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

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: 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.

OT Solutions: Adaptive Equipment

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Adaptive Equipment (AE) are pieces of equipment to compensate for a physical limitation, promote safety, and promote independence. They are used to facilitate completion of daily activities such as dressing, feeding, bathing, grooming, and functional mobility. One may also hear the term “assistive device;” these terms are often used interchangeably.

Pieces of adaptive equipment include, but are not limited to:

  • Dressing: long-handled shoehorn, sock aid, button hook and reacher
  • Bathing: long-handled sponge
  • Feeding: plate guards, cup adaptors, and built-up handles on utensils
  • Home management: ergonomic knives and adapted cutting board with side rails and prongs to stabilize foods
  • Additional pieces include: universal cuffs, doorknob extensions, and bed transfer devices.

Some patients may require the use of AE due to precautions put in place after an injury or surgery. For example, a sock aid, reacher, and long handled shoe horn are provided to individuals after a hip replacement to allow for increased independence with lower body dressing.

Pieces of AE are used in energy conservation and safety. For individuals with decreased balance, trunk stability, dizziness, or poor vision, a reacher is beneficial to eliminate the need to reach outside of their base of support to retrieve an item.  Additionally, too much bending and reaching can cause fatigue and shortness of breath. Utilizing pieces of AE can eliminate the need to bend/reach, and therefore allow for energy conservation during dressing tasks.

Adaptive equipment may also be used in conjunction with mobility devices, such as adding platform crutches and/or enlarged grips on walkers to comply with a non-weightbearing status or prevent further stress on joints.

Occupational therapists will carefully assess performance and collaborate which pieces may likely benefit an individual’s participation in their daily tasks. It may take lots of practice, patience, and trial and error as an individual learns to use a piece of adaptive equipment.

Occupational therapists will educate patients on how to use equipment with strategies and techniques based off of an individual’s needs and learning style. An occupational therapist will also collaborate with a patient’s interprofessional team, families, and/or guardians to allow for best follow through for use of the equipment.

Maggie Webber, OTD, OTR/L is an Occupational Therapist in the Senior Living setting but has experience with clients of all ages, from pediatric to geriatric. Her area of expertise are in General Occupational Therapy, Cardiac Critical Care Unit, Neurology & Neurotrauma ICU, Trauma & Trauma ICU Colorectal Surgery, Infectious Diseases, Dementia, and Parkinson’s Disease. Maggie believes in building positive, lasting relationships with her patients to help them reach their goals.

Choose PT First for Low Back Pain

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Around four out of five people have low back pain at some point in their lives. Low back pain is one of the most common reasons people visit their healthcare providers.  

What Can Cause Low Back Pain?

  • As people age, bodies change. Being less active can accelerate changes including reduced flexibility and strength, which can result ini pain and stiffness.
  • People who are carrying excess weight are more likely to suffer from low back pain with the added weight increasing pressure on the joints of the body.
  • Repetitive lifting and bending as part of your daily work can increase the risk of injury.
  • Acute injury from overexertion including lifting a heavy object or performing several hours of activity that your body isn’t prepared for.

Evidence has shown that most patients with low back pain can recover faster when the patient chooses physical therapy first. PT is a less costly alternative to medication, surgery, and other invasive medical procedures. This is why states have passed legislation allowing patients to go directly to a physical therapist without a physician’s referral.  

Don’t Be a Statistic

  • $50 billion is spent on back pain annually
  • There are 31 million people with back pain
  • 50% of working Americans admit to back pain
  • Only 7% of low back pain patients go to see a physical therapist

For the senior population, Physical Therapist Thad Poitevint goes by the mantra, “Check yourself and correct yourself before you end up with pain.” He adds, “Go heavy on the emphasis on good body mechanics and positioning with the senior population. I tell them to check their posture and make corrections in real time. Small changes that are made consistently over time can help prevent low back pain and other spine issues.”  

How to Prevent Low Back Pain

You can’t prevent all lower back pain, but you do have control over some aspects in your life that can help.

  • Maintain a healthy weight.
  • Get regular exercise to maintain flexibility and strength.
  • Reduce risk of injury when lifting by testing the weight, keeping the object as close as possible, engaging your core, and using your legs.  
  • Avoid bending and twisting at the same time.  

Physical therapy can help determine the cause of your back pain and design a treatment plan that is specific to you and your goals. If back pain is changing how you move, impacting daily function, or limiting the activities you enjoy, contact a physical therapist to schedule an appointment.