Do you remember hearing your gym teaching yell across the gym in the beginning of gym class during the boring old warm up stretches “if you can’t feel it then it’s not working”? Well that old gym teacher wasn’t too crazy because basic stretches to improve flexibility and decrease injuries.

With just a few minutes throughout the day of stretching several large muscle groups may increase your flexibility and help to prevent injuries. Why? How do I do that when I sit in the car all day or behind a desk? Well there are tons of things you can do during the day that do not require to move things in our office or even buy new things like a chair of desk. So let’s get started!

You may want to “warm your muscles up” with a light aerobic movement for 5-10 minutes prior to stretching. Performing a head to toe routine daily can be very beneficial and this can be done with no equipment! How neat is that?!?!

Several things to keep in mind when stretching are:

• You want the stretch, but not pain.
• No bouncing, this may cause the muscle to contract rather than relax
• Each stretch should be at least 30 seconds.
• Any areas that are uncomfortable, it may be helpful to repeat for a second tretch

Check out the exercise below to help you be motivated no matter where you are.

Daily routes help to improve flexibility and range of motion around a joint. Overall, stretching can make you feel better.

It is important to stretch both sides. Daily routes help to improve flexibility and range of motion around a joint. Overall, stretching can make you feel better.

"It's the most wonderful time of the year!" Definitely for parents but not the kids. Have you looked at your child standing with their pack back lately? The average weight of a loaded school pack is 19.8 pounds! About 20 million kids are carrying 2x the recommended weight on their spines. No wonder our poor kids look like Quasimodo with their packs on and no wonder we see kids and teens each year complain of back, neck, hip and shoulder pain which is caused by micro trauma due to improper weight and fit of their back packs. This abnormal force is detrimental to growing bones and causes injury to soft tissues including muscles, ligaments, tendons, joints, nerves and blood vessels.

Compressive forces on a growing spine can cause spondylosis (fracture of the vertebra). A child's constantly developing spine experiences the highest rate of growth from ages 10-12 for girls and 13-15 for boys. Their bodies are more susceptible to injury and developing compensations. Experts recommend back packs should be no more then 10-15% of a child's body weight. So a 100# child should have no more than a 10-15# on them. Heavy packs, especially if improperly worn, cause forces pulling a child's body backwards compressing vertebral joints. The student will naturally lean forwards to keep balance which causes the forward head/shoulder posture, compressing the shoulder complex pressing on nerves and blood vessels throwing their entire postural alignment out of whack. Also placing the pack on one shoulder causes asymmetrical loading on that side and strain on the opposite in efforts to compensate. In addition to what we stated above this all can result in changes in gait, balance, and even breathing!

How Do You Choose/Fit a Back Pack for your Child?

1. Choose the lightest material but also one that is well made with wide shoulder straps, a waist belt to distribute the weight evenly, as well as a good padded back. Wear pack on both shoulders not one side. It should rest on the mid back and not hanging low on the waist of hips.  Put the heaviest items closest to the back.
2. Properly picking up the load is just as important. Have your child squat keeping back straight facing the pack. Pick it up and put one shoulder in then the other. Not bending over and swinging the load over and around their shoulder.

Sensible Tips to consider:

1. Ask them to use lockers if possible. Don't procrastinate all week to do assignments where large texts are needed. Get it done and out of the way to lessen weight carried all week.
2. Ask teachers if they would help out by providing classroom texts so one could be left at home. Many texts are on line now which is great.
3. Schedule time every so often with your child to clean out their pack you'll be surprised the stuff they accumulate like full water bottles at the bottom!

Consult your PT at Superior Physical Therapy and Sports Rehab if your child is experiencing any of the symptoms mentioned above and we would be happy to evaluate/treat and most importantly teach you and your child how to prevent future pain, dysfunction or injury.

Have a Happy and Healthy School Year!
Janet S. Keller, PT
Superior PT and Sports Rehab Spring Ridge

References:

MoveForwardPT.com/APTA SpineUniverse.com Kidshealth.com

Dr. John O'Neil, DPT meets with the Athletic trainer for Loudoun Valley High School, Andrew Gordon, M.Ed., ATC to discuss how the athletes are cared for at his school

As the Athletic Trainer for Loudoun Valley High school (LVHS) for over 23 years, Andrew Gordon has diagnosed, managed, and led the rehabilitation for many students at his school who have had a concussion. A graduate of the University of Virginia for both his undergraduate and graduate studies, he has been the Athletic Trainer for LVHS since 1996, which is when he became the first full time Athletic trainer in the state of Virginia's high school systems. I had the opportunity to sit down with him and talk about the ins and outs of this ATC's view of the rehabilitative process of concussions, and how it is managed at LVHS.

What is a Concussion and how does it occur? It is a complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the brain. This can result in a variety of physical, cognitive, emotional, or sleep-related symptoms. With a concussion, neuro-imaging is typically normal, and the duration of symptoms is highly variable - from several minutes to days, weeks, months, or longer in some cases. After the injury there is a metabolic crisis, resulting in an increase in energy demand with a decrease in blood flow to the brain. It is important that during this time of the crisis that the athlete does not get hit again as it can create compounding stress to the brain.

In the United States, there are approximately 300,000 concussions injuries each year. A large percentage of total concussions happen to the youth, with 70.5% of sports & recreation-related traumatic brain injury ER visits were among persons aged 10-19 years.

With athletes in particular, it is essential to take them through a progressive, stepwise return to play protocol to ensure safe return to play. It is just as important for the youth and the parents to understand the signs and symptoms of what a concussion is, as it is not as strait forward as one might think.

What are the signs and symptoms of a concussion?
It is important to note that the presentation of concussions can vary, and if there are any signs/ symptoms of a concussion, per Virginia state High School guidelines, the athlete will be immediately taken out of play for the remainder of the day to protect the athlete. Also, a loss of consciousness is not required for the athlete to sustain a concussion.

• Cognitive Symptoms: Fogginess, difficulty concentrating, memory deficits, cognitive fatigue
• Somatic Symptoms: Headache, dizziness, nausea, light/sound sensitivity
• Mood Disruption: Irritability, feeling sad, anxiety
• Sleep alterations: Difficulty falling asleep, fragmented sleep, too much/little sleep

When does the athlete return to play?
Concussions, and the direct or indirect contact that resulted in a concussion can affect a variety of structures in the body, and thus a variety of testing needs to occur. This includes the assessment of strength/range of motion, oculomotor screening, vestibular testing, balance, and gait testing.

Additional criterion prior to return to play include:

• Clear oculomotor exam
• Clear vestibular exam
• Symptom free with cognitive or physical exertion
• Able to handle a full day/schedule at school
• Normal neurocognitive data

Questions with Andrew Gordon, M.Ed., ATC

What is done in the pre-season at Loudoun Valley high school (LVHS) for concussions?

For the Athlete: The individual has to sign a form (along with the parents) prior to play indicating the return to play protocol and signs/symptoms of a concussion. IMPACT test baseline testing is performed for freshman and juniors, or individuals new to sport. Individuals in low-contact sports do not need to take this test, as the incidence of concussions is very low. The highest incidence for boys is football, and for girls, soccer.

For the Parents: Andrew Gordon gives a parent meeting informing them about the concussion protocol at LVHS.

For the Coaches: Required completion of yearly concussion online course.

What happens when an athlete has a suspected concussion?
On field testing: If the individual has a potential mechanism of injury, and has any signs or symptoms, the athlete is done for the day. He then re-evaluates them the next day, and if a concussion is diagnosed by Andrew Gordon, it is a minimum 5 day recovery period to return to sport. The majority of concussions happen during games/matches of contact sports, all of which are required to have an ATC present.

In the Classroom, after injury: Andrew implements classroom accommodations as needed to not stress the healing individual, and to insure proper recovery. This can range from using sunglasses at school, no white boards, time allowed for each class, and getting the athlete out of the classroom prior to a fire drill.

Can sensors in the helmet help prevent or help identify concussions?
Short answer: No.

Long answer: This item has been extensively studied and has not been found to help identify concussions, and has resulted in many unnecessary evaluations that do not lead to better outcomes. Aside from concussions, valid sensor technologies can offer objective data that have been used to improve player safety and reduce injury risk, although this would be more for research purposes, rather that injury identification.

Message for the students?
Report your symptoms! With proper management of a concussion, you are much more likely to return to play faster than if you had pushed yourself through the symptoms. If you give Andrew Gordon 2-3 days now, you don't have to give him 2-3 weeks later. The goal is to get the athlete ready for playoffs, as he is looking more for the long term health of the athlete.

Message for the parents?
Same as the students, keep an eye on the symptoms, especially during academic tasks. Pushing the individual too much cognitively or physically can delay rehabilitation. Simple items such as looking at phone/television screens can sometimes over stress the individual, and delay rehab.

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:

• Strength/Range of motion
• Ocular motor screening
• Vestibular testing
• Balance/gait testing

Superior Physical Therapy and Sports Rehab

• Spring Ridge
  9093 Ridgefield Dr., Suite 201
  Frederick, MD 21701
  Phone: 301-696-5595
• Thomas Johnson
  65D Thomas Johnson Drive
  Frederick, MD 21702
  Phone: 301-663-7898
• Purcellville Orthopedic Physical Therapy
  850C East Main St.
  Purcellville, VA 20132
  Phone: 540-751-1970
• Frederick Indoor Sports Center (FISC)
  1845 Brookfield Ct
  Frederick, MD 21701
  Phone: 301-663-7896

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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 www.physicaltherapypurcellville.com.