The Classic Ankle Sprain- How To Diagnose, Treat, and Avoid Reoccurrence

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? 

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Why You Don't Have Sciatica- And What You Can Do About it Anyway

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. 

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Lymphatic Massage- The Most Effective Recovery Tool You are Probably Not Using.

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. 

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"My Hip Is Killing Me." The five most common causes of hip pain and what to do about it.

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

She's a badass endurance athlete, but those hips don't lie

She's a badass endurance athlete, but those hips don't lie

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 both feet are in the air, my hips are level from left to right. This is ideal. 

When both feet are in the air, my hips are level from left to right. This is ideal. 

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. 

When I am in stance phase on the right, my hips stay mostly level. My right hip glutes and stabilizers are sufficiently strong and active. 

When I am in stance phase on the right, my hips stay mostly level. My right hip glutes and stabilizers are sufficiently strong and active. 

My left glutes and stabilizers are a hot mess. Yikes. 

My left glutes and stabilizers are a hot mess. Yikes. 

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. 

leahsawyerpt.com

Diastasis Recti - The Five Things You Need to Know About Abdominal Injury

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. 

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Rock Climbing and Finger Injuries- The Five Things You Need To Know

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. 

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Triathletes and Shoulder Pain- Just shove it in a wetsuit and keep swimming, right?

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

Circumduct

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?

As I instruct Nash to hunch over and raise his arms as high as he can he says "but it hurts..." To which I respond, "yeah, that's exactly my point!"

As I instruct Nash to hunch over and raise his arms as high as he can he says "but it hurts..." To which I respond, "yeah, that's exactly my point!"

Side view. Wallace the cat is also participating in this demonstration, here.

Side view. Wallace the cat is also participating in this demonstration, here.

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? 

See how much happier Nash looks?!?

See how much happier Nash looks?!?

image.jpg

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.

leahsawyerpt.com

 

Why keeping my costs low keeps your pocketbook full- Five reasons that going to a cash-based physical therapist will benefit your health and your budget.

 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. 

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