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Sciatica describes a cluster of symptoms rather than a true diagnosis and involves irritation of the sciatic nerve and/or it’s branches as they exit the spine.  These symptoms can include back and/or leg pain (usually just one leg), abnormal sensory symptoms such as numbness and tingling and weakness or difficulty controlling the affected leg.  Most people do not present with all of these symptoms, but in severe cases all may be found.   

As stated, sciatica is really a set of symptoms and can be caused by several insults including: disc herniations (bulges), spinal stenosis, piriformis syndrome or some external source usually related to postural habits.  All of these causes involve some form of compression on either the spinal nerve roots or on the sciatic nerve itself and can eventually lead to irritation and pain.  So, it makes sense that the goal of conservative therapy would be to alleviate this pressure and restore normal mechanics to the spine and pelvic region in order to prevent the condition from returning.  In cases where severe spinal stenosis or a large disc herniation is present, physical therapy may not be effective and surgery may be the only option. 

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Tennis elbow or lateral epicondylitis, as it is known in the medical world, involves irritation of the common extensor tendon at the lateral epicondyle of the elbow.  That sounded a little technical.  To put things plainly, the lateral epicondyle is a bony knob on the outside of the elbow where the tendon of the muscles that extend the wrist attaches.  With overuse this tendinous attachment can become inflamed resulting in pain.

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It’s summer time again and that means people are heading off on vacation to catch up on a little rest and relaxation.  One would think that a week or two of relaxing would be the perfect prescription for nagging low back or neck pain, but in many cases the opposite may be true.   Most trips include sitting for extended hours in a car or plane to reach a particular destination, increased stress at the beginning and end of the trip, eating junk food, drinking alcohol and most likely exercising less.  All of these factors can lead to increased aches and pains and make your trip that much less pleasurable. 

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I think that most of us recognize that flexibility of our joints and muscles is helpful in preventing injuries and improving musculoskeletal health.  However, very few people set aside time to stretch when such a habit could greatly reduce pain levels and improve performance.

As a physical therapist, I see a variety of diagnoses throughout the day, but in reality most of these problems can be streamlined into just a few typical dysfunctional movement patterns.  keep reading, there’s more

Tibion Bionic Technologies has developed an electric knee orthosis that may be used to help patients suffering from a variety of conditions including neurologic disorders, surgery, generalized weakness and osteoarthritis.  The orthosis has the ability to detect the user’s actions and assist them as needed whether that be with walking, getting up from a chair or going up and down stairs just to name a few options. 

To read further check out the full article from MedGadget.

Have you ever experienced pain at the front of your knee when squatting or with prolonged sitting? 

This type of pain can be due to various causes, one of which includes patellofemoral joint syndrome.  The patellofemoral joint is formed by the articulation between the knee cap (patella) and the femur (large bone of the upper thigh) and relies on precise tracking of these two surfaces to function correctly (see image below).  If the patella does not track correctly within the femoral groove then excessive wear and tear of the cartilage supporting this joint can result leading to inflammation and pain.

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I hope the answer to this question does not surprise you, but your physical therapist is the correct choice!

A study published in the BioMed Central Journal of Musculoskeletal Disorders tested physical therapists and physical therapy students and compared their results with that of physicians from a variety of specialties and medical residents on their knowledge of musculoskeletal medicine.  The study showed that licensed physical therapists and physical therapy students in their last year of school scored higher than medical residents and all physician specialties except orthopaedic surgeons (see graph below).

With these results in mind, I ask that you support direct access legislation to physical therapy services in your state.  Many states have passed direct access laws, which means the consumer can go directly to a physical therapist for musculoskeletal problems without having to spend extra time and money by having to see their physician first.  However, some states have not passed direct access or have some limited version at this time.

For more information on direct access and to see what is going on in your state, please check out this link from the American Physical Therapy Association.  At the bottom of the page is a link to a document showing current direct access laws in each state.

Patients suffering from disc degeneration of the cervical spine (neck) often experience pain and radiculopathy or radiating symptoms into the arm.  When disc degeneration occurs,  water is lost from the disc leading to decreased disc height and narrowing of the space (intervertebral foramen) where the nerve root exits.  This narrowing is termed stenosis and can occur centrally at the spinal cord or laterally over the nerve root. 

In situations where physical therapy, medication, injections and surgical procedures designed to remove bone spurs and interfering disc material fail, many patients must undergo a cervical fusion.  Cervical fusions basically involve locking two vertebrae together to prevent further degeneration and restore the space between the vertebrae to it’s normal height.

This image is an x-ray of a cervical fusion.  You can see the space between each vertebrae, which is where the disc is located.  At the fusion level, you can see how the fusion has increased  the intervertebral space.

The problem with fusions is that they obviously prevent motion at the motion segment they are fusing.  This lack of motion at one segment often leads to increased degeneration at the segments above and below the fusion site.

The good news is that the FDA has just approved the BRYAN cervical disc replacement, which basically replaces the patient’s damaged disc with an artificial disc that allows motion. 

By allowing motion, degeneration at adjacent motion segments would be reduced.  Check out this articlefrom MedGadget for more information.

Many of us have suffered an injury and been diagnosed as having either a sprain or strain.  I often hear patients and individuals outside of physical therapy using these two terms interchangeably when really they refer to two very different injuries that affect two very different tissue types.

Sprains are injuries that affect ligaments, which are the passive stabilizers of our joints and cross from one bone to another bone.  They usually occur when a given joint is taumatically pushed beyond it’s normal range of motion and will often result in a “pop” type sound.  Sprains can be graded into three groupings (grade 1, 2 & 3) based on the pain and the amount of laxity found in a given joint upon clinical inspection. 

• Grade 1: pain and no joint laxity
• Grade 2: pain and some joint laxity
• Grade 3: no pain and complete ligament tear (very lax)

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When and how much to stretch is always a question that comes up in physical therapy.  I will usually encourage my patients to perform a dynamic warm-up prior to their regular exercise of choice and then perform static stretches after exercising. 

For those who are not familiar with these terms, a dynamic warm-up basically means you spend 10-15 minutes going through the motions of the exercise you are intending to complete, but at maybe 25-75% in order to make sure your tissue is warm.  Static stretching, on the other hand, is what most of us think of as stretching and includes holding a particular stretch position for 30 seconds to 2 minutes. 

A recent article from the Running Doc gives a good summary of current stretching recommendations that can be useful not only for runners, but for the rest of us as well.