Ask an Expert: How Do I Get Cleared to Return to Sport After My ACL Tear?

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Q: As an athlete, how do I get cleared to return to sport after my ACL tear?

A: That answer is multifaceted and requires an assessment of both your mental and physical capabilities post-operatively. We have generalized guidelines and criteria with each phase of protocol, to move on to the next, including range of motion, strength, and functional performance of activities.

However, the battery of testing at the end stage of rehab, to demonstrate readiness for return to sport, has more variables. We utilize a variety of ROM/strength testing in comparison to non-operative limb, functional movement testing, sport-specific testing, and psychological readiness testing. We use comparative measurements to the non-operative limb for tools, including but not limited to, the Y-balance test, single limb hop testing, and drop jump testing. We also use self-reporting questionnaires such as Single Assessment Numeric Evaluation and Tampa Scale of Kinesiophobia, which have normative data and guidelines for comparison.

The determination of readiness for return to sport is not just passing one test or participating in practice. It is our job to maximize functional gains while diminishing risk for reinjury. No one single test is able to give a pass or fail for readiness for return to sport, but the battery of tests, as a whole, can determine readiness for return to play and risk assessment for reinjury.

Megan Baker, PT, DPT, CMPT

Resuming Exercise After a Prolonged Break

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Engaging in physical activity offers both immediate and long-term physical and mental benefits. Exercise can enhance sleep quality and reduce the risk of depression and anxiety. Physically, it lowers the risk of cardiovascular disease, type 2 diabetes, infectious diseases, and certain cancers.

The United States Centers for Disease Control (CDC) recommends that adults engage in at least 150 minutes of moderate-intensity aerobic physical activity, such as brisk walking, each week. Additionally, the CDC suggests incorporating muscle-strengthening activities on two or more days a week, targeting all major muscle groups.

Beginning exercise after being inactive can seem like a daunting task. Follow these tips and advice to start your health and fitness journey on the right track!

Start Off Slow

  • Consult a Professional: Speak with a healthcare professional or physical activity specialist to determine suitable types and amounts of exercise, especially if you have a disability or chronic condition.
  • Proper Warm-Up and Cool-Down: Learn the importance of warming up and cooling down to prevent injuries. Spend 5-10 minutes stretching, stay hydrated with water and electrolytes, consume protein, and ensure you get adequate sleep.
  • Avoid Overexertion: Gradually increase your activity levels to avoid injuries that could hinder your progress.

Get Social Support

  • Join Groups: Participate in fitness classes or join walking, running, or hiking groups to stay motivated and engaged.
  • Lean on Loved Ones: Seek encouragement and support from family and friends to help maintain your motivation.

Utilize Technology

  • Use Apps and Devices: Leverage apps and activity monitors for coaching and guidance. For instance, the Nike Run Club offers guided runs by professionals. YouTube can also provide a wealth of workout advice and tutorials.
  • Focus on Form: These tools can assist you in maintaining proper form and technique, reducing the risk of injury.

Overcome Time and Energy Constraints

  • Integrate Activity: Incorporate physical activity into your daily routine by walking during lunch breaks or taking the stairs instead of the elevator.
  • Find Small Time Slots: Schedule short activity sessions throughout the day when you have more energy.
  • Move During Calls: Stand, stretch, or walk while on phone calls to stay active.
  • Consistency is Key: Maintaining consistency will help establish a sustainable fitness routine.

Reward Yourself for Reaching Goals

  • Celebrate Achievements: Recognize your accomplishments with rewards that benefit your mind and body, reinforcing positive behavior.

Do What You Like

  • Choose Enjoyable Activities: Engage in physical activities that you enjoy and avoid those you find unpleasant to ensure a more sustainable fitness routine.

By following these tips, you can create a balanced, enjoyable, and sustainable physical activity routine that fits your lifestyle and goals.

Source: Cleveland Clinic & United States Centers for Disease Control (CDC)

Senior Summer Games: Celebrating the Spirit of the Games!

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As the world’s eyes turn to Paris for the Summer Olympics, Tx:Team is thrilled to be bringing our Summer Games back for another year of friendly competition and camaraderie to our senior living communities. The Senior Summer Games will be taking place on July 25th at eight Bridge Senior Living communities and two Greenbrier Senior Living communities in the South!

This year, we’re hosting a variety of exciting events that cater to different interests and skill levels. Whether you’re a seasoned athlete or trying a new activity for the first time, there’s something for everyone. Here’s a glimpse into the thrilling lineup of events:

  1. Track and Field – Javelin Throw

Our seniors will channel their inner Olympians in the javelin throw, a classic track and field event. Participants will demonstrate their strength and precision, aiming to achieve the longest throws.

The javelin throw helps improve upper body strength, coordination, and flexibility, all of which are crucial for maintaining overall physical health and independence.

  1. Gymnastics – Balance Beam

Grace and balance take center stage in our gymnastics event, featuring the balance beam. Participants will showcase their agility and coordination as they navigate the “beam” – a line on the ground – with poise and confidence.

Balance exercises are vital for fall prevention, improving posture, and enhancing overall stability, which are particularly important for seniors.

  1. Basketball

In this modified version of basketball, participants will take turns throwing a ball into a bucket. It’s a simplified but engaging activity that focuses on precision and fun.

This activity enhances hand-eye coordination, improves focus, and promotes gentle physical activity, which is beneficial for maintaining joint flexibility and arm strength.

  1. Soccer

For our soccer event, participants will attempt kicking a ball into a goal. It’s a straightforward and enjoyable way to experience the thrill of scoring.

Kicking a ball helps improve leg strength, balance, and coordination. It also provides a light cardiovascular workout, which is great for heart health and overall stamina.

  1. Cup Stacking – An Ode to the Famous Eiffel Tower!

In a nod to our 2024 Olympic host city, we’re including a cup stacking event, inspired by the iconic Eiffel Tower. This unique and fast-paced activity challenges participants to stack and unstack cups in record time.

Cup stacking can improve hand-eye coordination, fine motor skills, and cognitive agility. It’s a fun way to keep the mind sharp and hands steady.

The Senior Summer Games are more than just a series of events. They provide our senior residents with the opportunity to stay active, engage in friendly competition, and create lasting memories. Our seniors are not only having fun, but also investing in their health and well-being.

As we cheer on the athletes in Paris, we’ll be rooting for our own champions here at home. Let’s celebrate the joy of movement and the power of community together.

Ask an Expert: What Steps Can I Take to Avoid the Problem from Returning and Needing Further Physical Therapy?

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Question: Now that my condition has improved and I’m feeling much better, what steps can I take to avoid the problem from returning and needing further physical therapy?

Answer: During your physical therapy (PT) sessions, we conduct a comprehensive assessment to identify factors that may have led to your initial issue. These factors can include strength imbalances, posture issues, balance deficits, and ergonomic considerations such as workstation setup, and footwear choices. Additionally, we address sport-specific, lifestyle, and job-related factors that may contribute to your condition.

To prevent the recurrence of your issue, it is crucial to integrate the techniques and interventions learned during PT into your daily routine. This proactive approach significantly reduces the likelihood of a relapse. You’ll also receive a tailored home exercise program designed to help you maintain the strength gains achieved during your PT sessions. We prioritize designing a program that is both effective and manageable, ensuring it doesn’t become burdensome in your daily life.

Jennie Gaskill, PTA

 

Ask an Expert: How Can Therapy Help If I Have a Rotator Cuff Tear?

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Question: What does the rotator cuff do, and how can therapy help if I have a rotator cuff tear?

Answer: The rotator cuff is a group of four muscles that work together to perform rotational movements of the upper arm, but also to maintain stability of the joint by preventing excessive sliding around of the “ball” (head of the humerus) in the “socket” (glenoid fossa) of the shoulder and scapula, and by keeping the ball centered in the socket.

There can be normal changes in the structure of the rotator cuff musculature, just as there are in the bones of a joint as we age.  Therefore, the rotator cuff is more susceptible to tears after age 50.

A partially torn rotator cuff can improve with Occupational or Physical Therapy intervention by providing treatment to reduce pain associated with a tear. Education in activity and postural modification, as well as instruction in therapeutic exercise and activity are also provided.  The purpose of this is to increase the stability of the shoulder joint, to keep the ball centered in the socket, maximize the space through which the rotator cuff muscles travel in the top shoulder joint to decrease pressure on the rotator cuff, and increase the ease of overhead reach and rotation. This can enable one to return to pain-free function of the involved arm, to perform activities such as fixing one’s hair, throwing a ball, playing golf, or casting that fishing line!

Erin Winters, OTR at Putnam County Hospital

Ask an Expert: How Long Will it Take to Recover From a Stroke and When Should I Start Therapy?

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Question: How long will it take to recover from a stroke and when should I start therapy?

Answer: Every stroke is different, just as every person is different. Generally, you will see the most improvement or recovery within six months to a year. After a year, recovery and improvements are still possible, however, the rate of recovery tends to slow down.

To minimize disability and improve your recovery, therapies should begin as soon as possible. It is common for patients to think they need to rest after a stroke, but research shows greater improvements if you start therapy 24-48 hours post stroke.

There are various factors that may affect your rate of recovery including:

  • Severity of stroke regarding physical and cognitive aspects
  • Emotional factors that affect mood and motivation
  • Social environment and support of family/friends

It is normal to experience a wide range of difficulties or “bumps” along the way that could impede or slow progress including other medical complications. Once you have a stroke, you are at a higher risk to have a another stroke. It is important to continue to monitor blood pressure, blood sugar and heart rate, take all prescribed medications, follow up with doctors, and continue with therapies.

Erica Howard, PT, DPT

Ask an Expert: Why Do I Need Speech Therapy If I Can Talk Fine?

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Question: Why do I need speech therapy if I can talk fine?

Answer: Though our title of Speech-Language Pathologist suggests we focus on speech only, our scope of practice is much broader!

In addition to speech and language, SLPs assess and treat swallowing disorders and cognitive-linguistic impairments. Swallowing treatment addresses difficulty chewing and swallowing, and can include instruction in exercise, diet texture analysis, and training for compensatory techniques. Cognitive-linguistic treatment addresses changes in cognitive function and may include training in techniques to enhance memory, orientation, problem solving, and executive function skills.

Lisa Pinnell, CCC-SLP

Ask an Expert: Can PT Relieve My Pelvic Pain?

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Question: Can physical therapy relieve my pelvic pain?

Answer: Yes! A pelvic health physical therapist is trained to evaluate and treat the possible causes of abdominal and pelvic pain to include muscle tightness, joint dysfunction, irritation of nerves, weakness, and scar tissue.

After the evaluation is complete the therapist will design a plan of care that may focus on manual therapy to address scar management or tenderness, stretching for muscle tension to improve flexibility and strengthening for added stability for daily tasks. Other treatments may include the use of modalities such as TENs for pain management, biofeedback to gain awareness of muscle tension, pelvic floor relaxation exercises and posture retraining.

Every plan of care is individualized for each patient to assist them with relieving their pelvic pain in order to return to all desired daily activities.

 

Amy Hauerstein, PT, CAPP-Pelvic

Easy Steps to Keep Your Bladder Healthy

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Good bladder habits can improve bladder control whereas poor bladder habits can lead to poor bladder control. Here are four steps to keep your bladder healthy!

Step 1 — Use Good Toilet Habits

  • It is normal to go to the toilet four to six times per day (approximately every 3 ½ to 4 hours).
  • You shouldn’t get up to go to the toilet more than once a night.
  • Don’t get into the habit of going to the toilet “just in case.” Try to go to the toilet only when your bladder is full. Going to the toilet just before you go to bed is fine.
  • Women should sit down to go to the toilet. Do not hover over the toilet seat.
  • Take your time, relax when you are on the toilet. This helps your bladder to empty out fully. If you rush, you may not empty your bladder fully and over time can result in a bladder infection.  You may even need to rock your body while on the toilet and then relax again for a second urination. This is called the double void technique.

Step 2 — Look After Your Pelvic Floor Muscles

  • Keep your pelvic floor muscles strong with pelvic floor muscle training.
  • Practice your Kegels after every bathroom trip (for example, while washing your hands), when you sit at a stoplight, check your watch, or wait on tv commercials. Contact a pelvic physical therapist to make sure you are doing Kegels correctly.
  • Return to physical therapy if you feel you are regressing in any significant way. Remember, you will have “good days and bad days,” but you should feel like you are in control of your bladder for the most part.

Step 3 — Keep Good Bowel Habits

  • Avoid constipation.
  • Do not strain when using your bowels. This puts extra load onto your pelvic floor muscles and may weaken the muscles. The pelvic floor muscles help with bladder and bowel control.
  • Eat two pieces of fruit and five servings of vegetables daily.
  • Keep active. Physical activity helps to keep your bowels regular.

Step 4 — Drink Fluid Every Day

  • Fluid is everything you drink. Fluid includes milk, juice, and even soup, but the best fluid to drink is water.
  • Cut down on how much caffeine and alcohol you drink, as these may upset your bladder. There is caffeine in chocolate, coffee, and tea. Avoid fizzy drinks which contain caffeine, including cola and sports drinks.

Christie DeCraene, PT is an outpatient Physical Therapist who has over 25 years of experience treating not only Women’s Health issues but also orthopedic and neurological deficits. Christie uses a variety of treatment approaches with an emphasis on education, function-based therapeutic exercises, and manual-based treatments.

Rehabilitation for Stroke Survivors: Speech and Motor Recovery

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May is National Better Speech & Hearing Awareness Month, and we thank all Tx:Team Speech-Language Pathologists for their continued dedication to their patient, their community, and to Tx:Team. During this month, we want to raise awareness about hearing and speech problems, and to encourage people to think about their own speech and hearing and seek assistance through a Speech-Language Pathologist.

You may wonder, what does a Speech-Language Pathologist do?

A Speech-Language Pathologist provides skilled therapy services to stroke survivors in the areas of dysphagia, communication and/or cognitive impairments. As we know, seeking medical services immediately while experiencing signs/symptoms of stroke is critical because, “Time lost is brain lost. Every minute counts.”

Therapy services should be implemented as soon as the patient is able to participate, as early intensive therapy may lead to better outcomes. Depending on the location and severity of the stroke as well as impact on functioning, a patient may participate in skilled services while in the hospital and subacute rehab with home health or in the outpatient setting.

Impairments treated by a Speech-Language Pathologist are varied secondary to location of the stroke and may include the following:

A swallowing disorder known as Dysphagia may demonstrate impairments in oropharyngeal functioning. A patient may have an objective swallow study completed such as a Modified Barium Swallow Study (MBSS) or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) to assess oropharyngeal functioning, rule out risk of aspiration, and recommend an appropriate diet texture/liquid consistency that may need to be modified. The objective swallow study will also drive the Speech Therapy plan of care to provide appropriate swallow rehabilitation including recommendations, exercises, and strategies to facilitate safe intake of least restrictive diet to maintain nutrition/hydration orally.

Communication impairments include motor speech (Dysarthria or Apraxia) with deficits in articulation, respiration, and resonance via reduced coordination and strength as well as motor planning. Receptive and/or expressive language deficits (Aphasia) to understand communication (verbal and written) as well as being able to express wants, needs, thoughts, etc. to familiar and unfamiliar communication partners. A stroke survivor may also experience Dysphonia, which is a voice disorder with deficits affecting vocal quality and vocal functioning. A Speech-Language Pathologist will provide rehabilitation services as well as educating and developing appropriate compensatory strategies to enhance a patient’s ability to communicate independently without fear, frustration, or embarrassment.

Cognitive impairments may include deficits in memory and attention skills, which can directly impact their ability to communicate in addition to impaired safety awareness impacting a patient’s ability to maintain a level of independence.

It is important to recognize that a Speech-Language Pathologist will be a part of a Stroke Survivor’s multidisciplinary team. Research indicates, “Screening for dysphagia (within 24 hours) and communication impairment (within 48 hours) is critical in working toward optimal outcomes for stroke survivors,” indicating the need for immediate medical attention if someone demonstrates the signs or symptoms of a stroke.

 

Johanna Ebbs, MS, CCC-SLP is an outpatient Speech-Language Pathologist who specializes in a wide variety of speech-language & cognitive abilities. She has extensive experience treating the adult neuro population and is LSVT LOUD® Certified. Johanna also treats patients undergoing/following treatment for head and neck cancer.

 

References:  

1. CDC. (2022, November 2). About Stroke | cdc.gov. Centers for Disease Control and Prevention. https://www.cdc.gov/stroke/about.htm#print 

2. Dilworth, C. (2008). The role of the speech language pathologist in acute stroke. Annals of Indian Academy of Neurology, 11(Suppl 1), S108–S118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204112/