Recovering from a Torn Medial Collateral Ligament

PTD1213_Skier No one wants a knee injury, of course, but if you have one, a torn medial collateral ligament (MCL) is one of the least serious. This is because MCLs will often heal on their own—meaning no surgery and a full return to activities, even when dealing with the most severe tears.

Located on the inside of your knee, the MCL attaches the thighbone to the lower leg bone. It keeps your knee from turning inward and can easily be injured when performing activities that require sudden changes in direction, or quick twists and turns—the types of movements common in sports such as skiing or soccer, for example.

The good news is that MCLs are known for their ability to heal, as opposed to other common knee injuries like a torn anterior cruciate ligament that necessitate surgery or lengthy immobilization. When the MCL is torn, a blood clot forms, setting into motion a natural repair process involving “healing” blood cells that help correct the tear.

The protocol for treating an MCL injury is determined by the severity of the tear.

  • Grade 1 tears, considered to be mild, can be treated by having you use crutches for a few days, as well as resting and icing the knee at home.
  • Grade 2 tears are a bit more serious and may mean you have to wear a hinged knee brace and avoid putting weight on your knee for a few weeks.
  • Grade 3 tears are the worst type of MCL injury, but even these do not usually require surgery. Instead, you will be instructed to wear a hinged knee brace for approximately six weeks while you are using crutches.
  • For all grades of tears, we may insist that you wear a shoe with a heel at least one inch in height as you return to walking to enhance your gait.

Regardless of the MCL tear severity, working with us will increase your range of motion and strengthen the tendons and muscles surrounding the injured MCL.

We can design and implement a progressive therapy program that aids your body’s natural ability to heal the MCL. The earlier we can start your individualized exercise program, the less likely your problem will become chronic and the sooner you can return to the activities you enjoy.

Pillow Talk: Physical Therapy for Sleep Apnea

PTD1213_Sleep2Obstructive sleep apnea (OSA) is a condition in which you stop breathing, temporarily, in your sleep, often multiple times an hour. As the name suggests, something blocking an airway causes the problem. The implications of untreated OSA can include excessive daytime fatigue, high blood pressure and a greater risk of stroke or heart attack.

In some cases, the primary cause of OSA is that your tongue is longer or larger than normal and collapses in the rear of your throat during sleep. Many cases of OSA have other roots, however, including obesity, physical obstructions (enlarged tonsils, deviated septum, etc.) and genetics (OSA tends to run in families).

Certainly, we cannot change your family history, nor can we perform surgery to correct a problem like enlarged tonsils (although such surgery may indeed be warranted). However, to deal with a collapsed tongue, we can prescribe tongue and throat exercises that may strengthen the muscles and provide enough “training” so this will happen much less often.

When obesity is a primary cause, excess tissue is present in the airways, blocking them and preventing normal respiration. Because losing weight improves OSA, we will begin by customizing a diet and exercise plan expressly for you, your age and your fitness level.

Not only will exercise help you lose weight but the physical exertion itself may help improve your sleep. Studies have shown a correlation between a better night’s sleep and a period of exercise, 10 minutes or more, during the previous day. Walking is a great place to start, but consult your physician if you have not been exercising for a while.

By the way, experts no longer believe that, for most people, exercising too close to bedtime detracts from sleep. Fitting in exercise whenever you can is fine and can break the vicious cycle of not sleeping well, then feeling too tired to exercise, then having the lack of exercise detract from sleep and so on.

Because a satisfactory night’s sleep is getting more and more recognition as essential to good health, we strongly recommend a comprehensive physical therapy treatment for OSA. Let us put you on the way to a restful sleep and a wide-awake, productive day!

The Golden Age of Fitness

PTD1213_ExerciseAs we get older, we may still feel young mentally, but after age 50 or so, we must acknowledge that our bodies need slightly different physical accommodations than we did earlier in our exercising lives.

Working out reduces the risk of cardiovascular disease, osteoporosis, breast and colon cancer, depression and type 2 diabetes, for starters. To become fit, make your routines progressively more difficult by raising the bar more slowly and carefully than you might have 20 years ago—and pick activities that you enjoy, so you will be more likely to stick with them.

We can design an exercise program that includes strength training and aerobic activity. Strength training with weights or other resistance equipment such as bands helps support joint and bone health and can be performed at virtually any age. Benefits include better balance, lessened risk of falls and increased metabolism. The weights used and/or number of repetitions performed can be increased over time, depending on your age and fitness level.

For the aerobic workout, many people use general guidelines related to maximum heart rate (MHR) to determine how hard they should exercise. The formula begins with 220 minus your age. If you are 60 years of age, for instance, 220 minus 60 equals 160, so 160 beats per minute is your MHR.

  • A low-intensity workout for a 60-year-old would involve working at 40% to 50% of MHR, or up to 80 beats per minute.
  • A moderate-intensity workout would be up to 112 beats per minute, 50% to 70% of MHR.
  • A high-intensity workout, 70% to 85% of MHR, would mean up to 136 beats per minute, and for many older people, it might not be recommended.

In addition to your age, any medications you take, your current fitness level, weight and preexisting medical conditions can influence your MHR number and determine what intensity level is safe.

We will work with your physician to design an exercise program that will help you to achieve your individual fitness goals. With a plan you enjoy and can stick to, you will attain the ultimate workout that will strengthen your body and maintain your health.

A Sticky Solution to Plantar Fasciitis Pain

PTD1213_TapeIt seems almost too good to be true: Could something as simple as taping up your foot relieve the pain and discomfort of plantar fasciitis? The good news is that the answer is a definitive—and scientifically proven—yes. However, there are some caveats, and it is important to understand how taping works so you can utilize this treatment effectively.

If you are suffering from plantar fasciitis, you probably already know that this painful inflammatory condition is caused by the overuse of a thick band of tissues on the bottom of the foot. Plantar fasciitis commonly strikes middle-aged men, as well as those with foot arch problems, runners and individuals struggling with obesity. It is one of the most common foot problems seen by orthopedists and is often treated with physical therapy, including stretching, strengthening, ice/heat and anti-inflammatory medications (if your physician approves).

Taping involves wrapping the affected foot in a porous athletic tape, so that the plantar fascia ligament is supported and relieved of tension and pressure. The tape acts like a splint, allowing many people to resume normal activities without the telltale pain and stiffness in the bottom of the foot or heel. This is similar to what many athletes do as a preventative measure: taping their feet or ankles for extra support and protection.

While it is not a cure, most people find that the tape works well as a temporary or complementary solution, a modality that

  • protects the ligament from further damage
  • relieves tension
  • reduces uncomfortable symptoms
  • facilitates the therapeutic process

We can instruct you on the best way to apply the tape correctly and to make sure you are a good candidate for taping. For example, people with diabetes or peripheral vascular problems should not use tape. In addition, wearing the tape too often can lead to additional issues, such as skin irritation.

Taping is just one part of a larger therapeutic program. By following our instructions, you can enjoy pain relief and avoid future problems. You will soon be back on your feet—literally!

A Measured Response to Longer Limbs

PTD1213_LegsThe pediatrician seems concerned that your child’s arms and legs seem longer than normal. Will he or she just grow up to be tall? A good pediatrician screens children for signs of syndromes that might not be apparent to parents. Particularly long limbs are possible indicators of at least two: Marfan syndrome and Ehlers-Danlos syndrome.

These syndromes are both relatively rare, inherited genetic conditions that affect connective tissue. Because connective tissue provides cell structure, it exists throughout every part of the body, from the eyes to the bones.

  • In Marfan syndrome, the connective tissue is weakened because of a defect in the production of fibrillin, a protein. Cardiovascular complications can occur as well. Fortunately, compared to decades ago, heart and circulatory defects can be detected earlier and treated with monitoring, medication or surgery.
  • Ehlers-Danlos syndrome has at least six subvariations, all of which involve the collagen component of connective tissue. While all forms affect the musculoskeletal system significantly, one variation particularly impacts the skin, for example; another, the joints; and yet another, the cardiovascular system.

Anyone with Marfan syndrome should strive to stay fit, but sports and exercises that put excess stress on the heart or lungs, or that could involve chest blows, are off-limits. We can help structure routines involving activities such as walking, swimming, dancing or cycling. Sports to avoid include football, basketball and weightlifting. But strength training can confer a huge benefit: It can improve posture, reduce back pain and scoliosis risk, increase bone-mineral density and contribute to overall quality of life.

Fitness is important for those with Ehler-Danlos, as well. We can design physical therapy routines that carefully take all limitations into account. Joint-stabilization exercises might be appropriate for one patient, for instance, possibly in conjunction with supportive braces. For another, a major concern may be assuring the proper rest breaks during aerobic exercise to minimize heart strain.

Your pediatrician will likely want your child to undergo further testing to rule out or diagnose one of these syndromes. While it is undeniably difficult to learn that your child has obstacles to overcome on the path to a “normal” life, caring medical professionals, including our physical therapy team, can lend support by helping your child manage symptoms to attain a better quality of life.