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Orthopaedics
Physical therapy always begins with a detailed history and evaluation of the problem. The physical therapist takes many things into account, including age, general health, occupation, and lifestyle along with an objective evaluation including functional ability, postural assessment, strength, neurological testing and visual inspection.
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Spine |
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Lower Back
In our modern, industrial society, back pain is the most common cause of loss of activity among adults under 45. It is estimated that over 80% of all American workers suffer back pain at some time during their careers. The cost, to all, is staggering. American industry loses billions in productivity, and consumers and insurers pay billions more for treatment.
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However, there is some good news: most bad backs respond well to conservative treatment by a physical therapist. When more invasive treatment such as surgery is required, physical therapy is integral to the overall medical plan to return the patient to an optimal level of physical activity.
The body depends on the spine for both structural stability and mobility. Thus, problems may result from a variety of internal and external factors. Physical therapists with Crescent City Physical Therapy receive advanced education in the evaluation and treatment of spinal disorders. Careful evaluation by the therapist along with the physician's diagnosis are key to the successful rehabilitation of the patient with a back problem. Additionally, the active involvement of the patient in their own rehabilitation and postural re-education is critically important for lasting relief from pain and dysfunction.
Physical therapists may utilize a wide variety of treatment techniques, depending upon the patient's problems and the acuity of the problem: rest positioning, exercise, manual therapy, mobilization, ASTM, therapeutic activities, unweighting, postural education, electrical stimulation, heat, ultrasound and ice. Some of the most common back problems treated by the physical therapist are:
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Herniated Disc
Sciatica
Osteoarthritis
Degenerative Disc Disease |
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Spondylolysis
Scoliosis
Low Back Syndrome |
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Facet Impingement
Spinal Stenosis
Spondylolisthesis |
Cervical Spine
The most common disorders of the cervical spine are cervical strain and sprain as a result of injury or trauma, repetitive strain and poor posture. Symptoms of dysfunction and pain may be localized to the neck or radiate distally
into the shoulders and arms.
Postural dysfunction is a result of poor posture which contributes to the forward head posture syndrome where the upper cervical spine are held in extension while the lower cervical and upper thoracic spine are in flexion. Patients may experience non-specific pain in the neck and upper back, frequent headaches and pain in the upper extremities. Palpable muscle tightness, guarding and spasm are often noted as well as difficulty performing daily self-care and work activities.
Degenerative joint or disc disease is also commonly seen by physical therapists in the clinical setting and may be characterized by an old spinal injury and a long history of joint pain and stiffness. Active and passive movements are usually painful and restrictive with tenderness to palpation at the involved spinal segments and aggravated by sustained postures.
Disc herniation may be a complication of degenerative disc disease, with or without nerve root involvement. Signs include central or referred pain and possible neurological signs or sensory and reflex changes along with muscle weakness.
Facet joint impingement is characterized by pain with movement and relief with rest. Specific active and passive cervical movements may be restricted and painful. Pain may be unilateral and may radiate.
Treatment of physician-referred patients is based upon the physician's diagnosis and the therapist's evaluation and assessment. A plan of care is established and communicated with the referring physician. Treatment may include modalities such as ultrasound, moist heat, electrical stimulation, manual or mechanical traction, joint mobilization, postural correction, therapeutic exercise and education regarding home exercise program, postural control, and the necessity for lifestyle and occupational changes and use of assistive devices for sitting and sleeping.
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Shoulder |
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The shoulder joint is capable of more and varied range of motion than any other joint in the body. Unfortunately, it also tends to be unstable which can contribute to problems that may require the expertise of a physical therapist.
Athletes (throwers, tennis players, swimmers) are at especially high risk for shoulder problems, though they can occur in anyone; and, in most cases, the therapist helps to speed recovery and enhance functional return to all activities.
The shoulder is a complex of three major joints: the glenohumeral (GH) joint, the acromioclavicular (AC) joint, and the scapulothoracic (ST) joint which are surrounded and supported by bones, muscles, tendons, ligament and bursa sacs that must work in precise harmony with each other for painfree, purposeful function.
Some of the most common shoulder disorders treated by the physical therapist are the result of the aging process, including disuse and atrophy; strain and overuse; and trauma. Problems diagnosed by the physician as tendonitis, rotator cuff injury, bursitis, degenerative arthritis, rheumatoid arthritis, frozen shoulder, and impingement syndrome are common problems treated in physical therapy along with traumatic conditions such as subluxation, dislocation, fracture and post-surgical problems resulting from fracture fixation, rotator cuff repair, and repair of one or more of the joints comprising the shoulder complex and total shoulder replacement.
Physical therapy treatment will be guided by the physician's referral and the therapist's evaluation of the patient. A therapeutic program of manual therapy, therapeutic exercise, soft tissue mobilization, postural correction, functional activities and modalities such as electrical stimulation, ultrasound, and ice may all play a roll in the rehabilitative process.
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Hip |
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The most common hip disorders seen in an outpatient setting are osteoarthritis, bursitis, impingement syndrome, piriformis syndrome, iliotibial band syndrome, and post-surgical orthopaedic hip surgery. Other less common problems, such as Legg-Calve-Perthes disease and slipped capital femoral epiphysis may also be treated by the physical therapist from time to time.
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Osteoarthritis is characterized by discomfort in the morning that worsens with activity. Hip range of motion is limited and muscular strength declines producing gait deviations and difficulty weight bearing. This condition may be produced by an old injury or trauma and may, with extreme pain and dysfunction, be the reason for total hip replacement surgery.
Signs and symptom of bursitis are localized tenderness about the region of the greater trochanter. Patients may have referred pain throughout the thigh and have difficulty lying on the affected side.
Posterior hip pain during weight bearing activities may be a sign of impingement syndrome. The tensor fascia latae is typically shortened and weakened and there is a decrease in strength of the lateral hip rotator muscles and the gluteal muscles. The patient complains of groin pain with single knee to chest or with straight leg raise and may exhibit excessive hip internal rotation and limited hip external rotation.
Piriformis syndrome involves increased pain with standing and walking that is relieved with sitting. Pain may follow the sciatic nerve distribution, without involvement of the back. There is tenderness of the piriformis muscle and a reproduction of complaints with hip flexion, medial rotation and adduction.
Iliotibial band syndrome produces pain along the lateral aspect of the thigh and/or knee. Pain is worse with activities such as climbing stairs, walking up hill, or jogging.
Individuals who undergo orthopaedic hip surgery are also candidates for physical therapy. Treatment may include electrical stimulation, ultrasound, moist heat, ice, ASTMadvantEDGE(tm), soft tissue and joint mobilization, therapeutic exercise for stretching and strengthening, therapeutic functional activities, gait training, and balance and co-ordination activities.
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Knee |
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The knee is a complex joint that does a complicated job: to provide mobility while bearing weight and transferring and/or accommodating to multiple forces both within and external to the body. Thus, it is a common area for problems, pain and dysfunction even in children as well as during adolescence and well into adulthood.
The physical therapy examination of patients with knee problems begins with a careful history and physical examination. Information from the treating physician, including past treatment, including surgery, is particularly important. Examination should also include evaluation of the low back, hip and ankle as other body areas may refer pain to the knee or may contribute to the symptomology about the knee.
Patients with knee problems often report pain, instability, stiffness, swelling, locking or weakness. These findings can occur in or around any aspect of the knee. For that reason, the therapist will carefully examine each patient for the type of pain he or she experiences:
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Acute pain following traumatic injury – meniscal injuries, ligamentous injuries, extensor mechanism injuries, contusions.
Chronic pain with nontraumatic conditions – arthritis, bursitis, tendonitis and other overuse syndromes.
Location of Pain – Anterior knee pain, Medial knee pain, Lateral knee pain, Posterior knee pain
Instability – between the tibia and the femur and/or between the patella and the femur. This may involve "giving way" or "slippage" or "buckling" which may be secondary to pain or muscle weakness in the quadriceps mechanism.
Stiffness – often accompanies joint swelling that may limit joint flexion and/or extension. Arthritis is a common cause of stiffness that may also be the result from any inflammatory or traumatic condition.
Swelling – may be intra- or extra-articular effusion. This may be described as stiffness, but must be differentiated by the physician and the physical therapist.
Locking – occurs when the knee is stuck and the patient is unable to unlock the knee without manipulating it in some way. Pseudolocking occurs with arthritis when the adjacent rough surfaces stick momentarily as they glide onto one another.
Weakness – weakness of the muscles about the knee can occur acutely or gradually. Acute weakness may be the result of a disruption of the extensor mechanism, surgery, or swelling, while gradual weakness may occur as a result of arthritis or other more gradual onset of knee pain. |
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Foot & Ankle |
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A unique service provided by Crescent City Physical Therapy is the evaluation and treatment of foot and ankle disorders, injuries and disabilities. Whether the result of athletic injury or other accident or trauma, our physical therapists work closely with general orthopaedists and those orthopaedists who specialize in foot and ankle problems.
Frequently, our patients are participants in weight-bearing athletic activities such as running, soccer, volleyball, tennis, football and basketball. However, we also treat teachers, nurses and other industrial workers who are “on their feet” much of the day. Patients requiring orthotics for their shoes may be fitted by CCPT therapists by physician referral.
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Foot problems and pain may keep patients from walking, running, dancing, working and/or driving. Many of the aches, pains, and biomechanical problems can be helped by strengthening and stretching exercises along with various modalities, such as ASTYM, ultrasound, electrical stimulation, contrast baths, and ice to alleviate inflammation followed by exercises to maintain relief and to restore the foot to its full or optimal function. Some of the more common foot problems are:
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Plantar Fasciatis
Achilles Tendonitis
Heel Pain
Retrocalcaneal Bursitis
Post-fracture Rehabilitation |
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Sesmoiditis
Post-surgical Rehabilitation
Posterior Tibial Tendonitis
Metatarsalgia
Rheumatoid Arthritis |
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Pes Planus and Pes Cavus
Neuroma Pain
Problems resulting from Osteoarthritis
Diabetes |
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Temporomandibular Joint (TMJ) Dysfunction |
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Temporomandibular Joint (TMJ) problems can present the physical therapist with many persistent symptoms that often go untreated. Evaluation of TMJ Dysfunction begins with an evaluation by the therapist of the postures of the head and neck that often predispose patients to a change in the normal arthrokinematics of the TMJ. Muscles used in chewing may become tight, inflamed and weak and/or hypertrophied which may be the result of chewing on the same side all the time, clenching and/or bite problems. TMJ problems may result from synovial disc displacement, degenerative changes and/or acute inflammatory onset. Emotional factors such as stress can also play an important role.
Often patients will complain of pain on one side of the jaw and the inability to open the mouth. Other symptoms are an earache and headaches in the temporal area. Some patients have undergone dental procedures and their symptoms are triggered by keeping the mouth open for a prolonged period of time.
Patients with disc displacement usually complain of popping or clicking of the TMJ on one or both sides. An incident of the jaw locking and pain in the TMJ and/or ear area may also be associated with disc displacement as well as a deviation on opening to one side rather than opening midline. Patients with degenerative joint changes may experience tenderness, aching, stiffness and swelling. Many of these patients also complain of occasional earaches and/or ringing in the ears.
All TMJ patients may have neck pain, shoulder pain and/or headaches. These patients usually have postural problems that effect or irritate the upper cervical and/or TMJ problems. These associated problems will also be addressed in physical therapy.
Treatment procedures include exercise, ultrasound, electrical stimulation, stretching techniques, manual therapy and soft tissue mobilization. Thorough physical therapy evaluation and proper treatment are imperative for the alleviation of these patient problems. Education regarding proper head postures and positions that aggravate TMJ dysfunction along with a home exercise program are essential to obtain lasting results.
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