Acute Injury Care-"R.I.C.E."

Appropriate care for acute, or new, injuries is easy-just remember "RICE": Rest, Ice, Compression, and Elevation. The primary goal of acute injury care is to control pain and swelling and the "RICE" method is simple to follow.



Rest is often easier said than done, but allowing an injured joint or muscle to rest is an important step in the road to recovery. If you have injured your arm, avoid lifting or carrying heavy objects for a few days. If you have injured your foot, try to limit the amount of walking you do. Let common sense prevail--if it hurts, don't do it.



Applying ice, especially this time of year, is not comfortable, but it is essential to controlling pain and swelling. The old "15 minutes on, 15 minutes off" method of icing is not bad, but not really practical. Applying ice for 15-20 minutes once every hour or two is just as effective. Be careful when applying ice or a frozen gel pack directly to your skin, it is possible to give yourself frostbite. A pillowcase provides a barrier thick enough to protect your skin, but thin enough to allow the cold through.

An elastic bandage, or "ace wrap", is the best thing to use to provide compression. When applying an elastic bandage, always start away from the heart and work your way towards the heart. For example, if you are wrapping an ankle, start at the toes and wrap up towards the calf. Keep the bandage taut enough to provide compression, but not so tight as to cut off circulation.

The final component of the "RICE" method is elevation. The key to effective elevation is having the injured limb elevated above the heart, not just off the ground. Sitting in a chair with your foot propped on an ottoman will not provide the same benefit as laying flat on the couch with your foot propped on a few pillows.

The "RICE" method is a great way to start caring for a new injury. As always, if you have any questions or concerns, you can always contact your favorite physical therapy clinic!

-Tina Valentine MS, ATC

Knee pain and ankle biomechanics

Knee pain is a common complaint of people who seek out physical therapy. When examining a client who comes in with knee pain our physical therapist’s at U-District will not only look at the knee but will also examine the hip and ankle to determine the cause of the pain symptoms. For this blog, ankle biomechanics will be discussed in relationship to the potential for faulty mechanics that can lead to knee pain.
First the foot and ankle complex is made up of several joints that result in the overall motion that can be observed when a person moves. The movements of the foot and ankle include dorsiflexion (when the toes come closer to the front of the knee), plantar flexion (when the toes are pointed), pronation (when the arch moves closer to the ground) and supination (when the arch moves away from the ground). When an individual has too much of or lacks one or more of these motions it can lead to pain in the foot and/or ankle, the knee or the hip.
Excessive pronation during walking often leads to complaints of medial knee and/or patella-femoral pain. This occurs because pronation occurring at the wrong time during walking, going up and down stairs, squatting or any other activities increases the potential for abnormal stress to be placed on the inside structures of the knee and can result in an increased net lateral pull of the quadriceps or iliotibial band on the patella/knee cap.
In the opposite extreme, excessive supination or not enough pronation can also lead to knee pain. Not enough pronation leads to decreased shock absorption by the foot and ankle and then the force of impact is taken up to the knee. This type of knee pain will most likely be seen in people who perform repetitive load bearing activities such as running and jumping.
As explained above, faulty biomechanics in the foot and ankle may lead to knee pain. At U-District, our physical therapists will look at strength, flexibility, range of motion, balance and proprioception and potential foot orthoses or shoe recommendations to address a client’s knee pain.

If you have any questions, please don’t hesitate to call or email us. Aaryn Hieb, DPT

Proper Snow Shoveling

Let it snow! Shoveling snow may be a blessing in disguise….if done correctly. According to the Surgeon General’s Report, 15 minutes of shoveling counts as moderate physical activity. However, most shoveling is done incorrectly and can put stress on your heart and back.
Safe snow shoveling requires proper preparation, the right tools, and good technique. If you have a heart conditions, high blood pressure, or any back issues we recommend you talk with your doctor before you start any exercise program, including snow shoveling.
Before you start, U-District recommends a 5-10 minute warm-up. This may include a simple walk around the block to get your blood flow moving to your lifting muscles. A common error is shoveling first thing in the morning or after a nap, without a proper warm up. Here is an example of a flexibility program:
· Neck rolls
· Arm circles
· Trunk rotations
· Body weight squats
· Hamstring Stretches (place foot on step or chair and reach toward toe with back straight)
o Very important. Hamstring flexibility decreases the stress placed on the back during bent over and lifting activities.
Now you are ready to shovel. We recommend a small plastic blade that is lightweight and sturdy. Find an ergonomically correct model with a curved handle. The jumbo size shovels that pick up twice as much snow, are just increased stress on your back and should be avoided. Finally, if the snow is sticking to the shovel, use a silicone lubricant on the blade for easier shoveling.
Most importantly, proper shoveling techniques must be used. Each winter our physical therapy clinic works with individuals who injured themselves shoveling snow. The most common mistake is bending over with the back rounded and tossing snow across the body. We recommend always try to push snow rather than lifting it. Here are a few tips for protecting yourself when you lift:
o stand with feet at hip width for balance
o hold the shovel close to your body
o space hands apart to increase leverage
o bend from your knees, not your back
o tighten your stomach muscles while lifting
o avoid twisting while lifting
o walk to dump snow rather than throwing it
o if throwing, step in that direction to reduce low back twisting

Make sure to listen to your body. Stop if you feel pain or observe any heart attack warning signs. Snow shoveling can be great exercise, but must be done correctly!

Let us know if you have any questions, Brian Cronin MPT, CSCS

Welcome

Dear valued clients and friends,

In an effort to better inform our clientale, present and future, we have created this physical therapy blog. As the blog evolves, you will find topic discussions on important physical therapy subjects. We have chosen to select one topic per week and have one of our five physical therapists or certified athletic trainer write on the chosen topic from their individual perspective and treatment approach. When appropriate we will include videos to further emphasize and clarify the chosen topic. We invite all readers who desire clarification or have questions to email us at udistrictpt@hotmail.com and we will be happy to elaborate further or discuss any of our many outstanding services we offer. We are excited about the blog and we hope you enjoy it!

Shoulder Stabilization

For the first blog topic, I have chosen to write on stabilization, an often-missed component of shoulder health. This topic is pertinent to general shoulder pain and pathology, and specifically to the medical diagnoses of: Multi-Directional Instability (MDI), Rotator Cuff (RC) Repair, pre-operative RC pathology, and partial RC tears. In the initial stages of physical therapy (PT), the focus of therapy is on reducing inflammation/pain, regaining full ROM, and stabilizing the glenohumeral joint (GHJ), what we common refer to as the shoulder.
Without going into elaborate detail, the humerus and scapula are the two bones that make up the shoulder complex. In speaking about shoulder stabilization, the primary goal is to use the surrounding musculature (primarily the rotator cuff) to approximate the two bones in the GHJ. The primary function of the rotator cuff is to assist in the approximation of this joint and keep the humerus held down (inferiorly) in the joint. Besides RC strength, proprioception, or joint position sense, is also a key component to shoulder stabilization and health. Finally scapular stabilization and the rhythm between the scapula and humerus (scapulohumeral rhythm) during movement is very important.
In order to achieve these goals, I employ a very specific exercise progression aimed at gaining stabilization before focusing on strengthening. Please refer to the video for a brief description of each exercise and a demonstration. After a significant amount of stabilization is achieved, general shoulder strengthening and a functional progression to sport-specific or recreational activity is started.


Posted by:
Chris Leck, DPT, CSCS