Ask an Expert: Why Do My Legs Swell?

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Question:  Why do my legs swell?

Answer:  There are many reasons why the legs can swell. Medical conditions such as decreased kidney function, lymphedema, congestive heart failure and pulmonary edema and obesity. You should see your physician to rule out more serious conditions before coming to physical therapy or occupational therapy for lymphedema treatment.

A primary cause of worsening swelling throughout the day typically is from having the legs in the dependent position such as sitting in a chair with the knees bent for prolonged periods of time. When the knees are bent that put some additional strain on the venous system to return blood to the circulatory system because of the cramping down affect with the knees bent gravity working against blood flow returning to the trunk region.

A few helpful tips to minimize swelling of the feet and lower legs are to not sit more than 20 to 30 minutes at a time, elevate the legs, pump your ankles back-and-forth, stand up more often and complete marching in place or heel raises.

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

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: Can Occupational Therapy Help Me?

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Q: Can Occupational Therapy help me with shoulder pain and weakness even though I had surgery over 10 years ago? 

A: Absolutely! Whether or not you had therapy following your surgery, your condition has probably changed since that time. Arthritis, joint degeneration, soft tissue overuse/damage, impingement, and joint positioning are some of the causes of inflammation and joint limitations resulting with pain and weakness.

Occupational Therapists assist in recovering from injuries and regaining functional abilities. Occupational Therapy is often referred by a doctor to address these issues for improved pain management and functional mobility of your shoulder.

 

Kelly van Vliet graduated from Towson State University in Maryland with an Occupational Therapy degree. She has over 30 years of experience and specializes in treating upper body limitations related to orthopedic and neurological deficits. She provides a range of other OT evaluations and treatments including pet care capability, power mobility operation, low vision needs, continence improvement, and cognitive care. Kelly is certified in LSVT BIG® to treat clients with Parkinson’s Disease.

Ask an Expert: Can OT Help My Mom Feed Herself?

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Question: My mom has dementia and seems to have forgotten how to use her silverware to feed herself. Can OT help?

Answer: Yes! Sometimes, as dementia progresses, people can have more difficulty feeding themselves. OTs can figure out what’s getting in the way of self-feeding and provide the best amount of support that helps the client maintain their skills for as long as possible.

Your OT can recommend changes in things like the type of dishes used, the kind of food offered and how it is presented, distraction level, and adjusting routines and schedules. OTs train caregivers in offering the right kind of cueing and support. OTs also take into consideration other factors outside of dementia that may be impairing self-feeding.

 

Stephanie Grunklee, MOT, graduated from Maryville University of St. Louis with a Master of Occupational Therapy degree. Stephanie is a champion of the Wound Care Program. She is passionate about geriatric rehabilitation and understands the importance of an interdisciplinary team-based approach to help patients reach their goals.

Ask an Expert: Where Can I Find a Good Pair of Supportive Shoes That Still Look Good?

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Question: Where can I find a good pair of supportive shoes that still look good?

Answer: We recommend searching within your community for a local shoe store that specializes in footwear. Shoes are categorized by features that address different foot mechanics and diagnoses. Shoes are classified by three types such as neutral, stability, and motion control.

Shoe stores often cater to walkers and runners, but others have the resources to meet the needs of a more complex population with uncommon foot pathologies. These stores offer an abundant selection of footwear spanning from running shoes to sandals to dress shoes.

Conditions such as over pronation, posterior tibial tendonitis, heel spurs, bunions, and a host of other health conditions may be relieved with appropriate footwear made of quality materials. In more severe instances, custom orthotics are also an option.

We find that if shoes do not look good our patients will not wear them. With enough research and effort our patients can often find a shoe that offers a compromise between support, quality, and fashion.

Chris Barrett, PTA

Ask An Expert: How Should I Feel After Physical Therapy?

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How should I feel after physical therapy? Is it going to be painful?

Physical therapists have gained a little bit of a reputation when it comes to pain. If you’ve been through physical therapy before, chances are you initially felt like treatment was making things feel worse. BUT, if you stick with it, the gains and improvements come with time.

We, as therapists, are focused on a number of things including, but not limited to, increasing your endurance, balance, flexibility, and strength. All of those things require prescribing specific exercises almost like you would do in a gym. Improving strength is only achieved by putting an adequate amount of “stress” on a muscle group which, in turn, causes some ache, fatigue, and soreness.

That being said, the level of soreness you feel after therapy should not interfere with your daily activity. Your physical therapist will constantly be checking in on how you felt after all activities. Ask questions if you aren’t sure if what you’re feeling is normal. You’ll hear a lot of people say “no pain, no gain,” but the real saying is “consistency over intensity.” Keep your bodies moving and stay healthy!

Kim Rea, PTA

Temporomandibular Joint Dysfunction

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Temporomandibular joint dysfunction (“TMD”) is a musculoskeletal problem of the jaw generally characterized by jaw pain and clicking and often accompanied by headaches, tinnitus (ringing in the ears), and neck pain. It can be worsened by poor postural habits, grinding/clenching teeth while sleeping or awake, sleep apnea, dental conditions, chewing gum, ice or other dense items, eating foods that require wide jaw opening, stress or psychological trauma, and others. Common treatment options include a bite or night guard, dental care, psychotherapy, physical therapy, and surgery.

Physical therapists evaluate and treat both the temporomandibular joint (TMJ) and the cervical spine (neck). Clinicians begin a course of care by evaluating the neck and jaw to identify patients’ unique presentation and develop customized treatment plans accordingly. During the evaluation process, neck and jaw mobility, strength, jaw opening and closing, airway clearance, surrounding tissue tenderness, muscle and ligament tightness, disc and retrodiscal tissue mechanics, signs of grinding/clenching and posture are assessed.

Physical therapy treatment often involves a combination of manual therapy, exercise, postural training, eating and chewing education, dry needling, and other modalities to address both jaw and neck pain and dysfunction. Physical Therapy is often provided in conjunction with medical management, dental care, and psychotherapy as appropriate. Treatment for TMD can range from weeks to months and is often related to complexity and chronicity of condition.

Patients who are compliant with care including self-management typically appreciate the greatest success. Your dentist, physician, nurse practitioner or physician assistant can refer you to physical therapy.

 

Dr. Mike Winebrenner is a 1999 graduate of the Bachelor of Science program in Physical Therapy at Daemen College and a 2008 graduate of the Master of Business Administration program from Loyola College in Maryland.  He earned his Doctor of Physical Therapy from Widener University in 2009.  Mike is Dry Needling, LSVT BIG and Bike Fit certified. Additionally, he has advanced training in temporomandibular joint dysfunction (TMD). With a strong background in spine care, his focus is on long term prevention and wellness.  Mike’s commitment to exercise and wellness is evident by his active lifestyle, including cycling, fishing, kayaking, hiking and health club exercise.