Jan 13

Kendra’s Journey

Kendra injury

Kendra

In April of 2013, I had surgery to repair my labrum and rotator cuff.  The last thing I remember the doctor saying to me before I went under anesthesia was that I would never Olympic lift again.  Two months of rehabilitation and physical therapy with my doctor and I was still struggling with daily functional movements like lifting my arm above my head.

Chase Ingraham of CrossFit Big D referred me to Michael Tillman of Tillman Physical Therapy & Sports Training Center, Inc. Three months after surgery, I traveled to Cedar Park and started working with Michael.  Within a matter of a few sessions, he restored my range of motion and my basic functional movements and began to build strength.

Before surgery, I struggled with building strength in all of my Olympic Lifts. Michael’s therapy began to rebuild and strengthen my shoulders in each position and I was able to match and eventually beat all of my pre-surgery lifts within 6 months.  Mike paid particular attention to the quality of movement throughout my recovery knowing my goals were to continue competing as a CrossFit Athlete.  With his help, I was able to compete in CrossFit again 8 months post surgery.  There have been bumps in the road over the last 20 months and with each hiccup, he has been there to help assess and direct me towards a stronger overhead position.

Pre-surgery overhead numbers
(April 2013)
Strict press – 82.5
Snatch – 130
Jerk – 170

Post-surgery overhead numbers
(December 2014)
Strict press – 92.5 (Three Rep Max)
Snatch – 150
Jerk – 185

Kendra

Nov 24

Shoulder Study

Incorrect Form: Looking down in the overhead position.

Incorrect Form: Looking down in the overhead position.

35 year old female with left shoulder pain that commenced for no apparent reason.  Pain was rated at 5/10 and worse with any overhead activity-crossfit movements and a moderate interference with daily activities .

MRI Results May 10, 2012: Left Shoulder Partial thickness articular surface tear of the supraspinatus tendon with noted increase subacromial/subdeltoid fluid presents that may reflect an occult full thickness tear versus mild bursitis. Moderate glenohumeral effusion with more irregular and inferior extent of fluid than is typical. Orthopedic suggestion:  Best bet is surgery and that she would definitely not be able to crossfit anymore. Evaluation deficits on June 15, 2012 Weakness 4-/5(moderate) of L shoulder external rotation at waist level, L internal rotation weakness at 90 deg 4-/5 (moderate)  and L triceps 4/5(mild).  Noted biceps/pectoral tightness. Pain with left shoulder flexion and with reaching up behind back. Assessment “Tightness Inhibits Strength”  has proven to be true time and time again. Weakness in triceps, external rotation, and internal rotation at 90 deg is a direct result of tightness in biceps and pectorals. Repeated testing:  Repeated external rotation at 90 flexion decreases pain with reaching overhead is most likely due to stretching of tight pectoral muscles.  Pt was then progressed to extension and later progressed with extension with internal rotation to focus on biceps mobility allowing for improved strength of triceps and external rotators.   Pt was able to progress to overhead lifting in 2-3 weeks allowing for gradual return to crossfit.  Once pain free can start to re-introduce progression back to pulling with balance of mobility and pushing activities.  Retest after 1 month of therapy shows 5/5 no weakness in all shoulder movements.

Correct Form: Looking straight  forward  in the overhead position.

Correct Form: Looking straight forward in the overhead position.

Form correction given: Look forward when lifting weight overhead allowing for improved shoulder mobility.  Programming caution: Balance pulling and pushing workouts.   Pulling workouts would encourage biceps tightness and can lead to a regression. Follow Up:  As of 8-15-14 Pt was pain free and was able to compete in crossfit regional for 2014.  Best of all no surgery needed.

Aug 20

What is a concussion?

concussion

What is a concussion?

A concussion is an injury to the brain or spinal cord typically caused by some form of impact resulting in the movement of the brain inside of the skull. A growing number of incidences are occurring especially among athletes, children, and young adults. Symptoms from a concussion often vary from person to person. These may include:

  • confusion
  • visual acuity problems
  • memory loss
  • slowed cognitive processing
  • dizziness
  • headaches
  • balance deficits
  • jaw pain or clicking

Often, concussions can resolve on their own if the brain has time to rest and fully recover, usually taking a period of 1-3 weeks. Rest is the first stage to recovery.

Sometimes, however,  symptoms from a concussion can linger, and new manifestations of symptoms can occur as a result of  the trauma to the neck and head following the incident. This prolonged experience of unresolved symptoms is called Post-Concussion Syndrome. In these cases, vestibular rehabilitation treatment by a physical therapist can help pave the road to recovery.

When issues occur within the vestibular system, whether  as a result of concussion or disease, a person may experience dizziness, balance, and coordination deficits.  The brain then tries to compensate for the lack of information or misinterpreted signals it receives from the vestibular system. For instance, the brain may become overly dependent on visual input to influence body movement. Altered body mechanics to improve postural control and modified movement patterns of the head and neck to avoid dizziness and vertigo can occur. These compensation techniques delay functional improvement of the vestibular system and may even cause worsening of symptoms such as headaches, muscle fatigue, and joint pain.

Vestibular rehabilitation treatment can help retrain the brain to rely on information from the vestibular system in conjunction with oculomotor and proprioceptive inputs to reduce dizziness, and improve balance, coordination, and postural control.

 Treatment

 At Tillman Physical Therapy, treating  PCS with vestibular rehabilitation begins with a thorough examination to observe and measure movement and postural compensation strategies. Depending on these observations, an individualized treatment and exercise plan is designed that incorporates oculomotor exercises, proprioceptive training, postural control, and balance activities.  These treatments help the brain recognize and interpret signals from the vestibular system and integrate them with other sensory systems of the body. Additionally, in some instances, a canalith repositioning procedure (a series of specific head and body positioning techniques) may be necessary to reposition otoconia of the inner ear that have been displaced as a result of the injury. Proper placement of the otoconia plays an important role in dizziness reduction and improved balance. Once these sensory systems are retrained to work together optimally, the body is able to regain function, allowing for  safe sport specific training.

If you’ve experienced a concussion, check with your doctor to see if you may benefit from vestibular rehabilitation. At Tillman Physical Therapy, we are dedicated to helping you achieve a quicker and safer return to daily function and sports specific activities.

Aug 08

Plantar Fasciitis

 

“Ouch. My feet hurt” A common phrase that often seems to become a long and lasting problem.

Plantar Fasciitis is a strain or overuse of the ligament that supports your arch. Often this presents as pain with early morning steps, pain with prolonged walking or standing, and noted tenderness at the bottom of the foot because of the swelling that occurs.

How does the ligament get strained? Often it starts with tightness in the calf muscles (gastrocnemius and soleus). The tight calves lead to excessive pulling on the Achilles tendon thus pulling on your heel bone. With prolonged tightness the heel bone rotates causing the plantar fascia tendon to become tight. This can eventually result in plantar fasciitis and sometimes bone spurs. Ouch!

How do your calves get tight? This can be a result of poor sitting posture, weight gain, shoe choices, incorrect gait pattern with walking or running, or simply not stretching. At that point most patient are looking at several possible treatment options.

1.)  Stretching:  Treatment should focus on recovery of adaptive shortening tissue (progressive stretching!). We typically start stretching with a low load stretch, this may give some relief, but it’s also where treatment may fail. If stretches are not progressed correctly the tightness will return and the fascia will never fully recover. This is accomplished through the guidance of a physical therapist.

2.)  Orthotics: These force your foot into a more restricted position. However, don’t we want to become flexible?  Why if you were pain-free for decades do you now need orthotics to tolerate walking?  Have you gained weight recently? Orthotics may be necessary for excessive weight gain.  With regards to flexibility, the orthotics may only provide temporary relief because they restrict your foot’s ability to move.

The firmness of the orthotic often limits foot mobility.  Yes, sometimes they are required and medically necessary, but for plantar fasciitis I recommend trying a supervised stretch program first.

 

3.) Injections may be helpful to reduce swelling that occurs from an abnormal tightness, however that swelling will return until you have full recovery of flexibility.

 

4.) Surgery can be used to stretch the plantar fascia.  This requires months in a boot/shoe, time off work, and is the most costly course of treatment.  Then the patient normally will go to therapy for progressive stretching and rehab.

This leads us back to the best treatment option; stretching.  To fully remodel adaptive shortened tissue, the stretch must first be performed often; this typically means every 2-3 hours. Second, the stretch must be progressed frequently with increasing force as tolerated. This is a crucial stage in recovery and should only be done under the supervision of a physical therapist.

There are benefits to both orthotics and injections in many other medical cases but in the case of plantar fasciitis the main focus needs to be on flexibility. We at Tillman Physical Therapy are dedicated to fixing your problem long term.   Please contact us if you are ready to take your first step to recovery.