Will Blake Bortles miss Week 6 with an AC Sprain?

Fantasy Football Injury of the Week:  How bad is Blake Bortles Grade I AC Sprain?

Blake Bortles has not typically been on the radar of many fantasy players since he joined the league in 2014.  However in 2015 he has had a sneaky good start to the season despite Jacksonville’s 1-4 record.  In my Yahoo league, he is currently the 7th best QB.  He has better numbers this year than our very own Peyton Manning (by a longshot) and fantasy studs like Drew Brees and Matt Ryan.

Unfortunately, Bortles may suffer a bit of a setback if he is forced to miss Week 6 against Houston.  Bortles suffered a Grade/Type 1 acromioclavicular (AC) joint sprain of his throwing shoulder at some point during Jacksonville’s week 5 loss to the Buccaneers.  Anytime a quarterback sustains an injury to the throwing shoulder it can be a scary situation.  Fortunately for Bortles, a grade one AC sprain leaves us optimistic that he will be able to play this week and here’s why.

What’s the difference between Grade 1, 2, and 3 AC Sprains?

An AC sprain is typically graded in its severity from a one to a three.  It easy to visualize the severity of an AC sprain in the graphic below:

ACJointSeperation-pic2©

A grade/type 1 sprain is mild or partial injury to the joint ligaments or capsule.  In this grade there is a slight tear or sprain of the acromioclavicular ligament.  This ligament helps to stabilize the AC joint and ultimately the shoulder itself.  Bortles likely will rest the shoulder this week and participate in physical therapy everyday to retain his range of motion, strength, and help control the pain with modalities like the Gameready ice machine:

File_000(note: this is not Blake Bortles)

A grade/type 2 sprain is a more significant tear of the acromioclavicular ligament as well the ligament below the clavicle called the coracoclavicular ligament.  

A grade/type 3 sprain is a severe injury to the shoulder.  In this situation, both acromioclavicular and coracoclavicular ligaments are completely torn.  The shoulder is very unstable and an athlete will often choose to have surgery to stabilize the joint by placing a screw or looped suture into the collar bone to anchor it back down.  This grade of injury will mean the player misses weeks or months of their sport.

So What’s the Prognosis?

Fortunately for Bortles he has been diagnosed with the most mild form of an AC sprain, a grade one.  Early in the week his shoulder probably felt sore and a little weak or unstable  He may have had some difficulty reaching overhead or across his body and lifting activities might have been uncomfortable.  Kinesiotaping can be helpful in giving stability and pain relief during this phase of recovery.

 

With daily physical therapy rehab, Bortles’ symptoms will likely improve significantly or resolve completely by Sunday.  

Prediction: Blake Bortles is able to play in Week 6 against Houston

 

Injury Revisited: Dez Bryant, Jones Fracture

With no high-profile injuries to players at skilled positions this week, we bring you an update on the status and likely return to play for Dallas Cowboys wide receiver Dez Bryant.  Dez suffered a right 5th metatarsal fracture, commonly referred to as a Jones fracture, during the Cowboys’ week 1 win over the New York Giants (video and more information here).

jones-fracture

Jones fracture (not Dez Bryant’s)

The base of the 5th metatarsal can be a particularly difficult bone to heal.  This is due to the area’s poor blood supply as well as the huge amount of force transmitted through the area, especially with running, jumping and cutting.  The day after the injury he underwent a surgical procedure that was reported to include internal fixation with hardware as well as a bone graft.  Given current surgical procedures, the graft was most likely a marrow aspirate with demineralized bone matrix injected at the fracture site.  This is essentially used to speed up healing and increase the likelihood that the fracture with heal completely.  In most cases, a bone graft is used when a fracture has been recurrent or chronic in nature.  However, it is very likely that they are treating this as aggressively as possible to allow for the quickest return to play possible. 

 

jonesrepair

Jones Fracture Repair (Not Dez Bryant’s)

A recently published study followed 25 NFL players from their surgery through return to play.  The study found that 100% of players returned to full participation and 12% of them ultimately refractured their 5th metatarsal and required a revision surgery.  The time from surgery to return to play was between 6 and 14 weeks, with the average being 8.7 weeks.  

Dez is undoubtedly receiving excellent care as he rehabilitates this injury.  He is likely undergoing joint mobilization, stretching, strengthening, stability and balance training and quite possibly trigger point dry needling in an effort to regain range of motion and full function.  

Given recent data on Jones fractures amongst NFL players, along with the demands put on the foot of a wide receiver such as Dez Bryant,  The Therapydia PTs believe this will be a fairly lengthy recovery.  

Prediction: Dez Bryant misses just over 10 weeks and returns to face the Carolina Panthers on Thursday, November 26th.  

 

Hamstring Strains for Lynch and McCoy (9-28-15 Fantasy Football Injury of the Week)

 

This week we saw two key running backs leave the game early with hamstring strains.  Marshawn Lynch left the game at halftime and never returned.  The diagnosis at this time is a mild hamstring strain after an MRI was performed yesterday.  Typically you get a little more detail from these MRIs but the news has been vague and sparse.  What is interesting about Lynch’s injury is that he entered week 3 questionable to play with a calf strain.   As physical therapists that work in sports medicine rehab, it is not uncommon for us to see this type of situation where one injury quickly leads to another if an athlete tries to return to their sport too quickly.  In this case, a calf strain followed by a hamstring strain is not surprising in the least, especially for a powerful runner like Lynch.  The calf muscle (gastrocnemius and soleus) primarily acts to point the foot downward like in a heel raise A woman running in her bright colored shoes showing off her calf musclestype exercise or pushing off when running.  However, it also assists the hamstrings in bending the knee (flexion).  It makes sense that if you strain the calf muscle and it’s not contributing as much to knee flexion, then your hamstrings (the primary knee flexor) may take on the extra load and potentially lead to injury.

LeSean McCoy also left last Sunday’s game with a hamstring strain.  Unfortunately, this is the second time he has strained his hamstring since training camp.  The fact that he has now had two significant injuries to the same hamstring likely means he is going to miss some extra time.  This time around, if he doesn’t allow for adequate rest to allow the muscle to heal completely, this could be a lingering problem for the entire season.

Knowing the severity of these injuries would be helpful in determining how much time will be missed but unfortunately it is difficult to find this information.  We are going to speculate that Lynch has a Grade 1 hamstring strain and McCoy is dealing with a strain closer to a Grade 2 since this is the second time it has happened.  The image below gives a good visual of the difference between a Grade 1 vs a Grade 2 hamstring strain.

blood cell types

blood cell types

If you ever wondered what the rehab looked like for a hamstring strain, here is an excellent video of a typical exercise protocol starting from very basic strengthening exercises and progressing over time to sport specific drills.  At Therapydia Denver, Josh and I would also incorporate various type of hands on manual therapy including myofascial release, trigger point dry needling, stretching, and joint mobilizations as needed.

Prediction: LeSean McCoy misses weeks 4 and 5.  Returns week 6 against Bengals

Prediction: Marshawn Lynch misses week 4.  Returns week 5 against Bengals

Rotator Cuff Strain for Drew Brees (9-21-15 Fantasy Football Injury of the Week)

Stated Injury: Rotator Cuff Injury

New Orleans Saints quarterback Drew Brees suffered a shoulder injury in the second half of their loss to the Tampa Bay Buccaneers.  The injury appears to have happened as Brees was going through his throwing motion as an opponent’s attempt to swat the ball abruptly stopped the forward motion of his arm (video and more information here).  

Preliminary reports have referred to the injury as a “rotator cuff injury” or a “rotator cuff bruise”.  The rotator cuff is a collection of 4 muscles that run from the shoulder blade to the upper arm.  These muscles are instrumental in most movements of the arm, especially rapid overhead movements (like throwing a football).

The severety of the injury depends on what tissues have been injured (torn or bruised) and how much.  A rotator cuff strain (mild tearing of muscles or tendons) can usually be rehabilitated using stretching, strengthening and trigger point dry needling.  A full-thickness rotator cuff tear (most commonly occurring at the supraspinatus tendon) usually requires surgery and extensive rehabilitation lasting from 8-12 months prior to return to sport.  Furthermore, professional overhead athletes rarely return to previous form after a full-thickness tear that required surgery.  

Luckily, Brees was able to finish the game.  This suggests that his injury is less-serious than the one he returned from in 2006.  

Given the information at hand, the Therapydia Denver PTs believe that Drew Brees will miss one game due to a rotator cuff strain.  After a few weeks of treatment including Physical Therapy, he will return to full participation against The Dallas Cowboys on Sunday, October 4th.  

Fantasy Football Injury Of The Week

New for the 2015-2016 NFL season:  

Each week, the Therapydia Denver PTs will analyze and discuss the NFL injury with the most serious implications for your fantasy football team.  In this analysis and discussion, we will include a description of the injury, the most likely treatment options for the injury and a prediction as to when the injured player will be back on the field.  

We will explore all available information outlets, then employ our extensive training and experience in orthopedic and sports physical therapy to give you an informative yet concise evaluation of the injury of the week.  

We will give you all the information you need to make an informed decision.  The rest is up to you.  Start, bench, trade or hop on the waiver wire.  

 

Summer Knee Pain? Trigger Point Dry Needling May Be The Solution.

run assessment denver

Summer in Colorado brings warmer temperatures, longer days and inevitably more time spent outdoors. Many Coloradans choose to take advantage of summer by hiking or running on our vast network of urban and mountain trails. Oftentimes, this increase in miles traveled on our feet can lead to pain in and around the knee, specifically the kneecap. This pain is technically termed patellofemoral pain syndrome, but is commonly referred to as hiker’s or runner’s knee.

How Do I Know If I Have Hiker’s Or Runner’s Knee?

Another sign that you may be at risk for developing hiker’s or runner’s knee is a knock kneed (valgus) position during activities like squatting or walking up or down stairs. This position makes it more likely that your knee will become irritated or painful. The hallmark sign of hiker’s or runner’s knee is pain around or under the kneecap. This pain is usually worsened with squatting and walking up or down stairs or hills.

runner knee signs

 

Image credit: http://what-when-how.com/

What Is Patellofemoral Pain Syndrome?

Patellofemoral pain refers to pain arising from excessive or faulty contact between the kneecap (patella) and the bottom portion of the thigh bone (femur). The patella lies in a groove between two rounded portions of the bottom of the femur.  It is essentially like the patella is sitting in a valley between two hills.patella pain running

During weight bearing activity where the knee is bending and straightening (such as walking, hiking or running), the patella glides up and down in the valley between the hills. If the patella does not glide perfectly in the valley, it may grind awkwardly on one or both of the hills.  This grinding causes irritation, popping, pain and sometimes swelling.

What Causes Patellofemoral Pain Syndrome?

The patella is a sesamoid bone, meaning that it is suspended between two tendons rather than being attached to another bone by a ligament. The top portion of the patella is connected to the quadriceps tendon, which then attaches to the quadriceps muscle group. The bottom portion of the patella is connected to the patellar tendon, which then attaches to the shin bone (tibia).  This unique arrangement allows the patella to be pulled one way or another based on variability in muscle strength and flexibility.

patellofemoral dry needling

Image credit: http://physioworks.com.au/

The most common strength/flexibility issue leading to patellofemoral pain involves weakness in muscles on the inside of the thigh (vastus medialis obliquus) coupled with tightness in the muscles and tendons on the outside of the thigh (vastus lateralis, iliotibial band).  This weakness on the inside and tightness on the outside pulls the patella to the outside, causing it to grind up on the lateral hill rather than gliding perfectly in the valley.

Another common flexibility issue leading to patellofemoral pain involves tightness in the muscles on the back side of the thigh, also known as the hamstrings. Tightness in the hamstring group pulls the shin bone backwards, thus increasing the amount of force with which the patella is sitting in the valley. This increased force can lead to grinding and irritation between the patella and the femur, even if it is gliding in the correct portion of the valley.

How Can Trigger Point Dry Needling help?

Trigger Point Dry Needling (also known as functional dry needling or intramuscular manual therapy) involves inserting a tiny filiform needle into a taut band of muscle tissue, also known as a trigger point.  This causes the muscle to momentarily cramp and eventually release.  This treatment option is extremely effective in releasing muscle tension and restoring normal flexibility and function rapidly.

When addressing patellofemoral pain, releasing muscle tension and restoring normal muscle flexibility can decrease the likelihood that the patella will be pulled out of the valley and cause grinding, irritation and pain.  Releasing tension in the hamstring group can help decrease the amount of force with which the patella is pushing into the valley.  Coupled with specific strengthening and stretching exercise as prescribed by your Physical Therapist at Therapydia, Trigger Point Dry Needling is an effective tool in combating knee pain in hikers and runners.

Performing At Your Highest Level Starts With a Good Night’s Sleep

good nights sleep morning run

Whether you are a high level athlete, weekend warrior, or simply trying to make it through the work day, sleeping is an integral part of being a highly functioning individual. For many, the challenging part of sleeping well is simply finding and staying in a comfortable position. Difficulty sleeping due to pain or discomfort may stem from underlying musculoskeletal issues. If the problem is due to positioning, changing your preferred sleeping position can be extremely difficult, as most people have been in the habit of sleeping a certain way for years. Here are some easy tips to modify your preferred sleeping position in hopes of getting a better night of rest and performing at your optimal capacity during waking hours.

Side Sleepers:

When sleeping on your side, major pain generators are often related to lower or upper spinal rotation. If your top knee slides forward coming to rest on the mattress you may experience discomfort stemming from lower back rotation. This can be easily remedied by placing a pillow between your knees, shins and feet. This will help decreased rotation of your low back, while relieving potential pressure points between your knees and ankles.

side-sleeping-position-pain

Side sleepers may also suffer from pain associated with upper spinal rotation. This may occur if your top arm and shoulder slide forward. This can be corrected by sleeping with a pillow just in front of your chest, with your top arm resting on it.

side-sleeping-pain-management

Another problem with side sleeping can be related to your mattress. Soft or worn mattresses and box springs can allow sagging of your torso between your hips and your shoulders, thus putting your back in a side-bent position (a). This can be remedied by actively bringing your down-side hip and shoulder closer to one another (b), and then relaxing (c). The active arch in your back (think of making a space between your side and the mattress), followed by relaxing your core will allow your spine to rest in a more neutral position.

a)side-sleeping-posture b)side-sleeping-good-posture c)side-sleeping-posture-pain-relief

Back Sleepers:

When sleeping on your back, the most likely pain generator is prolonged excessive low back extension. Resting with both legs straight slightly tilts your pelvis forward, causing an increased bend in your low back. This can be relieved by placing a pillow underneath your knees. This minor elevation of your lower extremity will place your pelvis in a slight backward tilt, thus flattening out your low back and easing tension due to prolonged excessive extension.

back-sleeper-pain-relief

Stomach Sleepers:

When sleeping on your stomach, the most likely contributor to pain is rotation of your neck. In order to breathe effectively, a stomach sleeper must turn their head one way or another. This prolonged rotation can cause skeletal or muscular restrictions to take hold. An easy way to decrease the amount of neck rotation is to place pillows under the side of your body that your head is turned towards. This elevation of half of the torso and shoulders results in a relative decrease in rotation of you neck.

stomach-sleeper-pain-relief

Still having trouble getting comfortable?

Give these slight alterations to your preferred sleeping positions a try. If you are still experiencing difficulty getting comfortable you may need further musculoskeletal evaluation. Physical Therapists at Therapydia have undergone extensive training and possess the skills to evaluate and treat what may be causing your neck or back pain. If you are not getting quality sleep due to discomfort in your muscles and joints, don’t hesitate to contact Therapydia. We’ll help you get back to sleep so that you can tackle the day, able to perform at your highest level.

Prevent Winter Sports Injuries With FMS and Never Miss a Powder Day

FMS denver

One of the main reasons so many people who love to ski, snowshoe and ice skate move to Colorado is for our amazing winters. These winter sports are thrilling, relaxing and everything in between, but lower body muscle weakness, balance issues on slippery surfaces and poor flexibility can cause injuries and most commonly we tend to see a significant number of knee and shoulder injuries. Treatment for these injuries tends to be costly both from a financial and time perspective. It is not unusual for someone to miss the entire winter sports season from one injury, but these injuries can be prevented. The Functional Movement Screen (FMS) can help those who are at risk of injury know what their weaknesses are to improve them.

Functional Movement Screen 101

FMS was developed in 1995 by physical therapist Gray Cook and his colleague Dr Lee Burton, a certified athletic trainer with a doctorate in health performance and wellness. The screen looks at 7 integral human movement patterns to identify dysfunctions or imbalances between right and left side of the body. Weakness, asymmetry and limited flexibility of muscles are common sources of musculoskeletal injury. Each of these seven movements are graded on a 0-3 scale with 0 indicating pain during the movement and 3 being a normal/non-dysfunctional movement pattern. The highest score you can get is 21, and the key benchmark is 14. Some examples of the movements are shown below.

FMS Therapydia Denver functional movement screen denver  

14 or Below Scorers Are 50% More Likely To Be Injured

Several studies have shown that if a person scores 14 or lower, they have a 50% higher chance of suffering an injury. One study looked at 38 female collegiate athletes at the start of their fall or winter sport and found that 69% of the athletes that scored 14 or less suffered an injury during the season. A 2nd study looked at an entire professional football team and again 14 was the magic number that indicated who was most likely to get injured during their season. The likelihood increased from a pre-test probability of injury of 15% to just over 50% when the player scored 14 or less .

Taking Action Based On Your FMS Results

A big reason why we like to use the FMS is because they have a software program that let’s us tailor a specific home exercise program that is individualized to you based on your specific score and movement dysfunctions. You will be emailed directly with your results along with descriptive pictures and videos of each exercise.

FMS results

Most FMS clients make a one-on-one physical therapy appointment to review the exercises and address any pain or dysfunction that was encountered during the FMS. Our PTs use the information from FMS, along with a PT evaluation, to create a custom workout that is specific to your winter sport. Schedule your FMS appointment today to stop injuries before they can happen!

Sciatica: What Is It and How Can Physical Therapy Fix It?

Medical man with back ache

Sciatica is one of the most common diagnoses that we see in physical therapy.  But what exactly is sciatica and how do PTs treat this complex diagnosis?  Well the simple answer is the treatment is all dictated by the source.

Generally, sciatica is a term that is commonly used to describe pain, weakness, numbness, or tingling that radiates down the back of the leg. Typically, the symptoms follow the distribution of the sciatic nerve but there can be some confusion as to the source of the pain especially when the patients symptoms are found to be referred.  Our job as PTs is to determine what the source of the nerve irritation or referral origin is and treat it accordingly.  This can often be accomplished with a thorough musculoskeletal exam and typically without the need for costly medical imaging.   Below are the most common causes of sciatica seen in PT and how we typically treat them.

DISC HERNIATION

 

HERNIA OF THE DISC - SLIPPED DISCThe most common source of sciatica is pressure on the sciatic nerve from a herniation or protrusion of a spinal disc.  This pressure on the nerve can create an irritation and inflammatory response causing symptoms to radiate down the leg following the path of the nerve that is compressed.

What can physical therapy do to help patients with sciatica caused by a disc herniation?

Studies have shown that patients respond well to repetitive lumbar range of motion in improving sciatica symptoms related to lumbar disc herniation.  Typically the direction that most patients report relief of their symptoms is lumbar extension.  However, a thorough physical therapy assessment will help decide a patient’s specific “directional preference”.

Core stabilization exercises in conjunction with lumbar range of motion are also effective at reducing sciatica symptoms.  PTs tend to focus on strengthening the transversus abdominis and gluteal muscles in both static and dynamic activities.

Patient education is probably the most important component of the rehab of disc herniation.  Patients are educated on proper sitting and standing postures as well as proper body mechanics with lifting activities to avoid causing further disc herniation.

STENOSIS

 Denver Physical Therapy Stenosis

Narrowing of the space where the spinal cord or nerve roots exit the spinal canal is called stenosis.  If the space is narrowed, that can create pressure on the cord or the nerves causing pain to radiate down the leg.

Stenosis is typically seen in a condition called degenerative disc disease.  Our discs are located between the bony vertebrates and over time they can start to lose some of their height.  This loss of height causes the narrowing of space seen in stenosis.

Another cause of stenosis is tiny little bone spurs called osteophytes that can form in the spinal cord or nerve root space.

What can physical therapy do to help patients with sciatica caused by stenosis?

Our goal in PT is typically to help improve ROM in the lumbar spine to help open up the narrowed space.  Patients with stenosis often respond well to lumbar flexion or bending exercises, which is in contrast to the lumbar extension exercises often seen in disc herniation.  However, a thorough physical therapy exam will help determine the appropriate stretches/range of motion exercises.

As with disc herniation, core stabilization and posture/movement retraining are important for patients with sciatica caused by stenosis.

Functional dry needling (i.e. Trigger point dry needling) is also very effective for patients with lumbar stenosis.  Photo Oct 27, 9 29 32 AMBy using tiny, hair thin needles, we can quickly decrease the muscle tightness of spinal muscles, resulting in decreased compression of the lumbar vertebrae.  We will discuss dry needling more in the last section

 

PIRIFORMIS SYNDROME

Deep in your buttock/gluts is a muscle that runs diagonally from the outside of your hip to the lowest part of your spine.  This muscle, called the piriformis, can get short and tight or even be in spasm. In 85% of the population, the sciatic nerve runs just beneath the piriformis and in the other 15% it runs through the muscle.  The sciatic nerve can become compressed and irritated when the piriformis is taught or in spasm creating symptoms of sciatica down the back of the leg.

piriformis_anatomy02Image credit: http://www.methodistorthopedics.com/piriformis-syndrome

What can physical therapy do to help patients with sciatica caused by piriformis syndrome?

Typically, a physical therapist will prescribe a thorough home exercise program that includes stretches for the piriformis, hamstrings, and glute muscles (see linked video for example of a piriformis stretch).

Sciatic nerve glides/flossing can be effective at getting the sciatic nerve moving again if it is trapped by the piriformis, especially in conjunction with the stretches above (see linked video for example of a sciatic nerve glide).

A common theme with all of the causes of sciatica is core stabilization.  Core and glute strengthening exercises will help to reduce the demands put on the piriformis muscle with daily and recreational activities (see linked video for an example of a core exercise).

Trigger point dry needling has also been found to be very effective at quickly reducing the tension of the piriformis.

 

TRIGGER POINT REFERRAL PAIN

2014-05-10_1543

Image credit:  http://www.partnersinhealthclinic.com/conditions-treated-with-tdn

Trigger points are tender knots in skeletal muscles that often cause radiating or referral pain.  In the case of sciatica, trigger points in the gluteus minimus, gluteus medius, and piriformis muscles are common sources of radiating pain into the back of the leg.  Trigger points are located in almost all muscles in the body but usually lay dormant without referring pain.  Dysfunction of movement patterns, compensation for weaknesses, or postural deficits, among many other things, can cause the trigger points in the dysfunctional muscle to become active and painful.

What can physical therapy do to help patients with sciatica caused by trigger points?

Physical therapists can assess movement patterns to determine if the trigger point is the source of sciatica symptoms and correct any movement dysfunction that they find.

Joint mobilization, massage therapy, and myofascial release are common techniques to release or inhibit an active trigger point.

Trigger point dry needling (also known as TDN, functional dry needling or intramuscular manual therapy) is becoming a very popular treatment for a variety of musculoskeletal issues but especially sciatica.  As mentioned above, TDN involves the insertion of a tiny filiform needle into the trigger point.  When the needle reaches the trigger point it creates a twitch response which feels like a cramp.  The muscle relaxes and the trigger point becomes inhibited, alleviating the symptoms of sciatica.

We’re open!

therapydia denver physical therapy

Therapydia Denver is excited to join the Therapydia network! We opened our doors at the beginning of March at 800 Lincoln Street, conveniently located in central Denver (can’t find us? we’re located within the Vital Strength and Fitness facility). Therapydia is a national network of Physical Therapy clinics that emphasize ongoing wellness programs like Yoga, Pilates, and TRX. We strive to create an environment that is conducive to wellness with clinics that are well-appointed, well-equipped and well-staffed.

Led by expert Clinic Director, Casey McNitt, Therapydia Denver offers a range of physical therapy and personal wellness services.  Therapydia picks top physical therapists in each city through a selctive screening process. We look for PTs who have extensive clinic experience, studied at top schools and who continually expand their knowledge base through evidence based continuing education. Our PTs have unparallelled experience in specialized areas of treatment and are highly trained in cutting-edge wellness practices.

Most importantly, Therapydia clinics use state of the art technology to improve patient satisfaction and outcomes. Our clinics take patient satisfaction very seriously, in fact, Therapydia clinics have an average national satisfaction score of 9.7. With our proprietary patient relationship management software, ReferralJETSM, we are able to track satisfaction and assure we are providing the best quality of care possible.

Want to learn more or schedule an appointment? We’d love to hear from you! Send us a message and we will be in touch shortly.