnosed, the athlete is unable to return to play for a minimum of five days. Some concussion recoveries can go slowly, with symptoms lingering. When this occurs, concussion and vestibular rehabilitation by a licensed physical therapist is a great option.

Nearly all of these injuries can be resolved with the help of a licensed physical therapist. If you suspect that you have one of these injuries, please contact a center near you to request an appointment today. With a guided treatment and exercise plan provided by a licensed physical therapist, you can be back on the court in no time.

References:

• https://www.muellersportsmed.com/blog/post/five-common-basketball-injuries
• https://www.excelsiorortho.com/blog/2016/03/21/the-5-most-common-basketball-injuries-and-how-to-prevent-them
• https://www.stopsportsinjuries.org/STOP/STOP/Prevent_Injuries/Basketball_Injury_Prevention.aspx
• Erica N. Fletcher, Lara B. McKenzie, and R. Dawn Comstock (2014) Epidemiologic Comparison of Injured High School Basketball Athletes Reporting to Emergency Departments and the Athletic Training Setting. Journal of Athletic Training: May/Jun 2014, Vol. 49, No. 3, pp. 381-388.

By: Wyneisha Mason, MAT, ATC. ‘Neisha is an athletic trainer with RUSH Physical Therapy in Chicago, Illinois.

RUSH and KORT are part of the Select Medical Outpatient Division family of brands. 

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Posted on 12/15/2020

Recently while watching a NFL football game, I came across a commercial with former professional football player John Elway. Mr. Elway was talking about a hand issue he was having called Dupuytren’s contracture, and he explained that there is now a non-surgical treatment option for this condition.

As a certified hand therapist for almost 17 years now, I am very familiar with Dupuytren’s contracture. However, to see this hand issue brought to life via a TV commercial definitely caught my attention as it isn’t often discussed. In the commercial, Mr. Elway talks about having difficulty with common, everyday tasks and shows a picture of the contraction in the palm of his hand.

So, you may ask, “What is this condition?”

Imagine having a finger, or fingers, bent into the palm and being unable to open the hand up fully. This would affect your ability to lay your hand flat on a tabletop, place your hand into a glove or shake hands. In the case of Mr. Elway, he could not grip or throw a football correctly, an activity that he had done for 16 years as a football player. It even affected his golf game.

There is no known cause of how Dupuytren’s develops. It has been thought of as a condition that people who have origins in northern European countries can contract. It is often called “The Viking’s Disease.” It is most commonly found in men of 50-60 years of age, but women can also be impacted. It affects three percent of the U.S. population.

Dupuytren's symptoms can take a long time to develop. Mr. Elway mentions in the commercial that he was diagnosed 15 year ago. Signs of Dupuytren’s includes:

• A hard lump in your palm
• Inability to place your hand flat on a surface such as a tabletop or counter
• Scar-like bands that form in the palm
• Fingers bent into the palm with the inability to open/extend your finger fully
• Hand pain (although this is less common)

Our hands contain a tough, fibrous layer of tissue called palmar fascia which gives us a protective layer between our skin and tendons. It also gives our palms firmness. In Dupuytren’s, the fascia can thicken and contract. The most common, visible sign of Dupuytren’s are the hard lumps and bands which are known as nodules and cords. The combination of nodules, cords and the contracting palmar fascia can make your fingers bend in toward your palm.

I often see patients with Dupuytren’s contracture after they have had some sort of procedure or surgery done to their hand. Many have come to me after they have been diagnosed and treated by a hand surgeon. There are two popular techniques to manage Dupuytren’s contracture, as there is no cure:

• Surgery, where a hand surgeon opens up the skin and removes all the excess tissue. 
• An injection to the fibrous cords, which will break them down.

Typically after either surgery or the injection, therapy by a certified hand therapist is indicated. There are many ways that a certified hand therapist can help patients with Dupuytren’s contracture.

Therapy after surgery or injection would first consist of an extension orthosis, commonly known as a splint. An orthosis is custom-made for each patient using a piece of thermoplastic material and Velcro strapping. This would help the finger or fingers stay straight. A patient can wear this full-time or just at night, depending on what their surgeon indicates.

Range of motion exercises are given to help regain full mobility of the hand and fingers. A patient’s wound would be addressed if they have had surgery to watch for infection and manage scar tissue. Lastly, a patient’s strength would be addressed. The end goal for our patients is that they will have functional capability of their hands and are able to perform all the activities of daily living that they choose to do in their lives.

Please contact your local outpatient center to schedule an appointment with a certified hand therapist to discuss the various options for Dupuytren’s contracture and determine if therapy may be beneficial for you.

By: Kelly Lee O’Connor, M.S., OTR/L, CHT. Kelly is an occupational therapist/certified hand therapist for NovaCare Rehabilitation in Horsham, PA. Images supplied by Linda Lamaute, M.S., OTR/L, CHT.

NovaCare and KORT are part of the Select Medical Outpatient Division family of brands

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