Tennis elbow anyone?

Tennis elbow is a common catchall phrase for inflammatory disorders of the elbow. However, most of the time it doesn’t have anything to do with playing tennis. Tennis elbow (lateral epicondylitis) is an overuse/strain disorder caused by repetitive contraction of the muscles of the forearm and wrist. In addition to racquet sports, activities such as painting, using a screwdriver or a knife for food preparation can all cause inflammation and pain in the elbow. Conservative treatment would begin with resting the upper extremity, using ice on the affected area and over the counter NSAIds (Advil, Aleve). There are cases where chronic imflammation of the elbow can lead to adhesions or scar tissue to form around the joint which can result in nagging pain or even disability. If this is a condition you may be dealing with that hasn’t responded to conservative treatments, come see us at First Choice Physical Therapy where our therapists can design a treatment program to get you felling better soon.

Have you ever suffered from constant headaches that start in the back of your neck and end up feeling like the pain is right behind your eye? What about after a long day at work, do you ever have a dull headache that will not go away until you lay down and try to “relax” with little to no relief? This type of headache is referred to as a “tension headache” and originates in the deep muscles of your neck that attach at the bottom of your head and can result in intense headaches. Due to poor posture, along with myofascial restrictions and cervical immobility, tension headaches are very difficult to relieve with home remedies. If you are suffering from headaches and want to do something about them, come in for an evaluation by one of our Doctors of Physical Therapy to decrease your pain and get rid of that headache once and for all.
Brannon Chester, DPT
Doctor of Physical Therapy

We have all heard people say “My balance isn’t what is used to be when I was younger”. Although this is probably a true statement, losing the ability to balance isn’t necessarily a consequence of getting older. Studies reveal that in non active individuals, balance peaks in the mid 20s, slows into the 30s and sharply declines by the 6th decade. The balance system is comprised of three primary systems: vision, vestibular (inner ear) and proprioception (balance-where our limbs are in space). A 2002 study by Verschueren SMP, et al, revealed that focused practice balance activities, regardless of age, improved overall balance and stability. If you feel like your balance isn’t what it used to be, come see us at First Choice Physical Therapy where a customized stability program can get you on your way to better balance.
Scott Champagne, PT.

As the high school baseball season comes to an end, many baseball players are experiencing the aches and pains and the “normal” shoulder/arm soreness that comes with a long season. In the past, baseball players were able to enjoy 5-7 months off from baseball activity to allow the proper healing and rest that the young athlete needs. However, the sport has evolved into a year- long season with high school baseball starting in January and ending in May, summer ball kicking up and running until late July, and fall baseball starting up as soon as school starts in August. The competitiveness and necessity of year round baseball has not allowed for the young athlete to completely heal and recover from the demands of a baseball season.
Complaints of shoulder and elbow pain are the most common reasons why a baseball athlete seeks medical attention. According to Dr. James Andrews, “Most injuries are a consequence of cumulative micro-trauma from the repetitive, dynamic overhand throwing motion inherent to the sport.” In other words, the constant repetitive demands put on the shoulder from throwing a baseball without the proper strength, mechanics, and rest are the major cause for injury in a baseball player.
Overthrowing and over utilizing the young athlete has become a huge problem in youth baseball today. Doctors have found a link between throwing volume and shoulder/elbow injuries among youth baseball pitchers and these findings have prompted the USA Baseball Medical and Safety Advisory Committee to recommend pitch limits for youth pitchers. According to the USA Baseball Medical team, not only monitoring pitch counts but having pitchers (1) compete NO MORE than 9 months in a calendar year, (2) develop and maintain good mechanics, (3) commit to year-round physical conditioning as their bodies develop, (4) participate in only 1 performance as a pitcher per day, (5) avoid showcase participation, and (6) limit participation to 1 team per season.
Rehabilitation plays a vital part for the athlete, in not only returning to sport, but injury prevention as well as pre-season training to prepare the body for the demands of their respective sport. Traditional rehabilitation is not sufficient and cannot reproduce the speed or the joint forces generated during throwing. According to Journal of Sport Rehabilitation, “The only way to mimic the forces of a baseball throw is to actually throw a ball. Interval throwing programs are progressive, sport specific regimens that gradually expose an athlete to the demands they will experience upon a return to sport.” If not properly prepared, an athlete is vulnerable to injury upon return to sports participation. This is true whether the athlete has a throwing-arm injury, a non-throwing-arm injury, or an injury to any region of the body that has resulted in lost playing time.
As the spring season wraps up, and the summer baseball season begins, make sure your athlete is prepared for the stresses associated with throwing. If you have had any shoulder/elbow pain from throwing come by First Choice Physical Therapy for an in depth evaluation which includes shoulder mechanics, strength deficits, and an interval throwing program instruction.
Brannon Chester, DPT
Doctor of Physical Therapy

We have all made the assumption that balance degenerates as we get older and fall risk is primarily due to age related changes. However, loss of balance and decreased gait stability are not necessarily inevitable throughout the aging process. There are key factors to look for which may contribute to a fall. Common factors include dizziness, apprehension, taking more that one medication (poly pharmacy), prolonged bed rest or inactivity and loss of strength in the legs and feet. Falls are not typically the result of a single factor but rather a combination of factors, that is why it is important to be proactive and control the variables that you can. If you feel like your balance is not what is used to be, come see us at First Choice Physical Therapy where our therapists can restore strength in your legs, improve coordination, balance and reduce the likelihood of a fall being in your future.
Scott Champagne, PT

Do you have heel pain that bothers you when you get out of bed in the morning? Are you constantly standing at work? You can’t exercise because you’re afraid your foot is going to hurt after exercise or the next morning? You might have plantar fasciitis. Plantar fasciitis is a repetitive use injury that occurs for several reasons whether it is because of wearing old, worn out shoes, weight gain, or a sudden return to activity. At First Choice, we treat plantar fasciitis almost every day, usually with great results. After following our clinical treatment protocols and home exercises, patients are able to get back to work, running, or other exercise without receiving injections or worrying about surgery. Occasionally, patients will require orthotic fabrication which we do in house, however, the majority of the patients we treat do not require them to return to activity. Our therapists will also look at the patient’s running shoes to determine if they are the correct type of shoe for that patient. If this sounds like you or someone you know, contact First Choice Physical Therapy and get back to living.

Within the medical realm, there has been quite a bit of discussion regarding patients’ significant profit from the direct access to physical therapy in the last few weeks. Numerous great points are made in a Washington Post article “Physical Therapy vs Imaging” (see previous blog post). This article lists several ways in which patients can profit from seeing a physical therapist before going through various doctors offices.
If you were not yet aware, you can come to First Choice, first. This will save you time, money and potentially even surgery. Call us today for your evaluation!

There is a growing trend among health care professionals and patients of physical therapy clinics that recognizes the effectiveness of manual therapy in treating variety of neuro-musculoskeletal conditions. Joint manipulation and soft tissue mobilization, hands- on or instrument assisted, form the backbone of majority of treatment plans in our clinic. One of the most utilized therapeutic modalities integrated into physical therapy treatment is myofascial release.
To understand the term “myofascial release”, it is crucial to explain, what the myofascia is. Prefix “myo” means muscle in Greek language, “fascia”, on the other hand, comes from Latin and it means a flat band or bandage . Fascia is the dense connective tissue composed of elastin and collagen fibers that surrounds and covers every muscle, nerve, blood vessel and organ in our body. Similar to yarn in a sweater, pull and damage in one area will strain distant areas and cause tension throughout fascial network. Healthy myofascial tissue has the ability to stretch and move without restriction. Due to poor posture, sedentary life style, emotional stress, inflammation, repetitive motions, surgical procedures, or traumas such as a fall or car accident, fascia scars and hardens. It loses its pliability, adheres to muscle, which leads to restricted range of motion of the neighboring joints and abnormal biomechanical functioning.
Myofascial release is an effective hands-on or instrument assisted technique that involves applying sustained pressure directly on the myofascial tissue. Initially, a therapist seeks autonomic or reflexive effects and gently stimulates sensory receptors in the skin and at the level of the subcutaneous fascia. This way a therapist desensitizes affected area and gains entry level to deeper structures with less potential for tissue microtrauma and exacerbation of pain. The next step of the intervention is mechanical change such as a stretch of the contracted muscle or superficial tissue rolling to mobilize adhesions. After freeing up the superficial restrictions, stronger pressure is applied to go through the “layers” until the deeper tissues are accessed. At times, forceful technique is required to free up longstanding restrictions. When optimal length and mobility of the soft tissue are established, therapy focuses on changing abnormal joint alignment and normalizing patient’s movement patterns.
The purpose of myofascial release is to break down scar tissue, loosen tightened fascia, reduce hypertonicity of the contracted muscle and decompress lesions such as nerve impingement. It is also intended to increase blood circulation, lymphatic drainage and facilitate tissue repair capacity. Although fascia and its corresponding muscle are the prime targets of the myofascial release, other structures, such as Achilles tendon or forearm common extensor tendon, are frequently treated with this technique.
Myofascial release therapy has been effectively utilized for relief from common problems such as neck and low back pain, headaches, plantar fasciitis, lateral epicondilitis (tennis elbow) to name just a few. It shortens and optimizes recovery from traumatic injury or surgery and improves performance in high level athletes. By targeting specific areas of restrictions, myofascial release therapy reduces pain, restores normal mobility and allows the patients to return to their normal functional capacity.
Maggie Garbiec, PTA