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CONDITION OF THE MONTH - MAY

FROZEN SHOULDER

What is a Frozen Shoulder?

Frozen shoulder or adhesive capsulitis, is a condition that causes restriction of motion in the shoulder joint. The cause of a frozen shoulder is not well understood, but it often occurs for no known reason. Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue.

What causes frozen shoulder?
Most often, frozen shoulder occurs with no associated injury or discernible cause. There are patients who develop a frozen shoulder after a traumatic injury to the shoulder, but this is not the usual cause. Some risk factors for developing a frozen shoulder include:

· Age & Gender
Frozen shoulder most commonly affects patients between the ages of 40 to 60 years old, and it is twice as common in women than in men.

• Endocrine Disorders
  Patients with diabetes are at particular risk for developing a frozen shoulder. Other endocrine abnormalities, such as thyroid problems, can also lead to this condition.
• Shoulder Trauma or Surgery
  Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop a frozen shoulder joint. When injury or surgery is followed by prolonged joint immobilization, the risk of developing a frozen shoulder is highest.
• Other Systemic Conditions
  Several systemic conditions such as heart disease and Parkinson's disease have also been associated with an increased risk for developing a frozen shoulder.

What happens with a frozen shoulder?
No one really understands why some people develop a frozen shoulder. For some reason, the shoulder joint becomes stiff and scarred. The shoulder joint is a ball and socket joint. The ball is the top of the arm bone (the humeral head), and the socket is part of the shoulder blade (the glenoid). Surrounding this ball-and-socket joint is a capsule of tissue that envelops the joint.

Normally, the shoulder joint allows more motion than any other joint in the body. When a patient develops a frozen shoulder, the capsule that surrounds the shoulder joint becomes contracted. The patients form bands of scar tissue called adhesions. The contraction of the capsule and the formation of the adhesions cause the frozen shoulder to become stiff and cause movement to become painful.

A frozen shoulder causes a typical set of symptoms that can be identified by your doctor or physical therapist. The most important finding is restricted movement. Other shoulder conditions can cause difficulty with movement of the shoulder, such as a rotator cuff tear; therefore it is important to have an examiner familiar with this condition for a proper diagnosis.

What are the typical symptoms of a frozen shoulder?

· Shoulder pain; usually a dull, aching pain

· Limited movement of the shoulder

· Difficulty with activities such as brushing hair, putting on shirts/bras

· Pain when trying to sleep on the affected shoulder

Types of Treatments

Frozen shoulder treatment primarily consists of pain relief and physical therapy. Most patients find relief with these simple steps, although the entire treatment process can take several months or longer.

· Exercises and Stretching
Stretching exercises for frozen shoulder serves two functions:

· First, to increase the motion in the joint

· Second, to minimize the loss of muscle on the affected arm (muscle atrophy)

The importance of stretching and exercises cannot be overemphasized as these are the key to successful frozen shoulder treatment. Patients cannot expect to have successful frozen shoulder treatment if they perform exercises only when working with a therapist. These exercises and stretches must be performed several times daily.

Moist Heat
Applications of moist heat to the shoulder can help to loosen the joint and provide relief of pain. Patients can apply moist heat to the shoulder, then perform their stretching exercises--this should be done at least three times daily. Moist heat can be applied by using a hot-soaked washcloth on the joint for 10 minutes before stretching.

Physical Therapy
Physical therapists can help a patient develop a stretching and exercise program, and also incorporate ultrasound, ice, heat, and other modalities into the rehabilitation for frozen shoulder. As said previously, it is important that patients perform their stretches and exercise several times daily--not only when working with the therapist.

Anti-inflammatory Medications
Anti-inflammatory medications have not been shown to significantly alter the course of a frozen shoulder, but these medications can be helpful in offering relief from the painful symptoms.

If you have persistant shoulder pain, you can see one of our physical therapist. In the state of Pennsylvania, you can seek treatment from a physical therapist WITHOUT a physician’s prescription. You can usually be seen by one of our physical therapists within 48 hours. If needed, we can refer you to one of the orthopedic surgeons we work closely with who are located closest to where you live.

High School & Club Sports in Full Swing.

With high school and club sports starting up, the increase in injuries also starts to rise. Please be aware of your health. No pain is too small to get checked out. Whether you are a little league pitcher with slight elbow pain or a high school soccer player with a knee injury you may need to see a physical therapist. Please keep us in mind for all of your orthopaedic and sports medicine needs. Please do not hesitate to call us @ 610-279-6290.

Happy Holidays!!!

Happy Holidays from all us here at Montgomery County Rehabilitation & Sports Therapy. We wish everyone a safe and wonderful holiday season.

We would also like to take this time to remind everyone we are here for all of your physical therapy needs, and we welcome any and all questions. Please visit our website @ www.montcorehab.org or call us @ (610)279-6290.

Back Surgery and Physical Therapy

This is a great article about Physical Therapy helping, where back surgery has failed.

http://www.msnbc.msn.com/id/39658423/ns/health-pain_center

Check Us Out!!!

Please check out the Physical Therapy special in this months issue of Philly Fit Magazine. Click http://phillyfit.com/CurrentIssue.html and go to page 35. Enjoy.

CONDITION OF THE MONTH - JUNE

POOR POSTURE

What is good posture?
Posture is the position in which you hold your body upright against gravity while standing, sitting or lying down. Good posture involves training your body to stand, walk, sit and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities. Proper posture:

• Keeps bones and joints in the correct alignment so that muscles are being used properly.
• Helps decrease the abnormal wearing of joint surfaces that could result in arthritis.
• Decreases the stress on the ligaments holding the joints of the spine together.
• Prevents the spine from becoming fixed in abnormal positions.
• Prevents fatigue because muscles are being used more efficiently, allowing the body to use less energy.
• Prevents strain or overuse problems.
• Prevents backache and muscular pain.
• Contributes to a good appearance.

Proper posture requirements

1. Good muscle flexibility
2. Normal motion in the joints
3. Strong postural muscles.
4. A balance of muscles on both sides of the spine.
5. Awareness of your own posture, plus awareness of proper posture which leads to conscious correction. With much practice, the correct posture for standing, sitting, and lying down will gradually replace your old posture.

What contributes to bad posture?

• obesity
• pregnancy
• weak muscles
• high-heeled shoes
• tight muscles; decreased flexibility
• poor work environment
• poor sitting and standing habits

Body mechanics is defined as maintaining proper position during movement. Constant or repeated small stresses over a long period of time can cause faulty body mechanics and can lead to injury.

Ergonomics is the process of changing your environment to encourage good body mechanics. This can be accomplished by modifying a tool, work station, counter height, task or job.

The essentials of good body mechanics include:

• Learning proper posture, lifting and carrying techniques
• Becoming aware of your body position during all activities
• Altering your habits, positions or your environment to provide a safe and efficient work area
• Practicing good body mechanics at all times, not just when you are recovering from pain or injury

Correct standing position

1. Hold your head up straight with your chin in. Do not tilt your head forward, backward or sideways.
2. Make sure your earlobes are in line with the middle of your shoulders.
3. Keep your shoulder blades back.
4. Keep your chest forward.
5. Keep your knees straight.
6. Stretch the top of your head toward the ceiling.
7. Tuck your stomach in. Do not tilt your pelvis forward or backward.
8. The arches in your feet should be supported.
9. Avoid standing in the same position for a long time.
10. If possible, adjust the height of the work table to a comfortable level.
11. When standing, try to elevate one foot by resting it on a stool or box. After several minutes, switch your foot position.
12. While working in the kitchen, open the cabinet under the sink and rest one foot on the inside of the cabinet. Change feet every 5 to 15 minutes.

Correct positions for stooping, squatting and kneeling
Decide which position to use. Kneel when you have to go down as far as a squat but need to stay that way for awhile. For each of these positions, face the object, keep your feet apart, tighten your stomach muscles and lower yourself using your legs.

Correct sitting position
1. Sit up with your back straight and your shoulders back. Your buttocks should touch the back of your chair.
2. All three normal back curves should be present while sitting. A small, rolled-up towel or a lumbar roll can be used to help you maintain the normal curves in your back.

• Here's how to find a good sitting position when you're not using a back support or lumbar roll:
  --Sit at the end of your chair and slouch completely.
  --Draw yourself up and accentuate the curve of your back as far as possible. Hold for a few seconds.
  --Release the position slightly (about 10 degrees). This is a good sitting posture.

3. Distribute your body weight evenly on both hips.
4. Bend your knees at a right angle. Keep your knees even with or slightly higher than your hips. (use a foot rest or stool if necessary). Your legs should not be crossed.
5. Keep your feet flat on the floor.
6. Try to avoid sitting in the same position for more than 30 minutes.
7. At work, adjust your chair height and work station so you can sit up close to your work and tilt it up at you. Rest your elbows and arms on your chair or desk, keeping your shoulders relaxed.
8. When sitting in a chair that rolls and pivots, don't twist at the waist while sitting. Instead, turn your whole body.
9. When standing up from the sitting position, move to the front of the seat of your chair. Stand up by straightening your legs. Avoid bending forward at your waist. Immediately stretch your back by doing 10 standing back bends.

It is ok to assume other sitting positions for short periods of time, but most of your sitting time should be spent as described above so there is minimal stress on your spine.

Correct driving position

• Use a back support (lumbar roll) at the curve of your back. Your knees should be at the same level or higher than your hips.
• Move the seat close to the steering wheel to support the curve of your back. The seat should be close enough to allow your knees to bend and your feet to reach the pedals.

Correct lifting position

• If you must lift objects, do not try to lift objects that are awkward or are heavier than 30 pounds.
• Before you lift a heavy object, make sure you have firm footing.
• To pick up an object that is lower than the level of your waist, keep your back straight and bend at your knees and hips. Do not bend forward at the waist with your knees straight.
• Stand with a wide stance close to the object you are trying to pick up and keep your feet firm on the ground. Tighten your stomach muscles and lift the object using your leg muscles. Straighten your knees in a steady motion. Don't jerk the object up to your body.
• Stand completely upright without twisting. Always move your feet forward when lifting an object.
• If you are lifting an object from a table, slide it to the edge to the table so that you can hold it close to your body. Bend your knees so that you are close to the object. Use your legs to lift the object and come to a standing position.
• Avoid lifting heavy objects above waist level.
• Hold packages close to your body with your arms bent. Keep your stomach muscles tight. Take small steps and go slowly.
• To lower the object, place your feet as you did to lift, tighten stomach muscles and bend your hips and knees.

What is the best position for sleeping and lying down?
No matter what position you lie in, the pillow should be under your head, but not your shoulders, and should be a thickness that allows your head to be in a normal position.

• Try to sleep in a position which helps you maintain the curve in your back (such as on your back with a pillow under your knees or a lumbar roll under your lower back; or on your side with your knees slightly bent). Do not sleep on your side with your knees drawn up to your chest. You may want to avoid sleeping on your stomach, especially on a saggy mattress, since this can cause back strain and can be uncomfortable for your neck.
• Select a firm mattress and box spring set that does not sag. If necessary, place a board under your mattress. You can also place the mattress on the floor temporarily if necessary. If you've always slept on a soft surface, it may be more painful to change to a hard surface. Try to do what's most comfortable for you.
• Try using a back support (lumbar support) at night to make you more comfortable. A rolled sheet or towel tied around your waist may be helpful.
• When standing up from the lying position, turn on your side, draw up both knees and swing your legs on the side of the bed. Sit up by pushing yourself up with your hands. Avoid bending forward at your waist.

The following advice will benefit a majority of people with back pain. If any of the following guidelines causes an increase of pain or spreading of pain to the legs, do not continue the activity and seek the advice of a physician or physical therapist