Jacksonville Arthritis Walk

March 9th, 2010

On May 15, 2010 at Jacksonville Municipal Stadium people will be gathered to walk for the health of their joints and to raise money and awareness to a cause that is so prevalent but yet so misunderstood.  The term arthritis encompasses many different pathologies, from the sore hands of an elderly woman to the sore hips and knees of a 5 year old.  Most people thing of the first example: waking up stiff in the morning due to “old Arthur” setting in.  But as I have discussed before Juvenile and Rheumatoid Arthritis (plus the 100 others) are serious conditions that attack the joints of the body and at times render the person limited to complete the functions of daily life.  This spring we will be helping all people with arthritis, from the stiff knee in the 50 year old to the 11 year old that wants to try out for the basketball team but can’t because it would hurt too much. 

By going to www.2010awjax.kintera.org you can sign up to participate in the walk.  Form a team and recruit your friends, family, coworkers, and neighbors to donate or walk with you.  All money being raised goes to the Arthritis Foundation which services include free summer camp for kids with arthritis, Arthritis Today magazine, nearly 100 consumer educational brochures, booklets, and books, water and land based exercise classes, federal and state advocacy, and extensive funding of arthritis research nationwide.  The walk is a part of the Lets Move Together campaign by the foundation to facilitate awareness and fundraising for arthritis.  Go to www.letsmovetogether.com for more details.

Please show your support and walk or donate to a cause that affects 46 million Americans, including 300,000 children.  May 15th, registration starts at 8:15 and the walk is at 9am.  Go to the website or call 904-718-6820 for more information.  Thank you for your support.

Nathan Johnson

The Arthritic Knee

March 1st, 2010

A common place for osteoarthritis (OA) to occur is in the knee.  This joint is susceptible to wearing away of the cartilage due to the long lever arms transmitting forces through the joint and because of its weight bearing status.  OA in the knee can be very debilitating due to severe pain that leads to inactivity and further complications and changes in lifestyle.  However, there are things that can be done to help prevent or delay OA, manage OA once it’s there, or in the worst case scenario operate to reconstruct the joint to get rid of the damaged cartilage.

The common places for OA in the knee are between the medial surfaces of the tibia (lower leg) and femur (upper leg) and between the patella (knee cap) and femur.  The established factors for the cause of OA are obesity, age, OA at other sites, previous trauma or surgery to the area or being female.  Other potential contributing factors include: physical activity, genetics, and smoking.  From this list there are many things one can do to prevent or delay their cartilage from wearing down.  The most important is living a healthy lifestyle with a good daily diet and regular physical activity.  Glucosamine and chondroitin have been shown to be better than placebos in some trials and may facilitate the maintenance of healthy cartilage when taking regularly.   But, as some healthy athletic people know, that will not always keep it away, so what can be done once your joints start to get stiff with rest and ache with activity?

First, go see your physician to make sure that is what you have.  There are various conditions, musculoskeletal and systemic, that can cause similar symptoms including other forms of arthritis such as rheumatoid arthritis.  Once you know it is OA, your doctor may prescribe an anti-inflammatory to remove the chemical signals that cause the pain, but you are still left with weak and inefficient cartilage in your knee.  A physical therapist can help with best exercises practices, facilitate correction of poor and stressful body mechanics and instruct on activity modification.  As I have talked about previously, even though your joints hurt that does not mean that they need to just sit around.  They need properly dosed exercise to facilitate function and health of the remaining cartilage. 

Sometimes the best therapy in the world is not enough to facilitate a full functional lifestyle and that is when you would need to consult an orthopedic physician for more invasive options.  No matter what level of OA you have in your knee there are options for treatment.  You do not have to suffer from excruciating knee pain due to OA. 

Should I Exercise if I have Rheumatoid or Osteoarthritis? By Nathan Johnson

February 23rd, 2010

Emphatically YES!  Exercise can be very beneficial for people with arthritic conditions.  Arthritis is a general term of various types of conditions that create inflammation in and around the joints of our body.   Pain and decreased motivation to move are significant symptoms associated with arthritis, but both can be improved with exercise.

When your joints hurt I know the last thing you want to do is exercise, but what is your perception of exercise?  When a person’s joints are healthy and strong exercise consists of putting jogging shorts and headband on and going for a run, doing heavy weighted squats, or doing jumping jacks.  But when someone has irritation to their joints exercise may consist of playing in a pool, biking, or light resistance training.  The difference is that there is consideration for the stresses applied to the joints, but activity doesn’t have to be boring or painful.  The key is to find something that you enjoy and that is appropriate for your joints. 

Consulting your physical therapist would be an excellent place to start if you were concerned about arthritis but wanted to start exercising.  PT’s have advanced knowledge of the inner workings of all of the body’s joints to facilitate safe and effective exercise and hopefully you will have fun doing it. 

Arthritis - By Nathan Johnson PT, OCS

February 17th, 2010

Of the 100 different forms of Arthritis the 3 most prevalent are Osteoarthritis, Rheumatoid Arthritis, and Juvenile Arthritis.  Each can be devastating to the function and quality of life of an individual.  The Arthritis Foundation pushes for legislation and funds research that focuses on the prevention, control, and/or cure of arthritis. 

Osteoarthritis (OA) is the most common type of arthritis characterized by the breakdown of the joint’s cartilage.  It affects nearly 27 million Americans and causes them pain or stiffness in joints after periods of inactivity or excessive use.  OA causes the familiar grating or catching sensation during joint movement.  Bony growths, or spurs, can form at the margins of joints and further create loss of function. 

                Rheumatoid Arthritis (RA) is a chronic disease where the lining of the joints becomes inflamed.  This results in pain, loss of function, and disability.  The immune system plays against the body in attacking the lining.  Evaluation by a Rheumatologist is recommended to distinguish RA from other forms of arthritis and they can best manage the long term care and treatment.

                Juvenile Arthritis (JA) refers to any form of arthritis that occurs in children or teenagers less than 18 years old.  It can come in varying forms and its cause is unknown.  JA is not contagious.  Almost 300,000 children are affected by the disease and management focuses on controlling the inflammation, relieving pain, preventing joint damage and thereby maximizing functional abilities. 

                If you or someone you know is suffering from arthritis there are ways to help.  If they need to improve their function and are already under medical care, they should ask their doctor if physical therapy is right for them. 

Guest Blogger

February 16th, 2010

Dr. Beauchamp is going to start featuring guest bloggers here at www.whatphysicaltherapyis.com.  As the owner of Spine & Sport, he is fortunate to have a staff of talented clinicians to pull from. We hope that you will find the information they share, relevant and useful. Whether you are seeking answers to pain you are experiencing or you are a physical therapist looking for an exchange of ideas.

Nathan Johnson PT, OCS

Nathan Johnson PT, OCS

Our first guest blogger will be Nathan Johnson, the Director of Rehab at our new clinic in Jacksonville, Florida. He graduated from Bradley University in 2004 with his masters in Physical Therapy. He is a board certified orthopedic physical therapist that specializes in spinal rehabilitation. He completed his clinical certification through the Ola Grimsby Institute where he learned advanced manual therapy skills and scientific therapeutic exercise progression. Nathan is an active member in the orthopedic section of the APTA and the American Academy of Orthopedic Manual Physical Therapists.

Can a Physical Therapist Perform Spinal Manipulation? How Does Manipulation Compare to an Adjustment?

October 19th, 2009

 

 

 

Easy answer to the first part of the above question – YES!  Yes, except if you live in the State of Arkansas??  (See #1 below)

 

Let me start by defining some words we are using:

 

Mobilization or manual therapy means a group of techniques comprising a continuum of skilled passive movements to the joints or related soft tissues, or both, throughout the normal physiological range of motion that are applied at varying speeds and amplitudes, without limitation.

 

Manipulation utilizes a high velocity, low amplitude thrust technique whereby the joint is moved beyond its normal physiological range of motion.

 

Adjustment  “refers to a wide variety of manual and mechanical interventions that may be high or low velocity; short or long lever; high or low amplitude; with or without recoil. Procedures are usually directed at specific joints or anatomic regions. An adjustment may or may not involve the cavitation or gapping of a joint (opening of a joint within its paraphysiologic zone usually producing a characteristic audible “click” or “pop”). The common denominator for the various adjustive interventions is the concept of removing structural dysfunctions of joints and muscles that are associated with neurologic alterations. The chiropractic profession refers to this concept as a “subluxation.” This use of the word subluxation should not be confused with the term’s precise anatomic usage, which considers only the anatomical relationships.” (2)

 

Now, back to the topic! The manipulation technique has been added to most curriculums throughout the USA. (Interesting topic found link #3 below)  The manipulation technique has been taught by most physical therapy curriculums external of the US for a long time.  Some physical therapists use this technique frequently; others, not so much.  Every Physical Therapist is different, but it is my opinion that a manipulation technique can be very beneficial when used with the correctly identified patient.

 

A question I often get from the public when discussing this topic is, “What is manipulation as compared to an adjustment that is traditionally performed by Chiropractors.  Here’s the skinny:

 

The easy answer is that both techniques usually involve the technique culminating with an audible “pop”.  The pop is referred to as a cavitation in the physical therapy world and is the result of the release of nitrogen gas within the joint.  This is where the similarity between the two end.  Once again, I’m not a Chiropractor so I will not speak for them.  (Read link #4 and #5 to see what a Chiropractor has to say on this topic.)  As for the field of Physical Therapy, the cavitation itself is not the purpose of the technique, just a byproduct of it.  The primary reason why a Physical Therapist uses this technique is to create mobility in an otherwise tightened joint. 

 

This is a brief overview on this topic, but hopefully it gives you some insight.  If you have any questions, please ask!!

  

1-  http://physical-therapy.advanceweb.com/editorial/content/editorial.aspx?cc=61582&CP=4

2-  http://www.chirobase.org/05RB/AHCPR/08.html

3-  http://www.chirobase.org/17QA/ptschool.html

4-  http://www.chirobase.org/01General/chirosub.html

5-  http://www.chirobase.org/01General/01General/placebo.html

BLACK ELBOW STRAPS: 2009 VERSION OF THE MID-90’S FAD - “TV TAPE”

September 24th, 2009

Odd title, let me explain.  Back when I was a student athletic trainer with Saint Louis University Athletics, it was my duty to make sure all athletes were able to perform their sport and that included the cheerleaders.  Before each home game during the basketball season, it would be my duty to tape the male cheerleaders’ wrists.  Although I’m sure this added some stability to the joint, I would always tease my friend that the whole purpose of the tape was so that he could write words on the tape so that when the TV would pan across them, he would be able to get a message across; thus I named the wrist taping procedure as “TV Tape”.

 

Now, move forward 15 years and we have a new trend that is now pervasive throughout sport.  That is the wonderful Cho-Pat.  The Cho-Pat and similar bracing devices are designed to reduce the stress on the tendons at various places on the body where a tendinitis could be present: namely the elbow and knee.  Now, I am NOT saying that tendinitis does not occur or not a problem that is present in many athletes; HOWEVER I am saying I have never seen a single case of bilateral triceps tendinitis ever in my clinical career.  Add that fact to the reality that many athletes are now wearing these devices on both extremities at the same time and I am left believing that this fad is not being used in manner of the originally intended purpose.

 

If you do a quick little search on the web, I believe my suspicions are confirmed.  One site had a few respondents who actually believed it was used for a sweat reducer of some type.  Another responded to that person and stated it did not work too well, however he was continuing to use it as it “looked cool”.

 

People, c’mon!  Really!!

 

Alright, here’s the theoretical reason as to not use it in this manner.  When tendinitis is diagnosed, a person goes through treatment which can consist of various types, medication, physical therapy, etc.  Based on NOT getting a result of back to normal after those treatments are used, it is then decided to use a “brace” of some type to assist the body in doing the action it is having problems with.  That is where the problem arises.  If you add an external device to assist your body to do what it itself cannot do, over time you have to theoretically weaken the body as it is not meeting the demand itself.

 

Get it?  Theoretically you are actually weakening your body if you are using a device intended to assist a person do an activity pain-free IF they were unable to do it without the brace.

 

That is where we’re at with this.  If you think it looks cool, great!  But let’s look at the bigger picture here!  A medical device should be used if a medical condition is present; not due to the improved aesthetics of using the device.

More On Runner’s Knee

September 10th, 2009

The following is a continuation of my conversation and recommendations to a patient dealing with runner’s knee. This installment also covers my thoughts on the use of supplements and contains a link to our website where you can get more information on Amerisciences, the supplement line we carry at Spine & Sport. Enjoy, and as always, please feel free to send me any questions you may have.

 LJ: So would you weight train one day and run the next and just keep the rotation up? Do I just keep on weight training or is this just something that I need to do initially? I’m just wondering if this is something that you have to keep on doing for maintenance or not. I will definitely add this to my workouts though.

Thanks for the advice and happy running.

P.S. What do you think about using a glucosamine supplement to help with joints? I am curious if these are worth my time to help lubricate the joints. They are an expensive supplement so I am curious if you think there is a benefit. I have taken the product Osteo Bi-Flex in the past and wonder if you endorse something like this.

 Dr. Beauchamp: You could add the weight training in your routine when it is convenient for you.  I do some of mine when/during/after running ie lunges squats calf raises and the rest in a gym.  I would recommend lifting throughout.  In about 8 weeks you could decrease sessions per week to 2 and that will maintain.

I agree with the use of a glucosamine product as some of my patients have had success with using it.  The fact of the matter is the source of the glucosamine is where the problem is.  The majority of people taking supplements do not understand that what is in the pill can be significantly different from manufacturer to manufacturer.  The pills you find on the shelf at a discount rate at a local large distributor may or may not contain what it states it does contain - as there is minimal to no oversight of that industry (supplementation businesses).  The company that I promote and use is Amerisciences.  It uses better-than pharmaceutical grade measures that insure quality products.  The product I promote for joint pain is Joint Ease; it is the best product on the market for that particular problem.  Here’s a link on our website: http://www.spinesport.org/home.cfm/page/products/category/0/product/36_Joint_Ease_(1_Bottle).html

Runner’s Knee

September 2nd, 2009

For the next few blog posts I am going to address a real issue that a patient is facing and share with you my recommendations. I hope you find this information helpful. Please feel free to send me your questions.

LJ: This is a fairly new pain for me that started after yesterday’s run. It isn’t even that much of a pain as it is an uncomfortable annoyance. It surrounds the knee on both of them but is mostly on the bottom to the inner part of the kneecap. There is a lot of cracking when I bend my knee, but that has been better within the past few hours. I’m guessing I just over ran yesterday, but I would like to know how I should treat it now. Is this due to weak surroundings around my knee? If so what would you recommend for building that up? I plan on resting my knee until the pain goes away (a few days) and then running a little shorter (6-8 miles). I am wondering if swimming with a kick board for laps would be good enough strength training or if you would recommend more? Or if I need to hit some weights (which ones), or running high resistance on an elliptical or something? I’m probably babbling here so let me know if I need to clarify anything.

Dr. Beauchamp: I agree, just sounds like you overdid it that day.  Strengthening would absolutely help in reducing this discomfort.  The best strengthening exercises to do would be some form of leg press/squat, lunges, knee extension, leg curls (hamstrings) and calf raises.  You would want to perform your strengthening exercises 3-4x/week doing 3 sets of 10-12 reps.  Swimming is good but does not give you the same benefit of weight lifting.

The other component is your running program.  Make sure you are not increasing your volume (running by distance or time) by > 10% per week.  If you do you significantly increase your probability of injury.  If you are new to running, you may even want to back that down a little more.

In the short term, you needn’t worry about the popping/clicking as it will go away with rest.  That usually is secondary to swelling (even very small amounts).  If the popping/clicking starts to get painful, that would be a reason to go and have a healthcare practitioner take a look at it.

 

 

Residency-Trained Physical Therapists

August 5th, 2009

A relatively new trend in the field of physical therapy in the US is Residency.  It models that of other doctorate-degreed professions in that it is training that occurs after the individual has graduated from physical therapy school and has attained a license to practice.  Usually the residency-site is geared towards a specific field of specialty, orthopedics, neurology, pediatrics, etc.  The physical therapist applies for acceptance into the program and upon acceptance goes through a pre-determined, rigorous training program that includes written, demonstration, working with an expert trained clinician along with a few other tasks usually while working as a physical therapist in the clinic. 

Yes!  Quite demanding, however quite rewarding if the PT is looking to improve his/her skills!  The residency can last anywhere from 6-24 months depending on how the program is structured.  Upon graduating residency, the PT is then able to market him/herself differently than other therapists as the knowledge and skills acquired on the residency path lead to significant knowledge in that area as compared to his/her peers that are not residency trained. 

Obviously, experience is also important and this writer is not inferring that a person with 10+ years experience is less of a therapist than one who is residency trained.  However, I am saying that a residency-trained therapist comes to the table with knowledge and skills that some experienced therapists do not have.

Another form of training that a PT can do after graduating is Fellowship training.  I will discuss that in my next blog!