Effective utilization of tape can help you continue to be active as you rehab from your injury, making that annoying “grey area” of recovery a bit more bearable.Read More
When patients tell me "oh, I just have weak ankles", I get sad. Ankles don't do pull ups. Ankles don't fuel up on protein powder and creatine. Ankles don't faint in the sun because they have the vapors. People don't suffer from ankle pain simply because their ankles are inherently just "weak".
What is true is that previous incidence of ankle sprain is the biggest risk factor for future occurrence. What does that mean? If you have rolled your ankle once, you are statistically more likely to have a second, third, fourth (you get the picture) ankle injury. Seems kind of cruel and unfair, right?Read More
What does sciatica actually mean? First, it is important to understand that sciatica is not a diagnosis- it is a broad, umbrella description of symptoms that one may experience when their sciatic nerve becomes irritated. These symptoms nearly always occur on one side of the body, or are worse on one side than the other. They can include: radiating pain down the back or outside of the leg, a feeling of numbness and/or tingling in the leg or foot, weakness in the effected leg, pain with standing or walking, and pain with prolonged sitting. Symptoms of sciatica may or may not be accompanied by low back pain. In severe cases, loss of bowel and bladder control may occur.Read More
When the lymphatic system malfunctions or is injured, lymph fluid cannot be properly removed from our tissues. Think back to high school biology...remember the principles of osmosis? Lymph fluid is rich in protein, therefore if it is not properly reabsorbed by our lymphatic system it will continue to draw water and fluid towards it. Soon, lymph fluid will begin to accumulate excessively. When the nearby body part begins to appear enlarged and/or swollen, we call this lymphedema.
Lymphedema is NOT swelling, or edema. Swelling is what happens when your roll your ankle and it gets fat for a day or two. Swelling is what happens when your forehead walks into the side of the refrigerator while in search of a midnight snack (yes, speaking from personal experience). Swelling is a natural response to an acute injury and goes away with rest and time verses getting bigger and bigger and bigger.Read More
One of the most common areas I treat as a physical therapist is the hip. In fact, patients often complain of back or leg pain which is truly a result of hip dysfunction. It is easy to overlook how many structures cross the hip, how high our hip bones travel, and how intimately related the joint is to our pelvis and lumbar spine.
Hip pain can range from sharp and intense to dull. achy, and omnipresent. The cause and thus symptoms of such an injury differ greatly from person to person, however, the common theme is that hip pain is one huge bummer.
Although each individual's injury is truly unique, I tend to see some common themes in patient's who suffer from hip pain. If these tips help you, GREAT! If they do not fully resolve your symptoms, do yourself a favor and schedule an individualized assessment. Keep in mind that hip pain is NOT normal, and you don't have to live with it!
THE FIVE MOST COMMON CAUSES OF HIP PAIN
1. An Un-level Pelvis
Patients often tell me "oh, I have one leg that is longer than the other." Are you sure? Although it is possible for someone to have one leg with a femur that is actually longer than the other, it is unlikely. More often, muscles are tighter on one side or an individual stands in a asymmetrical posture which makes one leg seem longer. Do you have one leg that you typically like to stand on, and it just feels uncomfortable to lean on the other? Look down and see what that does to your pelvis. One side is up and one leg looks shorter, right?
Over time, muscles on one side can become short and tight and the pelvis can begin to elevate, rotate or shift on one side. This puts the hip joint and the associated muscles in a different position compared to the opposite hip. I always make the point that there is a reason that one side begins to hurt verses the other...it's not just a coin flip! Determining that reason and addressing it is an essential component of recovery.
2. A Tight Psoas, or Hip Flexor
Not to be dramatic or anything, but I believe that the psoas is the window to the soul. It is an epicenter for so many injuries that I have become somewhat obsessed with it. It has become one of my personal missions to teach others how to properly stretch the psoas.
Why does a tight hip flexor, or psoas, matter? The psoas is able to flex the hip (as in bring your knee closer to your chest) but it is also able to rotate, side bend, and extend the spine because it attaches to the front portion of multiple vertebra. How crazy is that? So a stiff psoas can compress your hip joint, decrease hip range of motion, cause an un level pelvis, contribute to back pain, decrease nerve space....the list goes on and on. Who knew one little muscle could cause so much mayhem?
3. Weak or Inactive Gluteal Muscles
The hip is a ball-and-socket joint, meaning that the head of your femur (the ball) sits in a cup-shaped portion of the pelvis called the acetabulum (the socket). This configuration gives the hip a ton of mobility, but also a lot of complexity. If muscles aren't working properly 360 degrees around the joint the ball can sit off-kilter in the socket and problems arise. One example of this would be a tight psoas, pulling the ball forward. Another would be weak or inactive gluteal muscles, pushing or allowing the ball to move forward inappropriately.
Although strengthening glutes and learning how to fire them properly is a very generalized approach to treating hip pain, it often works! Check out this video from Garrett Mclaughlin for ideas on a basic hip strengthening program.
4. Tight or Inhibited Gluteal Muscles
All of our muscles have a normal "resting length", meaning the length the muscle prefers to exist at in order to contract strongly and perform optimally. Try jumping by just using your calf muscles. Keep your knees straight and hop up and down like you are jumping rope. Take note of how high you can bounce. Now try to do the same jumping exercise by starting on your tip toes, which is a shortened position for the calf. Stay on your tip toes and don't let your heel come down at all as you try to jump. Now how high can you go? Can you get off the ground at all without cheating?
Tight gluteal muscles will be similarly weak and dysfunctional. You may have proper strength, but if your butt is all knotted up then good luck getting it to properly stabilize your pelvis. (A trip to Franklin Massage, anyone?)
5. Poor Movement Patterns and Habits
Here is where I swallow my pride and post pictures of myself running terribly in order to prove a point. I'd love to pretend that because I am a physical therapist I magically move perfectly, never get injured, and have perfect biomechanics. Shockingly...not the case. I've had a longstanding left hamstring and hip injury for over 2 years. Why the left side and not the right? As I said before there has to be a reason. Overuse injuries don't land on one side like the flip of a coin.
Take a look at me when both feet are off of the ground. My hips are level left to right, which is the ideal position for running. When hips are level in this plane it minimizes the force that goes through our joins and soft tissues.
When I am in stance phase on my right leg, my hips still stay fairly level. Not perfect, but not too bad. This indicates that my right gluteal muscles are strong-ish and function properly.
Ouch and yuck. My left glutes just didn't want to get out of bed today. Can you see how this would stretch the outside of my left hip with every step? The inside of my left knee? Compress the outside of my left knee and stretch my IT band? Make my right leg have to bend further to swing through and not stub a toe? With every single step?!? Bleh. Just gross.
Like I said, overuse injuries are never a coin flip.
Have you struggled with hip pain, or just tried to live with it? Don't. Ain't nobody got time for that. Find out what's going on and what you can do about it.
Knowledge is Power my friends.
The symptoms of diastasis recti extend far beyond the visual change in your stomach's appearance. Diastasis recti can compromise the integrity of your core musculature leading to consequences such as incontinence, difficulty lifting, low back pain, and increased likelihood of developing a hernia. The good news? A little bit of knowledge goes a long way.Read More
We know that the hand is anatomically complex and the various parts are small, so how confident are you that you can correctly diagnose yourself via a google search and a hunch? Know what you don't know- spend the time and money to be evaluated by a professional. Get an assessment of your unique injury, a diagnosis of what was specifically injured, and an educated estimate of how long it will take to heal. This will likely save you time, money, and heartache in the long run.Read More
Professional athlete and Newton runner Jeannette Faber speaks on hamstring strains, training frustrations, and the decision to continue competing.Read More
As triathletes we are accustomed to some level of regular pain: the pain of waking up early, the pain of racing hard, the pain of running off of the bike on a muggy Tennessee summer's day...Naturally then we can assume that pain with training is part of the process, right?
Wrong. I frequently see triathletes who come to me for treatment of an injury and eventually mention "a bit of shoulder pain", AKA a LOT of shoulder pain. Swimming may be the shortest part of the race, but ignoring discomfort with your swim stroke is detrimental to more than just your finisher's time. You could be training yourself towards rotator cuff pathology, labral tearing, bicipital tendonosis, subacromial bursitis, or arthritic degeneration.
The good news is that a skilled assessment of your posture, strength, muscular flexibility, and movement pattern can effectively avert the aforementioned disasters.
One must first understand the nature of the shoulder joint to comprehend how small deficits can contribute to large amounts of pain. The shoulder, like the hip, is classified as a “ball-and-socket joint”. This allows the shoulder to move about multiple axes. Think about it, we can-
Flex and Extend our shoulder
Abduct and Adduct
and even Internally Rotate and Externally Rotate
Our shoulders are extremely mobile and therefore less stable compared to other joints. For the purpose of simplification, we will use the analogy of a golf ball sitting in a tee; the golf ball is the shoulder head, or humerus, and the tee is the socket, or the glenoid fossa.
Take a look at the very simplified anatomy image of the shoulder. Keep in mind that this does not include multiple structures, yet it still demonstrates how little space we have available between the humerus and the bony arch above it (the acromioclavicular arch). Further keep in mind that the four rotator cuff muscles, the latissimus dorsi, the long head of the bicep, and the serratus anterior all interact with the shoulder joint and function to keep that golf ball sitting squarely in the middle of the tee. If there is muscular tightness, weakness, or poor upper back posture the golf ball can sit too far forward, too far back, or even wobble about. This will decrease the space between the humerus and the acromioclavicular arch during active movement of our arm. Tendons can become irritated or frayed, bursas can become inflamed, and joint surfaces can wear inappropriately due to an altered axis of movement. Swimming can become not only uncomfortable, but downright painful.
Try this simple little experiment- In the first picture, my handsome volunteer is demonstrating an exaggerated example of poor posture. His head is down, his pec muscles are tight, his upper back is rounded, his shoulders and forward and internally rotated, and his posterior scapular stabilizers (read: mid/upper back muscles) are in lengthened and weak position. How far can he raise his arms up over his head?
Nash can't raise far. Without even being prompted, he also notes that it feels terrible. Try it yourself! Do you feel uncomfortable pinching, d or downright pain with the motion?
Now extend your chest, pull your shoulders down and back, and lift your head up tall. Now raise your arms as high as possible. See the different in motion? FEEL the difference in your shoulder?
Imagine performing repetitive motion (such as swimming, overhead lifting, or even getting dressed every day) in the first posture. Over time, that temporary discomfort will become downright painful and injurious.
So what is the short summary of this detailed explanation? You need to get your golf ball sitting correctly in your tee, and you need to find why it is not doing so in the first place! If you suffer from shoulder pain, give me a call and we can talk golf. Or shoulders. Whatever.
I am not pressured to see a certain number of patients in order to "make rent". Nor am I hindered from taking a few days to travel, attend a continuing education course, or just holing up to write. I am only driven to treat patients and treat them well. As a result, I am able to pass those savings on to you by charging substantially less than market value. Go ahead and check the full price of your last physical therapy appointment, or get an accurate quote from a physical therapy office that follows a more traditional model of treatment. Let me know how I compare.Read More
Why it hurts so bad to go down the stairs, why run-ger is real, and why you need to wash your hands a hundred times today.Read More
Improve your ultra endurance performance by learning about cardiac drift, central nervous system fatigue, and how to perform a proper scientifically based KICK!Read More
So what actually happens to our bodies before, during, and after these ultra distance efforts? Have you ever stopped to think what is going on in your muscles, your blood, and your immune system on a cellular level? Perhaps you should. Not because I am going to attempt to dissuade you from doing whatever crazy thing you have your sights set on. I think you should do it. I just think you should know what to expect physiologically so that you can better plan for whatever asinine goal you are reaching for.Read More
I always give a little inward sigh when a new patient begins with a phrase like "well, when I was 12 I fell on my tailbone..." Unless you are currently under the legal drinking age, or that fall was off a multi-story building, it is very unlikely that such accounts will effect your symptoms and your treatment today.
I get it though. As a patient, it can be very difficult to know which details are significant and which are inconsequential. Why not share every single one you can think of and hope that the important ones stick?
Unfortunately, time is a limited resource for us all. If your elementary school health history takes 5 minutes to tell, you haven't even gotten to your high school track years, and you are coming in for an ankle sprain that happened yesterday on your 40th birthday after one too many cold ones... well we are taking up quite a bit of time here. I've had people show up to their evaluation with binders (yes, plural) of every test and medical visit they have had since the invention of the printer.
It's not that I don't want to hear the intricacies of your life! If I could sit and chat all day, and have endless time to treat, I would! Yet would you even let me? We are a society of busy people. When patients recall every minute detail of their health history, I become increasingly anxious. Again, I love to talk. I love to listen. I just want to make sure that you get every bit of treatment time available to you. I'm sure you want the same! The idea of wasting your time makes me a little damp under the armpits. (gross, sorry)
So what details are important to share? Let me preface this by saying if there is something you feel is important for your physical therapist to know, tell them! Do you love knitting, which is completely unrelated to your knee pain, but you just feel in your bones that your PT should be aware? Share that! Don't let me cramp your style! However, in general, the most important things to tell your physical therapist (or any healthcare provider for that matter) include:
- The duration of your symptoms. How long has this been bothering you? Did it come on gradually over a certain period of time, or did it come on suddenly? Was there a trauma or fall? Have you had it for months or years and it recently worsened? Knowing the duration of your symptoms will help your PT decide which exercises and treatment techniques you will best respond to. A very new injury will respond much differently than an injury that you have been battling on and off over a long period of time.
- The nature of your symptoms. What words would you use to describe your symptoms? Is it constant? Sharp? Dull? Achy? Tingling? Numb? Again, this gives your PT a clue into what structure is causing your issue, such as muscle, nerve, ligament, tendon, and/or joint.
- "Stuff" that makes you better, and "stuff" that makes you worse. When do you really notice your symptoms? Going downstairs? Waking up in the morning? At the end of the day? After a run? When lying on a certain side? It is equally important to note what reduces your symptoms. For example, does ice, heat, medication, rest, stretching, foam rolling, or drinking gallons of goat milk while meditating in a headstand position help? Great! Tell me.
- How do your symptoms progress? The easiest way to explain this one is to use a running analogy: If you have pain with running, does your pain come on after a certain distance? Does your pain get better as you warm up? Does it hurt when you start your run and just get worse as you go? Do you feel fine when you run but notice your symptoms after? These details help your PT assess the severity and stage of your injury.
- What have you already tried, and did it work? Are you currently going to a chiropractor? Have you already been to a physical therapist for this injury? Are you trying exercises prescribed to you by Dr. Google? If so, I need to know these things! It's ok to have a few cooks-in-the-kitchen so to speak, but I need to know who seasoned the soup already otherwise we are going to have an outright salty dinner. Stay with me now.
- History of the same, similar, or related symptoms. I realize how subjective this is. Do you feel like your fall as a 12yr old really did contribute to your current day symptoms? Then spill the beans! If not, go ahead and skip over it. If you have had episodes of similar symptoms, have a history of re-occurring injury on a specific side, or a history of the same type of injury on both sides...you can go ahead and bet that I will want to know. Patterns like this indicate what type of root cause may be contribution to your symptoms. They also help your PT determine the most appropriate intervention to break your cycle of injury.
- Have your hobbies or normal activities changed? Are you unable to run, buckle your seatbelt normally, or put on a bra? Are you unable to grip a coffee cup or shake a hand firmly? These details help set concrete goals and measure your progress. Did it hurt to swim more than 10 minutes originally, but you swam 30 this morning before your shoulder started pestering you? Great! We are not there yet, but we are making objective progress!
- Are you training for anything or would you like to be? If you have your dream race coming up in 2weeks we may approach your situation much differently than if your race is 3 months away and you have just started training. I will always aim to get my patients well as soon as possible, but the best path to doing so differs on a case per case basis.
- Have you had any images (MRI, x-ray, etc) or are you on any notable medications? I can certainly take an educated guess as to what is going on in your joints, but if you already coughed up the money for an image why would I? Share the knowledge! Did you get an x-ray and it came out clean? Great! Now we know you don't have a fracture and can be more aggressive with your exercises. Do you take medications for your heart, lungs, blood pressure, or are you on prescription anti-inflammatories? Do you have asthma? Yeah, I probably need to know all that. If any medication changes the way you are able to exercise or the way you feel your pain/symptoms, I want to know.
- How is your health in general? Do you burn the candle at both ends, or do you get a solid 8 hrs of sleep every night? Are you generally bullet proof, or do you feel like you are always injured and sick? Do you live on a diet or Starbucks, Halloween candy, and wine or are you the same weight as you were in high school, thank-you-very-much?
- Is anything weird. Do you have any radiating pain? Numbness or tingling? Unexpected weakness or dis-coordination? That's totally normal...NOT. You guessed it, I need to know that too. Let's rule out some of the Big Scaries before we just assume that your symptoms are a run of the mill injury.
So let's save the story of your 12yr old fall for a get together at Frothy Monkey. I can tell you a few embarrassing moments from my own childhood. During your treatment time though? I'm focused on you, what's going on with your body, and your recovery. Be a good historian, and help your physical therapist help YOU! Get the treatment you deserve!
Stay thirsty, my friends.
Proper treatment for tendonitis verses tendinosis is different, and those differences are important to your recovery. As providers of healthcare, we need to stop assuming that our patients don't understand and don't need to understand. As a patient, you need to educate yourself...Read More
Pain in the high hamstring area is one of the most common (and most frustrating!) athletic injuries. It hurts when you run, when you bike, when you sit, drive, tie your shoes, brush your teeth... it just hurts ALL OF THE TIME. Chances are if you have ever suffered from a hamstring injury even reading this first paragraph will make you a little queasy; they can be a notoriously persistent and long lasting issue. I still maintain that, given a choice, I would pick a stress fracture over a hamstring injury any day. When a bone heals, it heals. It stops hurting and you can start running. A soft tissue/hamstring problem can wax and wane seemingly without any reason and can certainly outlast your optimistic attitude. Allow me to be a little dramatic- it can squash your season and your soul.
So why does the hamstring take so long to heal, and why is it essential to seek treatment sooner rather than later? Let us consider...
The hamstring crosses two major joints in the body, and is responsible for both hip extension and knee flexion. This places the hamstring at even more risk for injurious forces and can increase the necessary recovery time. Recovery can be further delayed by misdiagnosis of the actual injury and failure to correct poor movement patterns and postures which caused the injury in the first place.
The hamstring is not a single muscle, but a group of three (arguably four) muscles which originate at the ischial tuberosity (read: sit bone) and attach below the knee on both sides. The infamous sciatic nerve innervates (read: feeds, makes work) the hamstring. The relationship between the sciatic nerve and the hamstring is significant and will be further explained below.
To effectively treat hamstring pain, there must be an understanding of its root cause. WHY was the tissue injured in the first place? Why the hamstring, and why one side verses the other? This leads us to...
TYPICAL CAUSES OF HAMSTRING PAIN AND INJURY:
- A hamstring sprain, strain, or pull- is a result of a micro trauma to the muscle fibers. Pain can be felt near the buttock, near the back of the knee, or anywhere along the length of the muscle belly. The injury can come on gradually or suddenly (as in during a sprint or a kicking motion) and can sometimes be accompanied with bruising or swelling in the back of the thigh.
- Hamstring tendonitis or tendonosis- Tendonitis (an inflammatory response within the tendon) or tendonosis (degradation and disorganization of the tendon fibers) of the hamstring is a common and frustrating injury. Pain is typically felt at the top of the thigh and gluteal area and will be worse with prolonged sitting, running hilly terrain, or doing speed work.
- Neural tension with or without low back contribution- A nerve may be restricted at multiple points along its path: where it exits the spine, where it dives under specific muscles, and/or where it bends around boney prominences. If the sciatic nerve doesn't glide and slide like it should (ie. "neural tension") it may mimic a feeling of extreme hamstring tightness. Furthermore, if there is neural tension in the sciatic nerve, the hamstrings are unable to work at their full capacity. This means that they are more likely to be overused, strained, and injured.
- Form and posture deficits- Poor movement patterns which overuse or overstretch the hamstring-muscle tendon complex put the tissue at risk for injury. This can include: weak abdominals, inactive gluteal muscles, unstable hips, overactive quadriceps and shortened hip flexors. These are intrinsic factors, or factors that are specific to an individual’s body.
- Extrinsic Causes- Extrinsic factors can also contribute to hamstring injury. An extrinsic factor is an "oops, that was stupid" or "probably shouldn't have done that" factor. Examples include a drastic increase in training intensity and/or volume. It could also be a sudden change in training activity (hot boxing 6x a week starting tomorrow anyone? YEYYYYY) or footwear. Weather can even be an extrinsic factor, like very very cold temperatures.
POTENTIAL TREATMENT OPTIONS:
Full rehabilitation and return to activity is certainly possible after a hamstring insult. I don't want you to think that your athletic life is over and that you should expand you scrapbooking skills. However, a thorough evaluation and specific recovery program is typically necessary.
- Manual therapy- techniques such as ASTYM, joint mobilization, trigger point dry needling, and soft tissue work is extremely beneficial in reducing immediate symptoms and allowing return of normal movement patterns.
- Progressive strength program- a specific program to strengthen the hamstring tendon, muscle, and supporting muscles is a must. The program should not provoke lasting symptoms, but also needs to be challenging enough to produce strength gains and changes in tendon health. Just "resting it" is not always the answer and can actually delay recovery in certain circumstances.
- Assessment of form- running form, bike fit, standing posture, etc in order to ensure that you are not moving repetitively in a pattern that continues to irritate your hamstring with every step, peddle stroke, and passing minute.
I always joke about starting a Nashville-Female-Endurance-Athletes-Suffering-Or-Having-Suffered-From-Hamstring-Insult support group. I'm only 10% kidding. It's real people.
Link to MY physical therapist's blog and my own personal experience HERE
Don't let your hamstring injury be a pain in the, I'm gonna say it...ready? ASS! Don't let it be a huge pain in the ass! Consult with your physical therapist today.
I think it helps to first understand WHY foam rolling is helpful. Consider this- a muscle is not a single rubber band that contracts uniformly. Rather, a muscle is a series of small units which can contract somewhat independently of each other. These units are called sarcomeres. Due to overuse, poor body mechanics, posture, etc a cluster of sarcomeres can stay contracted forming a trigger point.Read More
Included in my figurative list of FAQs is "do you take my insurance?" Let me preface my answer by saying that I am very passionate about affordable health care. I am very, VERY passionate about quality care that is specific, effective, and efficient. I believe that access to healthcare is a a basic right, not a privilege.
What are you doing to educate yourself on 1) how your health insurance works and 2) a strategy for spending your healthcare budget wisely?
If you are suffering from true plantar fasciitis, studies show that joint mobilization, trigger point manual therapy, taping techniques, and specific stretching exercises can powerfully reduce plantar fasciitis related pain in the short and long run. Night splints and custom or prefabricated orthotics were also shown to benefit. Do you know who can help you implement these treatments in a way that is right for you? You guessed it- your friendly neighborhood PT!
What I want to caution you against doing is assuming you have plantar fasciitis simply because you have pain at or near the bottom of your foot. An improper diagnosis will hinder your chances of a swift and long lasting recovery. Knowledge is power, empower yourself!Read More
One my biggest frustrations is to see a patient waste their time, money, and effort getting an image that they don't need. All to often, this assumption delays or takes the place of effective treatment.
So how do you know when to seek an xray, MRI, CT scan, or one of the many other images that are out there? A few things to consider:
1. Does it actually change your course of treatment?
I'll admit that there is some relief to having a conclusive answer. However, a physical therapist can often determine the specific source of your pain with a throughout evaluation. I have seen multiple patients with back pain decide to get an MRI "just to know". They spend an exorbitant amount of money (MRIs can cost upwards of $2000), delay helpful treatment, and return to me with the exact same diagnosis I have given them at their previous visit. I am not a human MRI machine, however, I am trained to be very accurate in diagnosing certain types of injuries without the aid of an image. Do I perform a little "booya" dance when I happen to get it exactly right? Yeah, yeah I do. Just not in the room in front of you. I keep my booya dancing private.
More importantly, the results of an MRI may not actually change a patient's course of treatment. So Sean-With-Shoulder-Pain just spent a couple of Bennys, valuable time, and emotional effort for NO CHANGE WHATSOEVER. Does he now know that he has tendonosis of the long head of the bicep? Yes. Does his PT know that he needs to improve his glenohumeral posture, address anterior chest wall tightness, and improve the strength and coordination of his posterior rotator cuff musculature in order to address his symptoms? Absolutely, but they knew that anyway. So now Sean's treatment will continue just as it would have pre-MRI.
2. Does the image actually show the source of your pain?
Now is probably a good time to address the fact that an MRI is an extremely sensitive image with a high rate of false positive findings. In more simple terms, an MRI is not the gold standard of imaging! Patients assume that if there is an abnormal finding on an MRI, then that finding is 100% the source of their symptom. Not so. According to the Sept/Oct issue of Swimmer Magazine, nearly 50% of all labral and rotator cuff tears found in a Master's Swim population are NOT the source of the swimmer's pain. "Most things seen on scans are almost never a cause of pain unless they are really profound- a full tendon rupture, for instance, suffered during a car crash."
On a similar note, multiple studies have shown that between 30-40% of the general population have one or more disc bulges in their spine with ABSOLUTELY NO PAIN. Some fun anecdotal evidence...I am one of these people. I have a "minimal to moderate central extrusion" of my T12 according to the lumbar MRI report taken this year. I can tell you that I've rarely, if ever, had back pain and experience none of the expected symptoms for such a finding.
3. Does it make economical sense for you and your specific situation?
So what if you and your physical therapist suspect that you are suffering from one of The Big Scary-ies: a meniscal or ligament tear, a disc bulge, or a labral disruption? Depending on a patient's age, overall health, and specific injury it is possible that these Big Scary-ies can heal with conservative care. This means that physical therapy, changes to technique or form, and relative rest may be all that is needed.
Ask yourself if you are willing to spend the thousands of dollars for surgery, take time off work/life, and initiate the post-surgical rehab that you will inevitably need. If not, perhaps you should give conservative care a shot. It will likely save you a lot of money, a lot of time, and give you lasting results.
4. Which image is most appropriate?
Do not step away from this post thinking that all images are worthless, overpriced scams- they are not. However, it can be helpful to be in-the-know so that when a physician gives you options you can make an educated decision regarding what you may or may not need. The basic images are:
X-RAY. X-rays are cheap, easy to acquire, valuable images that show BONES. An X-ray will show a fracture or break of most kinds. It will only show a stress fracture if the body has already started to heal the area, in which case the radiologist will find a "bone callus". An X-ray may suggest evidence of osteoarthritis as implied by a decrease in the expected space between the bones (ie. the joint space). An X-ray will NOT directly show ligament, meniscal, tendon, or other soft tissue damage. The exception to this is a chest X-ray, which is helpful in diagnosing pneumonia or lung pathology.
An xray will always expose the patient to some level of radiation, which is something to be aware of.
MRI. An MRi uses magnetic energy and radio waves. An MRI image is very helpful in finding swelling, bleeding, or abnormalities of bones, organs, joints, ligaments and other soft tissues. As mentioned before, MRIs are very sensitive.
An MRI is typically performed on an enclosed table. Patients who are claustrophobic are offered a sedative because of this. On a personal note, I do not consider myself claustrophobic but have to practice deep breathing pretty heavily during all of the MRIs I have had. It can be pretty freaky.
Patients with pacemakers or any metallic implants in their bodies are NOT allowed to receive an MRI, as the implant may dislodge from their body during the magnetic scan.
Ultrasound. Most people only think of ultrasound imaging in the context of pregnancy, although it's uses are much more widespread. Ultrasound is a non-invasive technique which uses sound waves to visualize anything inside the body: organs, tendons, blood vessels, and babies! It can be quickly and easily performed, however, the image quality may be poor in areas of high bone or fat density.
Your physician will likely use an ultrasound while giving an injection, such as a cortisone, to ensure that they are injecting the medication into the right spot.
CT Scan. To keep it simple, a CT scan is basically a fancy multilevel x-ray that is used to detect tumors, hemorrhaging, stroke, or a complicated injury. If your doctor recommends a CT, there is likely a good reason and they will have shared that reason with you.
Stay calm, know your stuff, and use your resources wisely. Contact a PT if you need help navigating what to do and where to go next!