Teemu Laakso knows injuries. In February 2009, the 22-year-old Milwaukee Admirals defenseman suffered a season-ending injury to his right shoulder. |
“I hit a guy during a game, and my shoulder popped out,” Laakso remembers. His pain was intense, and team doctors determined Laakso had torn cartilage. They repaired the tear surgically, and he needed five months of intense rehab.
Fast forward to December 2009. Laakso made contact with an opposing player in a game against the San Antonio Rampage and felt a similar tear in the same shoulder. He immediately pictured another major surgery and months of rehab.
“He was very uncomfortable, and absolutely 100 percent convinced that he was going to need more surgery,” says Mark Wichman, orthopedic surgeon at Aurora Advanced Healthcare and the Admirals’ team doctor. But Laakso’s new tear involved different cartilage, and Wichman recommended a different path: eschewing surgery for a course of physical therapy. There was little to lose, Wichman says; surgery would have ended his season yet again.
Laakso began making daily visits to the Aurora Sports Medicine Institute, and within two weeks he noticed that his shoulder was feeling better. A combination of shoulder-strengthening exercises, anti-inflammatory medication and rest did the trick, and by late winter, the shoulder felt “almost 100 percent better,” Laakso says. He’s glad he took the route that gave him more time on the ice.
Professional athletes aren’t the only ones to see real benefits from physical therapy. Orthopedic surgeons and physical therapists say PT is an effective way to heal the range of muscle and tendon injuries suffered by weekend warriors, backyard gardeners and unlucky klutzes. Of course, some injuries come with a ticket to the operating room. But in many other cases, physical therapy can help you avoid a scalpel, which has obvious payoffs, Wichman says. “Surgery has risks and costs and other concerns that make therapy preferable when it’s successful.”
A Big Bag of Tricks
Physical therapists offer a surprising range of techniques to ease pain and repair an injury. Your first visit to a physical therapy clinic usually involves an evaluation to determine the extent of your injury and to lay out your goals. Do you want to regain your killer serve on the volleyball court, or just lift your grandchild without pain? With that in mind, the therapist develops a treatment plan to help you strengthen the area while it heals.
For most of us (nonprofessional athletes), a round of physical therapy involves two sessions each week for four to eight weeks. But this time commitment is important; a good physical therapist watches closely to tailor the rehab to your progress and pain level, says Evan Nelson, a physical therapist at the Orthopaedic Hospital of Wisconsin. “There are small modifications that I can make in how I have a patient do an activity or the way I treat a person day to day depending on how they feel,” he says.
During an appointment, the therapist might perform hands-on therapies like soft-tissue massage to relieve pain and joint mobilization to improve range of motion. They can also use things like ultrasound to quell inflammation in injured tissue and ease soreness.
Other PT tricks include injury taping, which has evolved into an art form, says physical therapist Vicki Roth of the Aurora Sports Medicine Institute. Old-school athletic tape is good for immobilizing a joint, but new tapes made with different materials “can work to inhibit a muscle or assist a muscle,” depending on the way they’re applied, Roth explains. She can tape a patient’s injury during an appointment, and it will stay in place and provide pain relief for several days.
Wichman adds that physical therapists’ knowledge of the body makes them an important asset. “I rely on physical therapists to help uncover some of the muscle deconditioning and weakness in other parts of the body that might indirectly contribute to the patient’s problem,” he says. Regarding knee issues, for example, physical therapists often spot treatable problems that set the stage for the injury, such as hip weakness or feet that overpronate.
Still, all this expertise won’t help patients unless they perform prescribed exercises regularly, especially on days when they’re not in therapy. “Typically we see someone twice a week, and each appointment is 45 minutes,” Roth says. “In the spectrum of their life, that’s a very short period of time. If they can carry through the exercises the rest of the week, that makes the biggest difference.” And yes, therapists can tell when you haven’t done your homework, Nelson says with a chuckle. “Those patients improve slower than the people who do their exercises,” he says.
When Physical Therapy Works Best
People with back injuries are often prime candidates for physical therapy.
“In a lot of cases, a therapist skilled in treating the spine can offer a patient significant improvement in six to 15 visits,” Nelson says, “depending on how long they’ve had the back pain, and how serious the injury is.” He recommends seeing a therapist with experience in back pain.
Back treatment usually involves some combination of anti-inflammatory meds, rest and exercises to strengthen the core muscles of the body. “With back pain, typically the lower abdominal muscles will be weak,” Roth says. Stronger abs ensure that your back muscles don’t have to work as hard, reducing the risk of a future problem.
Many ankle sprains also respond well to physical therapy. Ankle sprains occur when the joint’s ligaments stretch or tear, and you risk future ankle sprains (and sometimes surgery) unless you rehab well. Anthony Ferguson, an orthopedic surgeon at the Orthopaedic Hospital of Wisconsin, suspects many people who need surgery for chronic ankle sprains “weren’t put through a real appropriate rehab program early on.”
Roth treats ankle sprains by reducing swelling with ice and elevation, eventually moving the patient through exercises that strengthen the muscles surrounding the ankle. She explains why balance exercises are crucial after an ankle sprain: “You can strengthen, strengthen, strengthen, but if you don’t get a patient up standing and balancing, they’re going to roll that ankle as soon as they get out there again.”
Balance work trains muscles to work together with small quick motions that keep you upright. When those muscles are strong, they can react quickly to right an ankle that begins to roll, Roth explains. She’ll often have patients perform exercises on uneven surfaces, or on a device called a Bosu ball.
Physical therapy can also treat chronic tendinitis, a painful condition often found in the Achilles tendon, knee or elbow that doesn’t resolve within two weeks. In chronic cases, soreness is triggered by changes in tendon tissue. But Nelson says research shows specific moves, called eccentric exercises, can return tendons to a normal state.
In eccentric exercise, the muscles that work with a tendon contract and get longer at the same time. (A traditional calf raise performed on a step is one example of eccentric exercise.) “It’s very strenuous to the muscle,” Nelson says. “But we can administer it in small doses, and we see that it starts to restructure the tendon tissue.” As the tissue changes, the pain recedes, he adds.
An Injury Resource
Wondering if your pain will go away on its own or if you need physical therapy? Or even surgery? Wichman recommends taking advantage of the free injury evaluations offered by some physical therapy clinics.
“I think they’re underutilized,” Wichman says. “Sometimes physical therapists are quite skilled in diagnosing musculoskeletal injuries, and they can be a good source of information. If you’re not sure if your problem is minor and just needs a few more days, or is potentially a big problem, an injury evaluation can be helpful.”
Nelson adds that in Wisconsin, you can usually see a physical therapist directly without a referral from your primary care doctor; most private insurance will reimburse for physical therapy. Check with your insurer before you make the appointment.
Nelson encourages people to consider physical therapy soon after an injury. He cites the example of back pain. “There’s a fair amount of research,” he says, “showing that a patient receiving physical therapy in the first two weeks following injury will improve at a faster rate than an individual waiting a month.”
Erin O’Donnell is a freelance writer based in Milwaukee.
Health Tips by Juile Sensat Waldren
Get Up, Stand Up Too much sitting can be deadly, warns a British Journal of Sports Medicine editorial. Prior studies have found that
people who sit more have higher death risks, regardless of whether they exercise. Experts say people should try to break up sedentary time as much as possible by getting up and walking around.
Text Tips For Moms Pregnant moms can now get free tips on topics such as immunization, nutrition, breast-feeding, birth defect prevention and car seat safety. Just text the word BABY (or BEBE in Spanish) to 511411, enter your due date or baby’s birth date, and you’ll begin receiving three text messages per week until your child’s first birthday. The Text4baby program was developed by the National Healthy Mothers, Healthy Babies Coalition, with support from the Centers for Disease Control and Prevention and the Health Resources and Services Administration. Find out more at text4baby.org.
Still Putting Off That Colonoscopy? A new blood test may help diagnose colorectal cancer in its early stages by measuring the levels of a protein called CD24. While colonoscopies are the best way of detecting early colorectal cancer and removing polyps before they become cancerous, many people avoid having them done. Researchers hope that the blood test – currently only available in clinical trials – will help identify which patients could benefit from a colonoscopy. The findings were reported at the 2010 Gastrointestinal Cancers Symposium.
I Can See Clearly Now
The Wisconsin Optometric Association offers free comprehensive eye exams to uninsured children from low-income families through a program called VISION USA – The Wisconsin Project. Participating eye doctors provide the services at no cost, and children may also be eligible for free prescription glasses. To qualify, kids must be under 18, have no vision health insurance and not have had a vision exam within the last year. Also, their parent or guardian must work at least part-time. For information, call 877-435-2020.
Internet Causes Depression? People who obsessively use the Internet to interact with people instead of developing real-world connections are more likely to be depressed, reports a study in Psychopathology. In the study, people who used the Internet excessively to visit social networking sites, gaming sites and sexual sites had a higher rate of depression than nonobsessed Internet users. Younger people and men showed the greatest tendency toward Internet addiction. It’s not yet clear whether excessive Internet use causes depression or vice versa.
