Whether a weekend warrior or an elite athlete, sports-related injuries can be a part of our lives. A Rehabilitation Physician (Physiatrist) can be an invaluable resource in the diagnosis of sport-related musculoskeletal problems. They can also assess body alignment and biomechanics to determine if there is an underlying factor that may be making the athlete vulnerable to injury. An experienced Physical Therapist can design an individualized treatment protocol to diminish the likelihood of reoccurring injury.
At RehabHealth, our Rehabilitation Physicians and Physical Therapists are proficient in the evaluation and non-surgical treatment of your sports-related injuries. A brief summary of the most commonly experienced injuries, categorized by area of injury is as follows:
- Shoulder region:
- Frozen shoulder
- Rotator cuff tendonitis or tears
- Ligament sprains
- Dislocated shoulder
- Shoulder impingement
- Upper back:
Injuries from the belt-line to the shoulder that occur in sports-related activities are usually the result of intense twisting motions or repetitive motion; (such as frequent throwing or use of a racket/bat). They can also be caused by utilizing poor body mechanics while lifting weights. These injuries include Thoracic (Dorsal) Spine and Trunk Ligament Sprains and Muscle Strains.
- Epicondylitis (such as tennis or golfer’s elbow)
- Biceps tears
- Biceps or triceps muscle strains
- Ligament sprains of the elbow joint
- Subluxation of the patella
- Cartilage (meniscus) tears
- Ligamentous sprains or tears (ie. ACL tear)
- Osgood Schlatter’s (in adolescents)
- Post-traumatic osteoarthrithis (ie.”an old football injury”)
- Groin strains
- Partial tears of hamstrings
- Shin splints
- Illiotibial band tightness
- Hip bursitis
- Muscle strains
- Achilles (Heel Cord) tendonitis or partial tears
- Foot and ankle:
- Heel spurs
- Plantar fasciitis
- Tarsal tunnel syndrome
- “Turf toe”
- Ankle ligament sprains
Many different conditions can lead to joint pain, and the pain may range from mild to severely debilitating. A joint is a region where two or more bones meet. Joints are made up of cartilage, ligaments, tendons, fluid-filled cushioned sacs called bursas that pad bony prominences, and a lubricant called synovial fluid. Causes of joint pain include, but are not limited to, arthritis, bursitis, tendonitis, sprains or strains.
At RehabHealth we treat
- shoulder pain
- elbow pain
- hand pain
- neck or back pain
- hip pain
- knee pain
- ankle pain
When you see a physician at RehabHealth, you will be asked about your medical history and undergo a comprehensive physical examination to ascertain the cause of your joint pain. Blood work and/or imaging testing (X-Rays, MRIs, CTs) may be ordered.
Once a diagnosis is established, a variety of treatments will be discussed. Possible treatments include prescribed or over the counter oral medications and topical medications. Anti-inflammatory medications may be prescribed to decrease joint inflammation, muscle relaxers may be prescribed to treat muscle spasm, and some medications used to lessen nerve irritability and help block pain signals, so these may be prescribed as well.
The experienced physical therapists at RehabHealth, who work conveniently in the same building as our medical offices, are experts in musculoskeletal therapy including various types of joint pain. Modalities help to control pain and swelling, while exercises strengthen musculature that support the joint. Bracing may also be recommended.
Another option for joint pain which can be performed at your office visit, or scheduled to be performed under X-ray guidance, is a “cortisone” injection into the affected joint. “Cortisone” or steroid injections decrease inflammation, and thereby decrease pain, in the painful, inflamed joint.
Our physicians are trained in hyaluronic acid injections, or viscosupplementation, for knee osteoarthritis. Hyaluronic acid is a chemical found in healthy joint fluid. The injectable hyaluronic acid acts to provide a lubricant for an arthritic knee, and decrease pain.
No matter what the cause, joint pain can be very bothersome and life altering, and our practitioners at RehabHealth we are highly trained to fully evaluate and treat the condition.
What is Peripheral Neuropathy?
Peripheral Neuropathy is a condition of pain, numbness, tingling, or weakness caused by nerve damage. It can be as subtle as mild numbness or tingling of the hands and feet, or as severe as marked pains in the extremities. It is one of the common causes of restless leg symptoms interfering with sleep at night. It can be static (not changing over time) or progressive.
What are the causes of Peripheral Neuropathy?
- Trauma/Injury - which usually only effects one arm or leg
- Infections - such as Gullian-Barre Disease
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
- Metabolic Problems - such as from Diabetes (very common); relating to kidney disease; Thyroid or Liver problems; or vitamin deficiencies
- Toxic Problems - such as from certain medications, chemotherapy, or heavy metal exposure; and alcohol is a common toxic cause
- Inherited or Genetic Problems - such as Charcot-Marie-Tooth Disease or Amyloid Neuropathy
- Autoimmune Problems - such as Lupus or Rheumatoid Arthritis
- Tumors (including benign non-cancerous tumors) - can directly press on nerves or can have remote effects on nerves through metabolic or auto-immune changes
How is Peripheral Neuropathy tested for?
- Electrodiagnostic Studies, also called Electromyography (EMG) and Nerve Conduction Studies (NCS) are done (see our Nerve Muscle and Testing section) to look for location of injuries, type and severity of nerve damage, and helps with prognosis
- Blood Studies are ordered to look for auto-immune markers, rheumatological markers, metabolic problems, toxins, and vitamin deficiencies
- Imaging studies, such as MRI or CT Scans may be necessary to look for mechanical pinching of nerves, such as herniated discs, tumors, or arthritic spurs
- Rarely a nerve biopsy may be performed.
How is Peripheral Neuropathy treated?
- When possible the underlying cause of the neuropathy must be treated, and may reduce or eliminate the symptoms
- Medications: There are many medications that help the symptoms of neuropathy.
- Anti-inflammatory medications to reduce swelling and inflammation around a nerve
- Pain medications and certain antidepressants (Cymbalta, Sinequan, Doxepin) can reduce nerve tingling and pain sensations
- Certain anti-seizure medications (Gabapentin, Lyrica and Tegretol) can stabilize nerve membranes to make them less irritable, and thereby reduce tingling and pain
- Lidocaine cream and patches can be very helpful to reduce pain in certain types of neuropathy, especially post-herpetic neuropathy or PHN (Shingles)
- Anti-inflammatory medications to reduce swelling and inflammation around a nerve
- TENS Units can "turn off or block pain pathways"
- Nerve blocks (many types of local injections that also include epidural steroid injections) can reduce inflammation and calm down irritable nerves
- Diet and vitamin therapy can improve general nerve health
- Physical Therapy can help relieve pressure on nerves, teach ergonomics and postural changes, and establish exercise programs to strengthen effected muscles and improve extremity blood flow
- Proper foot wear and certain splints and pads can help reduce pressure on nerves, and reduce secondary effects of poor sensation, such as ulcer formation.
RehabHealth physicians, therapists, and staff are experts in managing injuries due to motor vehicle accidents, work-related accidents, and personal Injuries. We have many years of experience in diagnosing and treating musculoskeletal and nerve injuries. We can manage most complications from non-surgical medical orthopedic problems to post-surgical recovery. We understand the emotional and economic stress that injuries place on families, co-workers and employers, as well as the patient. So, our focus is always to help manage and reduce pain, and return our patients to all their prior level of activities as soon as possible. We can speed up the recovery process since many tests and treatments are done right in our facility. We are familiar with the authorization process and insurance systems that must be managed to make the recovery process as smooth as possible. We are often asked and prepared to comment on work status, as well as to determine any partial permanent impairments or disabilities to help settle claims if needed. It is best if we are involved immediately after injury, but we are often called on to improve comfort and function months or years later, when patient's feel that they did not reach the level of recovery that they expected.
Chronic and acute pain affect millions of people world-wide. The goal of pain management is to identify the source of pain and manage it. The specialists at RehabHealth take the time needed to accurately pinpoint the pain generator through a thorough history and physical examination, as well as with diagnostic testing. By providing an appropriate treatment plan, we help you to lessen your pain level and restore maximum functioning. Our compassionate staff understand that you are in pain, and are committed to formulating a plan to decrease this pain.
Pain management techniques that RehabHealth physicians employ are non-surgical and include medications, injections, bracing or orthotic prescriptions, and detailed physical therapy prescriptions, in which physical therapy can be done conveniently on-site.
Medication management consists of over the counter or prescribed anti-inflammatories, topical agents, muscle relaxers, corticosteroids, as well as certain medications that target nerve and muscle pain. The philosophy at RehabHealth includes managing pain without the use of opioids. We do not maintain people who are on chronic opioids, and actually help to decrease the use by incorporating the above techniques.
If the decision to undergo injections is established, these can be done at your office visit, or scheduled to be done under x-ray (fluoroscopic) guidance. Included are joint injections, myofascial (muscle) trigger point injections, nerve blocks or spinal injections.
Physical therapy prescriptions, written by our specially trained physical medicine and rehabilitation doctors, are also an integral part of the treatment of pain. The role and goal of physical therapy is to decrease pain, increase strength, stamina and flexibility, and restore function. The RehabHealth physical therapists pursue these roles with compassion, experience, and much support.
The commitment at RehabHealth by our specialists to decrease your pain level and improve activity is unsurpassed. We provide a supportive, compassionate environment so that you can get back to doing the things that you enjoy.
Electromyography (EMG) and Nerve Conduction Studies (NCS) test nerves and muscles for injury or disease. Specially trained physician’s record and analyze electrical impulses between muscles and nerves, to diagnose and help treat many different types of muscle and nervous system disorders. Typically, there are 2 main parts to the study. The first part, Nerve Conduction Studies, uses stick-on skin electrodes that record the muscle and nerve activity. A small brief impulse is used to stimulate the nerves and muscles. The second part, Electromyography, uses a very thin needle to record the natural current in the muscles. No stimulation is used with this portion. At times a small brief discomfort may be experienced with the needle recordings, but this is usually very tolerable with today's ultra-fine needles.
The test can localize the nerve or muscle problem; determine how bad or advanced the problem is; and offer a prognosis for improvement.
Typical problems that can be tested for:
- Carpal Tunnel Syndrome (pinched nerve in the wrist)
- Guyon Tunnel Syndrome (pinched nerve in the wrist)
- Tarsal Tunnel Syndrome (pinched nerve in the ankle/foot)
- Cubital Tunnel Syndrome (pinched Nerve at Elbow)
- Pinched Spinal nerves (Radiculopathy) from disc disease or arthritis in the cervical spine and low back
- Foot Drop
- Many other pinched or injured nerves in the arms and legs
- Pain, tingling, numbness, and weakness caused by diabetes, kidney disease, toxicity from certain drugs and heavy metals in the environment, infections, and auto-immune problems
- Genetic and inherited muscle and nerve problems, such as Muscular Dystrophy, Myotonia, Inclusion Body Myositis ALS and Spinal Muscular Atrophy
- Rheumatological and connective tissue diseases that effect muscles and nerves
- Diseases that effect the muscle-nerve junction, such as Myasthenia Gravis
In preparation for the test you should not apply creams or lotions to any limb being tested for at least 2 days prior to test.
It is estimated that 80 percent of all Americans will have an episode of back pain during their lives. Back pain is a leading cause of loss of work. Studies have shown that early diagnosis and treatment leads to faster recovery time. The Rehabilitation Physicians (Physiatrists) and Physical Therapy team at RehabHealth specialize in non-surgical treatment of neck and back pain.
The spine is one of the most important structures in our body. It gives us the ability to be upright, offers us flexibility and most importantly protects our spinal cord. Maintaining a healthy spine is vital to our well being. The spine can be divided into three main regions; cervical, thoracic and lumbar. The cervical spine is the upper portion, the thoracic (dorsal) is the mid-back region and the lumbar is the lower back. The area below the lumbar region is known as the sacrum.
Our spine is made up of 24 bones known as vertebrae. Between each of these vertebrae is a gel-filled cushion known as a disc. Other important structures of the spine are the ligaments and tendons. Ligaments hold the bones together. Tendons attach the postural muscles to the vertebrae. There are also small joints on each side of the spine, where one vertebra meets the vertebra above or below it. These joints are known as the facet joints.
Disc injuries, joint arthritic changes, ligament or tendon sprains, or muscle strains can result in neck or back pain.
Some of the more common causes for neck and low back pain are:
Muscle strains (i.e. “whiplash”, “pulled muscles”)
Sprained ligaments (caused by overuse or trauma)
Herniated or bulging disc (when the gel-filled cushion between the vertebrae begins to “bulge” and put pressure on surrounding structures)
Radiculopathy (when a nerve root is compressed from either a disc, tight muscle band, or arthritic changes of the spine)
Muscle tension headaches (chronic headaches caused by muscle tightness )
Spinal stenosis (narrowing of the spinal canal usually caused by degenerative/arthritic changes)
Facet joint problems (degenerative/arthritic changes)
Pregnancy related low back pain
Arthritis of the neck and back (can cause inflammation of the joints of the spine, bone spurs)
Compression fractures (frequently caused by osteoporosis)
The rehabilitation physicians (physiatrists) at RehabHealth will perform a thorough evaluation to determine the cause of your neck or back pain and devise an individualized treatment plan. Medication options may include anti-inflammatories, muscle relaxers or pain relievers. The physicians also may recommend cortisone or muscle trigger point injections (which are performed “in-house”). In some instances (such as radiculopathy, stenosis or facet joint dysfunction) they may perform specialized injection techniques under x-ray guidance.
Often an integral component of neck or back rehab includes physical therapy. RehabHealth’s onsite physical therapy department works closely with our physicians to provide hands-on manual therapy techniques, modalities to decrease pain/inflammation, and to instruct patients in customized exercise programs that address their specific needs.
Whether it be a herniated disc, “whiplash” from a car accident, chronic tension headaches, or a strained low back from a work or sports related injury; the physicians and physical therapists at RehabHealth have the knowledge and expertise to decrease your pain and get you back to enjoying your life.
The term “pinched nerve” is used to describe the condition that occurs when pressure is placed on a nerve. When a person has pressure on a nerve, they may experience a variety of symptoms. These symptoms may include numbness, tingling or burning, weakness, pain or cramping. In many instances pressure on the nerve can cause symptoms away from the area of compression. For example, a “pinched nerve” in the neck may cause forearm or hand symptoms. Likewise a problem with a nerve in the low back may cause numbness, tingling, pain, cramping, or weakness in the leg or foot. For this reason it is important to have a physician perform a thorough evaluation to determine the cause of the symptoms.
There are a variety of situations that can cause pressure on a nerve. A nerve can be compressed due to a tight muscle band or muscle in spasm. A herniated or bulging disc in the neck or back may cause compression of a nerve root at the spine. Arthritic conditions that cause bone spurs or thickening of tendons can also cause nerve impingement. Two common conditions that are actually “pinched nerves” are “carpal tunnel syndrome” and “sciatica”
Many lifestyle situations may contribute to the onset of pinched nerves. Pregnancy, being overweight or poor posture may cause pressure on a nerve. Overuse injuries as a result of repetitive stress at a job or sport/hobby and can cause pressure to be applied to a nerve.
A thorough evaluation by a Rehabilitation Physician can help pinpoint the cause of the nerve impingement. A nerve conduction test may be performed to determine the location and extent of impingement. Once diagnosed, a proper course of treatment can be implemented. Treatment options may include the use of anti-inflammatory medications or medications targeted specifically for nerve pain, nerve blocks, specific trigger point injections to decrease muscle compression on the nerve, or physical therapy for stretching and postural education. In the case of compression of the nerve root at the spinal level, the physician may also recommend, Physical Therapy, exercises, or epidural steroid injections to decrease pressure caused by the discs or arthritic changes of the spine.
With proper evaluation and treatment, the pain and suffering associated with a “pinched nerve” can be diminished and in many cases alleviated without the need for surgery.