Lyme Disease: How to avoid it and how we can help treat it

Last year, my family and I moved to a beautiful patch of woods in Lititz, PA.  It is very scenic and my twin daughters love playing in nature.  However, there is an unseen danger lurking out there that we all need to be aware of…ticks!  Unfortunately, a few months ago, we did find a tick embedded in the back of my daughter’s neck. After hearing so many stories of people getting bit and not knowing what to do or what resources to use, it inspired me to dig deeper into what is out there as far as resources to help individuals with Lyme Disease. You may be surprised to learn that physical therapy can be a source of reprieve to many who are living with Lyme’s Disease.

First, let’s identify it: Lyme disease is the most common vector-borne disease in the United States. As many of you know, it is transmitted by a bite from a blacklegged, infected deer tick.

What to look for: If you think you may have come in contact with a tick, it is important to look for a few signs of a bite. The most common symptoms include: a red circle around the area in which you were bitten, fatigue, headaches, fever, red rash. If not caught and treated early, symptoms can then progress to joint pain, affect the nervous system, and your potentially your heart.

Prevention: Prevention is the best form of defense. Here are a few tips:

  1. Wear long pants and long sleeves when working outside, especially if you live in the woods or if you know it is an area in which ticks like to hide (tall grasses).
  2. Tuck your pant legs into your socks. This sounds weird and it may not be a fashion statement, but the less skin exposure, the better.
  3. Some bug repellents contain chemicals that repel ticks and can be an added measure for prevention.
  4. Always, always search your body and head for those creepy crawlers afterwards.

These are just a few simple ways to decrease your chances of getting a tick. This website has some other great measures that can be taken around your home to help decrease the chances of ticks being attracted to your backyard.

If you find a tick: Try your best to remove the entire tick. Take tweezers and grab as much of the tick as you can, pull with constant pressure. Do not twist or yank as this can cause the head of the tick to break off and become stuck within your skin.

In my daughter’s case, we were not able to remove the entire tick. Don’t panic. If you cannot get all of it, just leave what is left under the skin. The body will do the work for you. Eventually the skin will shed the rest of the tick and it will heal. This is exactly what happened with my daughter.

Make sure to save the tick in an airtight container, so that you can take it somewhere to be tested for different things like Lyme. I used Tickcheck.com which sent me a label to put on the envelope.  In PA, it will be sent to the Wildlife Genetics Institute. If positive for Lyme Disease, it may come back saying positive for Borrelia burgdorferi.

Treatment: In the early stages of Lyme disease, oral antibiotics are frequently used as a treatment. However, if not caught early, treatment can vary based on symptoms, age, and medical history. Here is a good site for additional information and research about Lyme’s Disease. It is also important to see a Lyme-Literate doctor who can perform very specific testing to confirm that you have Lyme.

Here is a list of a few Lyme literate doctors in Pennsylvania (this list is not all-inclusive):
Smith, Regina DO, Internal Medicine           (717) 795-4862       Mechanicsburg, PA
Rhoads, Rita, CNM, NP, Obstetrics               (717) 468-7491      Bart, PA
Makous, Marina, MD  Chronic Disease         (484) 876-1362      Exton, PA
Noonan, Frank C., DO, Integrative Medicine (717) 866-0055     Myerstown, PA

How could physical therapy help those with Lyme’s Disease? Symptoms of Lyme may include joint pain, muscle tightness/ soreness, and fatigue. All of these symptoms can be evaluated and treated in physical therapy:

  1. Muscle soreness: for muscle soreness we often utilize techniques such as stretching, soft tissue massage (STM) and instrument-assisted soft tissue massage (IASTM) to help decrease the tone and to lengthen the muscles. At Hartz Physical Therapy we have several providers that are IASTM trained.
  2. Fatigue: When addressing fatigue, a physical therapist will assess you during the initial evaluation to check your baseline with various activities. Your therapist be able to customize a home exercise program (HEP) that is specific to your needs. At the following visit, the HEP will be reviewed and the exercise regime may be tweaked to progress, if necessary.
  3. Joint pain: For joint pain, the use of aquatic therapy to help unload joints will allow freedom of movement and therefore strengthening of surrounding muscles. It is important to build the muscles that help support your joints so there is less pain. We can also use one of our many available modalities as an adjunct to pain control, if deemed appropriate upon your initial evaluation.  Modalities include moist heat, ice, game ready, electrical stimulation and ultrasound.

The therapists at Hartz Physical Therapy strive to help you achieve your best outcome, no matter the diagnosis. We listen to what our patients have to say and collaborate with them to  create goals that are challenging but achievable.

Additional Resources:

https://www.cdc.gov/lyme/

www.ilads.org

www.tickcheck.com

Wildlife Genetics Institute
562 Independence Rd, Suite 114
East Stroudsburg, PA 18301

Understanding Pain

Pain in general can be difficult to explain to others, and sometimes patients experiencing chronic pain are faced with colleagues or loved ones that don’t understand. You know that when you stub your toe that pain will usually follow, but why is it that it sometimes lingers on? Have you ever wondered why we feel pain?

Pain is a signal to your brain that something is not right. Nerves throughout our body send information about what is happening in our environment to the brain through the spinal cord. The brain then sends information back to our nerves, helping us to perform actions in response.

Acute pain vs. chronic pain: There are two major categories of pain: acute pain (short-term) and chronic pain (long-term).

Acute pain is a severe or sudden pain that resolves within a specific amount of time. You might feel acute pain when you experience an injury, have surgery, or are sick. An example of acute pain is when you sprain your ankle. The nerves in your ankle respond by sending signals to the central nervous system (your spinal cord and brain) to let them know that something is wrong. The brain then decides how bad the injury is and what to do next. Think of your brain as an extensive database stored with every event like this in your life. Your brain decides whether to invoke tears, raise your heart rate, release adrenaline, or perform one of a million other possible responses.

With chronic pain, however, the initial pain receptors continue to fire after the injury. Chronic pain is generally defined as pain that lasts more than three months. Chronic pain can be caused by a disease or condition that continuously causes damage such as arthritis. Sometimes though, there is no longer a mechanical cause of pain, but the pain response is the same. In these cases, it is difficult to pin down the cause of the chronic pain and thus difficult to treat.

What influences pain? Each person’s response to pain is unique. Because pain messages pass through the thought process regions of your brain, your experience of pain is shaped not just by the physical stimulus, but by psychological, emotional and social factors as well. Memories of past painful experiences, genetics, health problems, coping strategies, and attitude towards pain can all contribute to how you feel pain and how your brain decides to respond.

What should I do about chronic pain? Research has shown that movement is one of the most effective ways to treat chronic pain. Although many people are initially fearful of motion, physical therapy and exercise that is slowly reintroduced is key to managing chronic pain. A Physical Therapist can analyze an individual’s total pain picture and provide services that allow you to better manage your pain, as well as restore your mobility and function.

Heat or Ice for Pain? It Depends…

When it comes to managing symptoms at home, many patients report they avoid utilizing adjuncts, including heat and ice, due to a lack of knowledge on which one they could, or should, be using. It is important to have more tools in our back-pocket for managing pain levels (and other symptoms such as swelling & bruising) especially for patients who are not able to make it into the office for an appointment. Both heat and ice work in different way to change the way our nerves sense pain and the way our brain processes the pain sensation. The goal of this post is to help you understand under what circumstances each is indicated.

Ice acts as a vasoconstrictor (ie: it makes the blood vessels smaller) to allow for less blood/fluid to pass into the surrounding tissues. This is especially important following a recent, acute injury, including (but not limited to) sprains, post-operatively or a gout flare up because these traumas initiate their own inflammatory process.  While some inflammation is necessary to the overall healing process, promoting extra inflammation through the use of heat during this time is not recommended. Ice is particularly important in the first 24-48 hours following a new injury, and while there are varying definitions of acute and chronic based on the type of injury, utilizing ice to decrease inflammation can often be a benefit to healing up until the six week mark.

Here are some additional tips to consider when applying ice:

  • Total time of use in one sitting should not exceed 15-20 minutes, as frostbite could occur.
  • Ice packs should never be placed directly on the skin. Instead try wrapping the ice pack in a thin towel.
  • Allow 2-3 hours in between sessions and then ice again.
  • For maximum inflammation reduction, it is recommended you elevate the affected area above your heart; keeping the area below the level of your heart, such as in a recliner, is not a sufficient elevation height to remove this excess fluid from an extremity.

Ice should be avoided if you have been previously diagnosed with: Raynaud’s disease, allergies to cold temperatures, impaired circulation (including peripheral vascular disease or blood clots), and on open wounds. It is important to be cautious with your use of ice if you have a history of hypertension, sensory deficits, such as from neuropathy, or Rheumatoid conditions.

Heat, on the other hand, acts as a vasodilator (ie: the circumference of the blood vessels expands) to promote an increase in blood flow to the tissues. Heat can be an important tool when dealing with chronic pain, muscle tightness, and arthritis. Heat helps to promote relaxation, relieve stiffness and reduce muscle spasm. As a result, you’ll often find increased motion at the impacted joint and improved pain levels.  If you find that your joints/muscles feel better after a nice warm shower/bath, heat is probably for you. If you are beyond the six week mark of an acute injury, you are also likely ready to try heat (if you prefer heat to ice).

There are many different heating methods for use at home, most commonly including moist heat and heating pads. Here are some tips for proper use of heat:

  • Heat should be applied for bouts of 15-20 mins as this gives the underlying tissues time to heat to their optimal temperature to have some of the effects previously mentioned.
  • There is no hard and fast rule of how many times per day you can heat, however it is important to monitor the skin for signs of burns (including redness, blistering) or to have someone in your home who can help monitor this if you do not feel you are sufficiently able to on your own.
  • It is important NOT to fall asleep while utilizing a heating pad, as this can lead to burns and presents a fire hazard.
  • Moist heat packs should be wrapped in 6-8 layers of towels to prevent possible burns; laying directly on a moist heat pack should also be monitored as this can speed the heat transfer process and lead to faster negative skin changes.

Heat should not be used in these instances: over an area of malignancy, presence of acute musculoskeletal trauma, arterial disease, bleeding or hemorrhage, over an area of compromised circulation, in presence of peripheral vascular disease or thrombophlebitis, areas where you have recently applied a heat rub/cream.

If you are at home without access to a traditional hotpack, here are some other ideas:

  • Fill half an old sock or ziploc bag with uncooked rice, tie or sew shut & microwave for 1-2 mins (start with less time and go up if needed, don’t put ziploc bag directly on skin)
  • Soak a kitchen towel in hot water and put in ziploc bag (or put wet towel in ziplock bag. (Do not seal bag when microwaving) Heat for 1-2 minutes.
    *Be sure to test heat prior to applying. If too hot, use a kitchen towel or paper towels as a barrier until it cools down.

Should you have further questions on managing your symptoms independently, please do not hesitate to reach out to the staff at HARTZ PT.

Arthritis + Aquatics = Pain Relief

It is no secret that most of us take our bodies for granted, assuming they are going to work when and how we want them to work.  However, the reality is, at some point, after using and abusing our bodies year after year, it is just going to scream, “Stop!”.  That “voice of reason” may come in the form of joint pain, commonly caused by arthritis.

Believe it or not, osteoarthritis is alive and well in every single one of us in some form or another.  By definition, osteoarthritis is the painful inflammation and swelling of a joint.  However, let’s not sugar coat the reality.  Simply put, arthritis hurts!   So, what can we do to manage those painful symptoms?

When working in the physical therapy world, arthritis has a daily presence.  Therapy professionals are always studying and researching ways to best treat arthritic joints. Time after time, there is one that just makes the most sense – Aquatics!

Why Aquatic Therapy? Well, aquatic therapy eliminates the weight-bearing stresses that we experience every day, reducing stress on the joint and therefore, less pain.   If fact, when standing in water up to your calves, you are already putting 15% less weight on your joints, at your knees, 35% less, hips 50%, shoulders 75% and neck 90% less stress on your joints!

Reducing the stress on these joints, will also reduce the pain you experience when moving the joints.  With the joints now given the ability to move pain-free in the water, patients are able to begin strengthening the muscles surrounding the arthritic joint.  Why is this so important?  Several long-term benefits will come from increasing the strength of the surrounding muscles of an arthritic joint:

  • Increased stability and balance
  • Reduced need for compensation by other limbs
  • Less demand on the arthritic joint resulting in a decrease in inflammation
  • Reduced pain when on land

We would suggest starting an aquatic exercise program with slow walking in shallow water at a comfortable depth.  For some variety, you can walk forward, backward or sideways…you can even march or jog if you are feeling good!  All walking motions are able to be duplicated in the deep water for a complete non weight bearing exercise.

If you are looking to focus on upper extremity joints, arm raises to the front and side are both easy to perform.  These are also easy to incorporate with walking for an added total body strengthening experience.  Besides walking, a patient favorite exercise is grabbing a noodle, placing it under the arms and gently moving your legs in a bicycle motion.  This exercise is best performed in deeper water with varying rates of intensity.

Aquatic therapy is one of the most effective means of treatment for an individual of any age suffering from arthritis.  HARTZ Physical Therapy offers aquatic facilities at our Lititz, Lancaster-East and Mount Joy locations.

Who, Me? Three Factors that Increase Your Risk for Falls

When you were little did you like to think about monsters, thunderstorms, or sharks in the ocean? Unpleasant things are unpleasant to think about. But unlike the boogeyman, falls are a real occurrence and considering your risk for a fall now can save you from one big nightmare later on. Below we discuss three main factors that can substantially increase your risk for falls.  Assess your risk now and keep a potential fall from happening.

Multiple medications lead to massive instability. Sedatives and antidepressants can be culprits as well as seemingly innocent over the counter medications. Dizziness is a common side effect of many medications and can also occur due to drug interactions when taking multiple drugs. Check with your doctor or pharmacist to ensure all medications are necessary and will not interact negatively with each other.

Nerve pain and poor vision could inhibit your body’s natural ability to balance. Do you have poor sensation in your feet or nerve damage courtesy of neuropathy? Those important nerves send signals to your brain telling you how to balance and move reactively to your environment. Without these signals, you are at a higher risk for falls. Vision deficits also heavily contribute to fall risk, as your vision is the largest single sensory contributor to maintaining your balance. Eye care is crucial in preventing a fall.

Poor environment sets you up for disaster. That cute throw rug, poor lighting or a slippery tub could all lead to a fall. Take an honest look around your home environment to see what simple changes you can make to increase safety in your home. If you frequently get up in the middle of the night, a nightlight is essential.  In addition, ensure all electronic cords, books, and decor are out of walking areas prior to going to bed each evening.

If any of these risk factors apply to you, it means you are at an increased risk of falling. But don’t worry! Although some of these factors are beyond your control, there are several actions you can take to reduce your risk for a fall!

Balance and strength (which is necessary for good balance) can be improved, even if vision or sensation is impaired. CLICK HERE to view a video offering 5 easy exercises that you can do at home to help improve your balance (all you need is a chair!).  Please be have someone available to spot you the first time you try these exercises and start slow.

In addition, balance training is offered here at HARTZ Physical Therapy to keep you confident and stable. Our therapists are trained to push you beyond your limits while maintaining your safety at all times. In addition, our balance master is a unique machine that can aid in training you to react to a variety of situations. Free balance screenings with the balance master are available at our Lancaster office on New Holland Avenue. We would love to assist you with your balance goals, keeping you safe without worrying about the possibility of a fall.

Source: “Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2017, www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.

What are Therapeutic Modalities?

Therapeutic Modalities…it may sound like a term from Star Wars, but believe it or not, this is a medical term.  If you have been to a physical therapist, you may have experienced therapeutic modalities without even knowing it!  This blog is meant to help you understand what this term means and how therapeutic modalities might be utilized on your road to recovery.

WHAT ARE THEY? Therapeutic modalities are tools your physical therapist might use to help generate healing and assist with muscle reeducation.  This tool can help by decreasing pain and swelling or lessening muscle spasms which may be causing the pain. A few examples of the most common therapeutic modalities include hot and cold packs, devices which will apply pressure and cooling to the affected area (such as Game Ready equipment), electrical stimulation, ultrasound and iontophoresis among others.

HOW ARE THEY USED? It’s important to note, therapeutic modalities are not required to be used during therapy sessions. On the contrary, they are available for use at the therapist’s discretion, based on the patient’s needs.  Therapeutic modalities should never be used exclusively without other forms of therapy such as exercise, stretching and manual therapy.  As a matter of fact, the American Physical Therapy Association (APTA) released a position statement this past August on the use of Therapeutic modalities:

“The use of biophysical agents as a standalone intervention, or the use of multiple biophysical agents with a similar physiologic effect, is not considered physical therapy nor is it considered medically necessary without documentation that justifies the use of the biophysical agents for those purposes”

SO WHY USE THEM?  Therapeutic modalities have been used as a part of the practice of physical therapy for many years. The rationale behind their continued use is based on documented patient experience, or therapists witnessing an improvement in their patients following use of such devices. However, current research does not confirm or discredit the use of the therapeutic modalities as a way to achieve therapeutic goals.  There is some evidence to suggest that certain therapeutic modalities produce no physiologic benefit at all!

WHEN MIGHT THESE BE USED? As a patient who is actively engaged in your therapy, here are some things to keep in mind when talking to your physical therapist about their plan to use (or not to use) these tools:

  • Modalities should never be used exclusively during your therapy visit. For example, if your therapy session begins with a hot pack and Estim, it should be either preceded by or followed with manual (hands on) therapy and rehabilitation exercises or stretches during the same visit.
  • These tools are designed to have an immediate impact. If a modality does not demonstrate a change following the initial application (i.e. decrease pain or muscle spasm, improve a muscle’s ability to contract), it should be modified or discontinued.
  • If the use of a modality does not produce a carryover effect (for example: decreased pain) for >1 day after its use, it may not be medically necessary.

In the end, the choice to use therapeutic modalities, or physical agents, lies solely on the clinical judgement of your physical therapist. He or she may choose to utilize a particular modality initially to help you cope with your pain and then discontinue use after you demonstrate decreasing pain levels. Conversely, they may choose to add it to your therapy plan after several visits to help with muscle reeducation.   However these tools are utilized, it is important to have an open line of communication with your therapist about your progress and their evolving plan to get you back on track toward full function.

As a patient, you have the choice of where you go for physical therapy.  This allows you to be your own advocate. It gives you a voice in a medical world where patients often feel their questions and concerns are the last to be considered.  Choose a physical therapist that explains why they chose certain interventions, and why not, and don’t be afraid to ask questions. We, as physical therapists, are prepared to answer them, and happy to do so.

Arthritis: It is Not Always the Same Animal

Arthritis is a buzz word coined for joint pain, however rarely is a difference delineated between the two different types of arthritis: Osteoarthritis and Systemic Arthritis. These forms of arthritis stem from different causes and are treated with different approaches. According the Centers for Disease Control and Prevention (CDC), it is estimated that Osteoarthritis affects an estimated 27 million Americans and develops later in life, whereas rheumatoid arthritis affects an estimated 1.3 million Americans and generally develops in patients anytime between the ages of 30 and 60 years old.

OsteoarthritisAs we age, normal wear-and-tear of our weight-bearing joints can often cause pain.  Cartilage is the tissue between joints that provides cushioning between bones and allows for smooth gliding of bones. Repetitive activities place continuous pressure on those same joints which may erode the cartilage. Furthermore, previous injuries that did not heal properly, increase the risk of developing osteoarthritis.  Symptoms include:

  • Joint pain and stiffness usually affecting hands, fingers or knees
  • Joints on one side affected worse than on the other side
  • Morning stiffness lasting fewer than 30 minutes
  • Possible spine and hip pain as well

Systemic Arthritis: Systemic arthritic (also called rheumatoid or psoriatic arthritis, depending on the location of the pain) is triggered by an autoimmune disorder whereby harmful antibodies are produced that attack the healthy joint tissue in patients. The triggering factors for systemic arthritic conditions are thought to be genetic, environmental, hormonal, and even certain lifestyle factors like smoking and obesity. Symptoms include:

  • Joint pain, stiffness, swelling affecting multiple joints
  • Symmetrical symptoms affecting both sides of the body
  • Morning stiffness lasting longer than 30 minutes
  • Additional symptoms like fatigue, fever, and malaise

Common Treatments:

  1. Thorough physical exam: Treatment generally begins with a visit to the family doctor or the physical therapist. A proper physical evaluation combined with the patient’s medical history will help to distinguish the proper course of action.
  2. Imaging: The patient is often required to get medical imaging (ex: X-ray or MRI) performed to evaluate the joint surfaces.
  3. Bloodwork: If signs and symptoms appear to be more consistent with a Systemic Arthritis, the patient is generally referred to a rheumatologist to undergo blood work and evaluation to properly diagnose. Systemic Arthritis generally requires medicinal interventions.
  4. Physical Therapy is generally prescribed for patients with both Osteoarthritis or Systemic Arthritis. Physical therapy can help alleviate stress on joints by increasing flexibility and strengthening muscle surrounding the joint which will ultimately reduce pain.
  5. Targeted Exercise: Believe it or not, a few simple exercises may quickly and effectively reduce pain and improve mobility.

If you think you have Osteoarthritis or Systemic Arthritis, call your physician or physical therapist to get an evaluation; a few simple exercises may be the difference between living with constant pain or doing the things you want to do!

HARTZ Physical Therapy has 4 convenient locations in Lancaster County and most insurances do not require a physician’s referral to be treated.  Don’t live another day in pain! Call today!

Osteoporosis- Tips to Keep those Bones Strong

What is contentious, funny, serious, can be picked, has its own song named after it, and is only appreciated when broken? The answer: a 206 piece puzzle you carry around with you every day. Not only does it keep you from falling into a soft puddle of ooze on the floor, your bones also help form blood cells (red and white), store and release minerals, hold (and hide!) some triglycerides, and protect your brain and spine. When it comes to your bone health, osteoporosis is a chief concern to wrecking your source of stability. Here are key lifestyle changes that will reduce your risk for fractures, as well as a quick peek at the disease process itself.

What is osteoporosis? It all relates back to that mineral holding and releasing property mentioned earlier. If your body keeps stealing your bone minerals for other functions, the skeleton loses its density, causing bones to become more brittle, thereby increasing likelihood of fracture.

So where does this come from and who does it affect? Women are the strong favorites for osteoporosis, as well as the elderly. Other risk factors include: Family history, European or Asian descent, sedentary lifestyles, smoking, low calcium/Vitamin D intake, more than 2 drinks imbibed daily, as well as certain prescription medications which increase your risk.  Granted, some of these risk factors can’t be helped. Changing your family history or age is truly impossible, despite our best efforts!  However WE CAN focus on changing some lifestyle factors affecting the disease.

Medication may feel like the easy way out of bone compromise. There are generally two types of drugs: Antiresorptive drugs which slow down bone loss, and bone-building drugs, which promote increased bone mass. However some of these drugs can increase your risk of cancer, heart disease, and other side effects, warranting a discussion with your doctor before utilizing such medication.

A more natural option is focusing on mineral intake. Calcium and vitamin D are crucial in building bone mass. Calcium alone is difficult for the body to utilize without vitamin D. Once again speaking with a doctor or nutritionist is important in setting dietary goals and intake levels. Other dietary changes can include reducing alcohol consumption and ceasing smoking.

Finally, low impact exercises can be very beneficial in building bone mass. Walking, hiking, dancing, lifting weights, and biking are all excellent option to improve bone mass. However in cases of severe osteoporosis, low impact exercise, such as swimming, may be a better starting point. Talk to us, your local movement experts, for recommendations for a good exercise plan tailor-made to keep you happy and growing stronger! Here at HARTZ PT, we offer a Medically Adapted Gym (MAG) which is designed to customize your fitness goals with a supervising exercise physiologist.  Our Better Bones, Better Balance Class is also designed to keep you on your feet and reduce injury and the fear of falling, allowing you to move with confidence.

No matter where you are in your bone health journey, let us help you stay healthy or improve your health with our exceptional therapy services, tailored gym work-outs, or focused balance classes. Remember, you have a lot of bones to keep in working order!

Snap Krackle Pop…The Truth about Joint Cracking

It’s a long day. Tension is telling your spine that you need some relief so you decide to crack your back. Your mom’s voice echoes in the back of your head “Don’t do it! Cracking your joints is not good for you!” You ignore the voice and obtain a satisfying “pop” before returning to the workload, wondering if you did yourself a favor or contributed to future joint degeneration.

So what makes that sound anyway? And how can something that feels so good ever seem bad for you? One theory is that quick movements change joint pressures, moving nitrogen bubbles inside your joint fluid (synovial fluid) and resulting in that desired “pop”. Another mechanism that can cause noise is ligaments undergoing rapid tension. These sounds typically occur when a joint is in a position where it is running out of movement. This is why you may have to bend or twist your body in an unnatural position before you get a “crack”. These mechanisms are usually what are involved when joint cavitation (the medical term for pop) is discussed.

Joint pressure and ligament tension changes are the main causes we will discuss, however there are a few other sources of joint noise which may include tendon rolling, arthritis, or other conditions/mechanisms.

Let’s look at spontaneous popping first (the kind that happens with ordinary movements). Despite these sometimes ominous noises there are usually few reasons to be concerned. Most health professionals agree that cavitation is a very normal occurrence that doesn’t contribute to osteoarthritis or other degenerative joint conditions. So if things get noisy when you roll out of bed in the morning, stand up from a chair, or warm up for your next athletic event, don’t worry. It’s a normal occurrence that doesn’t necessarily point to a brewing joint problem.

Repetitive, intentional joint cracking (the kind your mom didn’t like) is a little different. This self-administered cracking is a little more controversial when applied to the spine. Why the concern? Looking back at the physiology, we see that joint cracking has the potential to apply stress to ligaments. This is due to those tight, end range movements. Concern arises when tight, irritated muscles and joint structures cause an individual to repetitively treat themselves with a crack multiple times per day. The problem is that muscle and other tissues get stretched (potentially) at the ligaments expense. This could create areas of instability in your spine if performed consistently and will not contribute to a long term solution for your stiff back.

So what’s the answer? Instead of twisting and manipulating your own spine, good posture, gentle stretching and strengthening can be beneficial in resolving your pain. See a physical therapist for treatment options on improving your painful neck, back, elbow, etc.

Cracking is only a concern when in conjunction with other problems. Medical examination may be warranted if joint cracking causes pain, results in restricted movement, or is accompanied by signs of inflammation such as redness or swelling. If any other abnormal joint functions occur (such as buckling) seek assistance from a doctor or physical therapist that is trained in joint care and can often see you without a prescription.

Bottom line: don’t worry if your body is determined to be noisy. If you constantly find relief from frequent cracking maneuvers you aren’t doomed to joint problems. However there are probably some other interventions that can fix the root of your problem like physical therapy. Finally, if you experience pain or concern involving a joint seek out a qualified medical professional.

Good Pain versus Bad Pain

For many reasons, I will never forget the first half marathon I ran.  In the spirit of full disclosure I will admit that I was never a runner (and by runner I mean slow jogger who could not hear the music through my ear buds over my own labored breathing). However I decided that with a little training and hard work, a half marathon would be a great challenge to undertake. After months of training, mostly pain-free, I completed a half marathon in Virginia with a time that I was only minimally embarrassed to disclose publically.

Along the 13.1 mile course, there were thousands of people cheering on the runners and holding up tons of signs that were a mix of motivation and humor. I remember one in particular that said in GIANT blue letters “Runners, enjoy your pain, you’ve earned it”. I laughed at the time and didn’t think more about it.

About a year or so later, while training for a full marathon, I often thought of that very sign when running became painful and I didn’t listen to my symptoms. I tried to continue running for a few weeks through foot pain by simply being, as my mother would put it, “a knucklehead”. As the pain got worse — which I would later learn was a stress fracture — I realized that some pain isn’t worth earning.

We’ve all heard the mantra “No pain, No gain”.  I’ve heard this phrase thrown around since my days of little league baseball, long before coaches monitored pitch counts and days’ rest for young growing arms. It’s popular in locker rooms, post-workout chats and even some physical therapy offices. The question we have to ask though is “Does this long held belief hold up when it comes to exercise? Sure it sounds great, heck it even rhymes, but does it still apply to individuals who are looking to get healthy and treat their bodies a little better in 2014? ”

Pain has a protective function in our bodies. Pain helps tip us off to tissue damage that is occurring and allows us the opportunity to change our activity so we may allow our bodies’ adequate time to heal. When exercising, it is normal to feel that deep burn in your muscles as lactic acid, a natural byproduct of muscle contraction, accumulates.

Pain is not a normal byproduct of exercise. Typically after an appropriate workout, you can expect to experience what is known as delayed onset muscle soreness. Most commonly experienced 24-48 hours after a good workout, this is simply soft tissue inflammation caused by asking your body to do more than it is accustomed to doing. If you experience no soreness, you can probably ramp it up a bit. If you’re sore for greater than 48 hours, you likely overdid it. When you experience pain sooner than 24 hours after your workout, it is an indicator that you are doing something incorrectly.

If you are having pain, consider getting it checked out by a physical therapist. Physical therapists are experts in how the body moves and can evaluate your pain to determine good vs bad and get you started on the path to exercise health.

Signs You May Have Injured Yourself

  • The pain you are feeling is sharp.
  • The pain you are feeling is shooting or accompanied by
    numbness, tingling, pins and needles
    .
  • There is a sudden onset of pain.
  • The pain developed in association withpopping, clicking,
    snapping or giving way underneath you
    .

~ Hayden McDevitt, DPT, OCS, CSCS, ART

Joint Pain: Is it Osteoarthritis?

PT Picture2-crop-smallJoint pain can often be caused by Osteoarthritis, which affects more than 3 million people in the US each year.

WHAT IS IT? The most common form of arthritis, it plagues women more often than men.  Our chances of developing the debilitating disease increase with age. It occurs when the cartilage at the end your bones begins to wear down. The cartilage naturally helps absorb the stress that is placed upon the joint from daily activities. When the cartilage begins to wear down, a “bone on bone” sensation at the joint may occur. Osteoarthritis can affect any joint in the body, but most commonly affects the knees, hips, hands, and spine.  Usually the person will experience inflammation and redness along with pain and tenderness at the affected area.  Pain usually becomes more substantial with weight-bearing tasks.  In addition, the joint with often feel stiff.

WHAT CAUSES IT? There are many factors that could contribute to development of osteoarthritis, including:

  • past injuries to the joint
  • continuous repetitive movements
  • age, gender, weight, genetics

WHAT CAN BE DONE ABOUT IT?  If you start to notice symptoms similar to these, your doctor may suggest an x-ray which will reveal osteoarthritis. Once diagnosed, nonsteroidal anti-inflammatory drugs (or NSAIDs) could be prescribed along with a physical therapy program.  In addition, depending on the severity of your condition, injections, draining the excess fluid within the joint, or even a joint replacement surgery may be suggested.

WHY PHYSICAL THERAPY? Physical therapy has proven to be very successful for people suffering with osteoarthritis, and does not feature any of the potential side effects of the other treatment options. A typical outpatient rehabilitation program should include the following elements:

  • A gentle stretching program which will help to restore the range of motion within the joint
  • Strengthening the muscles around the joint will help take away some of the stress on the joint which will help to alleviate pain.
  • If a land-based exercise program proves to be too painful or challenging, an aquatic exercise program is a great alternative option. The buoyancy of the water takes the stress off of the joints, making it less painful to perform weight-bearing exercises and easier to move the joint through a pain-free range of motion.

Osteoarthritis is the most common form of arthritis and it can be very painful and difficult to maintain your normal daily living. Maintaining a healthy lifestyle of diet and exercise can help to manage symptoms. A regimen of physical therapy, including aquatic-based exercises, is a great treatment option to help you return to a comfortable lifestyle.

HARTZ Physical Therapy provides aquatic therapy in our Lititz office.  Call today for more information.  (A physician’s referral is not necessary for most insurances)

Chronic Pain

Pile of assorted medicinesIt is estimated that 25 million people deal with chronic pain on a daily basis, meaning they have had this pain for greater than 3 months. Pain is a complex and individualized experience and one of the most common reasons why people seek medical care or consultation. Unfortunately, since 1999, while the amount of pain Americans report has not changed significantly, the prescriptions for opioid pain medication to treat pain have quadrupled.¹ With side effects like withdrawal symptoms, depression, overdose, and addiction, this new public health crisis of opioid use has moved the Center for Disease Control and Prevention (CDC) to release prescription guidelines earlier this year.

While there are times that opioid prescriptions are appropriate, such as for cancer treatment, palliative care, end-of-life care, and certain acute pain situations, the CDC recommends non-opioid approaches including physical therapy for their benefit of managing chronic pain without the harmful side effects.

 

The best remedy for chronic pain is to address it head-on and seek professional help immediately.  What may seem like small annoyances can manifest over time and before you know it, pain can incapacitate you in more ways than just the physical sense.

For chronic pain sufferers, exercise doesn’t come easily,  but by building your endurance, you can learn to move past pain and reap all the benefits that aerobic training can offer. In a study recently performed at the Cleveland Clinic foundation, patients who suffered from chronic pain participated in a 3-week aerobic training program.  They all reported that their pain became more manageable with consistent exercise.  They felt better prepared to deal with their pain, which resulted in an improved mood and self-confidence.

Some great exercise tips for dealing with chronic pain are:

  1. Walk: A simple walk to the mailbox may not seem like a lot, but this is a great place to start.
  2. Start slow! Most plans tell you that 20-30 minutes of continuous exercise are required, but even 5 minutes of continuous movement is better than none!
  3. Create a goal: Set attainable goals, but always be willing to adjust if necessary.
  4. Play Favorites:  Pick an exercise you enjoy!  You are much more likely to continue doing something if you like it.
  5. Be Buoyant!  The buoyancy of water provides many benefits that make exercising less painful on joints and therefore more effective.  Try a water aerobics class!  It might be more engaging than just swimming lap after lap.

Starting an exercise regimen can be a hard road, especially for chronic pain sufferers.  However, implementing an exercise plan can put you on the path to recovery.  If you don’t know where to start, contact a physical therapist for a consultation. (A physician’s referral is not necessary for therapists who are Direct Access certified.)  Physical therapists are musculoskeletal experts who can find and treat the source of your pain.  They will be able to educate you about what might be causing the pain and suggest ways to minimize or, in some cases, eliminate the pain.

For more information about exercise plans specific to your needs make an appointment with one of our Physical Therapists today!

 

Sources:
1. Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management

2. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016