Physical TherapyOur Doctors of Physical Therapy bridge the gap between the healing process and return to sport.
The ACL is located in the center of the knee joint and connects the femur (thigh bone) and the tibia (shin bone). Its primary purpose is to provide stability to the knee. It prevents the tibia from moving too far forward and from rotating too far inward under the femur. There are essentially four separate ligaments that stabilize the knee joint. On the sides of the joint lie the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) which serves as stabilizers for the side-to-side stability of the joint. The MCL is a broader ligament that is actually made up of two ligament structures, the deep and superficial components, whereas the LCL is a distinct cord-like structure.
This ligament is frequently injured in contact sports (such as football) and pivoting sports (such as soccer and skiing) – although there are many scenarios for injury to this ligament. Usually the patient complains of a sudden injury to the knee and the inability to walk right after the accident. Often, there is a significant amount of swelling that occurs relatively soon after the injury. In contact sports, such as football, the injury typically occurs when another player impacts the side of the knee. Non-contact ACL injuries are more common in women – such as a female soccer player who suddenly changes direction and feels a pop in her knee.
Naturally, women are built differently than men. These differences are evident when examining the muscles and bones of their hips and legs. Compared with men, women have a wider pelvis, and their hips are more flexible and have more rotation; their femur is tilted forward more at the top and is angled more toward the knee; their lower leg is turned inward and angled more toward the knee, but there are forces pushing outward; they have less developed thigh muscles, making the knee more dependent on the ligaments for stability; they have increased flexibility and hyperextension in their joints; and they have a narrower notch in the femur where their smaller anterior cruciate ligament is attached.
Why do these anatomic differences cause women to be more prone than men to ACL injuries? Because the thigh muscles are lax, the ACL must serve as the main stabilizer of the knee. However, the small ACL often cannot handle the forces put on it during sports participation, so it tears. Other contributing factors are associated with the sport and with the physical make-up of a woman. Her position, coordination, skill, talent, and coaching affect the way the female athlete uses her body and can affect whether she is at increased risk for ACL injury. A poorly conditioned or overweight body puts more pressure on the knee joint and puts the athlete at greater risk for ACL injury. Hormonal levels at certain times during the menstrual cycle and extremely low percentage body fat cause the ACL to be more lax and, therefore, at increased risk for injury. Recent research is pointing towards a biomechanical difference predisposing them to increase stress and risk of ACL. Some of these differences are weak hip musculature (Abductors and glute max and med), delayed muscle sequencing and poor body mechanics and lack of hip loading playing key roles in the tear of ACL’s. Doctors of physical therapy are continuing to do research to find the exact reason for this problem in women and to find the best ways to prevent it.
The majority of ACL injuries suffered during athletic participation are of the non-contact variety. Three main non-contact mechanisms have been identified: planting and cutting, straight-knee landing, and one-step stop landing with the knee hyper extended. Pivoting and sudden deceleration are also common mechanisms of non-contact ACL injury. Basketball, soccer, and volleyball consistently produce some of the highest ACL injury rates across various age-groups. Other activities with a high rate of injury are gymnastics, martial arts, and running. In most sports, injuries occur more often in games than in practice
Notably female athletes have been shown to perform athletic maneuvers with decreased hip and knee flexion, increase quadriceps activation, decreased hamstring, glute medius recruitment leading to increase valgus moments and stress. Some other factors that may contribute to ACL’s in both men and women is, decreased proprioception, and impaired motor control and patterning.
Ligament injuries are usually graded in terms of their severity:
Grade I sprain – some micro-tearing or slight stretching occurs, however the overall integrity of the ligament is preserved. The ligament hurts if stressed but is stable.
Grade II sprain – partial disruption of the ligament. Painful to stress, there is detectable laxity but the ligament has an eventual endpoint.
Grade III tear – complete ligament tear and laxity with no endpoint or stability to testing. As the nerves in the ligament are torn too, there is often minimal pain with stressing the joint
If you tear your ACL there are several techniques that can be used to repair it, with a patellar tendon graft being the gold standard. We will forgo this discussion for another time. How can one prevent an ACL tear is the more important question? One should see a qualified health professional, one who can perform an in depth evaluation and analysis ranging from strength, range of motion testing and movement pattern analysis. Once this has been performed and one has been medically cleared to start a training regiment, here are some exercises and key points that should be focused on.
Proper hip hinging / hip loading pattern should be developed, this can be developed with exercises like squat, deadlift and straight leg deadlift. Hip strengthening and sequencing focused on glute medius and max should be developed, some exercises that have been shown to have the greatest recruitment have been clamshells with the hips flexed to 60 degrees, sidelying abduction, and side steps. Another component that is key is proprioceptive or balance training, which should be performed on double or single leg and on a variety of surfaces to challenge the bodies system. Once these basics areas are addressed, higher level and more sport specific activities maybe be performed, with focus on plyometric training, accelerating and decelerating, cutting with emphasis on hip flexion to decrease the stress on the knee.
At Parabolic Performance and Rehab in Montclair our Doctors of Physical therapy can perform a thorough evaluation of an athlete in order to determine if they are at risk for an ACL injury. The assessment will serve as a road map for the areas that need to be addressed, and the athlete will be given a program to continue to perform on their own in order to stay injury free.
The way in which physical therapist are performing soft tissue mobilization or massage has changed recently. A growing number of physical therapists are moving towards IASTM, or instrument assisted soft tissue mobilization. This entails using some sort of hard edged instrument made of metal, plastic or ceramic in order to apply a force to soft tissue in an attempt to increase the body’s healing response. The tools provide advantages for both patient and therapist. They provide palpable feedback as they cross the affected fibers of the patient’s soft tissue, thus allowing the therapist to be efficient in their treatment. The other advantage is that they allow for an increased, focused amount of force to the affected area without significant discomfort to the patient or increased stress to the therapist’s hands.
The most popular theory on how the instrumentation works is that the contact between the tool and the underlying tissue causes micro-trauma that results in an increase in the number of high quality fibroblasts. Fibroblasts are cells that are produced by the body during the healing process of tissue. The “scrapping” of the tool over the affected tissue also helps convert collagen scar tissue to functional tissue with proper alignment of the tissue fibers. This will allow for normal elasticity of the tissue and as a result decreased pain with movement and functional activity.
The doctors of physical therapy at Parabolic Performance and Rehab frequently use IASTM on conditions that range from scar tissue build up after surgery, to tight muscles resulting from overuse injuries. If you have any questions regarding how IASTM is performed, and if it could help your particular condition, feel free to contact one of our doctors of physical therapy at either our Montclair or Little Falls offices.
One of the most important elements in kettlebell lifting is controlling the path the bell takes. Since most of the lifts are ballistic, once the weight is moving its going to keep going in whatever direction you send it, which in lifts like the swing and snatch is away from your body due to powerful hip extension. Thus, it is critical for the lifter to learn to manipulate the path of the bell while it’s “in flight”.
In this video Performance Coach John Martin demonstrates 3 different lifting techniques to help prevent the bell from “getting away from the lifter” after hip extension in the swing, each of which has its own situation benefits.
Please keep in mind that all lifting techniques and exercises are not applicable to all individuals and drills/techniques should be selected based upon an athlete’s needs and body mechanics.
A team of physical therapy nj doctors help runners, jumpers, and other athletes put heavy stress on their knees. “Runner’s knee” is a term used to refer to a number of medical conditions that cause pain around the front of the knee (patellofemoral pain). These conditions include anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella. The knee is a complex structure and a number of factors can contribute to runner’s knee, such as malalignment of the kneecap; tightness, imbalance, or weakness of leg and core muscles; and flat, hyperpronated feet.
Patellofemoral pain may be the result of irritation of the soft tissues around the front of the knee. Strained tendons are fairly common in athletes. Other contributing factors to patellofemoral pain include overuse, muscle imbalance and inadequate stretching. Furthermore, it is not just dysfunction of the knee and tissues surrounding the knee joint that can lead to patellofemoral pain, but dysfunction and balances in other areas of the body such as the low back, hip, and feet can all contribute to improper knee biomechanics. Therefore, pain or dysfunction that begins in another part of the body, such as the back or hip, can have an effect at the knee as the body tries to compensate for these problems.
In some people with runner’s knee, the kneecap is out of alignment. If so, vigorous activities can cause excessive stress and wear on the cartilage of the kneecap. This can lead to the softening and breakdown of the cartilage under the kneecap (chondromalacia patella) and cause pain in the underlying bone and irritation of the joint lining. Common complaints with PF pain syndrome are pain that occurs when walking up or down stairs, kneeling, squatting, and sitting with a bent knee for a prolonged period of time.
How do NJ Physical Therapists Diagnose Runner’s Knee?
Diagnosing PF pain syndrome can occur through x-rays or through a physical examination. A typical physical examination includes a check of the alignment of the lower leg, kneecap, and quadriceps; knee stability, hip rotation, and range of motion of knees and hips; strength, flexibility, firmness, tone, and circumference of quadriceps and hamstring muscles; and tightness of the heel cord and flexibility of the feet.
New Jersey’s Conditioning, Prevention and Treatment Options
PF pain syndrome can be prevented/treated through a well-rounded and balanced corrective sports physical therapy program. One of the most common reasons for PF pain is overuse and the consequent irritation and tightening of certain soft tissue structures such as the quads, ITB, and Achilles tendon. As a result, it is important to stretch these structures frequently after exercise. Furthermore, it is important to always perform a proper warm-up before beginning the main part of the workout. Additionally, sudden changes in the intensity of exercise should be avoided. The intensity or duration of activities should be increased gradually in order to avoid an excessive amount of strain and stress to be put on muscles, tendons, and ligaments of the body. Also, the type of shoe one wears can also play a role in causing or preventing PF pain. Shoes with good shock absorption and quality construction are important. If you have flat feet, you may need shoe inserts.
At Parabolic Performance and Rehab, our expert team of Doctors of Physical Therapy is well versed to provide the best physical therapy possible by individually tailoring a program to correct these possible areas of dysfunction. Our well-rounded corrective physical therapy programs usually includes reconditioning to regain full range of motion, strength, power, endurance, speed, agility, and coordination as well as stretches and manual hands-on techniques to normalize the flexibility and quality of the tissues. Other treatments involve taping the kneecap to help promote and maintain better alignment and tracking of the kneecap. Furthermore, special shoe inserts (orthotics) may sometimes be prescribed and may help relieve the pain. If your knees hurt, visit one of our convenient locations for conditioning in New Jersey, at either our Montclair or Little Falls centers.
As the topic and importance of diagnosing and managing concussion injuries becomes more maintstream and well-versed, it is important to be aware of the importance of being screened by a qualified health care professional trained in concussion management to establish if they should be removed from their activity and when it’s safe to return. In the past few years, concussion has received a great deal of attention as people in the medical and sports worlds have begun to speak out about the long-term problems associated with this injury. The Centers for Disease Control estimate that in sports alone, more than 3.8 million concussions occur each year. Recent scientific evidence highlights the need for proper care to prevent complications from concussion.
At Parabolic Performance & Rehab, our team of doctors of physical therapy are educated and trained to understand the process of recovering from a concussion and how to manage and deal with symptoms in order to return the individual to their prior level of function. A concussion is a brain injury that occurs when the brain is shaken inside the skull, causing changes in the brain’s chemistry and energy supply. A concussion might happen as a result of a direct blow to the head or an indirect force, such as whiplash. You might or might not lose consciousness. Other symptoms include:
• Difficulty with balance
• Difficulty with sleeping
• Double or blurred vision
• Sensitivity to light and sound
Cognitive (thinking) symptoms may include:
• Difficulty with short-term or long-term memory
• Slowed “processing” (for instance, a decreased ability to think through problems)
• Difficulty with concentration
Sports Physical therapy can evaluate and treat many problems related to concussion. Because no 2 concussions are the same, the physical therapist’s examination is essential to assess individual symptoms and limitations. Our doctors of physical therapy then can tailor specific exercises and training to reduce or stop dizziness and improve balance and stability. As symptoms due to concussion improve, the sports physical therapist will help you resume physical activity gradually, to avoid overloading the brain and nervous system that have been compromised by the concussion. It’s important that you follow the recommendations of all health care professionals so that you can achieve the greatest amount of recovery in the shortest amount of time.
Physical Therapy in NJ is evolving in its treatment of foot problems. Did you know that variations in foot structure, such as flat or high-arched feet, have long been recognized to cause stress on muscles, ligaments, and bones in the foot. Although there are many variations of flat or high-arched feet that may or may not be functionally abnormal, studies have demonstrated that flat or high-arched feet increase the risk of lower limb injury. The good news is that many lower limb injuries associated with abnormal foot posture can be treated with physical therapy and the proper foot orthoses and/or footwear modification.
The most typical abnormal foot posture seen is “flat feet.” Flat feet are caused by what is known as “over-pronation”. Over-pronating causes the foot to “unlock” resulting in a decrease in the normal arch of the foot and the foot flattening. Consequently, abnormal forces and stresses are put on the foot when the foot is in this over-pronated or flattened state. Common conditions due to over-pronating and flat feet are bunions, callus formation on the big toe, Morton’s neuroma, arthritis, plantar fasciitis, ankle sprains, Achilles tendon tears/tendonitis, and even foot/ankle fractures.
Other Body Parts May Be Affected, Need Conditioning in NJ
Abnormal foot posture can affect not only the foot, but can lead to injuries and dysfunction of other body parts including the knee, hip, and lower back. Flat feet and over-pronation can result in patellafemoral pain syndrome, ACL, MCL, meniscus tears, infrapatellar tendonitis, ITB-friction syndrome, hip arthritis, herniated discs, sciatica, and lower back pain. The body functions as a chain where problems in one area can lead to dysfunction in other areas. Therefore, it makes sense that correcting structural abnormalities of the foot could and should lead to corrections in other areas of the body.
Montclair and Little Falls, NJ Physical Therapy Treatment Options
Abnormal foot posture can be addressed through several sports physical therapy treatment techniques, including hands-on manual and soft-tissue techniques, strengthening and stretching exercises, and the use of foot orthotics. All of these methods are utilized with the main goal of correcting the foot’s posture by changing either soft-tissue (muscles, ligaments) length or the anatomical position of the bones of the foot in relation to each other and/or the ground.
Proper foot orthotics, when tailored specifically to the individual idiosyncrasies of a patient’s foot, is one of the most effective treatment methods. Custom-molded orthotics do not treat the symptoms of pain and dysfunction, but rather treat the source of these issues. As a result, the use of orthotics can lead to long-standing improvement and correction of the patient’s dysfunction, rather than just provide short-term relief. At Parabolic Performance & Rehabilitation, all of our professional New Jersey physical therapists are trained and certified in casting for custom orthotics that fit the specific requirements of the patient’s foot.
Through these best physical therapy practice techniques, proper and efficient biomechanics at the foot and ankle as well as the knee and hip joints can be restored. This will ultimately lead to an increase in pain-free mobility and a decrease in injury re-occurrence during your reconditioning, and we hope you will join us for some performance, strength, or speed/agility training sessions at one of our centers.