Simple Devices Can Make a Big Difference

When it comes to choosing an assistive device, such as a cane or crutches, there are several options. Some provide stability, but are quite bulky. Others are less cumbersome, but provide less support.

A cane can have a single point or four points (a quad cane). The quad cane provides additional stability, but added weight comes with that extra stability. In order to properly adjust the cane, stand up nice and tall, with your arm straight at your side. The top of the cane handle should come to the bed in your wrist. The cane should be placed in the hand opposite of the affected extremity. For example, if your right knee is injured, the cane would be held in the left hand. This reduces the amount of force through the injured extremity. When walking, the cane and the affected extremity move at the same time. So, take a step with the injured extremity, moving the cane forward, in the opposite hand, at the same time. Then, step through with the good, uninjured leg.


Crutches can provide a little more stability than a cane, as there are two points of contact with the ground. When adjusting crutches, again stand nice and tall, with your arm straight at your side. The crutches should be positioned so they are about 6 inches out from the sides of your feet. The hand grip should hit right at the bend in your wrist, when the arm is straight. You should be able to place 2 fingers between the top of the crutch and your armpit. Crutches are meant to be used by squeezing them a bit to your side and bearing weight through your arms, not leaning on the crutches at your armpits. Just as in walking with the cane, the crutches move forward with injured leg. Then, step through with good leg.


Walkers provide the most stability, but are a bit more cumbersome. They can come with or without wheels. Many have expressed concern that the wheeled walker may "get away from them." If you're are bearing weight through the walker and using it properly, this should not happen. Standing tall, with the arms straight at your side, the top of the walker handle should come to the bend in your wrist. With walking, push the walker forward first, stepping on the injured leg, and then bringing the good leg forward.

With stairs, a handrail, if present, is the best, most stable option to assist in this task. If there is no handrail or only one, the chosen assistive device generally stays with the affected leg. Going up stairs, you lead with your strongest leg, then follow with the affected leg and assistive device. Going down stairs, you lead with the weakest or injured leg. So, the injured leg and assistive device go first, followed by the strongest leg.

If you have any specific questions about what device would be most appropriate for you or how to use any assistive devices, please don't hesitate to ask.

Understanding Your “Frozen Shoulder”

Have you been having shoulder pain? Are you having difficulty reaching your arm overhead? You may be suffering from adhesive Capsulitis; or more commonly referred to as "frozen shoulder." Frozen shoulder has been found to be most common in women ages 40-65 (or even higher in those who have a history of Diabetes or thyroid conditions) and it can develop in several different ways.1 Generally, the condition may occur insidiously (no known cause) or following some type of trauma to your shoulder and can be classified into different stages. 1 In either case, adhesive capsulitis is an inflammatory response that results in the tightening of the joint capsule of your shoulder.

Frozen Shoulder

Stage 1: Pain

  • 0-3 Months
  • Pain during active and passive ROM
  • Mild Limitations of Flex, ABD, IR, ER

Stage 2: Freezing

  • 3-9 Months
  • Chronic pain
  • Significant motion limitations

Stage 3: Frozen

  • 9-15 Months
  • Mild pain, except at end ranges
  • Significant motion loss

Stage 4: Thawing

  • 5-24 Months
  • Mild pain
  • Gradual gains in motion

As you can see, the recovery process for this diagnosis is much longer than what you might think. The good news is that if managed properly, it can help you to reduce the duration of your symptoms. In the past, it was common thought that if your shoulder is stiff you've got to STRETCH, STRETCH, STRETCH. As physical therapists, it's our job to evaluate which stage of the condition you are in and then classify your symptoms into 1 of 3 categories to guide your treatment individually. We look to determine your level of shoulder "irritability" (High, moderate, low) in order to match the best treatments to your current status. Recent information has shown that we will continue to stretch and mobilize your shoulder as had previously been performed, but your level of shoulder irritability will determine whether we hold the stretch for short periods or long period as well as whether we mobilize conservatively or aggressively.1 The condition is common, but how we treat it shouldn't be.

  1. Kelley M, McClure P, Leggin B. Frozen shoulder: evidence and a proposed model guiding rehabilitation. The Journal Of Orthopaedic And Sports Physical Therapy [serial online]. February009;39(2):135-148. Available from: MEDLINE, Ipswich, MA.

The Human Body Is Incredible and Amazing

Written by: Teresa Grant, PT

Here are some fun facts regarding the human body.

  • Your body has enough iron in it to make a metal nail 3 inches long.
  • You shed 600,000 particles of skin per hour.
  • There are 100,000 miles of blood vessels in an adult human body.
  • The strongest muscle in the human body is the Masseter (jaw muscle).
  • Your ears and nose never stop growing.
  • When awake, the human brain produces enough electricity to power a small light bulb.
  • Human bones are ounce for ounce stronger than steel.
  • The human eye can distinguish approximately 10 million different colors.
  • Your heartbeat changes and mimics the music you listen to.
  • Your taste buds are replaced every 10 days.
  • Without your pinky finger, you would lose about 50% of your hand strength.
  • Your brain uses 20% of the total oxygen and blood in your body.
  • Your bones are composed of 31% water.
  • Every day your heart creates enough energy to drive a truck for 20 miles.
  • Sleeping less than 7 hours each night reduces your life expectancy.
  • Your brain keeps developing until your late 40’s.
  • When you take one step, you are using up to 200 muscles.
  • The human heart is not on the left-hand side of the body, it is in the middle.
  • One out of every 200 people has an extra rib.
  • The human neck and the giraffe neck have the same number of vertebrae - 7.

Glute Activation

What is it and why do we need it?

Glute activation is having the muscles of the buttocks, the gluteus maximus, gluteus medius and gluteus minimus, engaged during activity.

For most of us, we sit for long periods of the day. While sitting, our glutes are inactive and there’s a good chance they’re not firing properly when we are moving about.

Poor glute activation can lead to low back pain and pain in any of the joints of the lower extremities, i.e. the hip, knee and ankle. This happens because the body tends to compensate by using the incorrect muscles. Having strong gluts is key to being pain free and for getting the most out of your workout.

To activate the glutes, it is important to first loosen up any tight muscles. This can be done through the use of a foam roller and stretching.

Once you have stretched, you can begin several exercises that will get your gluts firing. These are listed below. Choose a few and perform 10-15 reps of each move.


Start in hands/knees posture (quadruped). Extend one arm out in front of you and the opposite leg behind you. Tighten your abdomen. Repeat with the opposite pair.


Start in quadruped. Extend one hip behind you. Keep your knee bent and kick up toward the ceiling. Do not let your lower back arch.


Start on your back with one leg bent with foot on the floor. Keep the other leg straight out in front of you. Lift your buttocks off the floor using the leg that is bent.


Start in quadruped. Keeping your knee bent, lift it out to the side. Lower slowly.

If you ever have any questions always know that you are welcome to stop by our clinic and speak with one of our highly qualified physical therapist. We are here to help you succeed and become better.

Sit and Stand Up Straight – There Are Good Reasons for It

Written by: Teresa Grant, PT

Remembering back when you were a youngster, how many times did our mother tell you to stand up straight? Or, as I have done with my daughters, you got the nudge right between the shoulder blades. And almost as quickly as you pulled your shoulders back, they seem to have slid right back to your previous posture.

Good posture is important for a number of reasons.

  1. It affects our BP, pulse, lung capacity and blood flow to our internal organs.
  2. Since the "thigh bone is connected to the knee bone" etc., being out of alignment can result in muscle fatigue under abnormal loads
    -it affects our mood, our confidence, and our looks.
  3. Our head with the brain weighs 10-11 lb. It is approximately the weight of a bowling ball. The head is meant to sit between our shoulders with our eyes level on the horizon. As our head drifts forward on our body, spinal tissues are subject to an increased load that over a sustained period start to deform. Our tissues adapt to this new position by shortening on the back of our neck and the muscles on the front of the neck get weak from being overstretched.

How heavy is your head?

Another area of our body where this push/pull occurs is in our upper back. Our shoulders start to drift forward and we hunch over. Over time the soft tissue on our chest shortens and the muscles that help keep up upright get overstretched and weak.

Some common contributors to developing poor posture are backpacks. Some children’s packs weigh 30#. Other culprits include the amount of time we spend on a computer, phone texting, playing video games or TV watching.

Solutions can be lightening those backpacks, positioning your computer so that the top one third of the screen is even with your eyes and sitting in a chair with your back supported for the video games and TV viewing.

Simple Exercises and Imagery

Imagine a string attached to the top of your head that is pulling you up to the ceiling/sky. You should feel your spine straighten; your head come back between your shoulders and your rib cage lift off your abdomen. Take a few deep breaths while you’re there and fill your lungs deeply.

Good Posture vs Bad Posture

If you're sitting, every 20-30 minutes, sit up straight, pull your neck and head back over your shoulders. Hold for the count of 3 and repeat 15-20 times.

When you're standing, stand against the wall and move your head back until it touches the wall. Keep your eyes on the horizontal (your chin should not be up in the air). Hold for a 3 count and repeat 20-25 times.

While you are on the wall, lift your arms out to your sides. Keeping your arms on the wall, raise them overhead like making a wall (snow) angel. Repeat movement for one minute.

Now turn and face the wall, close enough that your nose almost touches the wall. Place your arms overhead on the wall with your elbows straight. Alternate lifting one arm from the wall and then lift the other. You are wall swimming.

Good posture pays off in many ways and influences your health. Be persistent in your efforts. Every time you find yourself slouching, remember what your mother said, “Pull your shoulders back” or get ready for the nudge.

ACL Injury and Prevention

Dr. John O'Neil, DPT meets with renowned orthopedic surgeon, Dr. Andrew Bishop, MD to discuss ACL injuries

As a former NFL team doctor for the Atlanta Falcons from 1992-2004, Dr. Andrew Bishop has performed thousands of ACL reconstructions among many other orthopedic surgeries. He now practices out of Middleburg, VA in a quiet, more individualized setting, where he is able to spend much longer with his patients than he was previously able to. I had the opportunity to sit down with him and talk about the ins and outs of this surgeon's view of the ACL reconstruction process.

What is the ACL and how is it Injured?

The ACL (anterior cruciate ligament) is an important stabilizing ligament in the knee that attaches from the back of the femur (thigh) to the front of the tibia (lower leg). It resists forward motion of the tibia on the femur and inward rotation of the tibia, as well as playing an important stabilizing role in athletics.

In the United States, there are approximately 200,000 ACL injuries each year – or 1 in every 3,000 people. These injuries can range from a strain to a full thickness tear, with approximately 95,000 full thickness tears per year. Women are four to eight times more likely than men to suffer an ACL injury with anatomical, biomechanical and neuromuscular differences that are believed to be behind the gender disparity. They tend to occur during contact sports, cutting and twisting movements, or even just stepping in a small rut.

Depending on the severity of the injury, and the stability of the knee after the injury, surgery may be required. With or without surgery, physical therapy plays a vital role in recovery from this knee injury.

Are there any programs that work for ACL prevention?
ACL Injury prevention programs have been in existence for more than 15 years, but few have been tested for efficiency. A recent review noted that few of these programs had been assessed both for their effect on ACL injury rates and for athlete performance. The review determined that only two programs "had a positive influence" on both injury reduction and athletic performance among athletes.

The programs that had a successful reduction in ACL injuries were ones that made the chief focus of using drills to encourage proper form for jumping and landing during athletic participation, and ones that address the potential deficits in the strength and coordination of the dynamic stabilizing muscles around the knee, hip, and ankle joints.

Questions with Dr. Andrew Bishop, MD

When does he choose to surgically reconstruct the ACL?
The greatest rationale of whether or not to surgically reconstruct the ACL is not MRI results, but functional instability. He will generally only choose to reconstruct the ACL if functional instability is present. Also, the more active the patient is the more likely he will opt for a surgical approach, with the desired level of functioning being another chief concern for electing to partake in the surgery.

The younger the patient the more aggressively he will choose to perform a surgery, and with ages 40-60 usually going with a more conservative care approach. This again is all depending upon the desired level of function for the patient. With higher level plyometric/cutting activities requiring a more stable knee. While lower level activities just as walking and lighter activities of daily living can function with an ACL deficient knee.

Choice in type of graft? Hamstring, quadriceps tendon, or from a cadaver?
He has noticed that in previous years there was a switch to hamstring graft, when previously quad tendon was the standard, but now there is a switch back to quad grafts.

Dr. Bishop has always preferred quad grafts over hamstring, but says they both have good outcomes, and if the patient has his or her heart set on a particular graft, he will utilize it. In the younger population though, he strongly prefers either hamstring or quad tendon over cadaver. Quads or hamstrings typically have much greater tensile strength compared to taking a graft from a cadaver, and they tend to stretch much less in time, increasing stability. Typically for the larger male athlete he will go with quad, and for females he will choose hamstring for the smaller scar, without any other extenuating circumstances.

What does Dr. Bishop recommend doing prior to the surgery?
Dr. Bishop made it very clear that it very important to reduce the swelling to as close to baseline as possible, and improve the range of motion to full, especially extension.

If multiple structures were damaged in the ACL injury, he often requires waiting for the other injuries to heal or become stable prior to performing the ACL reconstruction, such as the medial collateral ligament. Also of great importance is having the knee as stable as possible prior to the surgery as it optimizes surgical outcome. The first few months after an ACL reconstruction are difficult, and this is made easier and results in a better surgical outcome if the knee is more stable prior to the surgery.

He reports that although strength is important, it is not as vital as range of motion and swelling to be returned to as close to baseline as possible prior to the surgery. The time it takes to accomplish this can take anywhere from a week to a few months, but needs to occur prior to optimize surgical outcome.

Time to Take a Stand!

Physical therapists use sound, scientifically proven principles of human anatomy, physiology, movement and psychology to help patients lead healthy, pain-free lives.

The therapist will conduct an initial evaluation followed by several progress notes to document progress over time. A comprehensive analysis establishes a 'clinical baseline' and identifies muscle imbalances, causes of pain and joint alignments. This is the foundation for short and long-term goals designed to help individuals recover completely. In fact, physical therapy can address every aspect of recovery including:

  • Gait
  • Biomechanical aspects like spine/hip/foot alignments
  • Lower back strength
  • Pain levels
  • Functional capability
Dr. Andrew Bishop, MD

107 W Federal St # 6, Middleburg, VA 20117
Phone: (540) 687-3390

  • Board certification: American Board of Orthopaedic Surgery, 1991 Recertified, 2001, 2011
  • Medical: Emory University School of Medicine, Atlanta,Ga 1982
  • Internship: Medical College of Virginia, Richmond, Va, General Surgery 1982-1984
  • Residency: Emory University School of Medicine, Orthopaedic Surgery 1984-1987
  • Society memberships: American Medical Association, State Medical Society, State Orthopedic Society
  • Additional Society Memberships: National Football League Team Physicians Society 1992-2004

Purcellville Orthopedic Physical Therapy
850 E Main St, Purcellville, VA 20132
Phone: (540) 751-1970

Ice vs. Heat

Written by: Dr. Stephanie Wilfong, DPT

Ice or heat, which is better? This is one of my most frequently asked questions in the clinic. As a general rule, I suggest ice for an acute injury and heat for a chronic injury.

An acute injury is an injury that just occurred. These may include ankle sprains or pain following an intense workout. It is usually accompanied by swelling, redness, bruising, and/ or warmth. Ice works to constrict blood vessels and blood flow to the area. This helps to reduce swelling and discomfort. Ice should be applied as soon after the injury as possible. The ice pack can be kept in place for up to 20 minutes, removing it once you feel numbness. Be sure to place a thin towel between the ice and your skin to protect your skin. Ice can be reapplied every few hours, as needed, and is most beneficial the first 2-3 days following injury.

Heat is a great tool for a chronic injury (injuries that have existed for a long time). These types of injuries may include joint stiffness or arthritis. Heat works to allow our blood vessels to expand, bringing more blood flow to the area. This can work to improve tissue elasticity, relax stiffness, and reduce pain. As with ice, be sure to place at least one layer between the hot pack and your skin to protect your skin. Heat can be applied for up to 20 minutes at a time. Do not apply heat or ice to an area where your sensation is not intact, as you may not realize if the heat is too hot or the ice too cold.

So, what happens if you apply heat to an acute injury? This can increase blood flow to the area, which increases the inflammation and irritation in the area. That reaction may then extend your healing time.

Don't hesitate to ask if you have any further questions about heat or ice in relation to your specific injury. Purcellville Orthopedic Physical Therapy is here to help in any way we can. Visit our site for more information

Benign Paroxysmal Positional Vertigo also known as BPPV

Written by: Dr. Stephanie Wilfong, DPT, LMT

When you are young, children often think it is fun to spin in circles and induce dizziness. A false sense of spinning, known as vertigo, is generally less desirable. Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo and is most prevalent in older adults. These bouts of dizziness are generally brief, but can range from mild to intense symptoms. These symptoms are generally brought on by certain movements, such as rolling over in bed or bending the head forward. BPPV itself is generally not serious, but it can be a problem if the feelings of dizziness may increase your risk of falls.

The brain receives input from different systems in order to maintain balance: Muscles and joints, such as your feet touching the ground Vision Vestibular system, located in the ear.

Within the ear, there is a series of fluid filled canals and little hairs that detect the position of your head. There are also little crystals within the inner ear that assist in providing input regarding the movement of your head. The reason is often unknown, but these crystals can become dislodged. Therefore, improper signals are sent to your brain.

If the brain is receiving mixed signals, altered balance can occur. During BPPV, the vestibular system is the main source of the improper signal. Maneuvers, such as the Dix-Hallpike, can be performed by your physical therapist or doctor to assist in returning those crystals to their rightful position in the inner ear. This will enable proper signals to be sent to your brain, helping to restore balance.

If you find yourself feeling these symptoms of dizziness or spinning, there are steps you can take to maximize your safety. Sit down immediately if dizziness occurs while standing. Use a cane or assistive device while walking. Ensure you have good lighting, especially when getting up during the night.

Symptom relief can often occur within a few treatments. Although BPPV can reoccur, your physical therapist can teach you management strategies and maneuvers to perform on yourself to assist in controlling your symptoms.

Should you need assistance, contact Purcellville Orthopedic Physical Therapy (; we’d be happy to set a plan in motion to get you back to a healthy and active lifestyle!

Temporomandibular Joint Dysfunction (TMD) and the Role of Physical Therapy

A few months ago, I encountered a patient suffering from temporomandibular joint dysfunction (TMD), a condition affecting the primary joint responsible for opening and closing the mouth. Her condition had progressively worsened over the past three years with symptoms so severe she could no longer chew without pain. In the mornings, she reported her jaw felt so stiff she struggled to brush her teeth comfortably. Her pain had even stopped her from going out to eat; she was embarrassed to be the only one left at the table due to her inability to chew her food in a timely manner.

Stories like this are all too common for those living with TMD. Not only did this patient's symptoms limit her in everyday activities but also affected her social life and self-esteem. The good news is - TMD can be treated!

Approximately 50% of all cases of TMD are the result of pain/tightness in muscles used to open and close the jaw. (1) Why is this important? Muscle pain and joint restriction can be managed with physical therapy. Reduction in tone of the muscles of mastication (AKA chewing muscles) and mobility improvements in the TMJ can easily reduce one's pain and improve one's ability to eat, speak, and perform everyday activities without pain.

I often get asked by patients, "How do I know if the pain I'm experiencing is related to my TMD?" Here are a few questions that are suggestive of TMD and may warrant an intervention from your physical therapist:

  1. Does your jaw click when you open or close your mouth?
  2. Does your jaw deviate to one side, either temporarily or throughout opening?
  3. Do you have tenderness in your jaw?

If you are experiencing facial, jaw, and/or neck pain and answered yes to any of these questions, you could be suffering from TMD. Don't be discouraged, the right physical therapist is equipped with the skills necessary to treat your individual needs and help you manage your condition. If you're looking for a solution, give me a call. I'd be happy to take a look.

Temporomandibular Joint | TMJ

Brendan Glackin, DPT, CSCS
Doctor of Physical Therapy
Certified Strength and Conditioning Specialist


  1. Marbach JJ, Lipton JA: Treatment of patients with temporomandibular joint and other facial pain by otolaryngologists. Arch Otolaryngol 108:102-107, 1982.